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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.

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: Pixabay; Copyright: HammerandTusk; URL:; License: Licensed by JMIR.

    Believing Is Seeing: A Proof-of-Concept Semiexperimental Study on Using Mobile Virtual Reality to Boost the Effects of Interpretation Bias Modification for...


    Background: Cognitive Bias Modification of Interpretations (CBM-I) is a computerized intervention designed to change negatively biased interpretations of ambiguous information, which underlie and reinforce anxiety. The repetitive and monotonous features of CBM-I can negatively impact training adherence and learning processes. Objective: This proof-of-concept study aimed to examine whether performing a CBM-I training using mobile virtual reality technology (virtual reality Cognitive Bias Modification of Interpretations [VR-CBM-I]) improves training experience and effectiveness. Methods: A total of 42 students high in trait anxiety completed 1 session of either VR-CBM-I or standard CBM-I training for performance anxiety. Participants’ feelings of immersion and presence, emotional reactivity to a stressor, and changes in interpretation bias and state anxiety, were assessed. Results: The VR-CBM-I resulted in greater feelings of presence (P<.001, d=1.47) and immersion (P<.001, ηp2=0.74) in the training scenarios and outperformed the standard training in effects on state anxiety (P<.001, ηp2=0.3) and emotional reactivity to a stressor (P=.03, ηp2=0.12). Both training varieties successfully increased the endorsement of positive interpretations (P<.001, drepeated measures [drm]=0.79) and decreased negative ones. (P<.001, drm=0.72). In addition, changes in the emotional outcomes were correlated with greater feelings of immersion and presence. Conclusions: This study provided first evidence that (1) the putative working principles underlying CBM-I trainings can be translated into a virtual environment and (2) virtual reality holds promise as a tool to boost the effects of CMB-I training for highly anxious individuals while increasing users’ experience with the training application.

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

    Use of Mobile and Computer Devices to Support Recovery in People With Serious Mental Illness: Survey Study


    Background: Mental health recovery refers to 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: This study aimed to identify smartphone, tablet, and computer apps that mental health service recipients use and want to use to support their recovery. Methods: In this pilot study, we surveyed a convenience sample of 63 mental health service recipients with serious mental illness. The survey assessed current use and interest in mobile and computer devices to support recovery. Results: Listening to music (60%), accessing the internet (59%), calling (59%), and texting (54%) people were the top functions currently 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 reported interest in trying more specific illness-management apps.

  • m-RESIST project. Source: The Authors; Copyright: m-RESIST consortium; URL:; License: Public Domain (CC0).

    Mobile Phone and Wearable Sensor-Based mHealth Approaches for Psychiatric Disorders and Symptoms: Systematic Review


    Background: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an innovative therapeutic program for treatment-resistant schizophrenia. The program exploits information from mobile phones and wearable sensors for behavioral tracking to support intervention administration. Objective: To systematically review original studies on sensor-based mHealth apps aimed at uncovering associations between sensor data and symptoms of psychiatric disorders in order to support the m-RESIST approach to assess effectiveness of behavioral monitoring in therapy. Methods: A systematic review of the English-language literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed through Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Studies published between September 1, 2009, and September 30, 2018, were selected. Boolean search operators with an iterative combination of search terms were applied. Results: Studies reporting quantitative information on data collected from mobile use and/or wearable sensors, and where that information was associated with clinical outcomes, were included. A total of 35 studies were identified; most of them investigated bipolar disorders, depression, depression symptoms, stress, and symptoms of stress, while only a few studies addressed persons with schizophrenia. The data from sensors were associated with symptoms of schizophrenia, bipolar disorders, and depression. Conclusions: Although the data from sensors demonstrated an association with the symptoms of schizophrenia, bipolar disorders, and depression, their usability in clinical settings to support therapeutic intervention is not yet fully assessed and needs to be scrutinized more thoroughly.

  • Source: The Authors; Copyright: The Authors; URL:; License: Public Domain (CC0).

