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On Friday, August 31, 2018 at 12:00 pm Eastern Time, JMIR will be completing a server migration to improve site stability and user experience. We expect to be back online Friday, August 31, 2018 at 5:00 pm Eastern Time. Should any problems arise our technical team will be using the weekend to resolve them, and users will be able to access our site by Sunday, September 2, 2018 at 1:00pm Eastern Time.

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Journal Description

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.


Recent Articles:

  • Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Using Smartphone Apps to Promote Psychiatric Rehabilitation in a Peer-Led Community Support Program: Pilot Study


    Background: Management of severe and persistent mental illness is a complex, resource-intensive challenge for individuals, their families, treaters, and the health care system at large. Community-based rehabilitation, in which peer specialists provide support for individuals managing their own condition, has demonstrated effectiveness but has only been implemented in specialty centers. It remains unclear how the peer-based community rehabilitation model could be expanded, given that it requires significant resources to both establish and maintain. Objective: Here, we describe the results from a study of one such program implemented within Waverley Place, a community support program at McLean Hospital, emphasizing psychiatric rehabilitation for individuals with severe and persistent mental illness, as well as describing the challenges encountered during the implementation of the program. Key questions were whether the patients could, and would, successfully use the app. Methods: The smartphone app offered multiple features relevant to psychiatric rehabilitation, including daily task lists, activity tracking, and text messaging with peer specialists. A 90-day program of activities, goals, and content specific to the community support program was created on the basis of a prior pilot, in collaboration between members of the app development team (WellFrame), and peers, clinical, and research staff associated with the program. Hospital research staff recruited patients into the study, monitored peer and patient engagement, and handled all raw data acquired from the study. Results: Of 100 people approached for the study, a total of 13 provided consent, of which 10 downloaded and used the app. Two patients were unable to complete the app installation. Five used the app regularly as part of their daily lives for at least 20 days of the 90-day program. We were unable to identify any specific factors (eg, clinical or demographic) that affected willingness to consent or engage with the app platform in the very limited sample, although the individuals with significant app use were generally satisfied with the experience. Conclusions: Smartphone apps may become a useful tool for psychiatric rehabilitation, addressing both psychiatric and co-occurring medical problems. Individualizing functions to each patient and facilitating connection with a certified peer specialist may be an important feature of useful apps. Unlike prior reports emphasizing that patients with schizophrenia will adopt smartphone platforms, we found that implementation of digital tools into existing community support programs for severe and persistent mental illness has many challenges yet to be fully overcome to realize the potential benefits such apps could have to promote systematization and cost reduction for psychiatric rehabilitation.

  • Source: Image created by the authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial


    Background: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. Objective: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. Methods: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. Results: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI –0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). Conclusions: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. Trial Registration: NCT02306434; (Archived by WebCite at

  • The app created on the smart watch. Source: The Authors; Copyright: Min Hooi Yong; URL:; License: Creative Commons Attribution (CC-BY).

    Emotion Recognition Using Smart Watch Sensor Data: Mixed-Design Study


    Background: Research in psychology has shown that the way a person walks reflects that person’s current mood (or emotional state). Recent studies have used mobile phones to detect emotional states from movement data. Objective: The objective of our study was to investigate the use of movement sensor data from a smart watch to infer an individual’s emotional state. We present our findings of a user study with 50 participants. Methods: The experimental design is a mixed-design study: within-subjects (emotions: happy, sad, and neutral) and between-subjects (stimulus type: audiovisual “movie clips” and audio “music clips”). Each participant experienced both emotions in a single stimulus type. All participants walked 250 m while wearing a smart watch on one wrist and a heart rate monitor strap on the chest. They also had to answer a short questionnaire (20 items; Positive Affect and Negative Affect Schedule, PANAS) before and after experiencing each emotion. The data obtained from the heart rate monitor served as supplementary information to our data. We performed time series analysis on data from the smart watch and a t test on questionnaire items to measure the change in emotional state. Heart rate data was analyzed using one-way analysis of variance. We extracted features from the time series using sliding windows and used features to train and validate classifiers that determined an individual’s emotion. Results: Overall, 50 young adults participated in our study; of them, 49 were included for the affective PANAS questionnaire and 44 for the feature extraction and building of personal models. Participants reported feeling less negative affect after watching sad videos or after listening to sad music, P<.006. For the task of emotion recognition using classifiers, our results showed that personal models outperformed personal baselines and achieved median accuracies higher than 78% for all conditions of the design study for binary classification of happiness versus sadness. Conclusions: Our findings show that we are able to detect changes in the emotional state as well as in behavioral responses with data obtained from the smartwatch. Together with high accuracies achieved across all users for classification of happy versus sad emotional states, this is further evidence for the hypothesis that movement sensor data can be used for emotion recognition.

