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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: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/man-browsing-laptop-near-sleeping-wife_1935495.htm#term=bed%20laptop&page=19&position=9; License: Licensed by JMIR.

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

    Abstract:

    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: http://mental.jmir.org/2019/1/e10844/; License: Creative Commons Attribution (CC-BY).

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

    Abstract:

    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: ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst)

  • Source: Pexels; Copyright: rawpixel.com; URL: https://www.pexels.com/photo/person-holding-pen-writing-on-daily-report-schedule-paper-1549001/; 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,...

    Abstract:

    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: https://www.istockphoto.com/ca/photo/face-to-face-online-psychotherapy-session-gm518410972-90025345; License: Licensed by the authors.

    Internet-Based Interventions for Problem Gambling: Scoping Review

    Abstract:

    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: http://mental.jmir.org/2018/4/e11464/; License: Creative Commons Attribution (CC-BY).

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

    Abstract:

    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: http://mental.jmir.org/2018/4/e10085/; 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:...

    Abstract:

    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.

  • Source: Flickr; Copyright: Antonio Trogu; URL: http://www.flickr.com/photos/61495861@N00/26571425392; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Desired Features of a Digital Technology Tool for Self-Management of Well-Being in a Nonclinical Sample of Young People: Qualitative Study

    Abstract:

    Background: Adaptive coping behaviors can improve well-being for young people experiencing life stressors, while maladaptive coping can increase vulnerability to mental health problems in youth and into adulthood. Young people could potentially benefit from the use of digital technology tools to enhance their coping skills and overcome barriers in help-seeking behaviors. However, little is known about the desired digital technology use for self-management of well-being among young people in the general population. Objective: This is a small, qualitative study aimed at exploring what young people desire from digital technology tools for the self-management of their well-being. Methods: Young people aged 12-18 years were recruited from the general community to take part in semistructured interviews. Recorded data from the interviews were transcribed and analyzed using inductive thematic analysis. Results: In total, 14 participants were recruited and completed the study, with a mean age of 14.6 years (female n=3). None of the participants reported using any digital tools specifically designed to manage well-being. However, as indicated through the emerged themes, young people used digital technology to reduce their stress levels and manage their mood, mainly through games, music, and videos. Overall, identified themes showed that young people were keen on using such tools and desired certain facets and features of an ideal tool for self-management of well-being. Themes related to these facets indicated what young people felt a tool should do to improve well-being, including being immersed in a stress-free environment, being uplifting, and that such a tool would direct them to resources based on their needs. The feature-based themes suggested that young people wanted the tool to be flexible and enable engagement with others while also being sensitive to privacy. Conclusions: The young people interviewed in this study did not report engaging with digital technology specialized to improving well-being but instead used media already accessed in their daily lives in order to self-manage their psychological states. As a result, the variety of coping strategies reported and digital tools used was limited to the resources that were already being used for recreational and social purposes. These findings contribute to the scarce research into young people’s preferred use of digital technology tools for the self-management of their well-being. However, this was a small-scale study and the current participant sample is not representative of the general youth population. Therefore, the results are only tentative and warrant further investigation.

  • priovi, a program offering psychoeducation content and therapeutic exercises for patients with borderline personality disorder (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://mental.jmir.org/2018/4/e10983/; License: Creative Commons Attribution (CC-BY).

    A Schema Therapy–Based eHealth Program for Patients with Borderline Personality Disorder (priovi): Naturalistic Single-Arm Observational Study

    Abstract:

