JMIR Mental Health
Internet interventions, technologies and digital innovations for mental health and behaviour change
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.
Editorial Board members are currently being recruited, please contact us if you are interested (jmir.editorial.office at gmail.com).
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Analysis of hourly variations in search engine query volumes for depression-related health information
Date Submitted: Oct 10, 2017
Open Peer Review Period: Oct 10, 2017 - Dec 5, 2017
Background: Depression is one of the most burdensome noncommunicable diseases in the world. One of the characteristics of depression is diurnal mood variation (DMV), which refers to noticeable daily c...
Background: Depression is one of the most burdensome noncommunicable diseases in the world. One of the characteristics of depression is diurnal mood variation (DMV), which refers to noticeable daily changes in the overall mood state in individuals suffering from depression. Studying search engine data for depression-related health information seeking behaviour has the potential to provide new meaningful insights into DMVs, as individuals suffering from mental health issues are more likely to seek information about their problems online. This kind of infodemiological research is promising, and has been shown to be reliable for predicting patterns of both communicable and noncommunicable diseases. Objective: The objective of this study is to analyse hourly search engine query data to find evidence for diurnal mood variation in Finland. Methods: Query volume data in the form of relative search volume (RSV) for six depression-related queries in Finland was downloaded from the Google Trends database. Data was downloaded every week to obtain data for every hour during the month of March 2017. This resulted in a relative search volume value for 744 hours for the six query terms (n=4464). Arithmetical means for the RSVs of the search queries for the different hours of the day were calculated. The hourly data was also trichotomized and analysed in three time blocks: 0.00 a.m. - 7.59 a.m, 8.00 a.m. - 3.59 p.m. and 4.00 p.m. - 11.59 p.m. to make comparisons between different time periods during the 24 hours of the day. Results: All query term volumes showed a unimodal regular pattern during the 24 hours of the day, with increasing search volumes from the evening towards midnight and decreasing interest from 3.00 a.m. towards morning. Analysis of mean search activity of the three time blocks showed peaks in the first time block (00.00 a.m. – 7.59 a.m.) for all six terms. The search volumes decreased significantly during the second time block (8.00 a.m. - 3.59 p.m), and rose again between the third (4.00 p.m. - 11.59 p.m) and the first time block. Conclusions: Search engine query data support the notion of the evening-worse pattern in depression. Symptoms of diurnal mood variation may be tracked by monitoring changes in Google search engine query volume during the different hours of the day. Information on the timely nature of depression on an hourly level could improve the chances for early intervention.
Feasibility and acceptability of a web-based treatment with telephone support for postpartum women with anxiety: A randomized controlled trial
Date Submitted: Oct 6, 2017
Open Peer Review Period: Oct 8, 2017 - Dec 3, 2017
Background: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer p...
Background: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. “What Am I Worried About” (WaWa) is self-guided treatment based on cognitive behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of nine modules with optional weekly telephone support. WaWa was adapted to a web-based version for the use in England (iWaWa). Objective: This study aimed to investigate the feasibility (engagement and usability), acceptability (usefulness, satisfaction, and helpfulness), and potential efficacy of iWaWa among English postpartum women with anxiety. Methods: Postpartum (<12 months) women with mild to severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control conditions. Treatment and study feasibility and acceptability were assessed post-treatment and anxiety symptoms were assessed before treatment, immediately after treatment and 1-month later using online questionnaires. Semi-structured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility. Results: Eighty-nine eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control condition (n=43). Women were predominantly White/Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Drop-out rates were high, especially in the treatment group (treatment: 82.60%, n=38; waitlist-control: 51.16%, n=22). Twenty-six women started iWaWa with only two women completing all nine modules. Anxiety levels decreased significantly for both groups from baseline to the 8-week follow-up, but there was no difference between the groups. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa’s accessibility, anonymity and weekly reminders, as well as the introduction to the principles of cognitive-behavioural therapy and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too wordy and long and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles. Conclusions: Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences which can inform research and development of web-based postpartum anxiety treatments to optimize adherence. Clinical Trial: ClinicalTrials.gov NCT02434406 https://clinicaltrials.gov/ct2/show/NCT02434406
Digital access in working age and older adults and their carers attending psychiatry outpatient clinics
Date Submitted: Oct 6, 2017
Open Peer Review Period: Oct 8, 2017 - Dec 3, 2017
Background: Background: It has been suggested that improving access to mental health services, supporting self-management and increasing clinical productivity can be achieved through the delivery of...
Background: Background: It has been suggested that improving access to mental health services, supporting self-management and increasing clinical productivity can be achieved through the delivery of technology-enabled care via personal mobile and internet-based services, but there is little evidence available about whether working age and older adults with mental health problems or their carers have access to these technologies, or their confidence with these technologies. Objective: To ascertain the prevalence and range of devices used to access the internet in patients and carers attending general and older adult psychiatry outpatient services, and their confidence in using these technologies. Methods: We conducted an anonymous survey of 77 patients and carers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology enabled care. Results: We found high levels of internet access and confidence in using the internet in working age adults, their carers, and older adult carers but not in older adult patients. Smartphone usage predominated in working age adults and their carers. Older adult carers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor. Conclusions: Access rates and uptake of internet based services have the potential to be high in working age adults and their carers, but are likely to be significantly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial.