  • Source: Flickr; Copyright: Jodie C; URL:; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).

    Perceived Attitudes About Substance Use in Anonymous Social Media Posts Near College Campuses: Observational Study


    Background: Substance use is a major issue for adolescents and young adults, particularly college students. With the importance of peer influence and the ubiquitous use of social media among these age groups, it is important to assess what is discussed on various social media sites regarding substance use. One particular mobile app (Yik Yak) allowed users to post any message anonymously to nearby persons, often in areas with close proximity to major colleges and universities. Objective: This study describes the content, including attitude toward substances, of social media discussions that occurred near college campuses and involved substances. Methods: A total of 493 posts about drugs and alcohol on Yik Yak were reviewed and coded for their content, as well as the poster’s attitude toward the substance(s) mentioned. Results: Alcohol (226/493, 45.8%), marijuana (206/493, 41.8%), and tobacco (67/493, 13%) were the most frequently mentioned substances. Posts about use (442/493) were generally positive toward the substance mentioned (262/442, 59.3%), unless the post was about abstinence from the substance. Additionally, posts that commented on the substance use of others tended to be less positive (18/92, 19.6% positive) compared to posts about one’s own use (132/202, 65.3% positive). Conclusions: This study provides a description of anonymous discussions on or near college campuses about drugs and alcohol, which serves as an example of data that can be examined from social media sites for further research and prevention campaigns.

  • The monitoring questions screen (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    An Embodied Conversational Agent for Unguided Internet-Based Cognitive Behavior Therapy in Preventative Mental Health: Feasibility and Acceptability Pilot Trial


    Background: Recent years have seen an increase in the use of internet-based cognitive behavioral therapy in the area of mental health. Although lower effectiveness and higher dropout rates of unguided than those of guided internet-based cognitive behavioral therapy remain critical issues, not incurring ongoing human clinical resources makes it highly advantageous. Objective: Current research in psychotherapy, which acknowledges the importance of therapeutic alliance, aims to evaluate the feasibility and acceptability, in terms of mental health, of an application that is embodied with a conversational agent. This application was enabled for use as an internet-based cognitive behavioral therapy preventative mental health measure. Methods: Analysis of the data from the 191 participants of the experimental group with a mean age of 38.07 (SD 10.75) years and the 263 participants of the control group with a mean age of 38.05 (SD 13.45) years using a 2-way factorial analysis of variance (group × time) was performed. Results: There was a significant main effect (P=.02) and interaction for time on the variable of positive mental health (P=.02), and for the treatment group, a significant simple main effect was also found (P=.002). In addition, there was a significant main effect (P=.02) and interaction for time on the variable of negative mental health (P=.005), and for the treatment group, a significant simple main effect was also found (P=.001). Conclusions: This research can be seen to represent a certain level of evidence for the mental health application developed herein, indicating empirically that internet-based cognitive behavioral therapy with the embodied conversational agent can be used in mental health care. In the pilot trial, given the issues related to feasibility and acceptability, it is necessary to pursue higher quality evidence while continuing to further improve the application, based on the findings of the current research.

