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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: Understanding the characteristics of commenters on mental health-related online discussion forums is vital for the development of effective psychological interventions in these communities...
Background: Understanding the characteristics of commenters on mental health-related online discussion forums is vital for the development of effective psychological interventions in these communities. Previous research has typically investigated these characteristics using surveys or textual analyses of online content. However, the way in which commenters interact with each other can also elucidate the characteristics of these commenters. Objective: The current study applied text-mining and network analyses to profile eating disorder-related (EDR) forum commenters in terms of the other forums to which they tended to contribute. Methods: The researchers identified all public EDR-forums with ≥1000 comments posted between March 2017 and February 2018 on a large online discussion platform (Reddit), compiled lists of commenters (N=14024) on each of these forums, and identified other forums in which the commenters posted. Text-mining and a network analytic approach enabled the identification of four subgroups of forums (e.g., pro-eating disorder, thinspiration). Then, for each subgroup, further network analyses were conducted using the EDR-forum commenter-overlap between 50 forums on which the subgroup’s commenters also posted. Results: The results focus on two subgroups – pro-eating disorder and thinspiration – and communities of commenters within both subgroups. Within the pro-eating disorder subgroup, five communities of commenters were detected who posted on forums regarding the body, eating and exercise, women and appearance, mental health, and self-harm. Regarding the thinspiration subgroup, 75% of the commenters had also posted on pornographic subreddits, and 29% on forums concerning the body and eating. These thinspiration communities overlapped, with over a third of the commenters posting on body and eating-related subreddits also contributing to pornographic forums. Conclusions: The findings provide insight into the characteristics (i.e., interests) of EDR-forum commenters, and have implications for the design of online interventions. With the publicly available data and code provided, researchers can easily reproduce the analyses, or conduct the same analyses with different groups of commenters.
Background: Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decisi...
Background: Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (e.g., smartphone apps, electronic pill dispensers, and telehealth). Many of the same intervention components have been used across different disorders. Further, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. Objective: To conduct a systematic scoping review of the literature in order to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. Methods: This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the PRISMA systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Two reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies which evaluate populations or individuals with a mental health or substance use disorder, and which contain at least one technology-delivered component (e.g., website, smartphone app, biosensor, algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multi-component interventions across mental health disorders. Results: The initial search identified 19,280 results - following duplicate removal and two-stage screening, 128 included studies remained (Cohen’s kappa: 0.8, 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include daily self-reports, remote direct visualization, fully-automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities included short message service (SMS), smartphone apps, websites, and interactive voice response (IVR). We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. Conclusions: Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature, and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
Background: Video game playing is a daily activity for many youths that replaces other media forms (e.g., TV watching) and serves as an important source of knowledge, with the potential to impact thei...
Background: Video game playing is a daily activity for many youths that replaces other media forms (e.g., TV watching) and serves as an important source of knowledge, with the potential to impact their attitudes and behaviors. Researchers are concerned about the impact of video gaming on youth (e.g., for promoting prosocial or antisocial behaviour). Studies have also begun to explore players’ experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing/shaping of knowledge and/or messages about mental illness. Objective: This study aims to review and examine messages about, and representations of mental illness, especially psychosis, and its context of care in commercial video games. Methods: On Steam (a popular PC gaming platform), we performed keyword searches on games made available between January 2016 to June 2017. A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained. Results: We used a game elements framework (characters, game environment/atmosphere, goals, etc.) to describe and then unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%) portray mental illness in negative, partial, misleading, and problematic ways (e.g., associating it with violence, scary, insanity, hopelessness, etc.). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. As mental illness was often associated with mystery, unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo “experiment treatment” to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as ongoing straggle as well as endless battle with their mind and themselves. Conclusions: The game elements of a large number of commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings further in relation current evidence on the impact of media portrayals of mental illness and stigma; the ability of serious video games, to promote alternative messages around mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce stigma associated with mental illness.
Background: Recent research has highlighted the “naturalistic uptake challenge” as a key barrier that limits the impact of technologies designed to support mental health interventions. While there...
