@Article{info:doi/10.2196/67744, author="Zhang, Jia and Wang, Jing and Zhang, JingBo and Xia, XiaoQian and Zhou, ZiYun and Zhou, XiaoMing and Wu, YiBo", title="Young Adult Perspectives on Artificial Intelligence--Based Medication Counseling in China: Discrete Choice Experiment", journal="J Med Internet Res", year="2025", month="Apr", day="9", volume="27", pages="e67744", keywords="artificial intelligence", keywords="medication counseling services", keywords="discrete choice experiment", keywords="willingness to pay", abstract="Background: As artificial intelligence (AI) permeates the current society, the young generation is becoming increasingly accustomed to using digital solutions. AI-based medication counseling services may help people take medications more accurately and reduce adverse events. However, it is not known which AI-based medication counseling service will be preferred by young people. Objective: This study aims to assess young people's preferences for AI-based medication counseling services. Methods: A discrete choice experiment (DCE) approach was the main analysis method applied in this study, involving 6 attributes: granularity, linguistic comprehensibility, symptom-specific results, access platforms, content model, and costs. The participants in this study were screened and recruited through web-based registration and investigator visits, and the questionnaire was filled out online, with the questionnaire platform provided by Questionnaire Star. The sample population in this study consisted of young adults aged 18-44 years. A mixed logit model was used to estimate attribute preference coefficients and to estimate the willingness to pay (WTP) and relative importance (RI) scores. Subgroups were also analyzed to check for heterogeneity in preferences. Results: In this analysis, 340 participants were included, generating 8160 DCE observations. Participants exhibited a strong preference for receiving 100\% symptom-specific results ($\beta$=3.18, 95\% CI 2.54-3.81; P<.001), and the RI of the attributes (RI=36.99\%) was consistent with this. Next, they showed preference for the content model of the video ($\beta$=0.86, 95\% CI 0.51-1.22; P<.001), easy-to-understand language ($\beta$=0.81, 95\% CI 0.46-1.16; P<.001), and when considering the granularity, refined content was preferred over general information ($\beta$=0.51, 95\% CI 0.21-0.8; P<.001). Finally, participants exhibited a notable preference for accessing information through WeChat applets rather than websites ($\beta$=0.66, 95\% CI 0.27-1.05; P<.001). The WTP for AI-based medication counseling services ranked from the highest to the lowest for symptom-specific results, easy-to-understand language, video content, WeChat applet platform, and refined medication counseling. Among these, the WTP for 100\% symptom-specific results was the highest ({\textyen}24.01, 95\% CI 20.16-28.77; US \$1={\textyen}7.09). High-income participants exhibited significantly higher WTP for highly accurate results ({\textyen}45.32) compared to low-income participants ({\textyen}20.65). Similarly, participants with higher education levels showed greater preferences for easy-to-understand language ({\textyen}5.93) and video content ({\textyen}12.53). Conclusions: We conducted an in-depth investigation of the preference of young people for AI-based medication counseling services. Service providers should pay attention to symptom-specific results, support more convenient access platforms, and optimize the language description, content models that add multiple digital media interactions, and more refined medication counseling to develop AI-based medication counseling services. ", doi="10.2196/67744", url="https://www.jmir.org/2025/1/e67744" } @Article{info:doi/10.2196/68544, author="Bakhti, Rinad and Daler, Harmani and Ogunro, Hephzibah and Hope, Steven and Hargreaves, Dougal and Nicholls, Dasha", title="Exploring Engagement With and Effectiveness of Digital Mental Health Interventions in Young People of Different Ethnicities: Systematic Review", journal="J Med Internet Res", year="2025", month="Apr", day="7", volume="27", pages="e68544", keywords="digital mental health interventions", keywords="young people", keywords="ethnicity", keywords="engagement", keywords="effectiveness", keywords="artificial intelligence", keywords="AI", abstract="Background: The prevalence of mental health difficulties among young people has risen in recent years, with 75\% of mental disorders emerging before the age of 24 years. The identification and treatment of mental health issues earlier in life improves later-life outcomes. The COVID-19 pandemic spurred the growth of digital mental health interventions (DMHIs), which offer accessible support. However, young people of different ethnicities face barriers to DMHIs, such as socioeconomic disadvantage and cultural stigma. Objective: This review aimed to summarize and evaluate the engagement with and effectiveness of DMHIs among young people of different ethnicities. Methods: A systematic search was conducted in MEDLINE, Embase, and PsycINFO for studies published between January 2019 and May 2024, with an update in September 