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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: Technology offers a unique platform for delivering trauma interventions (i.e., eHealth) to support traumatized populations. A challenge of eHealth for trauma survivors is to find out a me...
Background: Technology offers a unique platform for delivering trauma interventions (i.e., eHealth) to support traumatized populations. A challenge of eHealth for trauma survivors is to find out a mechanism of reducing posttraumatic stress symptoms (PTSS). Objective: The present study evaluated a proactive, scalable, and individually responsive eHealth intervention for trauma survivors, called My Trauma Recovery (MTR). MTR is an eHealth intervention aiming to support trauma survivors and consists of six modules: relaxation, triggers, self-talk, professional help, unhelpful coping, and social support. It was designed to enhance trauma coping self-efficacy (CSE-T). We tested the hypothesis that improvements in CSE-T perceptions while working with the website will directly relate to reductions in overall PTSS. We also evaluated the importance of module order on CSE-T. Methods: Ninety-two traumatized individuals (84.8% females, mean age = 34.80 years old) participated. The present study consisted of three sessions one week apart. Participants completed the baseline online survey assessing PTSS and CSE-T. Each session included completing assigned modules followed by the online survey assessing CSE-T. At the end of the last module, participants completed the online survey assessing PTSS and CSE-T. Results: Significant increases in CSE-T throughout sessions 1 and 2, F = 8.31, P < .001 were found. No significant change in CSE-T was found during session 3 (N = 92). A multiple regression analysis showed that change in CSE-T during the session 2 triggers module (β = -.46, P = .01) and session 2 relaxation modules (β = -.53, P = .01) were significant predictors of post-intervention PTSS. However, these effects were only found when participants worked on relaxation module first in session 1, (R2 = .37). Conclusions: The findings of the present study demonstrate that CSE-T is an important self-appraisal factor linked to reductions in PTSS. The results also show that the module presentation order is important to consider on the relationship between changes in CSE-T and changes in PTSS. These findings have important implications for trauma eHealth interventions.
Background: Mindfulness-based online interventions (MOI) are increasingly being delivered through the Internet to treat mental health conditions. Objective: To determine the effectiveness of MOI in cl...
Background: Mindfulness-based online interventions (MOI) are increasingly being delivered through the Internet to treat mental health conditions. Objective: To determine the effectiveness of MOI in clinical mental health populations. Secondary aims are to explore the impact of study variables on the effectiveness of MOI. Methods: Systematic review and meta-analysis of studies investigating the effects of MOI in clinical populations. Results: The search strategy yielded 9 eligible studies. MOI were effective in reducing depression in the total clinical sample (n=545 g=-0.748, p=0.004) and in the anxiety disorder subgroup (n=237 g=-0.730, p=0.000) but not in the depression disorder subgroup (n=308, p=0.11). Similarly, MOI significantly reduced anxiety in the total clinical sample (n=645, g=-0.398, p=0.003) and the anxiety disorder subgroup (n=337, g=-0.551, p=0.003) but not in the depression disorder group (n=308, p=0.28). Finally, MOI improved quality of life in the anxiety disorder subgroup (n=234, g=0.711, p=0.004) and mindfulness skills in the total clinical sample (n=281, g=0.615, p=0.005). Conclusions: Results support the effectiveness of MOI for reducing depression and anxiety, and enhancing quality of life and mindfulness skills, particularly in those with clinical anxiety. Results should be interpreted with caution given the high heterogeneity of MOI and the low number of studies included.
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Background: A national priority at the U.S. Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilit...
Background: A national priority at the U.S. Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet, many veterans, particularly those who use remote outpatient VA clinics, still do not receive much-needed evidence-based treatment. Strategies for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) in translating their clinical training to routine practice are needed. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy by providers in outpatient settings to patients with anxiety, including posttraumatic stress disorder, and depression. Objective: The objectives of the present study were to 1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups, 2) develop a prototype of the adapted program, and 3) determine the acceptability and feasibility of the modified program. Mental health stakeholders included VA leaders in the implementation of evidence-based psychotherapies within VA (n=4), VA experts in cognitive behavioral therapy (n= 4), VA CBOC mental health providers (n=8) and veterans (n = 8) receiving treatment in a VA CBOC and diagnosed with a mental health condition treated by the CALM program. Methods: An iterative approach comprising three waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. Results: The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype of the modified program was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results: Key stakeholders suggested modifications to the original CALM program that altered the appearance of the modules by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered the content to better reflect the demographic characteristics and experiences of rural veterans. Feedback from the stakeholder groups indicates that the changes will help VA patients to identify with program content, potentially enhancing veterans' treatment engagement. Conclusions: The development model used in this study is effective for economically gathering actionable recommendations from stakeholders to adapt computer-based programs and can result in development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in evidence-based psychotherapy.