  • Two adults using different types of technology devices. Source: Pexels; Copyright: No copyright (Creative Commons Zero (CC0) license); URL:; License: Public Domain (CC0).

    Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire


    Background: Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. Objective: The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. Methods: We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients’ interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). Results: In this study, 84.8% (89/105) of the patients had access to the internet and 88.6% (93/105) owned an electronic internet device. In total, 71.3% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). Conclusions: The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7% (23/80) of the studied patients rejected the use of internet interventions and 38.2% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments.

  • Source: Shutterstock; Copyright:; URL:; License: Licensed by the authors.

    For Better or for Worse? A Systematic Review of the Evidence on Social Media Use and Depression Among Lesbian, Gay, and Bisexual Minorities


    Background: Over 90% of adults in the United States have at least one social media account, and lesbian, gay, and bisexual (LGB) persons are more socially active on social media than heterosexuals. Rates of depression among LGB persons are between 1.5- and 2-fold higher than those among their heterosexual counterparts. Social media allows users to connect, interact, and express ideas, emotions, feelings, and thoughts. Thus, social media use might represent both a protective and a risk factor for depression among LGB persons. Studying the nature of the relationship between social media use and depression among LGB individuals is a necessary step to inform public health interventions for this population. Objective: The objective of this systematic review was to synthesize and critique the evidence on social media use and depression among LGB populations. Methods: We conducted a literature search for quantitative and qualitative studies published between January 2003 and June 2017 using 3 electronic databases. Articles were included if they were peer-reviewed, were in English, assessed social media use either quantitatively or qualitatively, measured depression, and focused on LGB populations. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed appropriate reporting of studies using the Strengthening the Reporting of Observational Studies in Epidemiology and the Consolidated Criteria for Reporting Qualitative Research for quantitative and qualitative studies, respectively. Results: We included 11 articles in the review; 9 studies were quantitative and cross-sectional and 2 were qualitative. Appropriate reporting of results varied greatly. Across quantitative studies, we found heterogeneity in how social media use was defined and measured. Cyberbullying was the most studied social media experience and was associated with depression and suicidality. Qualitative studies found that while social media provides a space to disclose minority experiences and share ways to cope and get support, constant surveillance of one’s social media profile can become a stressor, potentially leading to depression. In most studies, sexual minority participants were identified inconsistently. Conclusions: This review supports the need for research on the role of social media use on depression outcomes among LBG persons. Using social media may be both a protective and a risk factor for depression among LGB individuals. Support gained via social media may buffer the impact of geographic isolation and loneliness. Negative experiences such as cyberbullying and other patterns of use may be associated with depression. Future research would benefit from more consistent definitions of both social media use and study populations. Moreover, use of larger samples and accounting for patterns of use and individuals’ experiences on social media may help better understand the factors that impact LGB mental health disparities.

  • Source: Freepik; Copyright: sirinarth; URL:; License: Licensed by JMIR.

    Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change


    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: The aims of this study were to (1) explore the underlying characteristics of depressive symptom change, measured with the nine-item Patient Health Questionnaire (PHQ-9), 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: These objectives were explored using hypotheses that 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: Findings demonstrated that (1) individuals with severe depressive baseline symptoms had greater reductions in 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 PHQ-9 score distributions following treatment; and (3) models that measured symptom change as a proportional function resulted in greater model fit and reduced measurement error (<30%). 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 (eg, Cohen 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. Implications, limitations, and idiosyncrasies from these results are discussed.

  • Source: Dreamstime; Copyright: Oleksandr Brylov; URL:; License: Licensed by the authors.

