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Internet interventions, technologies and digital innovations for mental health and behavior change
JMIR Mental Health (JMH, ISSN 2368-7959) is a PubMed-indexed, peer-reviewed sister journal of JMIR, the leading eHealth journal by Impact Factor. (The projected inofficial impact factor for JMIR Mental Health is about 3.0)
JMIR Mental Health focusses on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change. This includes formative evaluation and system descriptions, theoretical papers, review papers, viewpoint/vision papers, and rigorous evaluations.
JMIR Mental Health publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research.
JMIR Mental Health features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs. The journal is indexed in PubMed, PubMed Central, and ESCI (Emerging Sources Citation Index).
JMIR Mental Health adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.
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Background: EHealth programs have hardly been investigated yet for people with borderline personality disorder (BPD). However this might be very promising given both the high economic and health-relat...
Background: EHealth programs have hardly been investigated yet for people with borderline personality disorder (BPD). However this might be very promising given both the high economic and health-related burden as well as high need for treatment in this patient group. Development and use of eHealth applications for BPD are complicated by (1) safety issues due to frequent aversive and dangerous behaviors of these patients, (2) their tendency to drop out of any type of treatment, relationship or activity, (3) long treatment duration and accordingly need for comparably long and complex eHealth interventions. Objective: We piloted the program priovi in 14 patients with BPD. Priovi was offered to support individual face-to-face schema therapy to assess whether it is feasible, safe, and potentially helpful. Methods: Priovi is a schema therapy based self-help program for patients with BPD, designed to be used over 6-12 months. The patients used priovi over a period of 12 months in addition to their individual face-to-face schema therapy. BPD symptom severity was assessed with self-reported and interview-based measures. Qualitative interviews were conducted to understand the patient’s experience with the program in more detail and to detect barriers to feasibility and safety. Results: BPD symptoms improved over one year with high effect size (Cohen’s d 1.0). Patients receiving BPD treatment for the first time improved more than chronic patients with prior treatments. Qualitative data showed that patients generally liked the program. They were well able to build up a functional relationship with priovi. Some exercises provoked mild anxiety, however no serious threads to safety could be detected. Conclusions: Priovi is a potentially helpful and safe tool to support individual schema therapy. The next step should be a larger randomized-controlled study Clinical Trial: German Clinical Trials Register DRKS-ID: DRKS00011538
Background: Postpartum minor and major depression (PPMD) has a 20% 3-month prevalence rate. The consequences of PPMD are significant for mother, infant, and family. There is a need for interventions t...
Background: Postpartum minor and major depression (PPMD) has a 20% 3-month prevalence rate. The consequences of PPMD are significant for mother, infant, and family. There is a need for interventions that prevent PPMD that are effective and accessible, however, many barriers exist for women who attempt to access perinatal depression prevention programs. Internet interventions for the treatment and prevention of depression are widely accepted as efficacious and may overcome some of the access to treatment barriers perinatal women face. However, internet interventions offered without any human support tend to have low adherence but positive outcomes for those who do complete treatment. Internet support groups often have high levels of adherence but minimal data supporting efficacy as a treatment for depression. Taken together, these findings suggest that combining the treatment components of individual interventions with the support provided by an internet support group may create an intervention with the scalability and cost effectiveness of an individual intervention and the better outcomes typically found in supported interventions. Objective: This report describes the development of a peer supported internet intervention to prevent postpartum depression and explore the feasibility and acceptability of this approach. Methods: Clinic based needs assessment and focus groups were used to develop the internet intervention. Once the intervention was developed, women who were 20-28 weeks pregnant with symptoms of depression (PHQ-9 scores of 5-14) but no major depression diagnosis were enrolled in an RCT to compare 8 weeks of a CBT based peer supported internet intervention to an individual internet intervention designed to prevent postpartum depression. Assessments took place at baseline, 4 weeks, 8 weeks (end of treatment), 4 weeks and 6 weeks postpartum. Results: Twenty-four women completed the RCT. PHQ-9 scores at 6 weeks postpartum remained below the clinical threshold for referral for treatment in both groups, with depression measures showing a decrease in symptoms from baseline to postpartum. At 6 weeks postpartum, only one woman out of twenty-four (4%) met criteria for PPMD. There was no difference between groups in adherence to the intervention, with an average of 14.55 logins over the course of treatment. Conclusions: Results suggest women were responsive to both peer support and individual internet interventions to prevent postpartum depression and that peer support may be a useful feature to keep participants adherent. Clinical Trial: Clinicaltrials.gov NCT02121015
Background: Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination...