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: Accurate measurement of treatment related change is a key part of psychotherapy research and the investigation of treatment efficacy. For this reason, the ability to measure change with ac...
Background: Accurate measurement of treatment related change is a key part of psychotherapy research and the investigation of treatment efficacy. For this reason, the ability to measure change with accurate and valid methods is critical for psychotherapy. Objective: Objective: The aims of this study were to (1) explore the underlying characteristics of depressive symptom change (PHQ9) following psychotherapy, and (2) compare the suitability of different ways to measure and interpret symptom change. A treatment sample of web-based psychotherapy participants (n=1098), and a waitlist sample (n=96) were used to (1) explore the statistical characteristics of depressive symptom change, and (2) compare the suitability of two common types of change functions; linear and proportional change. Methods: Methods: These objectives were explored using hypotheses which tested (1) the relationship between baseline symptoms and the rate of change, (2) the shape of symptom score distribution following treatment, and (3) measurement error associated with linear and proportional measurement models. Results: Result: Findings demonstrated that: (1) individuals with severe depressive baseline symptoms reduced by greater symptom scores than individuals with mild baseline symptoms (11.4 vs. 3.7). However, as a percentage measurement, change remained similar across individuals with mild, moderate or severe baseline symptoms (50-55%); (2) positive skewness was observed in PHQ9 score distributions following treatment; (3) models that measured symptom change as a proportional function resulted in greater model-fit, and reduced measurement error (< 30%). Conclusions: Conclusions: This study suggests that symptom scales, sharing an implicit feature of score bounding, are associated with a proportional function of change. Selecting statistics that overlook this proportional change (e.g., Cohen’s d) is problematic and leads to (1) artificially increased estimates of change with higher baseline symptoms, (2) increased measurement error, and (3) confounded estimates of treatment efficacy and clinical change.
Background: Lifestyle diseases continuously rise, with aging, epidemics, and life stressors altogether contributing to a growing need for solutions in mental health care. Mobile and wearable solutions...
Background: Lifestyle diseases continuously rise, with aging, epidemics, and life stressors altogether contributing to a growing need for solutions in mental health care. Mobile and wearable solutions have a large potential in this domain. Despite a significant growth in the availability of mobile apps in the past years, little is known about the characteristics of these applications and the end users’ perspectives about them, especially considering novel smart watch applications dedicated to promote mental health. Objective: To understand the current state-of-the-art smartwatch solutions for mental health, characterizing them in terms of features, benefits and drawbacks focusing on the end users’ perspectives, to identify opportunities to improve next-generation solutions. Methods: A comprehensive analysis of the existing applications for Apple Watch dedicated to mental health care, to characterize their state-of-the-art and provide a unified view of existing solutions, an analysis of their purposes, features, and users’ perspectives from online reviews and discussion boards to identify the main benefits and drawbacks with existing solutions Results: The smart watch applications analyzed focus mainly on intervention, rather than monitoring and tracking users’ affective states; they also focus on wellness and wellbeing and the sources tend to be non-medical; multimodal contents are explored to provide interventions, including audio, images and vibration; users enjoy the customization options and tend to use the applications in a regular basis, mainly to improve sleep quality, to focus, relax, meditate and distract themselves in adverse situations. Conclusions: There is a vast potential for wrist-worn applications for solutions in mental health, but the domain is still underexplored. Existing applications focus on interventions, and further development and research efforts are needed to advance on monitoring and personalized interventions. Privacy-enhanced solutions for access control and protection of human subjects and their data are essential in the development of mobile applications for mental health, still those remain as open questions to be addressed in the future.