@Article{info:doi/10.2196/67820,
author="Lo, Brian
and Durocher, Keri
and Charow, Rebecca
and Kimball, Sarah
and Pham, Quynh
and Sockalingam, Sanjeev
and Wiljer, David
and Strudwick, Gillian",
title="Application of a Sociotechnical Framework to Uncover Factors That Influence Effective User Engagement With Digital Mental Health Tools in Clinical Care Contexts: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="28",
volume="27",
pages="e67820",
keywords="user engagement",
keywords="nursing informatics",
keywords="clinical informatics",
keywords="mental health",
keywords="clinical care settings",
abstract="Background: Digital health tools such as mobile apps and patient portals continue to be embedded in clinical care pathways to enhance mental health care delivery and achieve the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. However, a key issue that has greatly hindered the value of these tools is the suboptimal user engagement by patients and families. With only a small fraction of users staying engaged over time, there is a great need to better understand the factors that influence user engagement with digital mental health tools in clinical care settings. Objective: This review aims to identify the factors relevant to user engagement with digital mental health tools in clinical care settings using a sociotechnical approach. Methods: A scoping review methodology was used to identify the relevant factors from the literature. Five academic databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched to identify pertinent articles using key terms related to user engagement, mental health, and digital health tools. The abstracts were screened independently by 2 reviewers, and data were extracted using a standardized data extraction form. Articles were included if the digital mental health tool had at least 1 patient-facing component and 1 clinician-facing component, and at least one of the objectives of the article was to examine user engagement with the tool. An established sociotechnical framework developed by Sittig and Singh was used to inform the mapping and analysis of the factors. Results: The database search identified 136 articles for inclusion in the analysis. Of these 136 articles, 84 (61.8\%) were published in the last 5 years, 47 (34.6\%) were from the United States, and 23 (16.9\%) were from the United Kingdom. With regard to examining user engagement, the majority of the articles (95/136, 69.9\%) used a qualitative approach to understand engagement. From these articles, 26 factors were identified across 7 categories of the established sociotechnical framework. These ranged from technology-focused factors (eg, the modality of the tool) and the clinical environment (eg, alignment with clinical workflows) to system-level issues (eg, reimbursement for physician use of the digital tool with patients). Conclusions: On the basis of the factors identified in this review, we have uncovered how the tool, individuals, the clinical environment, and the health system may influence user engagement with digital mental health tools for clinical care. Future work should focus on validating and identifying a core set of essential factors for user engagement with digital mental health tools in clinical care environments. Moreover, exploring strategies for improving user engagement through these factors would be useful for health care leaders and clinicians interested in using digital health tools in care. ",
doi="10.2196/67820",
url="https://www.jmir.org/2025/1/e67820"
}


@Article{info:doi/10.2196/64087,
author="Kotera, Yasuhiro
and Daryanani, Riddhi
and Skipper, Oliver
and Simpson, Jonathan
and Takhi, Simran
and McPhilbin, Merly
and Ingall, Benjamin-Rose
and Namasaba, Mariam
and Jepps, Jessica
and Kellermann, Vanessa
and Bhandari, Divya
and Ojio, Yasutaka
and Ronaldson, Amy
and Guerrero, Estefania
and Jebara, Tesnime
and Henderson, Claire
and Slade, Mike
and Vilar-Lluch, Sara",
title="Applying Critical Discourse Analysis to Cross-Cultural Mental Health Recovery Research",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="21",
volume="9",
pages="e64087",
keywords="critical discourse analysis",
keywords="cross-cultural mental health recovery research",
keywords="linguistic analysis",
keywords="social inequality",
keywords="mental health",
keywords="recovery research",
keywords="language",
keywords="social inequalities",
keywords="qualitative analytical approach",
keywords="linguistic expressions",
keywords="discourse",
keywords="analysis",
keywords="framework",
keywords="inequalities",
keywords="CDA",
doi="10.2196/64087",
url="https://formative.jmir.org/2025/1/e64087"
}


@Article{info:doi/10.2196/63484,
author="Hopkin, Gareth
and Coole, Holly
and Edelmann, Francesca
and Ayiku, Lynda
and Branson, Richard
and Campbell, Paul
and Cooper, Sophie
and Salmon, Mark",
title="Toward a New Conceptual Framework for Digital Mental Health Technologies: Scoping Review",
journal="JMIR Ment Health",
year="2025",
month="Feb",
day="19",
volume="12",
pages="e63484",
keywords="digital mental health",
keywords="digital health",
keywords="mental health",
keywords="eHealth",
keywords="categorization",
keywords="conceptual",
keywords="framework",
keywords="regulation",
keywords="synthesis",
keywords="review methods",
keywords="review methodology",
keywords="systematic",
abstract="Background: Digital mental health technologies (DMHTs) are becoming more widely available and are seen as having the potential to improve the quality of mental health care. However, conversations around the potential impact of DMHTs can be impacted by a lack of focus on the types of technologies that are available. Several frameworks that could apply to DMHTs are available, but they have not been developed with comprehensive methods and have limitations. Objective: To address limitations with current frameworks, we aimed to identify existing literature on the categorization of DMHTs, to explore challenges with categorizing DMHTs for specific purposes, and to develop a new conceptual framework. Methods: We used an iterative approach to develop the framework. First, we completed a rapid review of the literature to identify studies that provided domains that could be used to categorize DMHTs. Second, findings from this review and associated issues were discussed by an expert working group, including professionals from a wide range of relevant settings. Third, we synthesized findings to develop a new conceptual framework. Results: The rapid review identified 3603 unique results, and hand searching identified another 3 potentially relevant papers. Of these, 24 papers were eligible for inclusion, which provided 10 domains to categorize DMHTs. The expert working group proposed a broad framework and based on the findings of the review and group discussions, we developed a new conceptual framework with 8 domains that represent important characteristics of DMHTs. These 8 domains are population, setting, platform or system, purpose, type of approach, human interaction, human responsiveness, and functionality. Conclusions: This conceptual framework provides a structure for various stakeholders to define the key characteristics of DMHTs. It has been developed with more comprehensive methods than previous attempts with similar aims. The framework can facilitate communication within the field and could undergo further iteration to ensure it is appropriate for specific purposes. ",
doi="10.2196/63484",
url="https://mental.jmir.org/2025/1/e63484"
}