    Background: Electronic health (eHealth) programs have been found to be effective in treating many psychological conditions. However, regarding borderline personality disorder (BPD), only a few eHealth programs have been tested, involving small interventions based on the dialectical behavior therapy treatment approach. We investigated priovi, a program based on the schema therapy (ST) approach. priovi is considerably more comprehensive than prior programs, offering broad psychoeducation content and many therapeutic exercises. Objective: We tested the acceptability and feasibility of priovi in 14 patients with BPD as an add-on to individual face-to-face ST. Methods: Patients received weekly individual ST and used priovi over a period of 12 months. We assessed BPD symptom severity using self-reported and interview-based measures. Qualitative interviews were conducted with both patients and therapists to assess their experiences with priovi. Results: BPD symptoms improved significantly (Cohen d=1.0). Overall, qualitative data showed that priovi was positively received by both patients and therapists. Some exercises provoked mild anxiety; however, no serious threat to safety was detected. Conclusions: riovi is a potentially helpful and safe tool that could support individual ST. It needs to be further tested in a randomized controlled study. Trial Registration: German Clinical Trials Register DRKS00011538; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00011538 (Archived by WebCite at http://www.webcitation.org/74jb0AgV8)

  • Source: Shutterstock; Copyright: George Rudy; URL: https://www.shutterstock.com/image-photo/group-attractive-young-people-sitting-on-365329922?src=library; License: Licensed by the authors.

    Supported Internet-Delivered Cognitive Behavioral Therapy Programs for Depression, Anxiety, and Stress in University Students: Open, Non-Randomised Trial of...

    Abstract:

    Background: Many university campuses have limited mental health services that cannot cope with the high demand. One alternative is to use internet-delivered cognitive behavioral therapy (iCBT) as a way of tackling barriers such as lack of availability and scheduling issues. Objective: This study aimed to assess feasibility, acceptability, effectiveness, and satisfaction of a supported iCBT intervention offering 3 programs on depression, anxiety, and stress to university students. The design was an open or nonrandomized feasibility trial. Methods: Participants were recruited from 3 counseling centers at a large midwestern University in the United States. Those agreeing to take part chose 1 of 3 iCBT programs—Space from Depression, Space from Anxiety, or Space from Stress —all comprised 8 modules of media-rich interactive content. Participants were supported throughout the trial by a trained professional. The Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) questionnaire, and stress subscale of the Depression Anxiety and Stress Scale (DASS-21) were completed at baseline, 8 weeks, and 3-month follow-up. A Satisfaction With Treatment (SAT) questionnaire was completed at 8 weeks, and qualitative interviews were completed by a subsample of participants at 3 months. Results: A total of 102 participants were recruited, with 52 choosing Space from Anxiety, 31 choosing Space from Depression, and 19 choosing Space from Stress. Mixed-effects models showed a significant decrease in symptoms of depression (F4=6.36, P<.001), anxiety (F4=7.97, P<.001), and stress (F4=8.50, P<.001) over time across all 3 programs. The largest decreases in PHQ-9 scores at 8 weeks were among participants who chose the Space from Depression program (d=0.84); at 3 months, the largest decreases in PHQ-9 scores were among those who chose the Space from Stress program (d=0.74). The largest decreases in GAD-7 scores were among those who chose the Space from Anxiety program (d=0.74 at 8 weeks and d=0.94 at 3 months). The largest decrease in DASS-21 stress subscale scores was among those who chose the Space from Stress program (d=0.49 at 8 weeks and d=1.16 at 3 months). The mean time spent using the platform per session was 27.4 min (SD 33.8), and participants completed 53% (SD 37.6) of the total program content on average. Most (37/53, 69%) participants found the programs helpful or very helpful and liked the convenience and flexibility of the intervention. Qualitative interviews (n=14) indicated the intervention met students’ expectations, and they saw it as a valuable complement to face-to-face treatment. Conclusions: The iCBT programs tested in our study appear to be feasible, acceptable, and effective in a university environment. Participants described the benefits of having a flexible, supported Web-based intervention available on campus. Larger trials should be conducted to further test the effectiveness of supported Web-based interventions that give students a choice of program depending on their symptom profile.

  • Source: The Authors / Pixabay; Copyright: The Authors; URL: https://pixabay.com/en/city-smartphone-control-new-york-3317493/; License: Public Domain (CC0).