2024. The inclusion criteria were participants aged <25 years using DMHIs from various ethnic backgrounds. Three reviewers independently screened and selected the studies. Data on engagement (eg, use and uptake) and effectiveness (eg, clinical outcomes and symptom improvement) were extracted and synthesized to compare findings. Studies were assessed for quality using the Mixed Methods Appraisal Tool. Results: The final search yielded 67 studies, of which 7 (10\%) met inclusion criteria. There were 1853 participants across the 7 studies, all from high-income countries. Participants were predominantly aged 12 to 25 years, with representation of diverse ethnic identities, including Black, Asian, Hispanic, mixed race, and Aboriginal individuals. Engagement outcomes varied, with culturally relatable, low-cost interventions showing higher retention and user satisfaction. Linguistic barriers and country of origin impeded the effectiveness of some interventions, while near-peer mentorship, coproduction, and tailored content improved the effectiveness of DMHIs. While initial results are promising, small sample sizes, heterogeneity in outcome assessments, and a paucity of longitudinal data impeded robust comparisons and generalizability. Conclusions: DMHIs show potential as engaging and effective mental health promotional tools for young people of different ethnicities, especially when coproduced and culturally relatable. Initial data suggest that interventions facilitating near-peer mentoring, linguistic adaptation, low cost, and cultural relatability have improved engagement and effectiveness. Future research should focus on developing a consensus definition of DMHIs, exploring DMHIs in children aged <12 years, and conducting detailed qualitative and quantitative research on use factors and treatment efficacy of DMHIs for young people of different ethnicities. Trial Registration: PROSPERO CRD42024544364; https://tinyurl.com/yk5jt8yk ", doi="10.2196/68544", url="https://www.jmir.org/2025/1/e68544" } @Article{info:doi/10.2196/68362, author="Zhang, Xiaolong and Berry, Natalie and Di Basilio, Daniela and Richardson, Cara and Eisner, Emily and Bucci, Sandra", title="Mental Health Professionals' Technology Usage and Attitudes Toward Digital Health for Psychosis: Comparative Cross-Sectional Survey Study", journal="JMIR Ment Health", year="2025", month="Mar", day="31", volume="12", pages="e68362", keywords="digital mental health", keywords="psychosis", keywords="attitudes", keywords="implementation", keywords="smartphone app", abstract="Background: Digital health technologies (DHTs) for psychosis have been developed and tested rapidly in recent years. However, research examining mental health professionals' views on the use of DHTs for people with psychosis is limited. Given the increased accessibility and availability of DHTs for psychosis, an up-to-date understanding of staff perception of DHTs for psychosis is warranted. Objective: In this study, we aimed to investigate mental health professionals' usage of technology and their perception of service users' technology usage; their views toward the use of DHTs for psychosis, including their concerns; and barriers for implementing DHTs in a mental health setting. Methods: Two cross-sectional surveys were distributed to mental health care staff who had experience of working with individuals experiencing psychosis in the United Kingdom. Survey 1 (from April 2018 to September 2020) was distributed to 3 local UK National Health Service (NHS) trusts in Northwest England; survey 2 was administered nationally across 31 UK NHS trusts or health boards (from November 2022 to March 2024). The COVID-19 pandemic occurred between the 2 survey periods. Data were analyzed descriptively. Results: A total of 155 and 352 participants completed surveys 1 and 2, respectively. Staff reported high levels of technology ownership and usage in both surveys. In general, staff expressed positive views regarding the use of DHTs for psychosis; however, barriers and concerns, including affordability, digital literacy, and potential negative effects on service users' mental health, were also reported. We did not find notable changes in terms of staff use of digital technology in clinical practice over time. Conclusions: Staff sampled from a broad and diverse range expressed consistent optimism about the potential implementation of DHTs in practice, though they also noted some concerns regarding safety and access. While the COVID-19 pandemic is frequently regarded as a catalyst for the adoption of digital health care tools, the sustainability of this transition from traditional to digital health care appeared to be suboptimal. To address staff concerns regarding safety and potentially facilitate the implementation of DHTs, systematic evaluation of adverse effects of using DHTs and dissemination of evidence are needed. Organizational support and training should be offered to staff to help address barriers and increase confidence in recommending and using DHTs with service users. ", doi="10.2196/68362", url="https://mental.jmir.org/2025/1/e68362" } @Article{info:doi/10.2196/64617, author="Kelly, Anthony