@Article{info:doi/10.2196/69294,
author="Malouin-Lachance, Amylie
and Capolupo, Julien
and Laplante, Chlo{\'e}
and Hudon, Alexandre",
title="Does the Digital Therapeutic Alliance Exist? Integrative Review",
journal="JMIR Ment Health",
year="2025",
month="Feb",
day="7",
volume="12",
pages="e69294",
keywords="psychotherapy",
keywords="mental health",
keywords="psychiatry",
keywords="artificial intelligence",
keywords="therapeutic alliance",
keywords="digital interventions",
keywords="chatbot",
keywords="psychology",
abstract="Background: Mental health disorders significantly impact global populations, prompting the rise of digital mental health interventions, such as artificial intelligence (AI)-powered chatbots, to address gaps in access to care. This review explores the potential for a ``digital therapeutic alliance (DTA),'' emphasizing empathy, engagement, and alignment with traditional therapeutic principles to enhance user outcomes. Objective: The primary objective of this review was to identify key concepts underlying the DTA in AI-driven psychotherapeutic interventions for mental health. The secondary objective was to propose an initial definition of the DTA based on these identified concepts. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for scoping reviews and Tavares de Souza's integrative review methodology were followed, encompassing systematic literature searches in Medline, Web of Science, PsycNet, and Google Scholar. Data from eligible studies were extracted and analyzed using Horvath et al's conceptual framework on a therapeutic alliance, focusing on goal alignment, task agreement, and the therapeutic bond, with quality assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Results: A total of 28 studies were identified from an initial pool of 1294 articles after excluding duplicates and ineligible studies. These studies informed the development of a conceptual framework for a DTA, encompassing key elements such as goal alignment, task agreement, therapeutic bond, user engagement, and the facilitators and barriers affecting therapeutic outcomes. The interventions primarily focused on AI-powered chatbots, digital psychotherapy, and other digital tools. Conclusions: The findings of this integrative review provide a foundational framework for the concept of a DTA and report its potential to replicate key therapeutic mechanisms such as empathy, trust, and collaboration in AI-driven psychotherapeutic tools. While the DTA shows promise in enhancing accessibility and engagement in mental health care, further research and innovation are needed to address challenges such as personalization, ethical concerns, and long-term impact. ",
doi="10.2196/69294",
url="https://mental.jmir.org/2025/1/e69294"
}


@Article{info:doi/10.2196/65658,
author="Ennis, Edel
and Bond, Raymond
and Mulvenna, Maurice
and Sweeney, Colm",
title="Understanding Individual Differences in Happiness Sources and Implications for Health Technology Design: Exploratory Analysis of an Open Dataset",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="29",
volume="9",
pages="e65658",
keywords="happiness",
keywords="sexes",
keywords="age",
keywords="marital status",
keywords="parents",
keywords="affections",
keywords="achievements",
keywords="datasets",
keywords="digital health",
keywords="well-being",
keywords="mental health",
keywords="digital mental health interventions",
keywords="regression analyses",
keywords="evidence based",
abstract="Background: Psychologists have developed frameworks to understand many constructs, which have subsequently informed the design of digital mental health interventions (DMHIs) aimed at improving mental health outcomes. The science of happiness is one such domain that holds significant applied importance due to its links to well-being and evidence that happiness can be cultivated through interventions. However, as with many constructs, the unique ways in which individuals experience happiness present major challenges for designing personalized DMHIs. Objective: This paper aims to (1) present an analysis of how sex may interact with age, marital status, and parental status to predict individual differences in sources of happiness, and (2) to present a preliminary discussion of how open datasets may contribute to the process of designing health-related technology innovations. Methods: The HappyDB is an open database of 100,535 statements of what people consider to have made them happy, with some people asking to consider the past 24 hours (49,831 statements) and some considering the last 3 months (50,704 statements). Demographic information is also provided. Binary logistic regression analyses are used to determine whether various groups differed in their likelihood of selecting or not selecting a category as a source of their happiness. Results: Sex and age interacted to influence what was selected as sources of happiness, with patterns being less consistent among female individuals in comparison with male individuals. For marital status, differences in sources of happiness were predominantly between married individuals and those who are divorced or separated, but these were the same for both sexes. Married, single, and widowed individuals were all largely similar in their likelihood of selecting each of the categories as a source of their happiness. However, there were some anomalies, and sex appeared to be important in these anomalies. Sex and parental status also interacted to influence what was selected as sources of happiness. Conclusions: Sex interacts with age, marital status, and parental status in the likelihood of reporting affection, bonding, leisure, achievement, or enjoying the moment as sources of happiness. The contribution of an open dataset to understanding individual differences in sources of happiness is discussed in terms of its potential role in addressing the challenges of designing DMHIs that are ethical, responsible, evidence based, acceptable, engaging, inclusive, and effective for users. The discussion considers how the content design of DMHIs in general may benefit from exploring new methods informed by diverse data sources. It is proposed that examining the extent to which insights from nondigital settings can inform requirements gathering for DMHIs is warranted. ",
doi="10.2196/65658",
url="https://formative.jmir.org/2025/1/e65658"
}


@Article{info:doi/10.2196/60154,
author="Li, Xinyi
and Malli, Aikaterini Melina
and Cosco, D. Theodore
and Zhou, Guangyu",
title="The Relationship Between Self-Compassion and Resilience in the General Population: Protocol for a Systematic Review and Meta-Analysis",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="5",
volume="13",
pages="e60154",
keywords="self-compassion",
keywords="resilience",
keywords="resiliency",
keywords="adversity",
keywords="compassion",
keywords="coping",
keywords="coping styles",
keywords="health status",
keywords="meta-analysis",
keywords="meta-regression",
abstract="Background: Resilience can protect individuals from the negative impact of adversity, facilitating a swift recovery. The exploration of protective factors contributing to resilience has been a central focus of research. Self-compassion, a positive psychological construct that involves treating oneself with kindness, holds the potential to bolster resilience. Although several studies have indicated an association between self-compassion and resilience, there is a lack of systematic reviews and meta-analyses examining this relationship and the potential moderators and mechanisms. Objective: This study aimed to systematically review the literature on the relationship between self-compassion and resilience in the general population, perform a meta-analysis to quantify the effect size of their association, and explore potential moderators (eg, age, gender, culture, and health status) and mediators. Methods: We will search the Web of Science, PsycINFO, MEDLINE, Scopus, CINAHL, and CNKI databases for peer-reviewed studies (including observational and experimental studies) that examined the relationship between self-compassion and resilience, with no language restrictions. There are no restrictions regarding participants' age, gender, culture, or health status. Qualitative studies, conference abstracts, review articles, case reports, and editorials will be excluded. Two reviewers (XL and JH) will independently screen the literature, extract data, and assess the quality of the eligible studies. If possible, the pooled effect size between self-compassion and resilience will be meta-analyzed using a random-effect model. Meta-regression and subgroup analysis will be conducted to examine the moderating roles of age, gender, culture, health status, and other potential moderators. The characteristics and main findings of eligible studies will be summarized in tables and narrative descriptions. Results from the meta-analysis, meta-regression, and subgroup analysis will be presented quantitatively. Results: We registered our protocol with PROSPERO, conducted the search, and initiated the screening in April 2024. We expect to start data analysis in October 2024 and finalize the review by March 2025. Conclusions: The systematic review and meta-analysis will provide evidence on the protective role of self-compassion in resilience under adversity. Our investigation into potential moderators will highlight the contexts and groups where the benefits of self-compassion can be maximized. The findings are expected to provide valuable insights for health care professionals and stakeholders, informing the development of interventions aimed at enhancing resilience by fostering self-compassion. Trial Registration: PROSPERO CRD42024534390; https://tinyurl.com/3j3rmcja International Registered Report Identifier (IRRID): PRR1-10.2196/60154 ",
doi="10.2196/60154",
url="https://www.researchprotocols.org/2024/1/e60154"
}