    Patients’ Experiences of Web- and Mobile-Assisted Group Therapy for Depression and Implications of the Group Setting: Qualitative Follow-Up Study


    Background: Blended group therapy combines group sessions with Web- and mobile-based treatment modules. Consequently, blended group therapy widens the choice within blended interventions at reasonable costs. This is the first qualitative study on blended group therapy. Objective: The objective of this study was to investigate the patient-centered feasibility of blended group therapy for major depression, with special emphasis on the fit and dynamic interplay between face-to-face and internet-based elements. Methods: A total of 22 patients who had a variety of experiences through participating in one of the two blended group therapy interventions were interviewed following a semistructured interview guide. In-depth interviews were analyzed by three trained psychologists, using thematic analysis and a rule-guided internet-based program (QCAmap). The transcript of the interviews (113,555 words) was reduced to 1081 coded units, with subsequent extraction of 16 themes. Results: Web- and mobile-based elements were described as a treatment facilitator and motivator, increasing the salience and consolidation of cognitive behavioral therapy materials, resulting in in- and inter-session alignment to the treatment. Additionally, patients valued the option of intimate Web-based self-disclosure (by lateral patient-therapist communication), and therapists were provided with tools for between-session monitoring and reinforcement of exercising. In this context, group phenomena seemed to back up therapists’ efforts to increase treatment engagement. The dissonance because of noncompliance with Web-based tasks and the constriction of in-session group interaction were considered as possible negative effects. Finally, issues of tailoring and structure seemed to fulfill different preconditions compared with individual therapy. Conclusions: Blended group therapy constitutes a structured and proactive approach to work with depression, and the integration of both modalities initiates a beneficial interplay. Results support the patient-centered value of blended group therapy and provide the first insight into blended group therapy’s role in fostering therapeutic treatment factors. However, potential negative effects should be considered carefully.

  • Source:; Copyright: Bloomicon; URL:; License: Licensed by the authors.

    Reaching Those At Risk for Psychiatric Disorders and Suicidal Ideation: Facebook Advertisements to Recruit Military Veterans


    Background: Younger military veterans are at high risk for psychiatric disorders and suicide. Reaching and engaging veterans in mental health care and research is challenging. Social media platforms may be an effective channel to connect with veterans. Objective: This study tested the effectiveness of Facebook advertisements in reaching and recruiting Iraq and Afghanistan-era military veterans in a research study focused on mental health. Methods: Facebook ads requesting participation in an online health survey ran for six weeks in 2017. Ads varied imagery and headlines. Validated instruments were used to screen for psychiatric disorders and suicidality. Outcomes included impressions, click-through rate, survey completion, and cost per survey completed. Results: Advertisements produced 827,918 impressions, 9,527 clicks, and 587 survey completions. Lack of enrollment in Veterans Affairs health care (193/587, 33%) and positive screens for current mental health problems were common, including posttraumatic stress disorder (266/585, 45%), problematic drinking (243/584, 42%), major depression (164/586, 28%), and suicidality (132/585, 23%). Approximately half of the survey participants (285/587, 49%) were recruited with just 2 of the 15 ads, which showed soldiers marching tied to an “incentive” or “sharing” headline. These 2 ads were also the most cost-effective, at US $4.88 and US $5.90 per participant, respectively. Among veterans with current suicidal ideation, the survey-taking image resulted in higher survey completion than the soldiers marching image (P=.007). Conclusions: Facebook advertisements are effective in rapidly and inexpensively reaching military veterans, including those at risk for mental health problems and suicidality, and those not receiving Veterans Affairs health care. Advertisement image and headlines may help optimize the effectiveness of advertisements for specific subgroups.

  • Source: Flickr; Copyright: The home of Fixers on Flickr; URL:; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).

