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JMIR Mental Health

Internet interventions, technologies and digital innovations for mental health and behavior change


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. (The projected inofficial impact factor for JMIR Mental Health is about 3.0)

JMIR Mental Health focusses on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change. This includes formative evaluation and system descriptions, theoretical papers, review papers, viewpoint/vision papers, and rigorous evaluations.

JMIR Mental Health publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research

JMIR Mental Health features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs. The journal is indexed in PubMed, PubMed Central, and ESCI (Emerging Sources Citation Index).

JMIR Mental Health adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.


Recent Articles:

  • Researcher studying a flowchart of the process for using neural networks with routine electronic health records to identify suicide risk in patients (mock-up). Source: Image created by the authors/; Copyright: JMIR publications; URL:; License: Creative Commons Attribution (CC-BY).

    Using Neural Networks with Routine Health Records to Identify Suicide Risk: Feasibility Study


    Background: Each year, approximately 800,000 people die by suicide worldwide, accounting for 1–2 in every 100 deaths. It is always a tragic event with a huge impact on family, friends, the community and health professionals. Unfortunately, suicide prevention and the development of risk assessment tools have been hindered by the complexity of the underlying mechanisms and the dynamic nature of a person’s motivation and intent. Many of those who die by suicide had contact with health services in the preceding year but identifying those most at risk remains a challenge. Objective: To explore the feasibility of using artificial neural networks with routinely collected electronic health records to support the identification of those at high risk of suicide when in contact with health services. Methods: Using the Secure Anonymised Information Linkage Databank UK, we extracted the data of those who died by suicide between 2001 and 2015 and paired controls. Looking at primary (general practice) and secondary (hospital admissions) electronic health records, we built a binary feature vector coding the presence of risk factors at different times prior to death. Risk factors included: general practice contact and hospital admission; diagnosis of mental health issues; injury and poisoning; substance misuse; maltreatment; sleep disorders; and the prescription of opiates and psychotropics. Basic artificial neural networks were trained to differentiate between the suicide cases and paired controls. We interpreted the output score as the estimated suicide risk. System performance was assessed with 10x10-fold repeated cross-validation, and its behavior was studied by representing the distribution of estimated risk across the cases and controls, and the distribution of factors across estimated risks. Results: We extracted a total of 2604 suicide cases and 20 paired controls per case. Our best system attained a mean error rate of 26.78% (SD 1.46; 64.57% of sensitivity and 81.86% of specificity). While the distribution of controls was concentrated around estimated risks < 0.5, cases were almost uniformly distributed between 0 and 1. Prescription of psychotropics, depression and anxiety, and self-harm increased the estimated risk by ~0.4. At least 95% of those presenting these factors were identified as suicide cases. Conclusions: Despite the simplicity of the implemented system, the proposed methodology obtained an accuracy like other published methods based on specialized questionnaire generated data. Most of the errors came from the heterogeneity of patterns shown by suicide cases, some of which were identical to those of the paired controls. Prescription of psychotropics, depression and anxiety, and self-harm were strongly linked with higher estimated risk scores, followed by hospital admission and long-term drug and alcohol misuse. Other risk factors like sleep disorders and maltreatment had more complex effects.

  • Source: Pixabay; Copyright: StartupStockPhotos; URL:; License: Public Domain (CC0).

    Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals


    Background: This is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively. Objective: The objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Skåne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study. Methods: We distributed a full population Web-based questionnaire to psychiatric care professionals in Region Skåne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service. Results: A total of 41.5% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients’ questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62%) and doctors (36/94, 38%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40% of the health care professionals (239/650, 36.8%) reported that the Open Notes Service in psychiatry was a good idea. Conclusions: Most health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive.

  • Purple heart US Serviceman returning home. Source: Road Home Program at Rush; Copyright: Road Home Program at Rush; URL:; License: Creative Commons Attribution (CC-BY).