@Article{info:doi/10.2196/58493,
author="Tavory, Tamar",
title="Regulating AI in Mental Health: Ethics of Care Perspective",
journal="JMIR Ment Health",
year="2024",
month="Sep",
day="19",
volume="11",
pages="e58493",
keywords="artificial intelligence",
keywords="ethics of care",
keywords="regulation",
keywords="legal",
keywords="relationship",
keywords="mental health",
keywords="mental healthcare",
keywords="AI",
keywords="ethic",
keywords="ethics",
keywords="ethical",
keywords="regulations",
keywords="law",
keywords="framework",
keywords="frameworks",
keywords="regulatory",
keywords="relationships",
keywords="chatbot",
keywords="chatbots",
keywords="conversational agent",
keywords="conversational agents",
keywords="European Artificial Intelligence Act",
doi="10.2196/58493",
url="https://mental.jmir.org/2024/1/e58493"
}


@Article{info:doi/10.2196/49916,
author="Fernandes, Sara
and Brousse, Yann
and Zendjidjian, Xavier
and Cano, Delphine
and Riedberger, J{\'e}r{\'e}mie
and Llorca, Pierre-Michel
and Samalin, Ludovic
and Dassa, Daniel
and Trichard, Christian
and Laprevote, Vincent
and Sauvaget, Anne
and Abbar, Mocrane
and Misdrahi, David
and Berna, Fabrice
and Lancon, Christophe
and Coulon, Nathalie
and El-Hage, Wissam
and Rozier, Pierre-Emmanuel
and Benoit, Michel
and Giordana, Bruno
and Caqueo-Ur{\'i}zar, Alejandra
and Yon, Keon Dong
and Tran, Bach
and Auquier, Pascal
and Fond, Guillaume
and Boyer, Laurent",
title="Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study",
journal="JMIR Ment Health",
year="2024",
month="May",
day="16",
volume="11",
pages="e49916",
keywords="psychiatry",
keywords="public mental health",
keywords="schizophrenia",
keywords="major depressive disorders",
keywords="bipolar disorders",
keywords="patient-reported experience measures",
keywords="quality of care",
keywords="health services research",
keywords="computerized adaptive testing",
keywords="real-world data",
abstract="Background: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. Objective: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. Methods: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. Results: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95\% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5\% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. Conclusions: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial Registration: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866 ",
doi="10.2196/49916",
url="https://mental.jmir.org/2024/1/e49916",
url="http://www.ncbi.nlm.nih.gov/pubmed/38753416"
}


@Article{info:doi/10.2196/55750,
author="Marshall, Paul
and Booth, Millissa
and Coole, Matthew
and Fothergill, Lauren
and Glossop, Zoe
and Haines, Jade
and Harding, Andrew
and Johnston, Rose
and Jones, Steven
and Lodge, Christopher
and Machin, Karen
and Meacock, Rachel
and Nielson, Kristi
and Puddephatt, Jo-Anne
and Rakic, Tamara
and Rayson, Paul
and Robinson, Heather
and Rycroft-Malone, Jo
and Shryane, Nick
and Swithenbank, Zoe
and Wise, Sara
and Lobban, Fiona",
title="Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis",
journal="JMIR Ment Health",
year="2024",
month="May",
day="9",
volume="11",
pages="e55750",
keywords="digital mental health",
keywords="peer-to-peer support",
keywords="social networking",
keywords="moderation",
keywords="systematic review",
abstract="Background: Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. Objective: This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. Methods: We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. Results: Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users' perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. Conclusions: This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. Trial Registration: PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=352528 ",
doi="10.2196/55750",
url="https://mental.jmir.org/2024/1/e55750",
url="http://www.ncbi.nlm.nih.gov/pubmed/38722680"
}


@Article{info:doi/10.2196/55988,
author="Hadar-Shoval, Dorit
and Asraf, Kfir
and Mizrachi, Yonathan
and Haber, Yuval
and Elyoseph, Zohar",
title="Assessing the Alignment of Large Language Models With Human Values for Mental Health Integration: Cross-Sectional Study Using Schwartz's Theory of Basic Values",
journal="JMIR Ment Health",
year="2024",
month="Apr",
day="9",
volume="11",
pages="e55988",
keywords="large language models",
keywords="LLMs",
keywords="large language model",
keywords="LLM",
keywords="machine learning",
keywords="ML",
keywords="natural language processing",
keywords="NLP",
keywords="deep learning",
keywords="ChatGPT",
keywords="Chat-GPT",
keywords="chatbot",
keywords="chatbots",
keywords="chat-bot",
keywords="chat-bots",
keywords="Claude",
keywords="values",
keywords="Bard",
keywords="artificial intelligence",
keywords="AI",
keywords="algorithm",
keywords="algorithms",
keywords="predictive model",
keywords="predictive models",
keywords="predictive analytics",
keywords="predictive system",
keywords="practical model",
keywords="practical models",
keywords="mental health",
keywords="mental illness",
keywords="mental illnesses",
keywords="mental disease",
keywords="mental diseases",
keywords="mental disorder",
keywords="mental disorders",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="mood disorder",
keywords="mood disorders",
abstract="Background: Large language models (LLMs) hold potential for mental health applications. However, their opaque alignment processes may embed biases that shape problematic perspectives. Evaluating the values embedded within LLMs that guide their decision-making have ethical importance. Schwartz's theory of basic values (STBV) provides a framework for quantifying cultural value orientations and has shown utility for examining values in mental health contexts, including cultural, diagnostic, and therapist-client dynamics. Objective: This study aimed to (1) evaluate whether the STBV can measure value-like constructs within leading LLMs and (2) determine whether LLMs exhibit distinct value-like patterns from humans and each other. Methods: In total, 4 LLMs (Bard, Claude 2, Generative Pretrained Transformer [GPT]-3.5, GPT-4) were anthropomorphized and instructed to complete the Portrait Values Questionnaire---Revised (PVQ-RR) to assess value-like constructs. Their responses over 10 trials were analyzed for reliability and validity. To benchmark the LLMs' value profiles, their results were compared to published data from a diverse sample of 53,472 individuals across 49 nations who had completed the PVQ-RR. This allowed us to assess whether the LLMs diverged from established human value patterns across cultural groups. Value profiles were also compared between models via statistical tests. Results: The PVQ-RR showed good reliability and validity for quantifying value-like infrastructure within the LLMs. However, substantial divergence emerged between the LLMs' value profiles and population data. The models lacked consensus and exhibited distinct motivational biases, reflecting opaque alignment processes. For example, all models prioritized universalism and self-direction, while de-emphasizing achievement, power, and security relative to humans. Successful discriminant analysis differentiated the 4 LLMs' distinct value profiles. Further examination found the biased value profiles strongly predicted the LLMs' responses when presented with mental health dilemmas requiring choosing between opposing values. This provided further validation for the models embedding distinct motivational value-like constructs that shape their decision-making. Conclusions: This study leveraged the STBV to map the motivational value-like infrastructure underpinning leading LLMs. Although the study demonstrated the STBV can effectively characterize value-like infrastructure within LLMs, substantial divergence from human values raises ethical concerns about aligning these models with mental health applications. The biases toward certain cultural value sets pose risks if integrated without proper safeguards. For example, prioritizing universalism could promote unconditional acceptance even when clinically unwise. Furthermore, the differences between the LLMs underscore the need to standardize alignment processes to capture true cultural diversity. Thus, any responsible integration of LLMs into mental health care must account for their embedded biases and motivation mismatches to ensure equitable delivery across diverse populations. Achieving this will require transparency and refinement of alignment techniques to instill comprehensive human values. ",
doi="10.2196/55988",
url="https://mental.jmir.org/2024/1/e55988",
url="http://www.ncbi.nlm.nih.gov/pubmed/38593424"
}


