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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: Mental health recovery denotes an individual’s experience of gaining a sense of personal control, striving towards one’s life goals, and meeting one’s needs. Although people with ser...
Background: Mental health recovery denotes an individual’s experience of gaining a sense of personal control, striving towards one’s life goals, and meeting one’s needs. Although people with serious mental illness own and use electronic devices for general purposes, knowledge of their current use and interest in future use for supporting mental health recovery remains limited. Objective: To identify the applications of smartphones, tablets, and computers that mental health service recipients use and want to use to support their recovery. Methods: As a pilot study, we surveyed a convenience sample of 66 mental health service recipients with serious mental illness. The survey assessed current use and interest in the applications of mobile and computer devices to support recovery. Results: Listening to music (60%), accessing the internet (59%), calling (59%), and texting (54%) were the top functions regularly used by participants on their device to support their recovery. Participants expressed interest in learning how to use apps for anxiety/stress management (45%), mood management (45%), monitoring mental health symptoms (43%), cognitive behavioral therapy (40%), sleep (38%), and dialectical behavior therapy (38%) to support their recovery. Conclusions: Mental health service recipients currently use general functions, such as listening to music and calling friends, to support recovery. Nevertheless, they report interest in trying more specific illness-management functions.
Background: Medically unexplained physical symptoms (MUPS) are a substantial health problem in primary care, with a high burden for patients, general practitioners and the health care system. Most stu...
Background: Medically unexplained physical symptoms (MUPS) are a substantial health problem in primary care, with a high burden for patients, general practitioners and the health care system. Most studies focus on chronic MUPS patients. Little research is conducted in patients with moderate MUPS and an effective primary care intervention for prevention of chronic MUPS is lacking. Objective: Our objective is to identify treatment modalities based on experts’ opinion for the development of a multidisciplinary and blended intervention for patients with moderate MUPS to prevent chronicity. Methods: Two focus groups with professionals experts (general practitioners, physical therapists, psychologists and mental health nurses) were carried out. The focus groups were structured using the Nominal Group Technique. Results: A total of 70 ideas were generated from two nominal group meetings, 37 of these got votes, were included in the rank order and were sorted into eight separate themes. According to the participants the most important treatment modalities for a multidisciplinary and blended intervention in patients with moderate MUPS were 1) Coaching to a healthier lifestyle, 2) Education regarding psychosocial factors, 3) Therapeutic neuroscience education, 4) Multidisciplinary intake, 5) Multidisciplinary cooperation and coordination, 6) Relaxation / body awareness exercises, 7) Clear communication of professionals to the patient, and 8) Graded activity. Five colleagues checked the ideas and linked them to a theme to confirm the content analysis and to check the validity of the themes. Conclusions: From professional experts perspective eight themes should be included in a multidisciplinary and blended intervention to prevent chronicity. These themes provide a first step in developing an intervention for patients with moderate MUPS. Future research should focus on further development steps, in which patients with moderate MUPS should be involved to determine if the intervention matches their needs.
Background: Alzheimer’s disease (AD) is the most common cause of dementia. The number of AD patients is increasing worldwide, mainly due to the aging of the population. The lack of pharmaceutical i...
Background: Alzheimer’s disease (AD) is the most common cause of dementia. The number of AD patients is increasing worldwide, mainly due to the aging of the population. The lack of pharmaceutical interventions able to delay or treat AD underlines the potential of non-pharmacological strategies. As an estimated one third of dementia cases might be attributable to modifiable lifestyle factors, multi-domain lifestyle interventions show promise as a way to maintain or improve brain health. Offering such programs online would enable large-scale implementation. An overview of multi-domain online lifestyle programs for brain health is currently lacking though, which hampers the field to compare and improve programs in order to develop effective and sustainable innovations. Objective: We aim to provide a comprehensive overview and meta-analysis of online multi-domain lifestyle programs aimed at optimizing brain health in healthy elderly adult populations. Methods: Electronic databases (PubMed, EMBASE.com, PsycINFO) were searched for online lifestyle programs which were included when the program 1) aimed to optimize brain health; 2) focused on multiple lifestyle factors; 3) was completely online; 4) existed of multiple sessions; 5) focused on a healthy adult population. We extracted and compared program characteristics (target population, duration, frequency, tailoring, platform, availability) and results of program evaluations (effectiveness, user-evaluations and adherence). Studies using a controlled design were included in a random effects meta-analysis on effectiveness on brain health outcomes. The quality of these studies was assessed using the PEDro scale. Results: The systematic literature search resulted in 44 documents describing 14 online lifestyle programs, which together address a multitude of lifestyle factors. Physical and cognitive activities were included in all programs. The majority of the programs was not publicly available and restricted to research settings (6/14, 43%) or available after payment (2/14, 14%). Studies on user-evaluations were reported for 8 (57%) programs, of which only 3 studies described their methods. Five studies evaluated the effectiveness of 4 programs, of which 3 used a controlled design, hence eligible for the meta-analysis (N=449; studies of moderate-to-high quality on PEDro scale). Pooled results showed a significant small to medium effect of the online multi-domain lifestyle interventions on outcome measures for brain health (global cognition score, subjective cognitive score, lifestyle risk score; std. mean diff. 0.45, 95% CI [0.12-0.78]) with a high heterogeneity across studies (I2 = 75%, p=0.02). Conclusions: We found 14 online multi-domain lifestyle programs aimed at optimizing brain health. The programs showed heterogeneity in both characteristics and effectiveness evaluation, which limited direct comparisons. Despite this heterogeneity, the results from this meta-analysis suggest that these programs can positively influence brain health outcomes and therefore have potential to contribute to the prevention of dementia.
Background: Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, in spite of encouraging outcomes from early stage research...