    Predicting Social Anxiety From Global Positioning System Traces of College Students: Feasibility Study


    Background: Social anxiety is highly prevalent among college students. Current methodologies for detecting symptoms are based on client self-report in traditional clinical settings. Self-report is subject to recall bias, while visiting a clinic requires a high level of motivation. Assessment methods that use passively collected data hold promise for detecting social anxiety symptoms and supplementing self-report measures. Continuously collected location data may provide a fine-grained and ecologically valid way to assess social anxiety in situ. Objective: The objective of our study was to examine the feasibility of leveraging noninvasive mobile sensing technology to passively assess college students’ social anxiety levels. Specifically, we explored the different relationships between mobility and social anxiety to build a predictive model that assessed social anxiety from passively generated Global Positioning System (GPS) data. Methods: We recruited 228 undergraduate participants from a Southeast American university. Social anxiety symptoms were assessed using self-report instruments at a baseline laboratory session. An app installed on participants’ personal mobile phones passively sensed data from the GPS sensor for 2 weeks. The proposed framework supports longitudinal, dynamic tracking of college students to evaluate the relationship between their social anxiety and movement patterns in the college campus environment. We first extracted the following mobility features: (1) cumulative staying time at each different location, (2) the distribution of visits over time, (3) the entropy of locations, and (4) the frequency of transitions between locations. Next, we studied the correlation between these features and participants’ social anxiety scores to enhance the understanding of how students’ social anxiety levels are associated with their mobility. Finally, we used a neural network-based prediction method to predict social anxiety symptoms from the extracted daily mobility features. Results: Several mobility features correlated with social anxiety levels. Location entropy was negatively associated with social anxiety (during weekdays, r=−0.67; and during weekends, r=−0.51). More (vs less) socially anxious students were found to avoid public areas and engage in less leisure activities during evenings and weekends, choosing instead to spend more time at home after school (4 pm-12 am). Our prediction method based on extracted mobility features from GPS trajectories successfully classified participants as high or low socially anxious with an accuracy of 85% and predicted their social anxiety score (on a scale of 0-80) with a root-mean-square error of 7.06. Conclusions: Results indicate that extracting and analyzing mobility features may help to reveal how social anxiety symptoms manifest in the daily lives of college students. Given the ubiquity of mobile phones in our society, understanding how to leverage passively sensed data has strong potential to address the growing needs for mental health monitoring and treatment.

  • Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness


    Background: Mental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization’s response to a mentally ill worker. Objective: This pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers’ confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace. Methods: In total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired samples t tests. Results: Of all the invited managers, 59.1% (39/66) participated in the trial, with complete pre–post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers’ knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P<.001) significantly increased. In addition, a significant increase was observed from the baseline in managers’ self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02). Conclusions: Although caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff.

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  • User involvement in developing the MYPLAN mobile phone safety plan app: a case study

    Date Submitted: Aug 17, 2018

    Open Peer Review Period: Aug 17, 2018 - Oct 12, 2018

    Background: The efficacy of safety planning for people in suicidal crisis is not yet determined but using safety plans to mitigate acute psychological crisis is regarded ‘best practice’. In 2016-1...

    Background: The efficacy of safety planning for people in suicidal crisis is not yet determined but using safety plans to mitigate acute psychological crisis is regarded ‘best practice’. In 2016-17, Australian and Danish key stakeholders were systematically involved in revising and translating the Danish MYPLAN mobile phone safety plan app into a culturally appropriate version for Australia. Objective: The objective of this study was to examine stakeholders’ suggestions and significant developments of MYPLAN during the user involving processes. Methods: We utilized a case study design where audio recordings of four focus groups and five workshops in Denmark and Australia were subjected to thematic analysis. Results: The analyses identified three consecutive phases in the extensive development of the app: From phase one, ‘Suggesting core functions’, through phase two, ‘Refining functions’, to phase three, ‘Negotiating the finish’. The user involving processes continued to prevent closure and challenged researchers and app developers to repeatedly rethink the app’s basic design and functions. It was a limitation that the analysis did not include potentially determinative ‘backstage’ dimensions of the decision-making process. Conclusions: The extended user involvement prolonged the development process, but it also allowed for an extensive exploration of different user perspectives and needs.

  • Social features in game technologies for alcohol prevention in adolescents: a systematic review

    Date Submitted: Aug 10, 2018

    Open Peer Review Period: Aug 10, 2018 - Oct 5, 2018

    Background: Alcohol consumption among adolescents is a mainly public health issue. To prevent alcohol consumption onset during adolescence, school-based programs are needed. A key element of program s...