@Article{info:doi/10.2196/45754,
author="Slade, Emily
and Rennick-Egglestone, Stefan
and Ng, Fiona
and Kotera, Yasuhiro
and Llewellyn-Beardsley, Joy
and Newby, Chris
and Glover, Tony
and Keppens, Jeroen
and Slade, Mike",
title="The Implementation of Recommender Systems for Mental Health Recovery Narratives: Evaluation of Use and Performance",
journal="JMIR Ment Health",
year="2024",
month="Mar",
day="29",
volume="11",
pages="e45754",
keywords="recommender system",
keywords="mean absolute error",
keywords="precision",
keywords="intralist diversity",
keywords="item space coverage",
keywords="fairness across users",
keywords="psychosis",
keywords="Narrative Experiences Online trial",
keywords="NEON trial",
keywords="lived experience narrative",
keywords="recovery story",
abstract="Background: Recommender systems help narrow down a large range of items to a smaller, personalized set. NarraGive is a first-in-field hybrid recommender system for mental health recovery narratives, recommending narratives based on their content and narrator characteristics (using content-based filtering) and on narratives beneficially impacting other similar users (using collaborative filtering). NarraGive is integrated into the Narrative Experiences Online (NEON) intervention, a web application providing access to the NEON Collection of recovery narratives. Objective: This study aims to analyze the 3 recommender system algorithms used in NarraGive to inform future interventions using recommender systems for lived experience narratives. Methods: Using a recently published framework for evaluating recommender systems to structure the analysis, we compared the content-based filtering algorithm and collaborative filtering algorithms by evaluating the accuracy (how close the predicted ratings are to the true ratings), precision (the proportion of the recommended narratives that are relevant), diversity (how diverse the recommended narratives are), coverage (the proportion of all available narratives that can be recommended), and unfairness (whether the algorithms produce less accurate predictions for disadvantaged participants) across gender and ethnicity. We used data from all participants in 2 parallel-group, waitlist control clinical trials of the NEON intervention (NEON trial: N=739; NEON for other [eg, nonpsychosis] mental health problems [NEON-O] trial: N=1023). Both trials included people with self-reported mental health problems who had and had not used statutory mental health services. In addition, NEON trial participants had experienced self-reported psychosis in the previous 5 years. Our evaluation used a database of Likert-scale narrative ratings provided by trial participants in response to validated narrative feedback questions. Results: Participants from the NEON and NEON-O trials provided 2288 and 1896 narrative ratings, respectively. Each rated narrative had a median of 3 ratings and 2 ratings, respectively. For the NEON trial, the content-based filtering algorithm performed better for coverage; the collaborative filtering algorithms performed better for accuracy, diversity, and unfairness across both gender and ethnicity; and neither algorithm performed better for precision. For the NEON-O trial, the content-based filtering algorithm did not perform better on any metric; the collaborative filtering algorithms performed better on accuracy and unfairness across both gender and ethnicity; and neither algorithm performed better for precision, diversity, or coverage. Conclusions: Clinical population may be associated with recommender system performance. Recommender systems are susceptible to a wide range of undesirable biases. Approaches to mitigating these include providing enough initial data for the recommender system (to prevent overfitting), ensuring that items can be accessed outside the recommender system (to prevent a feedback loop between accessed items and recommended items), and encouraging participants to provide feedback on every narrative they interact with (to prevent participants from only providing feedback when they have strong opinions). ",
doi="10.2196/45754",
url="https://mental.jmir.org/2024/1/e45754",
url="http://www.ncbi.nlm.nih.gov/pubmed/38551630"
}


@Article{info:doi/10.2196/41428,
author="Zech, M. James
and Johnson, Morgan
and Pullmann, D. Michael
and Hull, D. Thomas
and Althoff, Tim
and Munson, A. Sean
and Fridling, Nicole
and Litvin, Boris
and Wu, Jerilyn
and Are{\'a}n, A. Patricia",
title="An Integrative Engagement Model of Digital Psychotherapy: Exploratory Focus Group Findings",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="26",
volume="7",
pages="e41428",
keywords="Health Action Process Approach",
keywords="lived informatics",
keywords="digital engagement",
keywords="messaging therapy",
abstract="Background: Digital mental health interventions, such as 2-way and asynchronous messaging therapy, are a growing part of the mental health care treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. User engagement, or client behaviors and therapeutic relationships that facilitate positive treatment outcomes, is a necessary condition for the effectiveness of any digital treatment. Developing a better understanding of the factors that impact user engagement can impact the overall effectiveness of digital psychotherapy. Mapping the user experience in digital therapy may be facilitated by integrating theories from several fields. Specifically, health science's Health Action Process Approach and human-computer interaction's Lived Informatics Model may be usefully synthesized with relational constructs from psychotherapy process--outcome research to identify the determinants of engagement in digital messaging therapy. Objective: This study aims to capture insights into digital therapy users' engagement patterns through a qualitative analysis of focus group sessions. We aimed to synthesize emergent intrapersonal and relational determinants of engagement into an integrative framework of engagement in digital therapy. Methods: A total of 24 focus group participants were recruited to participate in 1 of 5 synchronous focus group sessions held between October and November 2021. Participant responses were coded by 2 researchers using thematic analysis. Results: Coders identified 10 relevant constructs and 24 subconstructs that can collectively account for users' engagement and experience trajectories in the context of digital therapy. Although users' engagement trajectories in digital therapy varied widely, they were principally informed by intrapsychic factors (eg, self-efficacy and outcome expectancy), interpersonal factors (eg, the therapeutic alliance and its rupture), and external factors (eg, treatment costs and social support). These constructs were organized into a proposed Integrative Engagement Model of Digital Psychotherapy. Notably, every participant in the focus groups indicated that their ability to connect with their therapist was among the most important factors that were considered in continuing or terminating treatment. Conclusions: Engagement in messaging therapy may be usefully approached through an interdisciplinary lens, linking constructs from health science, human-computer interaction studies, and clinical science in an integrative engagement framework. Taken together, our results suggest that users may not view the digital psychotherapy platform itself as a treatment so much as a means of gaining access to a helping provider, that is, users did not see themselves as engaging with a platform but instead viewed their experience as a healing relationship. The findings of this study suggest that a better understanding of user engagement is crucial for enhancing the effectiveness of digital mental health interventions, and future research should continue to explore the underlying factors that contribute to engagement in digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT04507360; https://clinicaltrials.gov/ct2/show/NCT04507360 ",
doi="10.2196/41428",
url="https://formative.jmir.org/2023/1/e41428",
url="http://www.ncbi.nlm.nih.gov/pubmed/37099363"
}