Background: Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination of psychiatric disorders and SUD increases the risk of future violence. Chronic substance abuse can lead to a structural state of disinhibition, resulting in more drug taking and eventually loss of control over drug intake. When treating SUD, it is crucial to address high levels of impulsivity and lack of inhibitory control. Objective: The current study set out to investigate the effects of a theta/Sensorimotor rhythm (SMR) neurofeedback training protocol on levels of impulsivity, levels of drug craving and actual drug intake in a population of forensic psychiatric patients with a diagnosis of SUD. Methods: 21 participants received 20 sessions of SMR/theta neurofeedback training in combination with treatment as usual (TAU). Results were compared to 21 participants who received TAU only. Results: SMR magnitude showed a significant (P = .02) increase post-training for patients in the neurofeedback training group, whereas theta magnitude did not change (P >.05). Levels of drug craving as well as scores on the ‘motor’ subscale of the BIS-11 decreased equally for patients in the neurofeedback training group and the TAU group. Other measures of impulsivity, as well as drug intake, did not change post-treatment (P > .05). Therefore, neurofeedback + TAU was not more effective than TAU only. Conclusions: The current study demonstrated evidence that forensic psychiatric patients are able to increase SMR magnitude over the course of neurofeedback training. However, at the group level, the increase in SMR activity was not related to any of the included impulsivity or drug craving measures. Further research should focus on which patients will be able to benefit from neurofeedback training at an early stage of the employed training sessions. Clinical Trial: Dutch National Trial Register NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl)
Background: Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitat...
Background: Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone. Objective: This analysis assesses patient’s acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. Methods: PARTNERs is a research trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion. Results: During the consent process, 53.7% of 667 patients referred to the study declined to participate, and attributed their refusal to research-related factors (i.e., randomization and time commitment); a further 16.8% declined due to the telephone delivery of the intervention. Among 377 participants who were randomized to the one-year intervention, the overall retention rate was 81.8%. Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97.4% of comments related to the telephone components were positive, with key reported positive attributes being accessibility, convenience, and privacy. Conclusions: Our results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy. Clinical Trial: Trial registration: ClinicalTrials.gov Identifier: NCT02345122
Background: Background: Given the criticisms of life event (LE) checklists and the costs associated with interviews, LE research requires a sophisticated measure for research and clinical practice. Th...
Background: Background: Given the criticisms of life event (LE) checklists and the costs associated with interviews, LE research requires a sophisticated measure for research and clinical practice. Therefore, the Computerised Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. Objective: To test CLEAR’s reliability, validity, and association with depression. Methods: CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) was completed by 328 participants (126 students; 202 matched midlife sample: 127 controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined, and validity determined by comparing CLEAR with LEDs and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression. Results: CLEAR demonstrated good test-retest reliability for overall number of events (.89) but only fair reliability for overall agreement of events at both points (.21). Event characteristics for those that agreed had good reliability. Long-term problems (LTPs) showed similar findings. For validity, CLEAR had moderate sensitivity of 59% and specificity of 65% when compared to LEDS on matched events. Associations by category were good e.g. education (.81), work (.70) and health (.59), with high levels of specificity in these domains. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared to LTE-Q. CLEAR severe LEs and LTPs were significantly associated with depression (OR = 3.50, 95% CI: 2.10-5.85, P < .001; OR = 3.38, 95% CI: 2.02-5.67, P < .001) whereas LTE-Q events were not (OR=1.06, 95% CI: .43-2.60, P =.90). Conclusions: CLEAR has acceptable reliability and validity and predicts depression. It therefore has great potential for effective use in research and clinical practice identifying stress factors in depression and related disorders.
Background: There is growing interest in using technology-based tools to support mental health recovery. Yet, despite evidence suggesting widespread access to technology among people with mental illne...
Background: There is growing interest in using technology-based tools to support mental health recovery. Yet, despite evidence suggesting widespread access to technology among people with mental illnesses, interest in using technology to support mental health, and effectiveness of technology-based tools developed by researchers, such tools have not been widely adopted within mental health settings. Little is currently known about how mental health consumers are using technology to address mental health needs in real-world settings outside of controlled research studies. Objective: This qualitative study examined current practices and orientations toward technology among consumers in three mental health settings in the U.S. Methods: Ethnographic observations and semi-structured interviews were conducted. Observations focused on if and how technology was salient within the setting and documented relevant behaviors, interactions, and dialogue in fieldnotes. Ethnographic data informed the development of a semi-structured interview that inquired into technology use and interest among consumers (n=15) in a community mental health setting. Fieldnotes and interview transcripts were reviewed and coded by multiple researchers. Key concepts and patterns identified were refined by the research team to develop the main findings. Results: Ownership of technology, although common, was not ubiquitous and was varied across the sites. Participants had varying levels of awareness regarding the key capabilities of modern technologies. Participants used technology for many purposes, but there was limited evidence of technology use to support mental health. Technology-based tools specific to mental health were not routinely used although some participants found widely available mobile apps to be helpful in recovery. Conclusions: Qualitative findings suggest that most but not all clients will be interested in using technology to support mental health needs. The variability in type and quality of technology owned by participants suggests the need to design for a range of functionality in the development of mental health tools. Findings also suggest thinking broadly about using existing platforms and widely available tools to support consumers in mental health recovery.