    Veterans’ Perspectives on Fitbit Use in Treatment for Post-Traumatic Stress Disorder: An Interview Study


    Background: The increase in availability of patient data through consumer health wearable devices and mobile phone sensors provides opportunities for mental health treatment beyond traditional self-report measurements. Previous studies have suggested that wearables can be effectively used to benefit the physical health of people with mental health issues, but little research has explored the integration of wearable devices into mental health care. As such, early research is still necessary to address factors that might impact integration including patients' motivations to use wearables and their subsequent data. Objective: The aim of this study was to gain an understanding of patients’ motivations to use or not to use wearables devices during an intensive treatment program for post-traumatic stress disorder (PTSD). During this treatment, they received a complementary Fitbit. We investigated the following research questions: How did the veterans in the intensive treatment program use their Fitbit? What are contributing motivators for the use and nonuse of the Fitbit? Methods: We conducted semistructured interviews with 13 veterans who completed an intensive treatment program for PTSD. We transcribed and analyzed interviews using thematic analysis. Results: We identified three major motivations for veterans to use the Fitbit during their time in the program: increase self-awareness, support social interactions, and give back to other veterans. We also identified three major reasons certain features of the Fitbit were not used: lack of clarity around the purpose of the Fitbit, lack of meaning in the Fitbit data, and challenges in the veteran-provider relationship. Conclusions: To integrate wearable data into mental health treatment programs, it is important to understand the patient’s perspectives and motivations in using wearables. We also discuss how the military culture and PTSD may have contributed to our participants' behaviors and attitudes toward Fitbit usage. We conclude with possible approaches for integrating patient-generated data into mental health treatment settings that may address the challenges we identified.

  • Ask the Experts. Source: Shutterstock, Inc; Copyright: bleakstar / Shutterstock, Inc; URL:; License: Licensed by the authors.

    Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support


    Background: Digital technology is increasingly being used to enhance health care in various areas of medicine. In the area of serious mental illness, it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools, as well as the resources and training necessary for these patients to facilitate the use of this technology. Objective: The aim of this study was to conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and health care professionals), barriers and facilitators for appropriate use, and resources needed to optimize the use of digital health tools in patients with serious mental illness. Methods: A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey, rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across three ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the CI of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts’ responses to nine questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of digital health tools, (2) potential benefits or motivators and barriers or unintended consequences of digital health tool use, and (3) support and training for patients and health care professionals. Results: Among patient characteristics most likely to promote use of digital health tools, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain disease-associated signs and symptoms (eg, more severe symptoms, substance abuse problems, and a chaotic living situation) were considered likely to make it difficult for patients to use digital health tools. Enthusiasm among health care professionals for digital health tools and availability of staff and equipment to support their use were identified as variables to enable health care professionals to successfully incorporate digital health tools into their practices. The experts identified a number of potential benefits of and barriers to use of digital health tools by patients and health care professionals. Experts agreed that both health care professionals and patients would need to be trained in the use of these new technologies. Conclusions: These results provide guidance to the mental health field on how to optimize the development and deployment of digital health tools for patients with serious mental illness.

  • Source: Pixabay; Copyright: Ernesto Eslava; URL:; License: Public Domain (CC0).

    Predicting Caller Type From a Mental Health and Well-Being Helpline: Analysis of Call Log Data


    Background: This paper presents an analysis of call data records pertaining to a telephone helpline in Ireland among individuals seeking mental health and well-being support and among those who are in a suicidal crisis. Objective: The objective of our study was to examine whether rule sets generated from decision tree classification, trained using features derived from callers’ several initial calls, could be used to predict what caller type they would become. Methods: Machine learning techniques were applied to the call log data, and five distinct patterns of caller behaviors were revealed, each impacting the helpline capacity in different ways. Results: The primary findings of this study indicate that a significant model (P<.001) for predicting caller type from call log data obtained from the first 8 calls is possible. This indicates an association between callers’ behavior exhibited during initial calls and their behavior over the lifetime of using the service. Conclusions: These data-driven findings contribute to advanced workload forecasting for operational management of the telephone-based helpline and inform the literature on helpline caller behavior in general.

  • Sources of Strength peer leader assisting in the development of Text4Strength message sequences. Source: Image created by the Authors; Copyright: Anthony R Pisani; URL:; License: Creative Commons Attribution + Noncommercial (CC-BY-NC).

    Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test


    Background: Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach. Objective: We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention. Methods: We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students’ own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program. Results: Of the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful—even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated. Conclusions: Text4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy.

  • A case of pectus carinatum. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Fair use/fair dealings.

    Preliminary Evaluation of a Web-Based Psychological Screening Tool in Adolescents Undergoing Minimally Invasive Pectus Surgery: Single-Center Observational...