and Jensen, Kjems Esben and Grua, Martino Eoin and Mathiasen, Kim and Van de Ven, Pepijn", title="An Interpretable Model With Probabilistic Integrated Scoring for Mental Health Treatment Prediction: Design Study", journal="JMIR Med Inform", year="2025", month="Mar", day="26", volume="13", pages="e64617", keywords="machine learning", keywords="mental health", keywords="Monte Carlo dropout", keywords="explainability", keywords="explainable AI", keywords="XAI", keywords="artificial intelligence", keywords="AI", abstract="Background: Machine learning (ML) systems in health care have the potential to enhance decision-making but often fail to address critical issues such as prediction explainability, confidence, and robustness in a context-based and easily interpretable manner. Objective: This study aimed to design and evaluate an ML model for a future decision support system for clinical psychopathological treatment assessments. The novel ML model is inherently interpretable and transparent. It aims to enhance clinical explainability and trust through a transparent, hierarchical model structure that progresses from questions to scores to classification predictions. The model confidence and robustness were addressed by applying Monte Carlo dropout, a probabilistic method that reveals model uncertainty and confidence. Methods: A model for clinical psychopathological treatment assessments was developed, incorporating a novel ML model structure. The model aimed at enhancing the graphical interpretation of the model outputs and addressing issues of prediction explainability, confidence, and robustness. The proposed ML model was trained and validated using patient questionnaire answers and demographics from a web-based treatment service in Denmark (N=1088). Results: The balanced accuracy score on the test set was 0.79. The precision was ?0.71 for all 4 prediction classes (depression, panic, social phobia, and specific phobia). The area under the curve for the 4 classes was 0.93, 0.92, 0.91, and 0.98, respectively. Conclusions: We have demonstrated a mental health treatment ML model that supported a graphical interpretation of prediction class probability distributions. Their spread and overlap can inform clinicians of competing treatment possibilities for patients and uncertainty in treatment predictions. With the ML model achieving 79\% balanced accuracy, we expect that the model will be clinically useful in both screening new patients and informing clinical interviews. ", doi="10.2196/64617", url="https://medinform.jmir.org/2025/1/e64617" } @Article{info:doi/10.2196/58992, author="Ecclestone, Amy and Linden, Brooke and Rose, Jessica and Kullar, Kiran", title="Mobilizing Health Promotion Through Canada's Student Mental Health Network: Concurrent, Mixed Methods Process Evaluation", journal="JMIR Form Res", year="2025", month="Feb", day="27", volume="9", pages="e58992", keywords="mental health", keywords="health promotion", keywords="program evaluation", keywords="postsecondary", keywords="knowledge translation", abstract="Background: Mental health issues among Canadian postsecondary students are prevalent. In tandem, an increased acknowledgment of the need for upstream mental health support has been highlighted. While the majority of institutions offer some form of mental health promotion, research suggests students are failing to access support due to barriers including lack of awareness, geographical and financial barriers, and lack of relevance in offerings. Canada's Student Mental Health Network is a web-based knowledge mobilization initiative designed to fill these gaps. With content created and curated ``for-students, by-students'' and reviewed by subject matter experts, the Network serves as a one-stop shop for evidence-based, mental health support for postsecondary students. Objective: The goal of this research was to conduct the first component of a comprehensive program evaluation of the Network. This paper details a formative, process evaluation after approximately 1 year of operations, with the goal of assessing acceptability and feasibility. Methods: Using a concurrent mixed methods study design, quantitative and qualitative data were simultaneously collected from students in order to evaluate the acceptability and feasibility of the Network as a mental health promotion resource. Quantitative data were automatically collected through Google Analytics via the website over the course of the first year of operations. Data collected included the number of users accessing the website, user engagement, and user ``stickiness.'' Quantitative data were used to evaluate both accessibility and feasibility. Qualitative data were collected via individual, digital interviews conducted with a modest sample of students (n=8) across areas and levels of study. Qualitative data derived more detailed insights into user experience and website attributes, as well as feedback on content delivery, providing evidence used to evaluate feasibility. Results: A total of 1200 users globally accessed the Network within the first year of operations, with Canadian users accounting for nearly 90\% of total website traffic. An