@Article{info:doi/10.2196/44601,
author="Kotera, Yasuhiro
and Rennick-Egglestone, Stefan
and Ng, Fiona
and Llewellyn-Beardsley, Joy
and Ali, Yasmin
and Newby, Chris
and Fox, Caroline
and Slade, Emily
and Bradstreet, Simon
and Harrison, Julian
and Franklin, Donna
and Todowede, Olamide
and Slade, Mike",
title="Assessing Diversity and Inclusivity is the Next Frontier in Mental Health Recovery Narrative Research and Practice",
journal="JMIR Ment Health",
year="2023",
month="Apr",
day="17",
volume="10",
pages="e44601",
keywords="recovery narrative",
keywords="web-based mental health interventions",
keywords="inclusivity",
keywords="diversity",
keywords="collective action",
keywords="curation",
keywords="mental health",
keywords="digital health",
keywords="telemedicine",
keywords="clinical practice",
keywords="narrative research",
keywords="demographic",
doi="10.2196/44601",
url="https://mental.jmir.org/2023/1/e44601",
url="http://www.ncbi.nlm.nih.gov/pubmed/37067882"
}


@Article{info:doi/10.2196/37211,
author="Tran, V. Ha
and Nong, T. Ha T.
and Tran, T. Thuy T.
and Filipowicz, R. Teresa
and Landrum, R. Kelsey
and Pence, W. Brian
and Le, M. Giang
and Nguyen, X. Minh
and Chibanda, Dixon
and Verhey, Ruth
and Go, F. Vivian
and Ho, T. Hien
and Gaynes, N. Bradley",
title="Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="8",
volume="6",
number="7",
pages="e37211",
keywords="Friendship Bench",
keywords="Vietnam",
keywords="Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing",
keywords="ADAPT-ITT",
keywords="common mental disorders",
keywords="people living with HIV",
keywords="PWH",
keywords="people who inject drugs",
keywords="PWID",
keywords="methadone maintenance treatment",
keywords="MMT",
keywords="depression",
keywords="anxiety",
keywords="stress disorder",
abstract="Background: The prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)--based program that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam. Objective: This study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation) to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework. Methods: The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and testing phases. Results: The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this study was an adapted FB manual to be used for training and piloting to make a final program manual. Conclusions: This study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among people living with HIV on MMT in Vietnam. Trial Registration: ClinicalTrials.gov NCT04790201; https://clinicaltrials.gov/ct2/show/NCT04790201 ",
doi="10.2196/37211",
url="https://formative.jmir.org/2022/7/e37211",
url="http://www.ncbi.nlm.nih.gov/pubmed/35802402"
}


@Article{info:doi/10.2196/27707,
author="Brodbeck, Jeannette
and Berger, Thomas
and Biesold, Nicola
and Rockstroh, Franziska
and Schmidt, J. Stefanie
and Znoj, Hansjoerg",
title="The Role of Emotion Regulation and Loss-Related Coping Self-efficacy in an Internet Intervention for Grief: Mediation Analysis",
journal="JMIR Ment Health",
year="2022",
month="May",
day="6",
volume="9",
number="5",
pages="e27707",
keywords="grief",
keywords="divorce",
keywords="separation",
keywords="bereavement",
keywords="internet intervention",
keywords="emotion regulation",
keywords="coping self-efficacy",
keywords="mediation",
abstract="Background: Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, little is known about how internet interventions work and the mechanisms through which they are linked to the outcomes. Objective: As a first step in identifying mechanisms of change, this study aimed to examine emotion regulation and loss-related coping self-efficacy as putative mediators in a randomized controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation or divorce. Methods: The sample comprised older adults who reported prolonged grief or adaptation problems after bereavement, separation, or divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. The outcome variables were grief symptoms assessed using the Texas Revised Inventory of Grief and psychopathology symptoms assessed using the Brief Symptom Inventory. A total of 6 module-related items assessed loss-focused emotion regulation and loss-related coping self-efficacy. In the first step, path models were used to examine emotion regulation and loss-related coping self-efficacy as single mediators for improvements in grief and psychopathology symptoms. Subsequently, exploratory path models with the simultaneous inclusion of emotion regulation and self-efficacy were used to investigate the specificity and relative strength of these variables as parallel mediators. Results: A total of 100 participants took part in the guided internet intervention. The average age was 51.11 (SD 13.60) years; 80\% (80/100) were separated or divorced, 69\% (69/100) were female, and 76\% (76/100) were of Swiss origin. The internet intervention increased emotion regulation skills ($\beta$=.33; P=.001) and loss-related coping self-efficacy ($\beta$=.30; P=.002), both of which correlated with improvements in grief and psychopathology symptoms. Path models suggested that emotion regulation and loss-related coping self-efficacy were mediators for improvement in grief. Emotion regulation showed a significant indirect effect ($\beta$=.13; P=.009), whereas coping self-efficacy showed a trend ($\beta$=.07; P=.06). Both were confirmed as mediators for psychopathology ($\beta$=.12, P=.02; $\beta$=.10; P=.02, respectively). The path from the intervention to the improvement in grief remained significant when including the mediators ($\beta$=.26, P=.004; $\beta$=.32, P?.001, respectively) in contrast to the path from the intervention to improvements in psychopathology ($\beta$=.15, P=.13; $\beta$=.16, P=.10, respectively). Conclusions: Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Both should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. Trial Registration: ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1759-5 ",
doi="10.2196/27707",
url="https://mental.jmir.org/2022/5/e27707",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522459"
}


@Article{info:doi/10.2196/36775,
author="Mercadal Rotger, Josep
and Cabr{\'e}, Victor",
title="Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study",
journal="JMIR Ment Health",
year="2022",
month="May",
day="2",
volume="9",
number="5",
pages="e36775",
keywords="online psychological intervention",
keywords="therapeutic alliance",
keywords="digital health",
keywords="mental health",
keywords="mental health education",
keywords="mental health treatment",
keywords="health interventions",
keywords="health professional",
keywords="online health",
keywords="web-based health",
keywords="intervention modality",
abstract="Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2\%) of whom were men and 142 were (48.8\%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances---observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=--42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. ",
doi="10.2196/36775",
url="https://mental.jmir.org/2022/5/e36775",
url="http://www.ncbi.nlm.nih.gov/pubmed/35499910"
}