    Background: Preoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health support and enhanced recovery after surgery. Objective: This study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform. Methods: Patients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of the International Council for Harmonisation–Good Clinical Practice guidelines and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). An online preoperative psychological inventory was performed using the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and State-Trait Anxiety Inventory. Postoperatively, pain intensity and interference were assessed using the Multidisciplinary Pain Inventory, Coping With Pain Questionnaire, and numeric pain rating scale assessment. Patient satisfaction of the Web-based platform was evaluated. Results: A total of 21 adolescent patients used our Web-based psychological perioperative screening platform. Patients rated the mobile phone app, usability, and accessibility of the digital platform as good or excellent in 85% (17/20), 89% (17/19), and 95% (20/21) of the cases, respectively. A total of 89% (17/19) of the patients rated the effort of generating answers to the online questionnaires as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R=–0.72, P<.001) and overall anxiety characteristics (R=–0.49, P=.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R=0.52, P=.03 and R=0.6, P=.02, respectively) measured by the online self-report questionnaires. Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R=0.58, P=.02). Finally, there was a negative correlation between self-esteem and pain interference (R=–0.62, P=.01). Conclusions: Perioperative screening of psychological symptoms and trait characteristics with specific treatment, if necessary, could further improve postoperative pain and overall health status. Research on eHealth technology, even for psychological patient care, is rapidly increasing. Trial Registration: NCT03100669; (Archived by WebCite at

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

    A Smart Screening Device for Patients with Mental Health Problems in Primary Health Care: Development and Pilot Study


    Background: Adequate recognition of mental health problems is a prerequisite for successful treatment. Although most people tend to consult their general practitioner (GP) when they first experience mental health problems, GPs are not very well equipped to screen for various forms of psychopathology to help them determine clients’ need for treatment. Objective: In this paper, the development and characteristics of CATja, a computerized adaptive test battery built to facilitate triage in primary care settings, are described, and first results of its implementation are reported. Methods: CATja was developed in close collaboration with GPs and mental health assistants (MHAs). During implementation, MHAs were requested to appraise clients’ rankings (N=91) on the domains to be tested and to indicate the treatment level they deemed most appropriate for clients before test administration. We compared the agreement between domain score appraisals and domain score computed by CATja and the agreement between initial (before test administration) treatment level advice and final treatment level advice. Results: Agreements (Cohen kappas) between MHAs’ appraisals of clients’ scores and clients’ scores computed by CATja were mostly between .40 and .50 (Cohen kappas=.10-.20), and the agreement between “initial” treatment levels and the final treatment level advised was .65 (Cohen kappa=.55). Conclusions: Using CATja, caregivers can efficiently generate summaries of their clients’ mental well-being on which decisions about treatment type and care level may be based. Further validation research is needed.

  • Source: MIND Institute, UC Davis; Copyright: 2018 UC Regents; License: Licensed by JMIR.

    Computerized Cognitive Training in Children With Autism and Intellectual Disabilities: Feasibility and Satisfaction Study


    Background: Researchers are increasingly interested in testing and developing computerized cognitive training interventions for individuals with autism spectrum disorder due to the limited accessibility of treatments for this disorder. Understanding the feasibility of testing cognitive interventions for this population is critical, especially for individuals with ASD who have low to moderate intellectual ability. Objective: The aim of the study was to evaluate the feasibility of computerized cognitive training as measured by attrition rate and a parent satisfaction survey. Methods: A total of 26 participants aged 8-17 years with an autism spectrum disorder diagnosis and significant intellectual impairment were enrolled (mean age 11.1 years). They were instructed to complete 25 sessions of Cogmed Working Memory Training in 5 to 6 weeks with coach assistance. Attrition rate and parent satisfaction surveys were measured after the completion of training. Results: Most participants (96%, 25/26) completed the training and indicated high satisfaction (>88%). However, among the participants who completed the training, 5 participants (19%) were unable to finish in 6 weeks, the recommended training period by Cogmed. Parents noted various positive (eg, voice-overs) and negative (eg, particular graphic and sounds associated with a stimulus) features of the game that they thought affected their child’s response. Conclusions: Children with autism spectrum disorder and intellectual impairments can successfully participate in computerized cognitive training interventions but may require additional weeks to complete the training beyond the time needed for children without intellectual impairments. The overall completion rate, with extended time to complete the training, was high. Developers of cognitive training programs for this population should take into account potential issues regarding the noise level of stimuli and characteristics of the visual graphics.