overall 66\% engagement rate was observed, with the average user visiting 7 pages per session. Further support for the acceptability of the Network is demonstrated in the Canada-wide reach of the content development and review team. Evidence for the feasibility of the Network was observed through website use statistics indicating the most frequently viewed pages aligned with our goals: providing mental health education and increasing awareness of available resources. Qualitative feedback provided additional context surrounding the feasibility of the space, including positive feedback on the esthetics, relevance, usability, inclusion, and accessibility. Areas for content expansion and improvements to accessibility were also identified. Conclusions: The results of this study provide evidence in support of the feasibility and acceptability of the Network as a web-based knowledge mobilization initiative in support of postsecondary students' mental health and well-being. Future research will pursue a summative, impact assessment to evaluate utility. ", doi="10.2196/58992", url="https://formative.jmir.org/2025/1/e58992" } @Article{info:doi/10.2196/64318, author="Seo, Sujeong and Kim, Kyuli and Yang, Heyoung", title="Performance Assessment of Large Language Models in Medical Consultation: Comparative Study", journal="JMIR Med Inform", year="2025", month="Feb", day="12", volume="13", pages="e64318", keywords="artificial intelligence", keywords="biomedical", keywords="large language model", keywords="depression", keywords="similarity measurement", keywords="text validity", abstract="Background: The recent introduction of generative artificial intelligence (AI) as an interactive consultant has sparked interest in evaluating its applicability in medical discussions and consultations, particularly within the domain of depression. Objective: This study evaluates the capability of large language models (LLMs) in AI to generate responses to depression-related queries. Methods: Using the PubMedQA and QuoraQA data sets, we compared various LLMs, including BioGPT, PMC-LLaMA, GPT-3.5, and Llama2, and measured the similarity between the generated and original answers. Results: The latest general LLMs, GPT-3.5 and Llama2, exhibited superior performance, particularly in generating responses to medical inquiries from the PubMedQA data set. Conclusions: Considering the rapid advancements in LLM development in recent years, it is hypothesized that version upgrades of general LLMs offer greater potential for enhancing their ability to generate ``knowledge text'' in the biomedical domain compared with fine-tuning for the biomedical field. These findings are expected to contribute significantly to the evolution of AI-based medical counseling systems. ", doi="10.2196/64318", url="https://medinform.jmir.org/2025/1/e64318" } @Article{info:doi/10.2196/64414, author="Stroud, M. Austin and Curtis, H. Susan and Weir, B. Isabel and Stout, J. Jeremiah and Barry, A. Barbara and Bobo, V. William and Athreya, P. Arjun and Sharp, R. Richard", title="Physician Perspectives on the Potential Benefits and Risks of Applying Artificial Intelligence in Psychiatric Medicine: Qualitative Study", journal="JMIR Ment Health", year="2025", month="Feb", day="10", volume="12", pages="e64414", keywords="artificial intelligence", keywords="machine learning", keywords="digital health", keywords="mental health", keywords="psychiatry", keywords="depression", keywords="interviews", keywords="family medicine", keywords="physicians", keywords="qualitative", keywords="providers", keywords="attitudes", keywords="opinions", keywords="perspectives", keywords="ethics", abstract="Background: As artificial intelligence (AI) tools are integrated more widely in psychiatric medicine, it is important to consider the impact these tools will have on clinical practice. Objective: This study aimed to characterize physician perspectives on the potential impact AI tools will have in psychiatric medicine. Methods: We interviewed 42 physicians (21 psychiatrists and 21 family medicine practitioners). These interviews used detailed clinical case scenarios involving the use of AI technologies in the evaluation, diagnosis, and treatment of psychiatric conditions. Interviews were transcribed and subsequently analyzed using qualitative analysis methods. Results: Physicians highlighted multiple potential benefits of AI tools, including potential support for optimizing pharmaceutical efficacy, reducing administrative burden, aiding shared decision-making, and increasing access to health services, and were optimistic about the long-term impact of these technologies. This optimism was tempered by concerns about potential near-term risks to both patients and themselves including misguiding clinical judgment, increasing clinical burden, introducing patient harms, and creating legal liability. Conclusions: Our results highlight the importance of considering specialist perspectives when deploying AI tools in psychiatric medicine. ", doi="10.2196/64414", url="https://mental.jmir.org/2025/1/e64414", url="http://www.ncbi.nlm.nih.gov/pubmed/39928397" } @Article{info:doi/10.2196/59524, author="Ang, Heng