    Identifying Behaviors Predicting Early Morning Emotions by Observing Permanent Supportive Housing Residents: An Ecological Momentary Assessment


    Background: Behavior and emotions are closely intertwined. The relationship between behavior and emotions might be particularly important in populations of underserved people, such as people with physical or mental health issues. We used ecological momentary assessment (EMA) to examine the relationship between emotional state and other characteristics among people with a history of chronic homelessness who were participating in a health coaching program. Objective: The goal of this study was to identify relationships between daily emotional states (valence and arousal) shortly after waking and behavioral variables such as physical activity, diet, social interaction, medication compliance, and tobacco usage the prior day, controlling for demographic characteristics. Methods: Participants in, a technology-assisted health coaching program, were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. We asked a subset of participants to complete daily EMAs of emotions and other behaviors. From the circumplex model of affect, the EMA included 9 questions related to the current emotional state of the participant (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate two composite scores for valence and arousal. Results: Nonwhites reported higher scores for both valence and arousal, but not at a statistically significant level after correcting for multiple testing. Among momentary predictors, greater time spent in one-on-one interactions, greater time spent in physical activities, a greater number of servings of fruits and vegetables, greater time spent interacting in a one-on-one setting as well as adherence to prescribed medication the previous day were generally associated with higher scores for both valence and arousal, and statistical significance was achieved in most cases. Number of cigarettes smoked the previous day was generally associated with lower scores on both valence and arousal, although statistical significance was achieved for valence only when correcting for multiple testing. Conclusions: This study provides an important glimpse into factors that predict morning emotions among people with mental health issues and a history of chronic homelessness. Behaviors considered to be positive (eg, physical activity and consumption of fruits and vegetables) generally enhanced positive affect and restrained negative affect the following morning. The opposite was true for behaviors such as smoking, which are considered to be negative.

  • Head Mounted Displays. Source: Image created by the authors; Copyright: The Authors; License: Creative Commons Attribution (CC-BY).

    Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study


    Background: Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed. Objective: We aimed to develop a methodological framework with input from an international working group in order 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 on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments. Results: The interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR trials. Using the Food and Drug Administration Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs—VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through the 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 that evaluate efficacy against a control condition. Best practice recommendations for each trial were provided. Conclusions: Patients, providers, payers, and regulators should consider this best practice framework when assessing the validity of VR treatments.

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

    Adoption of Mobile Apps for Depression and Anxiety: Cross-Sectional Survey Study on Patient Interest and Barriers to Engagement


    Background: Emerging research suggests that mobile apps can be used to effectively treat common mental illnesses like depression and anxiety. Despite promising efficacy results and ease of access to these interventions, adoption of mobile health (mHealth; mobile device–delivered) interventions for mental illness has been limited. More insight into patients’ perspectives on mHealth interventions is required to create effective implementation strategies and to adapt existing interventions to facilitate higher rates of adoption. Objective: The aim of this study was to examine, from the patient perspective, current use and factors that may impact the use of mHealth interventions for mental illness. Methods: This was a cross-sectional survey study of veterans who had attended an appointment at a single Veterans Health Administration facility in early 2016 that was associated with one of the following mental health concerns: unipolar depression, any anxiety disorder, or posttraumatic stress disorder. We used the Veteran Affairs Corporate Data Warehouse to create subsets of eligible participants demographically stratified by gender (male or female) and minority status (white or nonwhite). From each subset, 100 participants were selected at random and mailed a paper survey with items addressing the demographics, overall health, mental health, technology ownership or use, interest in mobile app interventions for mental illness, reasons for use or nonuse, and interest in specific features of mobile apps for mental illness. Results: Of the 400 potential participants, 149 (37.3%, 149/400) completed and returned a survey. Most participants (79.9%, 119/149) reported that they owned a smart device and that they use apps in general (71.1%, 106/149). Most participants (73.1%, 87/149) reported interest in using an app for mental illness, but only 10.7% (16/149) had done so. Paired samples t tests indicated that ratings of interest in using an app recommended by a clinician were significantly greater than general interest ratings and even greater when the recommending clinician was a specialty mental health provider. The most frequent concerns related to using an app for mental illness were lacking proof of efficacy (71.8%, 107/149), concerns about data privacy (59.1%, 88/149), and not knowing where to find such an app (51.0%, 76/149). Participants expressed interest in a number of app features with particularly high-interest ratings for context-sensitive apps (85.2%, 127/149), and apps focused on the following areas: increasing exercise (75.8%, 113/149), improving sleep (73.2%, 109/149), changing negative thinking (70.5%, 105/149), and increasing involvement in activities (67.1%, 100/149). Conclusions: Most respondents had access to devices to use mobile apps for mental illness, already used apps for other purposes, and were interested in mobile apps for mental illness. Key factors that may improve adoption include provider endorsement, greater publicity of efficacious apps, and clear messaging about efficacy and privacy of information. Finally, multifaceted apps that address a range of concerns, from sleep to negative thought patterns, may be best received.