    Psychiatrists' Attitudes Toward Disruptive New Technologies: Mixed-Methods Study

    Abstract:

    Background: Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. Objective: The aim of this study was to explore psychiatrists’ perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. Methods: A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). Results: We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. Conclusions: This is the first study to assess psychiatrists’ views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies.

  • Source: Max Pixel; Copyright: Max Pixel; URL: https://www.maxpixel.net/Adult-Man-Unhappy-Sad-Sitting-Depressed-Hoodie-390341; License: Public Domain (CC0).

    Monitoring Online Discussions About Suicide Among Twitter Users With Schizophrenia: Exploratory Study

    Abstract:

    Background: People with schizophrenia experience elevated risk of suicide. Mental health symptoms, including depression and anxiety, contribute to increased risk of suicide. Digital technology could support efforts to detect suicide risk and inform suicide prevention efforts. Objective: This exploratory study examined the feasibility of monitoring online discussions about suicide among Twitter users who self-identify as having schizophrenia. Methods: Posts containing the terms suicide or suicidal were collected from a sample of Twitter users who self-identify as having schizophrenia (N=203) and a random sample of control users (N=173) over a 200-day period. Frequency and timing of posts about suicide were compared between groups. The associations between posting about suicide and common mental health symptoms were examined. Results: Twitter users who self-identify as having schizophrenia posted more tweets about suicide (mean 7.10, SD 15.98) compared to control users (mean 1.89, SD 4.79; t374=-4.13, P<.001). Twitter users who self-identify as having schizophrenia showed greater odds of tweeting about suicide compared to control users (odds ratio 2.15, 95% CI 1.42-3.28). Among all users, tweets about suicide were associated with tweets about depression (r=0.62, P<.001) and anxiety (r=0.45, P<.001). Conclusions: Twitter users who self-identify as having schizophrenia appear to commonly discuss suicide on social media, which is associated with greater discussion about other mental health symptoms. These findings should be interpreted cautiously, as it is not possible to determine whether online discussions about suicide correlate with suicide risk. However, these patterns of online discussion may be indicative of elevated risk of suicide observed in this patient group. There may be opportunities to leverage social media for supporting suicide prevention among individuals with schizophrenia.

  • Searching on the headstrong.life website. Source: Image created by the Authors; Copyright: The Authors; URL: http://mental.jmir.org/2018/4/e12428/; License: Creative Commons Attribution (CC-BY).

    Website Analytics of a Google Ads Campaign for a Men’s Mental Health Website: Comparative Analysis

    Abstract:

    Background: Men with mental health and addictions problems seek information and help from health service providers and community support less often than women with such problems. Online health resources offer men rapid access to self-care recommendations and resources and anonymity; however, only a few websites are specifically developed for men. Headstrong - Taking Things Head-On was a community pharmacy and online health promotion initiative for men living with mental health and addictions problems. The Headstrong website was developed to offer a curated collection of print and online recommended resources (primarily self-help oriented) for depression, anxiety, insomnia, tobacco and alcohol use problems, and suicide. To increase awareness of the initiative and use of the website’s content and resource recommendations, a Google Ads campaign was developed. Objective: This study aimed to compare user acquisition and behavior on the Headstrong website during and after a Google Ads campaign. Methods: The Google Ads campaign was launched on December 21, 2017, and run until February 28, 2018. Website analytics (acquisition of new users, behavior in terms of at-website actions and duration, devices used, and conversions [link-outs to recommended resources]) in a 30-day period during the campaign (January 26, 2018 to February 24, 2018) were compared to a similar 30-day period after the campaign (March 23, 2018 to April 21, 2018). A cost analysis of the ad campaign was also performed. Results: The ad campaign generated 3011 clicks and 4.5 million impressions in total. In addition, the campaign received 1311 website users during the 30-day period of the ad campaign as compared to 241 users during the 30-day period after the ad campaign (P<.001). Return visitor (17.7% vs 27.8%) and nonbounce (19.5% vs 39.8%) user rates as well as session duration (42 vs 102 seconds) and page views per session (1.4 vs 2.1) were lower during the ad campaign than after the campaign (P<.01 for all). The 30-day period of the ad campaign included 9 sessions with conversions initiated by an ad click. Paid and display ads accounted for 63% of the site traffic during the ad campaign, most of which came from mobile phone users. Desktops were the most-common device used after the ad campaign acquired the website via direct and organic searches primarily (92%). The estimated cost per session with one or more conversions was Can $54.69 and cost per conversion was Can $32.81. Conclusions: A Google Ads campaign designed to direct men to the Headstrong website increased the number of user visits by more than five-fold. However, engagement by users responding to the ad campaign was substantially lower than that by users who visited the website via other acquisition methods, possibly reflecting the nonspecific online targeting of men by the ad campaign. General targeting of men online to promote men’s mental health appears to have limited value.