Beng and Gollapalli, Das Sujatha and Du, Mingzhe and Ng, See-Kiong", title="Unraveling Online Mental Health Through the Lens of Early Maladaptive Schemas: AI-Enabled Content Analysis of Online Mental Health Communities", journal="J Med Internet Res", year="2025", month="Feb", day="7", volume="27", pages="e59524", keywords="early maladaptive schemas", keywords="large language models", keywords="online mental health communities", keywords="case conceptualization", keywords="prompt engineering", keywords="artificial intelligence", keywords="AI", abstract="Background: Early maladaptive schemas (EMSs) are pervasive, self-defeating patterns of thoughts and emotions underlying most mental health problems and are central in schema therapy. However, the characteristics of EMSs vary across demographics, and despite the growing use of online mental health communities (OMHCs), how EMSs manifest in these online support-seeking environments remains unclear. Understanding these characteristics could inform the design of more effective interventions powered by artificial intelligence to address online support seekers' unique therapeutic needs. Objective: We aimed to uncover associations between EMSs and mental health problems within OMHCs and examine features of EMSs as they are reflected in OMHCs. Methods: We curated a dataset of 29,329 posts from widely accessed OMHCs, labeling each with relevant schemas and mental health problems. To identify associations, we conducted chi-square tests of independence and calculated odds ratios (ORs) with the dataset. In addition, we developed a novel group-level case conceptualization technique, leveraging GPT-4 to extract features of EMSs from OMHC texts across key schema therapy dimensions, such as schema triggers and coping responses. Results: Several associations were identified between EMSs and mental health problems, reflecting how EMSs manifest in online support-seeking contexts. Anxiety-related problems typically highlighted vulnerability to harm or illness (OR 5.64, 95\% CI 5.34-5.96; P<.001), while depression-related problems emphasized unmet interpersonal needs, such as social isolation (OR 3.18, 95\% CI 3.02-3.34; P<.001). Conversely, problems with eating disorders mostly exemplified negative self-perception and emotional inhibition (OR 1.89, 95\% CI 1.45-2.46; P<.001). Personality disorders reflected themes of subjugation (OR 2.51, 95\% CI 1.86-3.39; P<.001), while posttraumatic stress disorder problems involved distressing experiences and mistrust (OR 5.04, 95\% CI 4.49-5.66; P<.001). Substance use disorder problems reflected negative self-perception of failure to achieve (OR 1.83, 95\% CI 1.35-2.49; P<.001). Depression, personality disorders, and posttraumatic stress disorder were also associated with 12, 9, and 7 EMSs, respectively, emphasizing their complexities and the need for more comprehensive interventions. In contrast, anxiety, eating disorder, and substance use disorder were related to only 2 to 3 EMSs, suggesting that these problems are better addressed through targeted interventions. In addition, the EMS features extracted from our dataset averaged 13.27 (SD 3.05) negative features per schema, with 2.65 (SD 1.07) features per dimension, as supported by existing literature. Conclusions: We uncovered various associations between EMSs and mental health problems among online support seekers, highlighting the prominence of specific EMSs in each problem and the unique complexities of each problem in terms of EMSs. We also identified EMS features as expressed by support seekers in OMHCs, reinforcing the relevance of EMSs in these online support-seeking contexts. These insights are valuable for understanding how EMS are characterized in OMHCs and can inform the development of more effective artificial intelligence--powered tools to enhance support on these platforms. ", doi="10.2196/59524", url="https://www.jmir.org/2025/1/e59524" } @Article{info:doi/10.2196/54973, author="Kariotis, Timothy and Prictor, Megan and Gray, Kathleen and Chang, Shanton", title="Patient-Accessible Electronic Health Records and Information Practices in Mental Health Care Contexts: Scoping Review", journal="J Med Internet Res", year="2025", month="Feb", day="7", volume="27", pages="e54973", keywords="patient-accessible electronic health records", keywords="patient portals", keywords="psychiatry", keywords="mental health", keywords="health informatics", keywords="mental illness", keywords="scoping review", abstract="Background: Patients are increasingly being provided with access to their electronic health records. However, in mental health care contexts, concerns have been raised due to a perception that such access would pose risks to patients, third parties, and the therapeutic relationship. These perceived risks may affect the information practices of health care professionals (HCPs) and patients, such as how they document, share, and use information in mental health care services with a patient-accessible electronic health record (PAEHR). Although there is growing research interest in PAEHRs, no study has specifically examined how they impact information practices. Understanding