Background: Recent research has highlighted the “naturalistic uptake challenge” as a key barrier that limits the impact of technologies designed to support mental health interventions. While there is increasing evidence regarding the efficacy of computerised interventions, as demonstrated through randomised controlled trials (RCTs), there is also increasing evidence that technologies are not succeeding as expected when deployed in real-world settings. Objective: This paper describes the results of a naturalistic, or uncontrolled, deployment of Pesky gNATs, a computer game designed to support Cognitive Behavioural Therapy (CBT) interventions for young people experiencing anxiety or low mood. The game is intended for use in face-to-face clinical sessions involving one therapist and young person. The design draws on several key principles in developmental and clinical psychology and in human computer interaction, with the aim of making CBT more accessible and engaging for young people. Methods: Pesky gNATs has been made available to mental health professionals worldwide through a not-for-profit organisation. After one year of use, we collected usage and user experience data from therapists who have used the game through an online survey and follow-up semi-structured interviews. The data collection addressed the expectations and experiences of both therapists and young people and also sought opinions on key themes including the flexibility of the technology and attitudes towards user-generated versus automated adaptations in future versions. We used thematic analysis across survey and interviews to identify key themes in the data. Results: 21 therapists who used the game with a total of 95 children completed the online survey. Five therapists participated in the follow-up interview. Confirming previous assessments, data suggests that the game can be helpful in delivering therapy and that the young people generally liked the approach. However, therapists shared diverse opinions regarding the young people for whom they deem the game appropriate. The following three themes were identified: 1) stages of use; 2) impact on the delivery of therapy; 3) further developments. We discuss therapists' reflections on the game with regard to their work practices and consider the question of customisation, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model. Conclusions: This research provides further evidence that therapeutic games can be helpful in the delivery of therapy in real intervention settings. However, therapists’ autonomy and decisions on when, with who and how to use technology varies strongly. This needs to be considered when designing technologies.
Background: Researchers and therapists have increasingly turned to digital games for new forms of treatments and interventions for people suffering from a variety of mental health issues. Yet, the dep...
Background: Researchers and therapists have increasingly turned to digital games for new forms of treatments and interventions for people suffering from a variety of mental health issues. Yet, the depiction mental illness within digital games typically promote stigmatized versions of those with mental health concerns. Recently, more games have attempted to implement more realistic and respectful depictions of mental health conditions. Objective: This paper presents an analysis of a new game which has the potential to change the way researchers and game designers approach topics of mental health within the context of gaming. Methods: A case study of Hellblade: Senua's Sacrifice was conducted using Goffman's (1974) frame analysis to show how design choices and player reception for this game present the potential for new ways of approaching games and mental health. Results: Research shows that both mental health researchers and game designers have struggled to develop successful guidelines for collaborations. The depiction of psychosis within Hellblade: Senua's Sacrifice shows how research-informed design can lead to innovative use of technology and game mechanics to create embodied experiences of mental health to promote empathetic understanding or mental health interventions. Conclusions: This paper highlights an exemplary case of collaborative game design with relation to mental health. Understanding the success of Hellblade's depiction of psychosis can improve serious games research and design. Further research must continue to provide deeper analysis of not only games, but also contextualize the experience of those who play these games.
Background: Quality of Life (QoL) is a prominent outcome measure in mental health. Conventional methods for QoL assessment, however, rely heavily on language‐based communication, and may therefore n...
Background: Quality of Life (QoL) is a prominent outcome measure in mental health. Conventional methods for QoL assessment, however, rely heavily on language‐based communication, and may therefore not be optimal for all individuals with severe mental health problems. Additionally, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalisation of QoL assessment and may therefore help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focuses on the development of an innovative, visual and personalised QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: A group of 59 participants contributed to the six iterations of the co-creative development of the QoL-ME. In the brainstorm stage, consisting of the first iteration, participants’ previous experiences with questionnaires and smartphone applications (apps) were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final two iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorm stage, participants stressed the importance of privacy and data security, and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of Visual Analogue Scales (VAS). The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The co-creative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and that has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME, and to investigate its usefulness in practice. Clinical Trial: Not applicable