Youth Co-design Of A Mobile Phone app to facilitate self-monitoring and management of mood symptoms in young people with major depression, suicidal ideation and self-harm
Date Submitted: Sep 26, 2017
Open Peer Review Period: Sep 26, 2017 - Nov 21, 2017
Background: Effective treatment of depression in young people is critical given its prevalence, impacts and link to suicide. Clinical practice guidelines point to the need for regular monitoring of de...
Background: Effective treatment of depression in young people is critical given its prevalence, impacts and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation, to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. Objective: We aimed to address the gap between guidelines about monitoring and real-world practice by co-designing an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. Methods: We engaged young people aged 18 to 25 who had experienced depression, suicidal ideation and/or self-harm, as well as clinicians in a co-design process. We used a human centred co-design “design studio” methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low fidelity hand drawn wireframes. Clinicians were engaged throughout the process via focus groups. Results: The app incorporated a mood monitoring feature with innovative design aspects that allowed customisation, and was named a ‘well-being tracker’ in response to the need for a positive approach to this function. Brief personalised interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (i.e., responding in a timely manner) and will need to be addressed in the full implementation of the app into clinical services. Conclusions: The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress, and increase access to timely and evidence based interventions are desirable outcomes. To achieve positive outcomes for young people using technology (app) based interventions, it is critical to understand an incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.
Date Submitted: Sep 23, 2017
Open Peer Review Period: Sep 24, 2017 - Nov 19, 2017
This manuscript needs more reviewersPeer-Review Me
Lamotrigine is an anticonvulsant used for the treatment of bipolar disorder, especially for depressive episodes. A randomized placebo controlled trial was conducted and self-reported mood scores were...
Lamotrigine is an anticonvulsant used for the treatment of bipolar disorder, especially for depressive episodes. A randomized placebo controlled trial was conducted and self-reported mood scores were collected over a period of 52 weeks. Different features were computed from the weekly time series produced by each subject. The coefficient of variation (σ/μ) and detrended fluctuation analysis scaling exponent (α), a measure of scaling and long-range persistence (long memory) in time series, were selected as having the most explanatory power. Data from patients taking lamotrigine show a general decrease in depression score in comparison to the patients taking placebo. The time series of lamotrigine patients tend to be rougher than the placebo group. A classifier was built and, based on the two chosen metrics, we are able to achieve a classification accuracy of more than 60% in predicting the treatment mode.
Psychosocial assessment using telehealth in adolescent and young adults with cancer: A randomised pilot study
Date Submitted: Sep 1, 2017
Open Peer Review Period: Sep 3, 2017 - Oct 29, 2017
Background: Adolescent and young adults (AYAs) with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of in-patient face-to-face psychosocial ca...
Background: Adolescent and young adults (AYAs) with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of in-patient face-to-face psychosocial care, whilst essential, may limit the capacity for clinicians to provide timely and personalised assessment and intervention to AYAs who are unable to attend due to barriers such as time, logistics, distance to travel and stigma. Telehealth offers a promising alternative towards increasing access to the provision of evidence-based psychosocial assessment and treatment for AYAs with cancer. Objective: This partially-randomised patient-preference pilot study aimed to examine the feasibility and acceptability of providing psychosocial assessment via telehealth to AYAs currently receiving treatment for cancer, relative to face-to-face delivery. Methods: Patients were eligible if they were: between the ages of 15-25; currently receiving treatment; had sufficient English; and were medically stable. Patients were recruited from oncology clinics/wards, and allocated to receive a psychosocial assessment (AYA Oncology Psychosocial Assessment Measure) with a clinical psychologist or social worker via face-to-face or telehealth modalities using a partially-randomised patient preference model. Patients completed a pre- and post-assessment questionnaire including validated and purposely designed feasibility and acceptability indices (YSQ, Treatment Credibility and Expectations Questionnaire, WAI) and measures of psychosocial wellbeing (K10, Peds-QL-AYA, AYA Oncology Screening Tool). Clinicians also completed a post-assessment questionnaire rating their impressions of the acceptability and feasibility of the intervention delivery via each modality. Results: Patients were recruited from three hospitals in Australia. Of 29 patients approached, 23 consented to participate (response rate = 79%). Participants were randomised to either the telehealth (n=8; 35%; mean age=16.50 years [range=15-23]; females=4 [50%]) or face-to-face (n=11; 62%; mean age=17 years [range=15-22]; females=8 [72.70%]) conditions. Four participants were withdrawn due to logistical/medical complications (attrition rate = 17.4%). The majority 6/8 (75%) of participants in the telehealth group used their own computer/iPad with minor technical difficulties occurring in 3/8 (37.5%) of assessments. Participants from both groups rated high working alliance (WAI: median patient response in the telehealth group = 74 [range: 59-84] and face to face group = 63 [range: 51-84]) and reported positive beliefs regarding the credibility and expectations of their treatment group. Post-assessment preferences between face-to-face or online modalities varied. The majority of patients in the telehealth group (5/8, 63%) reported no preference, whilst 6/11 (55%) in the face-to-face group reported a preference for the face-to-face modality. Conclusions: This study demonstrated that telehealth was acceptable, patient comfort was comparable across modalities, and no significant technological barriers were experienced. Despite this, patients varied in their preferred interview modality, highlighting the need to tailor treatment to patient preference and circumstance. Clinical Trial: ACTRN12614001142628, http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614001142628&isBasic=True