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

    Sexual Desire, Mood, Attachment Style, Impulsivity, and Self-Esteem as Predictive Factors for Addictive Cybersex


    Background: An increasing number of studies are concerned with various aspects of cybersex addiction, the difficulty some persons have in limiting cybersex use despite a negative impact on everyday life. Objective: The aim of this study was to assess potential links between the outcome variable cybersex addiction, assessed with the Compulsive Internet Use Scale (CIUS) adapted for cybersex use, and several psychological and psychopathological factors, including sexual desire, mood, attachment style, impulsivity, and self-esteem, by taking into account the age, sex, and sexual orientation of cybersex users. Methods: A Web-based survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: CIUS adapted for cybersex use, Sexual Desire Inventory, and Short Depression-Happiness Scale. Moreover, attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Impulsivity was measured by using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale. Global self-esteem was assessed with the 1-item Self-Esteem Scale. Results: A sample of 145 subjects completed the study. Addictive cybersex use was associated with higher levels of sexual desire, depressive mood, avoidant attachment style, and male gender but not with impulsivity. Conclusions: Addictive cybersex use is a function of sexual desire, depressive mood, and avoidant attachment.

  • One group using a cognitive training app and the other using a mindfulness training app. Source: The Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Effects of a Mindfulness Meditation App on Subjective Well-Being: Active Randomized Controlled Trial and Experience Sampling Study


    Background: Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. Objective: This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. Methods: Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. Results: Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=−.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=−.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=−.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). Conclusions: MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. Trial Registration: NCT03783793; (Archived by WebCite at

  • Source: Pexels; Copyright:; URL:; License: Licensed by JMIR.

    Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity,...


    Background: Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. Objective: The objective of our study was 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) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected 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 the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 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-related factors for the onset and maintenance of depression and related disorders.

  • Source: iStock by Getty Images; Copyright: verbaska_studio; URL:; License: Licensed by the authors.

    Internet-Based Interventions for Problem Gambling: Scoping Review


    Background: This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face-to-face treatment. Making treatment resources for problem gambling available through the internet is one way to reduce the impact of those systemic barriers. The use of internet-based resources to address problem gambling has been growing, and a field of research evaluating it has developed as well. However, little has been done to summarize this collection of research. Objective: This study aimed to provide a scoping review of the use of internet-based interventions for problem gambling treatment and prevention to provide an understanding of the current state of the field. Methods: A scoping review was performed for 6 peer-reviewed research databases (Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Social Science Abstracts, and Scopus) and 3 gray literature databases (MedEdPortal, Proquest: Dissertations, and OpenGrey). Article inclusion criteria were as follows: published over the 10-year period of 2007 to 2017, including an intervention for problem gambling, and involving the use of internet to deliver that intervention. Results: A total of 27 articles were found that met the review criteria. Studies were found from several different areas, with particularly strong representation for Australia, New Zealand, and Scandinavia. Cognitive behavioral therapy was the most common form of internet-based intervention. Internet-based interventions were generally shown to be effective in reducing problem gambling scores and gambling behaviors. A wide range of interventions that made use of internet resources included text-based interactions with counselors and peers, automated personalized and normative feedback on gambling behaviors, and interactive cognitive behavioral therapies. A lack of diversity in samples, little comparison with face-to-face interventions, and issues of changes in the treatment dynamic are identified as areas that require further investigation. Conclusions: Internet-based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barriers to accessing professional help. The state of the current literature is sparse, and more research is needed for directly comparing internet-based interventions and their traditional counterparts.

  • Searching for information on perinatal anxiety on the internet. Source: Image created by the Authors; Copyright: Virginia Harrison; URL:; License: Creative Commons Attribution (CC-BY).

    Advice for Health Care Professionals and Users: An Evaluation of Websites for Perinatal Anxiety


    Background: Many websites are available with information and resources for perinatal anxiety; however, there is limited research on the quality and content of these sites. Objective: This study aims to identify what sites are available on perinatal anxiety, identify any information and therapeutic advice given, and review its accuracy and website design. Methods: We conducted an evaluation 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 (46/50, 92%), but much less on screening (19/50, 38%). Most sites provided at least some resources to support mothers (49/50, 98%), but active, guided support was infrequent (25/50, 50%). Website quality was extremely variable and mostly difficult to read (42/50, 84%). Conclusions: This study recommends the top 4 websites on perinatal anxiety for health care 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. Furthermore, these sites should be easy to use and readable.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer:...