@Article{info:doi/10.2196/32312,
author="Manning, B. Julia
and Blandford, Ann
and Edbrooke-Childs, Julian",
title="Digital Companion Choice to Support Teachers' Stress Self-management: Systematic Approach Through Taxonomy Creation",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="16",
volume="6",
number="2",
pages="e32312",
keywords="digital technology",
keywords="digital health",
keywords="psychological treatment",
keywords="stress",
keywords="self-management",
keywords="mobile phone",
abstract="Background: There are thousands of digital companions designed for emotional well-being and stress, including websites, wearables, and smartphone apps. Although public evaluation frameworks and ratings exist, they do not facilitate digital companion choice based on contextual or individual information, such as occupation or personal management strategies. Objective: The aim of this study is to establish a process for creating a taxonomy to support systematic choice of digital companions for teachers' stress self-management. Methods: We used a 4-step study design. In step 1, we identified the dimension of stress self-management and strategic classifications. In step 2, we identified the dimension of the digital techniques and conceptual descriptions. In step 3, we created 6 criteria for the inclusion of digital companions. In step 4, we used the taxonomy framework created by steps 1 and 2 and populated it with digital companions for stress self-management, as identified in step 3. Results: First, in the dimension of stress self-management, we identified four classes of strategies: educational, physiological, cognitive, and social. Second, in the digital techniques dimension, we derived four conceptual descriptions for the digital companions' mechanisms of action: fostering reflection, suggesting treatment, peer-to-peer support, and entertainment. Third, we created six criteria for digital companion inclusion in the taxonomy: suitability, availability, evaluation, security, validity, and cost. Using the taxonomy framework and criteria, we populated it with digital companions for stress management ahead of presentation to teachers in a stress study workshop. Conclusions: The elements of our approach can be generalized as principles for the creation of taxonomies for other occupations or conditions. Taxonomies such as this could be a valuable resource for individuals to understand which digital companion could be of help in their personal context. ",
doi="10.2196/32312",
url="https://formative.jmir.org/2022/2/e32312",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171106"
}


@Article{info:doi/10.2196/30221,
author="Collins-Pisano, Caroline
and Velez Court, Juan
and Johnson, Michael
and Mois, George
and Brooks, Jessica
and Myers, Amanda
and Muralidharan, Anjana
and Storm, Marianne
and Wright, Maggie
and Berger, Nancy
and Kasper, Ann
and Fox, Anthony
and MacDonald, Sandi
and Schultze, Sarah
and Fortuna, Karen",
title="Core Competencies to Promote Consistency and Standardization of Best Practices for Digital Peer Support: Focus Group Study",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="16",
volume="8",
number="12",
pages="e30221",
keywords="COVID-19",
keywords="peer support",
keywords="competencies",
keywords="training",
keywords="digital",
abstract="Background: As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective: The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods: Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results: Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions: The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). ",
doi="10.2196/30221",
url="https://mental.jmir.org/2021/12/e30221",
url="http://www.ncbi.nlm.nih.gov/pubmed/34736223"
}


@Article{info:doi/10.2196/32007,
author="van Genugten, Rosalie Claire
and Schuurmans, Josien
and Hoogendoorn, W. Adriaan
and Araya, Ricardo
and Andersson, Gerhard
and Ba{\~n}os, Rosa
and Botella, Cristina
and Cerga Pashoja, Arlinda
and Cieslak, Roman
and Ebert, Daniel David
and Garc{\'i}a-Palacios, Azucena
and Hazo, Jean-Baptiste
and Herrero, Roc{\'i}o
and Holtzmann, J{\'e}r{\^o}me
and Kemmeren, Lise
and Kleiboer, Annet
and Krieger, Tobias
and Smoktunowicz, Ewelina
and Titzler, Ingrid
and Topooco, Naira
and Urech, Antoine
and Smit, H. Johannes
and Riper, Heleen",
title="Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="6",
volume="8",
number="12",
pages="e32007",
keywords="depression",
keywords="behavioral activation",
keywords="theoretical framework",
keywords="ecological momentary assessment",
keywords="random-intercept cross-lagged panel model",
keywords="behavior",
keywords="framework",
keywords="EMA",
keywords="smartphone",
keywords="mental health",
keywords="treatment",
keywords="engagement",
keywords="mood",
abstract="Background: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al's theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. Objective: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. Methods: Data were collected as part of the ``European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual'' trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. Results: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. Conclusions: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. Trial Registration: ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725 ",
doi="10.2196/32007",
url="https://mental.jmir.org/2021/12/e32007",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874888"
}


@Article{info:doi/10.2196/30310,
author="Abbasi, Zaib Amir
and Rehman, Umair
and Afaq, Zahra
and Rafeh, Abdur Mir
and Hlavacs, Helmut
and Mamun, A. Mohammed
and Shah, Umair Muhammad",
title="Predicting Video Game Addiction Through the Dimensions of Consumer Video Game Engagement: Quantitative and Cross-sectional Study",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="26",
volume="9",
number="4",
pages="e30310",
keywords="consumer video game engagement",
keywords="dedication",
keywords="absorption",
keywords="social connection",
keywords="interaction",
keywords="conscious attention",
keywords="enthusiasm",
keywords="video game addiction",
keywords="uses and gratifications theory",
keywords="cultivation theory",
abstract="Background: Video games are expanding exponentially with their increased popularity among users. However, this popularity has also led to an increase in reported video game addiction. There may be consumer engagement--related factors that may influence video game addiction. Objective: This study aims to empirically examine the impact of the dimensions of consumer video game engagement on video game addiction. The dimensions are dedication, absorption, conscious attention, social connection, enthusiasm, and interaction. We utilize the uses and gratifications theory to study the video game engagement dimensions as potential factors through which gamers feel gratified and engaged in video game playing. Additionally, this study incorporates the cultivation theory to investigate how video game engagement factors trigger video game addiction. Methods: A two-step process was applied for data analysis on valid cases of 176 gamers aged 15-25 years: video game addiction was specified and validated as a reflective-formative construct, and hypothesis testing was later performed using the WarpPLS on valid respondents. Results: The analysis uncovered 2 dimensions of video game engagement: social connection with P=.08 and interaction with P=.49, which did not significantly contribute to video game addiction. Conclusions: This study offers unique insights to a myriad of stakeholders, mostly psychologists and psychiatrists, who routinely prescribe behavior modification techniques to treat video game addiction. ",
doi="10.2196/30310",
url="https://games.jmir.org/2021/4/e30310",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842539"
}


@Article{info:doi/10.2196/28349,
author="Keyworth, Chris
and O'Connor, Rory
and Quinlivan, Leah
and Armitage, J. Christopher",
title="Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="14",
volume="23",
number="9",
pages="e28349",
keywords="self-harm",
keywords="implementation intentions",
keywords="acceptability",
keywords="online",
keywords="volitional help sheet",
keywords="digital health",
keywords="mental health",
abstract="Background: The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective: This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods: We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results: Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=?15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95\% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95\% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95\% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions: Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions. ",
doi="10.2196/28349",
url="https://www.jmir.org/2021/9/e28349",
url="http://www.ncbi.nlm.nih.gov/pubmed/34518153"
}