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

    A Web-Based Transdiagnostic Intervention for Affective and Mood Disorders: Randomized Controlled Trial


    Background: Research increasingly supports a transdiagnostic conceptualization of emotional disorders (ie applying the same underlying treatment principles across mental disorders, without tailoring the protocol to specific diagnoses), and many international researchers are currently investigating this issue. Objective: The aim of this study was to evaluate the efficacy and acceptability of a Web-based transdiagnostic program using a sample of Romanian adults diagnosed with anxiety and/or depression. Methods: Volunteer participants registered for the study and completed a series of online self-report measures. Participants who fulfilled basic inclusion criteria on these measures were contacted for a telephone diagnostic interview using the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders (SCID-I). Enrolled participants were randomized to either the active treatment group (N=69) or the wait-list control group (N=36) using a 2:1 ratio. The transdiagnostic treatment was based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al, 2011) that addresses common underlying mechanisms of anxiety and depression. Participants randomized to the active treatment condition received 10 weeks of Web-based treatment based on the UP. Throughout treatment, graduate students in clinical psychology provided guidance that consisted of asynchronous written communication on a secure Web platform. After the intervention, participants in both study conditions were invited to complete a set of self-report measures and a postintervention SCID-I interview conducted by a different team of graduate students blinded to participants’ group and diagnostic status. Six months later, participants in the active treatment group were invited to complete an online follow-up assessment. Results: During the intervention, active treatment participants completed on average 19 homework assignments (SD 12.10), and we collected data from 79.0% (83/105) at postintervention and 51% (35/69) at follow-up for self-report measures. Postintervention SCID-I interviews were collected from 77.1% (81/105) participants. Relative to the wait-list control group, the transdiagnostic intervention yielded overall medium to large effect sizes for the primary outcome measures (within-group Hedges g=0.52-1.34 and between-group g=0.39-0.86), and also for anxiety sensitivity (g=0.80), symptom interference (g=0.48), and quality of life (g=0.38). Significant within-groups effects only were reported for the active treatment group on Panic Disorder Severity Scale-Self Report (PDSS-SR, g=0.58-0.65) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS, g=0.52-0.58). Conclusions: Insignificant between-group differences for the Y-BOCS and PDSS-SR could be explained by the small number of participants with the associated primary diagnostic (eg, only 3 participants with obsessive compulsive disorder) by the choice of outcome measure (PDSS-SR was not rated among the evidence-based measures) and by the fact that these disorders may be more difficult to treat. However, the overall results suggest that the transdiagnostic intervention tested in this study represents an effective treatment option that may prove easier to disseminate through the use of Web-based delivery systems. Trial Registration: CT02739607; (Archived by WebCite at

  • Source: Flickr; Copyright: Daniel X O'Neil; URL:; License: Creative Commons Attribution (CC-BY).

    Diurnal Variations of Depression-Related Health Information Seeking: Case Study in Finland Using Google Trends Data


    Background: Some of the temporal variations and clock-like rhythms that govern several different health-related behaviors can be traced in near real-time with the help of search engine data. This is especially useful when studying phenomena where little or no traditional data exist. One specific area where traditional data are incomplete is the study of diurnal mood variations, or daily changes in individuals’ overall mood state in relation to depression-like symptoms. Objective: The objective of this exploratory study was to analyze diurnal variations for interest in depression on the Web to discover hourly patterns of depression interest and help seeking. Methods: Hourly query volume data for 6 depression-related queries in Finland were downloaded from Google Trends in March 2017. A continuous wavelet transform (CWT) was applied to the hourly data to focus on the diurnal variation. Longer term trends and noise were also eliminated from the data to extract the diurnal variation for each query term. An analysis of variance was conducted to determine the statistical differences between the distributions of each hour. Data were also trichotomized and analyzed in 3 time blocks to make comparisons between different time periods during the day. Results: Search volumes for all depression-related query terms showed a unimodal regular pattern during the 24 hours of the day. All queries feature clear peaks during the nighttime hours around 11 PM to 4 AM and troughs between 5 AM and 10 PM. In the means of the CWT-reconstructed data, the differences in nighttime and daytime interest are evident, with a difference of 37.3 percentage points (pp) for the term “Depression,” 33.5 pp for “Masennustesti,” 30.6 pp for “Masennus,” 12.8 pp for “Depression test,” 12.0 pp for “Masennus testi,” and 11.8 pp for “Masennus oireet.” The trichotomization showed peaks in the first time block (00.00 AM-7.59 AM) for all 6 terms. The search volumes then decreased significantly during the second time block (8.00 AM-3.59 PM) for the terms “Masennus oireet” (P<.001), “Masennus” (P=.001), “Depression” (P=.005), and “Depression test” (P=.004). Higher search volumes for the terms “Masennus” (P=.14), “Masennustesti” (P=.07), and “Depression test” (P=.10) were present between the second and third time blocks. Conclusions: Help seeking for depression has clear diurnal patterns, with significant rise in depression-related query volumes toward the evening and night. Thus, search engine query data support the notion of the evening-worse pattern in diurnal mood variation. Information on the timely nature of depression-related interest on an hourly level could improve the chances for early intervention, which is beneficial for positive health outcomes.