    Background: Clinical trials are often challenged with issues of recruitment and retention. Little is known concerning general attitudes and preferences toward trial design and willingness to participate among parents of children treated for cancer. Furthermore, willingness to participate in internet-administered psychological interventions remains unexplored. In this study, we examined attitudes and preferences of the population regarding study procedures for a hypothetical trial of an internet-administered psychological intervention. In addition, differences in the response rate between modes of study invitation and willingness to engage in internet-administered interventions were examined. Objective: The primary objective of this study was to examine attitudes and preferences toward participating in an internet-administrated psychological intervention. The secondary objective was to examine the response rates and help-seeking behavior among parents of children treated for cancer. Methods: A cross-sectional, Web-based survey was conducted with parents of children who had completed cancer treatment. This Web-based survey examined self-reported emotional distress, prior help-seeking and receipt of psychological support, past research participation, attitudes toward research, preferences concerning recruitment procedures, and attitudes toward different types of trial design. Results: Of all the parents invited, 32.0% (112/350) completed the survey, with no difference in response rate between modes of study invitation (χ21=0.6, P=.45). The majority (80/112, 71.4%) of parents responded that they had experienced past emotional distress. Responses indicated high (56/112, 50.0%) or somewhat high trust in research (51/112, 45.5%), and the majority of parents would accept, or maybe accept, internet-administered psychological support if offered (83/112, 74.1%). In addition, responses showed a preference for postal study invitation letters (86/112, 76.8%), sent by a researcher (84/112, 75.0%) with additional study information provided on the Web via text (81/112, 72.3%) and video (66/112, 58.9%). Overall, parents responded that trials utilizing a waiting list control, active alternative treatment control, or a patient-preference design were acceptable. Conclusions: Parents of children treated for cancer appear willing to participate in trials examining internet-administered psychological support. Findings of this study will inform the design of a feasibility trial examining internet-administered psychological support for the population.

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  • Using Ecological Momentary Assessment to Measure Mood Fluctuations during Drinking Episodes among Individuals with HIV

    Date Submitted: Feb 19, 2019

    Open Peer Review Period: Feb 22, 2019 - Apr 19, 2019

    Background: Individuals with HIV have high rates of mood disorders that have been noted to interrupt adherence care practices. Yet, intraday fluctuations in mood among these individuals are mostly unk...

    Background: Individuals with HIV have high rates of mood disorders that have been noted to interrupt adherence care practices. Yet, intraday fluctuations in mood among these individuals are mostly unknown. Objective: This study examined mood and alcohol use among a sample of individuals with HIV in their natural environments. Methods: This prospective 28-day pilot study enrolled 34 individuals engaged in HIV care. Mood was measured using the Positive and Negative Affect Scale-Short Form (PANAS-SF) and completed at the same moment of their alcohol consumption questionnaire. Descriptive and multilevel analyses aimed at identifying predictive patterns of mood changes in relation to alcohol use. Results: Among the 27 participants who completed the study with alcohol use reports, mood was measured at each of the 227 drinking episodes. The positive and negative affect scores ranged from 10 to 50, with a mean of 25.7 and 11.4 for each, respectively. There was significant reduction in mean positive mood scores from the start of the alcohol episode to the following day. Means for negative mood reports and fluctuation was low in this sample. Those that had a higher drinking pace overall were more likely to be in a worse mood at the end of the alcohol episode, regardless of the number of drinks consumed. Conclusions: This pilot study reveals the initial relationships between mood and alcohol use, namely reductions in positive mood after alcoholic drinks were consumed. These patterns suggest intervention opportunities, yet larger scale studies are likely to identify more significant opportunities for interventions.

  • How is gamification applied towards improving mental health and well-being?: A systematic review

    Date Submitted: Feb 14, 2019

    Open Peer Review Period: Feb 15, 2019 - Apr 12, 2019

    Background: While gamification has received considerable interest from the health community in recent years, research on its application to mental health and well-being (MH&W) interventions is sparse,...