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  • 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

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    Date Submitted: Jan 8, 2019

    Open Peer Review Period: Jan 11, 2019 - Mar 8, 2019

    Background: The rapid uptake of Information and Communication Technology (ICT) over the past decade – particularly the smartphone – has coincided with large increases in sexting. Previous Australi...

    Background: The rapid uptake of Information and Communication Technology (ICT) over the past decade – particularly the smartphone – has coincided with large increases in sexting. Previous Australian studies examining prevalence rates of sexting activities in young people have all relied on convenience or self-selected samples. Concurrently, there have been recent calls to undertake more in-depth research on the relationship between mental ill health, suicidal thoughts and behaviours and sexting. How sexters (including those that receive sexts, send sexts, and two-way sext) and non-sexters apply ICT safety skills also warrants further research. Objective: To extend the Australian sexting literature by measuring: (1) changes in the frequency of young people’s sexting activities from 2012 to 2014; (2) young people’s beliefs about sexting; (3) the association of demographic, health and wellbeing items, and Internet use with sexting activity; and (4) the relationship between sexting and ICT safety skills. Methods: Computer-assisted telephone interviewing (CATI) using random digit dialling was used in two Young and Well National Surveys conducted in 2012 and 2014. Participants included representative and random samples of 1,400 young people aged 16 to 25 years. Results: From 2012 to 2014, sexting activity changed significantly (Χ2=20.79, P <.001). There were increases in two-way sexting (2012: n=521, 38.1%; 2014: n=591, 42.2%) and receiving sexts (2012: n=375, 27.4%; 2014: n=433, 30.9%); whereas not sexting (2012: n=438, 32.0%; 2014: n=356, 25.4) and sending sexts (2012: n=35, 2.6%; 2014: n=20, 1.4%) reduced. The most common reason for sexting was ‘to get attention from a dating partner’ (n=1,217, 88.9%) and nearly all respondents (n=1,363, 92.3%) believed that sexting had ‘serious negative consequences’. Being male, speaking a language other than English, being in a relationship, experiencing suicidal thoughts and behaviours, reporting body image concerns, cyber-bulling others and late-night Internet use were associated with significantly greater adjusted odds of both two-way sexting and sending sexts. Receiving sexts was significantly associated with being male, being cyber-bullied, late-night Internet use, and lower rates of living with parents or guardians. Not sexting was significantly associated with being female, living with parents or guardians, and lower rates of drugs being a personal concern, being cyber-bullied and late-night Internet use. Converse to non-sexters, Pearson correlations demonstrated that all sexting groups (two-way; sending; receiving) had a negative relationship with endorsing the ICT safety items relating to being careful online and not giving out personal details. Conclusions: Our research clearly demonstrates that the majority of young Australians are sexting, or are exposed to sexting in some capacity. Sexting is associated with negative health and wellbeing concerns including suicidal thoughts and behaviours, body image issues and cyber-bullying. Multifaceted approaches that promote safer ICT practices for those that do sext include better education about sexting impacts as well as targeted support for more vulnerable groups.

  • Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: A Qualitative Study

    Date Submitted: Jan 7, 2019

    Open Peer Review Period: Jan 8, 2019 - Mar 5, 2019

    Background: The privacy of patients with mental health conditions and addictions is prominent health information exchange (HIE) discussions. Because of the sensitive and intimate details in their per...

    Background: The privacy of patients with mental health conditions and addictions is prominent health information exchange (HIE) discussions. Because of the sensitive and intimate details in their personal health information (PHI), there is fear that HIE may erode the trusting relationships between the patient and provider, resulting in adverse behaviours due to privacy concerns about the electronic sharing of their PHI through HIE. While the privacy discourse centres around balancing the benefits of HIE against the appropriateness of including mental health records, the patient privacy perspective is often based on conjecture given the limited in-depth research on the matter, especially in the context of mental health and addictions. Objective: To explore the perspectives of patients with mental health conditions regarding PHI privacy in context of HIE. Methods: Semi-structured interviews were conducted with patients at an academic hospital for addictions and mental health. Interview transcripts were thematically analyzed using Braun and Clarke’s framework and guided by the Antecedent-Privacy Concern-Outcome macro-model—an information systems privacy framework. Results: We interviewed 14 participants and found privacy concerns to vary depending on the participants privacy experiences and healthcare perceptions. Media reports of privacy breaches and hackers had little impact on participants’ privacy concern due to a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in healthcare settings caused concern. Decisions to trust others with PHI depended on past history and healthcare needs. Participants were willing to participate in HIE because of the perceived individual and societal benefits. Conclusions: Participants were pragmatic, supporting HIE because they wanted the best care possible. Their fatalistic perspective highlights the importance of trust in building support for HIE. Participants place considerable trust in the healthcare system to protect their privacy. They rely on their healthcare experiences to determine PHI disclosing behaviours, which accentuates the importance of the patient experience in building trust in HIE. Unlike privacy, trust cannot be legislated. Effective communication of the value of HIE and PHI uses are the first steps in building trust and support for HIE. Moreover, positive patient experiences can reassure patients that the healthcare system is trying its best to improve care and protect patient privacy.

  • Seasonality Patterns of Internet Searches on Mental Health in Ontario

    Date Submitted: Nov 28, 2018

    Open Peer Review Period: Nov 30, 2018 - Jan 25, 2019

    Background: The study of seasonal patterns of public interest in psychiatric disorders has important theoretical and practical implications for service planning and delivery. The recent explosion of I...

    Background: The study of seasonal patterns of public interest in psychiatric disorders has important theoretical and practical implications for service planning and delivery. The recent explosion of Internet searches suggests that mining search databases yields unique information on public interest in mental health disorders—a significantly more affordable approach compared to population health studies. Objective: The present study aims to investigate seasonal patterns of Internet mental health queries in Ontario. Methods: Weekly data on health queries in Ontario from Google Trends were downloaded for a five-year period (2012-2017) for the terms “schizophrenia,” “autism,” “bipolar,” “depression,” “anxiety,” “OCD,” and “suicide.” Control terms were overall search results for the term “health” and the term “how.” Time series analyses using a continuous wavelet transform were performed to isolate seasonal components in the search volume for each term. Results: All mental health queries showed significant seasonal patterns with peak periodicity occurring over the winter months and troughs occurring during summer, except for “suicide.” The comparison term “health” also exhibited seasonal periodicity while the term “how” did not, indicating that general information seeking may not follow a seasonal trend in the way that mental health information seeking does. Conclusions: Seasonal patterns of Internet search volume in a wide range of mental health terms was observed, with the exception of “suicide.” Our study demonstrates that monitoring Internet search trends is an affordable, instantaneous and naturalistic method to sample public interest in large populations and inform health policy planners.

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