@Article{info:doi/10.2196/23193,
author="Hanley, Terry
and Sefi, Aaron
and Grauberg, Janet
and Prescott, Julie
and Etchebarne, Andre",
title="A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration",
journal="JMIR Pediatr Parent",
year="2021",
month="Mar",
day="22",
volume="4",
number="1",
pages="e23193",
keywords="telepsychology",
keywords="digital mental health",
keywords="online therapy",
keywords="young people",
keywords="Kooth",
keywords="Theory of Change",
keywords="positive virtual ecosystems",
abstract="Background: Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging. Objective: This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. Methods: A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers). Results: A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations). Conclusions: Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers. ",
doi="10.2196/23193",
url="https://pediatrics.jmir.org/2021/1/e23193",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749615"
}


@Article{info:doi/10.2196/19945,
author="Renfrew, Elise Melanie
and Morton, Peter Darren
and Morton, Kyle Jason
and Hinze, Scott Jason
and Przybylko, Geraldine
and Craig, Adrian Bevan",
title="The Influence of Three Modes of Human Support on Attrition and Adherence to a Web- and Mobile App--Based Mental Health Promotion Intervention in a Nonclinical Cohort: Randomized Comparative Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="29",
volume="22",
number="9",
pages="e19945",
keywords="human support",
keywords="adherence",
keywords="attrition",
keywords="engagement",
keywords="web-based mental health",
keywords="health promotion",
keywords="eHealth",
keywords="SMS",
keywords="videoconferencing",
abstract="Background: The escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app--based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. Objective: This study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. Methods: Subjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS \& VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). Results: Interested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3\% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9\% (44/201) withdrew from the S group, 19.3\% (39/202) from the S+pSMSgroup, and 31.6\% (64/202) from the S+VCS group. The remaining 75.7\% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1\% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9\% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5\%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). Conclusions: Early dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx ",
doi="10.2196/19945",
url="http://www.jmir.org/2020/9/e19945/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32990633"
}


@Article{info:doi/10.2196/16290,
author="Yeo, Caroline
and Hare-Duke, Laurie
and Rennick-Egglestone, Stefan
and Bradstreet, Simon
and Callard, Felicity
and Hui, Ada
and Llewellyn-Beardsley, Joy
and Longden, Eleanor
and McDonough, Tracy
and McGranahan, Rose
and Ng, Fiona
and Pollock, Kristian
and Roe, James
and Slade, Mike",
title="The VOICES Typology of Curatorial Decisions in Narrative Collections of the Lived Experiences of Mental Health Service Use, Recovery, or Madness: Qualitative Study",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="18",
volume="7",
number="9",
pages="e16290",
keywords="personal narrative",
keywords="mental health recovery",
keywords="decision making",
abstract="Background: Collections of lived experience narratives are increasingly used in health research and medical practice. However, there is limited research with respect to the decision-making processes involved in curating narrative collections and the work that curators do as they build and publish collections. Objective: This study aims to develop a typology of curatorial decisions involved in curating narrative collections presenting lived experiences of mental health service use, recovery, or madness and to document approaches selected by curators in relation to identified curatorial decisions. Methods: A preliminary typology was developed by synthesizing the results of a systematic review with insights gained through an iterative consultation with an experienced curator of multiple recovery narrative collections. The preliminary typology informed the topic guide for semistructured interviews with a maximum variation sample of 30 curators from 7 different countries. All participants had the experience of curating narrative collections of the lived experiences of mental health service use, recovery, or madness. A multidisciplinary team conducted thematic analysis through constant comparison. Results: The final typology identified 6 themes, collectively referred to as VOICES, which stands for values and motivations, organization, inclusion and exclusion, control and collaboration, ethics and legal, and safety and well-being. A total of 26 subthemes related to curation decisions were identified. Conclusions: The VOICES typology identifies the key decisions to consider when curating narrative collections about the lived experiences of mental health service use, recovery, or madness. It might be used as a theoretical basis for a good practice resource to support curators in their efforts to balance the challenges and sometimes conflicting imperatives involved in collecting, organizing, and sharing narratives. Future research might seek to document the use of such a tool by curators and hence examine how best to use VOICES to support decision making. ",
doi="10.2196/16290",
url="http://mental.jmir.org/2020/9/e16290/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32945771"
}


@Article{info:doi/10.2196/15572,
author="Shalaby, Hameed Reham A.
and Agyapong, O. Vincent I.",
title="Peer Support in Mental Health: Literature Review",
journal="JMIR Ment Health",
year="2020",
month="Jun",
day="9",
volume="7",
number="6",
pages="e15572",
keywords="peer support",
keywords="peer support workers",
keywords="mental illness and addiction",
keywords="social support",
keywords="literature review",
abstract="Background: A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources. Objective: In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields. Methods: The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care. Results: There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce. Conclusions: There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders. ",
doi="10.2196/15572",
url="https://mental.jmir.org/2020/6/e15572",
url="http://www.ncbi.nlm.nih.gov/pubmed/32357127"
}


@Article{info:doi/10.2196/13807,
author="Radomski, D. Ashley
and Wozney, Lori
and McGrath, Patrick
and Huguet, Anna
and Hartling, Lisa
and Dyson, P. Michele
and Bennett, J. Kathryn
and Newton, S. Amanda",
title="Potential Reduction of Symptoms With the Use of Persuasive Systems Design Features in Internet-Based Cognitive Behavioral Therapy Programs for Children and Adolescents With Anxiety: A Realist Synthesis",
journal="JMIR Ment Health",
year="2019",
month="Oct",
day="23",
volume="6",
number="10",
pages="e13807",
keywords="internet",
keywords="cognitive behavioral therapy",
keywords="computer-assisted therapy",
keywords="persuasive communication",
keywords="anxiety",
keywords="children",
keywords="adolescents",
keywords="review",
keywords="treatment effectiveness",
keywords="clinical effectiveness",
keywords="treatment efficacy",
keywords="clinical",
abstract="Background: Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy---therapeutic content, technological features, and interactions between the user and program---intended to reduce users' anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. Objective: The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. Methods: A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our prespecified inclusion criteria were appraised for relevance and methodological rigor. Data extraction was guided by the persuasive systems design (PSD) model. The model describes 28 technological design features, organized into 4 categories that help users meet their health goals: primary task support, dialogue support, system credibility support, and social support. We generated initial hypotheses for how PSD (mechanisms) and program delivery (context of use) features were linked to symptom changes (outcomes) across iCBT programs using realist and meta-ethnographic techniques. These hypothesized context-mechanism-outcome configurations were refined during analysis using evidence from the literature to improve their explanatory value. Results: A total of 63 documents detailing 15 iCBT programs were included. A total of six iCBT programs were rated high for relevance, and most studies were of moderate-to-high methodological rigor. A total of 11 context-mechanism-outcome configurations (final hypotheses) were generated. Configurations primarily comprised PSD features from the primary task and dialogue support categories. Several key PSD features (eg, self-monitoring, simulation, social role, similarity, social learning, and rehearsal) were consistently reported in programs shown to reduce anxiety; many features were employed simultaneously, suggesting synergy when grouped. We also hypothesized the function of PSD features in generating iCBT impacts. Adjunct support was identified as an important aspect of context that may have complemented certain PSD features in reducing users' anxiety. Conclusions: This synthesis generated context-mechanism-outcome configurations (hypotheses) about the potential function, combination, and impact of iCBT program components thought to support desired program effects. We suggest that, when delivered with adjunct support, PSD features may contribute to reduced anxiety for child and adolescent users. Formal testing of the 11 configurations is required to confirm their impact on anxiety-based outcomes. From this we encourage a systematic and deliberate approach to iCBT design and evaluation to increase the pool of evidence-based interventions available to prevent and treat children and adolescents with anxiety. ",
doi="10.2196/13807",
url="https://mental.jmir.org/2019/10/e13807",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647474"
}