    Background: While gamification has received considerable interest from the health community in recent years, research on its application to mental health and well-being (MH&W) interventions is sparse, and usage of gamification-related terminology remains inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting an overly behaviourist approach. Objective: In an attempt to gain an improved understanding of the current state of the field, we developed three research questions: RQ1) which gamification elements are most commonly applied towards improving MH&W; RQ2) which MH&W domains are targeted most by gamification; and RQ3) what reasons do researchers give for applying gamification to improving MH&W. To answer these questions, we conducted a systematic review of the literature. Methods: We searched ACM Digital Library, CINAHL, Cochrane Library, Embase, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying articles published within the last five years. To answer RQ1 and RQ2, articles were coded for gamification element and MH&W domain according to existing taxonomies in the game studies and medical literatures. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. Results: At the end of the search and screening process, we identified 70 qualifying articles that collectively reported on 50 apps and technologies. The most commonly observed gamification elements in our data set were levels/progress feedback, points/scoring, rewards/prizes, narrative/theme, personalisation, and customisation, and the most commonly observed MH&W domains were anxiety disorders, well-being, alcohol use disorders, depressive disorders, and physical health with MH&W outcomes. We coded researcher justification for applying gamification to improving MH&W in 41/70 (59%) of articles, which were broadly divided into two themes: 1) promoting engagement; and 2) enhancing an intervention’s intended effects. Conclusions: Our findings suggest that the current application of gamification to improving MH&W does not fit with the trend of positive reinforcement observed and critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behaviour change frameworks. Researcher justifications for using gamification appeared in just over half of the identified articles, with an overwhelming focus on promoting engagement. Future research can consider how rarely implemented gamification elements, such as randomness and social cooperation, may be implemented to further the goals of MH&W interventions, and to promote not just motivation, but also capability and opportunity, to change behaviour. We also call for the inclusion of more comprehensive and explicit descriptions of how and why gamification is applied and the standardisation of the usage of applied games terminology within and across fields.

  • Evaluation of, a Canadian Mental Health Website Portal: A Mixed Methods Assessment

    Date Submitted: Feb 6, 2019

    Open Peer Review Period: Feb 11, 2019 - Apr 8, 2019

    Background: There is a great need of mental health care and services in Canada which is far from being met. The website was created to facilitate and assist Canadians to 1) learn abou...

    Background: There is a great need of mental health care and services in Canada which is far from being met. The website was created to facilitate and assist Canadians to 1) learn about mental health, 2) screen for common mental health issues, and 3) find mental health treatment and support including peer support. Objective: This project used multiple methods to assess the characteristics of the users of, their perceptions and their satisfaction with the website. Methods: Website analytics (Google Analytics) provided information about the number of unique visits to the website and how the site is used. Online self-administered surveys were used to gather additional information on users’ characteristics and to assess their perception of the website and satisfaction with the website. Results: Web Analytic results showed from January 1 to December 31, 2017, there were 650K users, with 1.97M page views. Users were more often female than male, and the majority of users were aged 35 years and older. Most users were located in Canada (93%) and the most common city of origin of users was Toronto (15%), followed by Ottawa (11%), and Montreal. Online surveys were completed by 370 respondents in total from June to December 2017. Overall, the majority of users were satisfied with the website (93%, 320 out of 344 responses). Positive feedback was related to the content of the website as a helpful resource, and negative feedback was related to technical difficulties as well as the design of the main page. This analysis will be used to help the team with ongoing improvements to the website, for example improving technical issues and improving homepage usability. Conclusions: Most visitors reported satisfaction with their use of to learn about mental health, as well as where to find help. Mental health websites such as are a low-cost way to increase public awareness about mental health.

  • Online Help-Seeking in Young Adults: An Online Survey

    Date Submitted: Jan 31, 2019

    Open Peer Review Period: Feb 1, 2019 - Mar 29, 2019

    Background: Young people have been recognised as being particularly vulnerable to experiencing mental health difficulties during adolescence and very few seek treatment or help during this time. Onlin...

    Background: Young people have been recognised as being particularly vulnerable to experiencing mental health difficulties during adolescence and very few seek treatment or help during this time. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties, yet our current understanding of how young people seek help online is limited. Objective: This was an exploratory study which aimed to investigate the online help-seeking behaviours and preferences of young people. Methods: This study made use of an anonymous online survey. Young people aged 18-25 living in Ireland participated in the survey and were recruited through social media ads on Twitter and Facebook. Results: A total of 1308 respondents completed the survey. A majority of the respondents (80.66%, 1055/1308) indicated that they would use their mobile phone to look for help for a personal or emotional concern online. When looking for help online, 82.57% (1080/1308) of participants made use of an Internet search whilst 57.03% (746/1308) would make use of a health website. When asked about their satisfaction with these resources, 36.94% (399/1080) indicated that they were ‘satisfied’ or ‘very satisfied’ with an Internet search whilst 49.33% (368/746) indicated that they were ‘satisfied’ or ‘very satisfied’ with a health website. When asked about credibility health websites were found to be the most trustworthy with 39.45% (516/1308) indicating that found them to be ‘trustworthy’ or ‘very trustworthy’. Most of the respondents (82.95%, 1085/1308) indicated that health service logo was an important indicator of credibility, as was an endorsement by schools and colleges (54.97%, 719/1308). Important facilitators of online help-seeking included the anonymity and confidentiality offered by the Internet with 80% of the sample indicating that it influenced their decision ‘a lot’ or ‘quite a lot’. A noted barrier was being uncertain whether information on an online resource was reliable, with 55.96% of the respondents indicating that this influenced their decision ‘a lot’ or ‘quite a lot’. Conclusions: Findings from this survey suggest that young people are engaging web-based mental health resources to assist them with their mental health concerns. However, levels of satisfaction with the available resources are varied. Young people are engaging in strategies to assign credibility to web-based resources, however uncertainty around their reliability is a significant barrier to online help-seeking.