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

    Internet Use, Depression, and Anxiety in a Healthy Adolescent Population: Prospective Cohort Study


    Background: Psychiatric disorders, including conduct disturbances, substance abuse, and affective disorders, emerge in approximately 20% of adolescents. In parallel with the rise in internet use, the prevalence of depression among adolescents has increased. It remains unclear whether and how internet use impacts mental health in adolescents. Objective: We assess the association between patterns of internet use and two mental health outcomes (depression and anxiety) in a healthy adolescent population. Methods: A total of 126 adolescents between the ages of 12 and 15 years were recruited. Participants reported their typical computer and internet usage patterns. At baseline and one-year follow-up, they completed the Beck Depression Index for primary care (BDI-PC) and the Beck Anxiety Inventory for Primary Care (BAI-PC). Individual linear regressions were completed to determine the association between markers of internet use at baseline and mental health outcomes at one-year follow-up. All models controlled for age, gender, and ethnicity. Results: There was an inverse correlation between minutes spent on a favorite website per visit and BAI-PC score. No association was found between internet use and BDI-PC score. Conclusions: There is no relationship between internet use patterns and depression in adolescents, whereas internet use may mitigate anxiety in adolescents with higher levels of baseline anxiety.

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  • Social Networking Site for Suicide Database in Bangladesh

    Date Submitted: Jun 12, 2018

    Open Peer Review Period: Jun 20, 2018 - Aug 15, 2018

    The use of social networking sites has exponentially increased in the recent years and the increment was most noticeable among the youth. However, suicide is the second leading cause of death among th...

    The use of social networking sites has exponentially increased in the recent years and the increment was most noticeable among the youth. However, suicide is the second leading cause of death among this group and they are the most active group in the different social networking sites. They share their thoughts, photos, opinions and news including the news of suicide. Whenever, they came to know the death of a friend or follower they share the news express their grief. In addition they also show their condolence to the death of the relative or friends of Facebook friends Moreover, all the television channels and newspapers share their information and news in Facebook, Tweeter and other social media from where we can collect information. Bangladesh is a Muslim developing country in South East Asia that lacks any national suicide database due a number of sociocultural, religious and political factors. As a result, the existing the data on suicide in the country shows about 20 fold variation in different reports. However, the country can develop national suicide database by extracting the information shared in the Facebook and verifying each incidents from different Facebook users. This idea can solve a long lasting problem in many developing low and middle income countries.

  • Online positive affect journaling improves mental distress and well-being in general medical patients: Evidence from a preliminary randomized controlled trial

    Date Submitted: Jun 13, 2018

    Open Peer Review Period: Jun 20, 2018 - Aug 15, 2018

    Background: Positive affect journaling (PAJ), an emotion-focused self-regulation intervention, has been associated with positive outcomes among medical populations. It may be adapted for online dissem...