@Article{info:doi/10.2196/14719,
author="LaMonica, M. Haley
and Davenport, A. Tracey
and Braunstein, Katharine
and Ottavio, Antonia
and Piper, Sarah
and Martin, Craig
and Hickie, B. Ian
and Cross, Shane",
title="Technology-Enabled Person-Centered Mental Health Services Reform: Strategy for Implementation Science",
journal="JMIR Ment Health",
year="2019",
month="Sep",
day="19",
volume="6",
number="9",
pages="e14719",
keywords="implementation science",
keywords="mental health",
keywords="health care reform",
keywords="technology",
keywords="community-based participatory research",
abstract="Background: Health information technologies are being rapidly developed to improve the delivery of mental health care; however, a range of facilitators, barriers, and contextual conditions can impact the adoption and sustainment of these solutions. An implementation science protocol supports researchers to achieve primary effectiveness goals in relation to mental health services reform and aids in the optimization of implementation processes to promote quality health care, prolonging sustainability. Objective: The aim of this paper is to describe our implementation science protocol, which serves as a foundation by which to systematically guide the implementation of technology-enabled solutions in traditional face-to-face and Web-based mental health services, allowing for revisions over time on the basis of retrospective review and constructive feedback from the services in which the technology-enabled solutions are implemented. Methods: Our implementation science protocol comprises four phases. The primary objective of the scoping and feasibility phase (Phase 1) is to determine the alignment between the service partner and the quality improvement goals supported by the technology-enabled solution. This is followed by Phase 2, the local co-design and preimplementation phase, which aims to utilize co-design methodologies, including service pathway modelling, participatory design, and user (acceptance) testing, to determine how the solutions could be used to enhance the service. In Phase 3, implementation, the accepted solution is embedded in the mental health service to achieve better outcomes for consumers and their families as well as health professionals and service managers. Using iterative evaluative processes throughout Phase 3, the solution is continuously developed, designed, and refined during implementation to adapt to the changing needs of the stakeholders, including consumers with lived experience and their families as well as the service. Thus, the primary outcome of Phase 3 is the optimized technology-enabled solution that can be maintained in a service during the sustainment and scalability phase (Phase 4) for the purposes of mental health services reform. Results: Funding for the protocol was provided by the Australian Government Department of Health in June of 2017 for a period of 3 years. At the time of this publication, the protocol had been initiated in 11 services, serving three populations, all of which are currently operating in Phase 3. The first results are expected to be submitted for publication in 2020. Conclusions: With the aim of improving mental health service quality, our implementation science protocol aids in the identification of factors that predict the likelihood of implementation success, as well as the development of strategies to proactively mitigate potential barriers to achieve better implementation outcomes. Putting in place a theoretically sound implementation science protocol is essential to facilitate the uptake of novel technology-enabled solutions and evidence-based practices into routine clinical practice for the purposes of improved outcomes. ",
doi="10.2196/14719",
url="https://mental.jmir.org/2019/9/e14719",
url="http://www.ncbi.nlm.nih.gov/pubmed/31538938"
}


@Article{info:doi/10.2196/13498,
author="Brenas, Hael Jon
and Shin, Kyong Eun
and Shaban-Nejad, Arash",
title="Adverse Childhood Experiences Ontology for Mental Health Surveillance, Research, and Evaluation: Advanced Knowledge Representation and Semantic Web Techniques",
journal="JMIR Ment Health",
year="2019",
month="May",
day="21",
volume="6",
number="5",
pages="e13498",
keywords="ontologies",
keywords="mental health surveillance",
keywords="adverse childhood experiences",
keywords="semantics",
keywords="computational psychiatry",
abstract="Background: Adverse Childhood Experiences (ACEs), a set of negative events and processes that a person might encounter during childhood and adolescence, have been proven to be linked to increased risks of a multitude of negative health outcomes and conditions when children reach adulthood and beyond. Objective: To better understand the relationship between ACEs and their relevant risk factors with associated health outcomes and to eventually design and implement preventive interventions, access to an integrated coherent dataset is needed. Therefore, we implemented a formal ontology as a resource to allow the mental health community to facilitate data integration and knowledge modeling and to improve ACEs' surveillance and research. Methods: We use advanced knowledge representation and semantic Web tools and techniques to implement the ontology. The current implementation of the ontology is expressed in the description logic ALCRIQ(D), a sublogic of Web Ontology Language (OWL 2). Results: The ACEs Ontology has been implemented and made available to the mental health community and the public via the BioPortal repository. Moreover, multiple use-case scenarios have been introduced to showcase and evaluate the usability of the ontology in action. The ontology was created to be used by major actors in the ACEs community with different applications, from the diagnosis of individuals and predicting potential negative outcomes that they might encounter to the prevention of ACEs in a population and designing interventions and policies. Conclusions: The ACEs Ontology provides a uniform and reusable semantic network and an integrated knowledge structure for mental health practitioners and researchers to improve ACEs' surveillance and evaluation. ",
doi="10.2196/13498",
url="http://mental.jmir.org/2019/5/e13498/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31115344"
}


@Article{info:doi/10.2196/mental.4200,
author="Reynolds, Julia
and Griffiths, M. Kathleen
and Cunningham, A. John
and Bennett, Kylie
and Bennett, Anthony",
title="Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework",
journal="JMIR Mental Health",
year="2015",
month="Mar",
day="23",
volume="2",
number="1",
pages="e6",
keywords="translational medical research",
keywords="professional practice",
keywords="primary health care",
keywords="treatment of mental disorders",
keywords="Internet",
keywords="health care technology",
keywords="health promotion",
keywords="case management",
keywords="psychotherapy",
abstract="Background: Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care.   The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice.  Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. Objective: The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. Methods: Information about service providers' use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors' experience of training primary care service providers. Results: Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers Conclusions: The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care.  Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation. ",
doi="10.2196/mental.4200",
url="http://mental.jmir.org/2015/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26543912"
}