Background: Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, in spite of encouraging outcomes from early stage research, a consensus is needed for how best to develop and evaluate VR treatments within a scientific framework. Objective: We sought to develop a methodological framework with input from an international working group to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments. Methods: A group of 21 international experts was recruited based upon contributions to the VR literature. The resulting Virtual Reality Committee of Outcomes Research Experts (VR-CORE) held iterative meetings to seek consensus regarding best practices for development and testing of VR treatments. Results: The interactions were transcribed, and key themes were identified to support a scientific framework to support methodology best practices for clinical VR trials. Using the Food and Drug Administration (FDA) Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs, herein named VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through principles of human centered design. VR2 trials conduct early testing with a focus on feasibility, acceptability, tolerability and initial clinical efficacy. VR3 trials are randomized, controlled studies to evaluate efficacy versus a control condition. Best practice recommendations for each trial are provided. Conclusions: Patients, providers, payers and regulators may consider this best practice framework when assessing the validity of VR treatments.
This manuscript needs more reviewersPeer-Review Me
Background: Currently, assessment for mental health is done by experts using interview techniques, questionnaires, and test batteries, and following standardized manuals; however, there would be myria...
Background: Currently, assessment for mental health is done by experts using interview techniques, questionnaires, and test batteries, and following standardized manuals; however, there would be myriad benefits if behavioural correlates could predict mental health and be used for population screening or prevalence estimations. A variety of digital sources of data (e.g., online search data, social media posts) have been previously proposed as candidates for digital phenotyping—the digital quantification of disease phenotypes—in the context of mental health. Playing games on computers, gaming consoles, or mobile devices (i.e., digital gaming) has become a leading leisure activity of choice and yields rich data from a variety of sources. Objective: In this paper, we argue that game-based data from commercial off-the-shelf games have potential to be used as a digital biomarker to assess and model mental health and health decline. Although there is great potential in games developed specifically for mental health assessment (e.g., Sea Hero Quest), we focus on data gathered “in-the-wild” from playing commercial off-the-shelf games designed primarily for entertainment. Methods: In this paper, we argue that the behavioural traces left behind by natural interactions with digital games can be modeled using computational approaches for big data. To support our argument, we present an investigation of existing data sources, a categorization of observable traits from game data, and examples of potentially useful digital biomarkers. Results: Our investigation reveals different types of data that are generated from play, and the sources from which these data can be accessed. Based on these insights, we created a framework with six categories of observable traits that can be derived from game-based data, including: usage, cognitive performance, motor performance, social, affective, and content/preference. For each category, we describe the data type, the game-based sources from which it can be derived, its importance for mental health modeling, and any existing statistical associations with mental health that have been demonstrated in prior work. We close with a discussion on the limitations and potential of data from commercial off-the-shelf games for use as a digital biomarker of mental health. Conclusions: When people play commercial digital games, they produce significant volumes of high-resolution data—data that is not just related to play frequency, but that includes performance data reflecting low-level cognitive and motor processing, text-based data that is indicative of affective state, social data that reveals networks of relationships, content choice data that implies preferred genres, and contextual data that divulges where, when, and with whom they are playing. These data provide a source for quantification of disease phenotypes of mental health. Produced by engaged human behaviour, game data have potential to be leveraged for population screening or prevalence estimations, leading toward at-scale, non-intrusive assessment of mental health.
This manuscript needs more reviewersPeer-Review Me
Background: Post-work recovery is essential for the dissipation of work stress, and consequently wellbeing. Evidence suggests that activities that are immersive, active and engaging are especially eff...
Background: Post-work recovery is essential for the dissipation of work stress, and consequently wellbeing. Evidence suggests that activities that are immersive, active and engaging are especially effective at promoting recovery. Previous research has suggested that playing digital games might be effective in promoting recovery, but little is known about how they compare to other popular mobile activities, such as mindfulness apps, which are specifically designed to support wellbeing. Objective: This research aimed to investigate and compare the effectiveness of a digital game and a mindfulness app in promoting post-work recovery, first in a lab setting and then in a field study. Methods: Study 1 was a lab experiment (n=45) in which participants’ need for recovery was induced by a work task, before undertaking one of three break tasks: a digital game (Block! Hexa Puzzle), a mindfulness app (Headspace) or a non-media control with a fidget spinner (a physical toy). Recovery in the form of how energised participants felt (energetic arousal) was compared before and after the break task, and how recovered participants felt (recovery experience) was compared across the conditions. Study 2 was a field study with working professionals (n=20), for which participants either played the digital game or used the mindfulness app once arriving home from work over a period of five working days. Measures of energetic and tense arousal were taken before and after the task, and recovery experience was measured after the task, along with measures of enjoyment and job strain. Results: A 3x2 mixed ANOVA identified that the digital game condition increased energetic arousal (indicative of improved recovery) whereas the other two conditions decreased energetic arousal (F2,42=3.76, p<.05). However, there were no differences between the conditions in Recovery Experience (F2,42=.01, p=.99). In Study 2, a multi-level model comparison approach identified that neither intervention nor day of the week had a significant impact on how energised participants felt. However, for those in the digital game condition, daily recovery experience increased during the course of the study, whereas for those in the mindfulness condition it decreased (F1,20=2.1489, p<0.01). Follow up interviews with participants identified three core themes: Detachment and Restoration, Fluctuations and Differences, and finally, Routine and Scheduling. These suggested that the activities differed in how much they allowed individuals to detach from work, but there were also differences across days and participants, and in some ways, the benefit of the activities came from simply having an enforced routine. Conclusions: This work suggests that digital games may be effective in promoting post-work recovery in lab contexts, even without a high need for recovery (Study 1) and in the real world, although the effect in this case may be accumulative rather than instant (Study 2).