    Background: Alcohol consumption among adolescents is a mainly public health issue. To prevent alcohol consumption onset during adolescence, school-based programs are needed. A key element of program success is to encourage active participation of the students, which is achieved through group dynamics with peer interactions within the class. However, some of these methods require trained adults to be delivered. Game technologies can offer new promising approaches in the development of preventive programs promoting peer interactions without adult training. Game technologies can offer new promising approaches in the development of preventive programs promoting peer interactions. Objective: The current systematic review aims to identify online interventions with peer interactions features designed to address alcohol use among adolescents, and evaluate the effectiveness of these interventions. Methods: Web of Science and Scopus were electronically searched for all articles published between January, 2011 and June, 2018. Articles reporting on school-based, web-based interventions for teenagers to prevent alcohol that encouraged any kind of interaction within users were eligible for inclusion. A total of 1067 studies were identified, of which 88 were thoroughly analyzed according to our review protocol. Results: Five studies met inclusion criteria. Four of them showed positive results on outcome variables, although it is not possible to determine if social interaction among students contributed to their success in three of them. One protocol paper of a randomized trial currently underway was also identified. Conclusions: We conclude that game technologies that contain social interaction elements seem to present benefits to adolescent health within alcohol consumption prevention programs but more research is needed on this.

  • When All Else Fails, Listen to the Patient E-technology and Patient Self-Report Can Improve Precision in Mental Health Clinical Trials

    Date Submitted: Aug 7, 2018

    Open Peer Review Period: Aug 9, 2018 - Oct 4, 2018

    The global burden of psychiatric illness continues to increase during this troubling period of industry disinvestment in novel therapies. Reduced assay sensitivity in primary outcome measures has cont...

    The global burden of psychiatric illness continues to increase during this troubling period of industry disinvestment in novel therapies. Reduced assay sensitivity in primary outcome measures has contributed to the exodus of the pharmaceutical industry from the CNS space insofar as it has contributed to late phase failures in major CNS development programs. There are a number of reasons for this reduced assay sensitivity in psychiatry outcome measures including inappropriately broad measures, recall bias, and poor inter-rater reliability. A lack of a more nuanced understanding of how disorders like depression behave also contributes to measurement error in psychiatry clinical trials. We believe that Ecological Momentary Assessment (EMA) or frequent, real time assessment delivered via smart phone will help us overcome these psychometric challenges and prevent late phase failures by increasing the sensitivity of measurement, eliminating recall bias, eliminated bias added by the rater, and finally by producing data that will give researchers a better understanding of how the illnesses we treat behave.

  • A review of websites for perinatal anxiety: Advice for healthcare professionals and users

    Date Submitted: Jul 2, 2018

    Open Peer Review Period: Jul 6, 2018 - Aug 31, 2018

    Background: There are many websites available with information and resources for perinatal anxiety, however, there is limited research on the quality and content of these sites. Objective: To identify...

    Background: There are many websites available with information and resources for perinatal anxiety, however, there is limited research on the quality and content of these sites. Objective: To identify what sites are available on perinatal anxiety, identify any information and therapeutic advice given, and review its accuracy and website design. Methods: This study conducted a systematic review of websites for perinatal anxiety. Eligible websites (n=50) were evaluated for accuracy of information, resources for mothers, website quality and readability. Results: Information was often incomplete and focused on symptoms, rather than risk factors or impact of untreated perinatal anxiety. Websites often had information on treatment (92%), but much less on screening (38%). Most sites provided at least some resources to support mothers (98%) and active, guided support was infrequent (50%). Website quality was extremely variable, and mostly difficult to read (84%). Conclusions: The study recommends the top 4 websites on perinatal anxiety for healthcare professionals and users. There is a need for websites to be developed that provide accurate evidence-based information that women can relate to with quality support resources. These sites should also be easy to use and readable.