  • The Role of Moderators on Engagement of Adolescents with Depression and/or Anxiety in a Social Media Intervention: A Content Analysis of Online Interactions

    Date Submitted: Jan 27, 2019

    Open Peer Review Period: Jan 29, 2019 - Mar 26, 2019

    Background: The Supporting Our Valued Adolescents intervention aims to use a moderated social media website to encourage peer discussion about negative health beliefs which may prevent treatment uptak...

    Background: The Supporting Our Valued Adolescents intervention aims to use a moderated social media website to encourage peer discussion about negative health beliefs which may prevent treatment uptake. Online moderators with a background in behavioral health are utilized to facilitate peer conversation to promote a sense of community, provide social support, and ensure safety. Objective: Although moderation is a core component of this intervention, little is known on best practices for moderators to ensure safety while encouraging engagement. The present study seeks to describe interactions between moderators and peer users and understand moderator experiences through individual interviews. Methods: Blogpost text and comments were assessed using a content analysis approach and examined for comment contributor order. Results: It was found that conversations were more likely to continue when online moderators used elements of supportive accountability (such as being perceived as experts and using mirroring and verbal rewards as well as offering informational and emotional support). When the moderator provided the last comment under a blogpost, thereby potentially ending contribution by users, the moderator was often commenting about their own experiences. Conclusions: Moderators can elicit user engagement by offering gratitude and encouragement to users, asking users follow-up questions, and limiting their own opinions/experiences when responding to comments.

  • Efficacy of a Culturally Adapted Cognitive Behavioural Internet-delivered Treatment for Depression

    Date Submitted: Jan 18, 2019

    Open Peer Review Period: Jan 21, 2019 - Mar 18, 2019

    Background: Internet-delivered treatments for depression have proved successful in high-income Western countries. There may be potential for implementing such treatments in low and middle-income count...

    Background: Internet-delivered treatments for depression have proved successful in high-income Western countries. There may be potential for implementing such treatments in low and middle-income countries such as Colombia, where access to mental health services is limited. Objective: To assess the efficacy of the culturally adapted internet-delivered treatment for depression Methods: The study consisted of the implementation of a culturally adapted intervention using a randomised controlled trial (RCT) and 3-months follow-up. The internet-delivered cognitive behavioural therapy (CBT) programme consisted of 7-modules. Two hundred and fourteen Colombian college students with depressive symptoms were randomly assigned to either the treatment group (n= 107) or a waiting list control group (n=107). Participants received weekly support from a trained supporter. The primary outcome was symptoms of depression as measured by the Patient Health Questionnaire (PHQ-9) and the secondary outcomes were anxiety symptoms assessed by the Generalized Anxiety Disorder questionnaire (GAD-7). Results: Linear mixed model (LMM) showed significant effects post-treatment (t= -5.189, df = 197.54, p= <0.00) for the treatment group and these effects were maintained into 3-months follow up (t= 4.668, df =39.62, p=<.000). The results within groups for the treatment group yielded a large effect size post-treatment (d=1.44, p=<.001) and this was maintained at 3-months follow-up (d=1.81, p=<.001). Also, LMM showed significant differences between the groups (t=-5.189, df =197.54, p=<.00). The results showed a large effect size between the groups (d=.91, p=<.001). Conclusions: The research attrition was high in this study as was the drop-out from the intervention. This study was a first contribution investigating the potential impact of a culturally adapted internet-delivered treatment on depressive symptoms for college students as compared to a WL control group in South America. Future research should focus on monitoring participants who drop out prematurely from the study and at follow-up to evaluate the reasons for the treatment withdrawal. Clinical Trial: NCT03062215