    Background: Positive affect journaling (PAJ), an emotion-focused self-regulation intervention, has been associated with positive outcomes among medical populations. It may be adapted for online dissemination to address a need for scalable, evidence-based psychosocial interventions among distressed patients with medical conditions. Objective: This study examined the impact of a 12-week online PAJ intervention on psychological distress and quality of life in general medical patients. Methods: Seventy adults with various medical conditions were recruited from local clinics and randomly assigned to an online PAJ intervention (n=35) or usual care (n=35). The intervention group completed 15-minute online PAJ sessions on three days each week for 12 weeks. At baseline and the end of months 1 through 3, surveys of psychological, interpersonal, and physical well-being were completed. Results: Patients evidenced moderate sustained adherence to online intervention. PAJ was associated with decreased mental distress (p’s≤.045) and increased well-being (p’s ≤.046) relative to baseline. PAJ was also associated with less depressive symptoms (p=.047) and anxiety (p=.01) after one month, and greater resilience after the first (p=.044) and second month (p=.01), relative to usual care. Conclusions: Online PAJ may serve as an effective intervention for mitigating mental distress, increasing well-being, and enhancing physical functioning among medical populations. PAJ may be integrated into routine medical care to improve quality of life. Clinical Trial: NCT01873599

  • Do Mindfulness Meditation Apps Decrease Stress in College Students?

    Date Submitted: May 31, 2018

    Open Peer Review Period: Jun 1, 2018 - Jul 27, 2018

    Background: Mindfulness meditation apps have become popular self-help technology tools to manage stress and improve mental health. Mindfulness meditation classes have been associated with decreased st...

    Background: Mindfulness meditation apps have become popular self-help technology tools to manage stress and improve mental health. Mindfulness meditation classes have been associated with decreased stress levels, but the impact of mindfulness meditation apps at reducing stress levels among college students has not been thoroughly examined. Objective: The objective of this study was to assess how the frequency and duration of mindfulness meditation app use during a two-week interval affected self-reported stress levels. The study analyzed how minutes and days of app use during a 14-day period impacted change in self-reported stress compared to baseline. Methods: A longitudinal sample of 85 undergraduate students were recruited to the study through fliers and in-class announcements. Eligibility requirements ensured that participants had no prior or limited (< 2 hours) experience with mindfulness meditation. Pre- and post-assessment survey questions included perceived stress levels and the frequency and duration of meditation app use during the two-week study interval. Multiple linear regression analyses were used to assess whether there was a relationship between app use and change in stress. Results: The mean Perceived Stress Scale scores at time 1 and time 2 significantly differed (P < .001; t = 3.47), such that there was a significant decrease in self-reported stress over the study interval. The number of minutes of mindfulness mobile app use over the 14 days of the study was not predictive of stress change (P = .14), but the number of days practicing mindfulness was a significant predictor of stress change (P = .03). Conclusions: Consistently practicing mindfulness may be more predictive of stress reduction than length of practice, as evidenced by a significant relationship between change in stress and number of days practicing mindfulness meditation, but not number of minutes practiced.

  • Priovi, an EHealth Programm for Patients with Borderline Personality Disorder to support individual face-to-face schema therapy– Pilot Study

    Date Submitted: May 6, 2018

    Open Peer Review Period: May 7, 2018 - Jul 2, 2018

    Background: EHealth programs have hardly been investigated yet for people with borderline personality disorder (BPD). However this might be very promising given both the high economic and health-relat...

    Background: EHealth programs have hardly been investigated yet for people with borderline personality disorder (BPD). However this might be very promising given both the high economic and health-related burden as well as high need for treatment in this patient group. Development and use of eHealth applications for BPD are complicated by (1) safety issues due to frequent aversive and dangerous behaviors of these patients, (2) their tendency to drop out of any type of treatment, relationship or activity, (3) long treatment duration and accordingly need for comparably long and complex eHealth interventions. Objective: We piloted the program priovi in 14 patients with BPD. Priovi was offered to support individual face-to-face schema therapy to assess whether it is feasible, safe, and potentially helpful. Methods: Priovi is a schema therapy based self-help program for patients with BPD, designed to be used over 6-12 months. The patients used priovi over a period of 12 months in addition to their individual face-to-face schema therapy. BPD symptom severity was assessed with self-reported and interview-based measures. Qualitative interviews were conducted to understand the patient’s experience with the program in more detail and to detect barriers to feasibility and safety. Results: BPD symptoms improved over one year with high effect size (Cohen’s d 1.0). Patients receiving BPD treatment for the first time improved more than chronic patients with prior treatments. Qualitative data showed that patients generally liked the program. They were well able to build up a functional relationship with priovi. Some exercises provoked mild anxiety, however no serious threads to safety could be detected. Conclusions: Priovi is a potentially helpful and safe tool to support individual schema therapy. The next step should be a larger randomized-controlled study Clinical Trial: German Clinical Trials Register DRKS-ID: DRKS00011538