the impacts on information practices may help explain other outcomes of implementing PAEHRs and inform their design. Objective: This scoping review aimed to explore the research on PAEHRs in mental health care contexts and how PAEHRs affect information practices of HCPs and patients in this context. Methods: A scoping review was considered the most appropriate method due to the relatively recent adoption of PAEHRs in mental health care contexts and the heterogeneous nature of the evidence base. A comprehensive search of electronic databases was conducted for original empirical studies that described the use of PAEHRs or associated systems in mental health care contexts. One author reviewed all full texts, with 3 other authors reviewing a subset of studies. The study characteristics and findings were documented, and a thematic synthesis and textual narrative analysis were used to develop descriptive and analytical themes that addressed the research questions. Results: A total of 66 studies were considered eligible and included in the analysis. The impact of PAEHRs on information practices in mental health care contexts included the following: (1) they may change how HCPs document patient information, including a reduction in detail and a focus on information perceived by HCPs as objective rather than subjective; (2) they may negatively impact workflows due to changes in documentation practices and limited guidance for HCPs on how to use PAEHRs; and (3) they may contribute to improved communication between HCPs and patients, including constructive disagreements regarding what is documented in the health record. The changes to HCP information practices were influenced by a concern for the therapeutic relationship and patient safety. Furthermore, PAEHRs supported new information practices for patients, such as using their PAEHR to prepare for clinical encounters. Conclusions: We have identified several ways in which PAEHRs shape the information practices of HCPs and patients in the mental health context. These findings can inform the design of PAEHRs to promote information practices that contribute to improving the quality of mental health care. Further research is necessary to understand how changes in information practices due to the implementation of PAEHRs impact clinical outcomes and patient experiences of care. ", doi="10.2196/54973", url="https://www.jmir.org/2025/1/e54973", url="http://www.ncbi.nlm.nih.gov/pubmed/39918859" } @Article{info:doi/10.2196/65222, author="Macrynikola, Natalia and Chen, Kelly and Lane, Erlend and Nguyen, Nic and Pinto, Jennifer and Yen, Shirley and Torous, John", title="Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic", journal="JMIR Ment Health", year="2025", month="Jan", day="29", volume="12", pages="e65222", keywords="digital interventions", keywords="transdiagnostic treatment", keywords="evidence-based treatment", keywords="digital navigator", keywords="access to care", keywords="mobile phone", abstract="Background: Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services. Objective: To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity. Methods: Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants' app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing. Results: Of the 258 enrolled participants, 215 (83.3\%) completed the 8-week program. Most were White (n=151, 70.2\%) and identified as cisgender women (n=136, 63.3\%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission. Conclusions: Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care. ", doi="10.2196/65222", url="https://mental.jmir.org/2025/1/e65222" } @Article{info:doi/10.2196/62782, author="Nomeikaite, Auguste and Gelezelyte, Odeta and B{\"o}ttche, Maria and Andersson, Gerhard and Kazlauskas, Evaldas", title="Role of Tailored Timing and Frequency Prompts on the Efficacy of an Internet-Delivered Stress Recovery Intervention for Health Care Workers: Randomized Controlled Trial", journal="JMIR Ment Health", year="2025", month="Jan", day="28", volume="12", pages="e62782", keywords="internet interventions", keywords="mental health", keywords="stress", keywords="health care workers", keywords="short message service", keywords="cognitive behavioral therapy", keywords="internet-delivered cognitive behavioral therapy", keywords="psychotherapy", keywords="randomized", keywords="controlled trial", keywords="engagement", keywords="SMSl worker", keywords="usage", keywords="occupational health", keywords="provider", keywords="prompt", keywords="message", abstract="Background: Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful. Objective: The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers. Methods: The 2-arm randomized controlled trial included 87 health care workers (99\% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023). Results: The results showed that tailored prompts, although appreciated by the majority (39/40, 98\%), did not improve intervention usage indicators, such as the number of logins (t85=--0.91; P=.36), modules opened (t83.57=--1.47; P=.15), modules completed (t85=--0.71; P=.48), exercises completed (t85=--1.05; P=.30), or the time spent using the program ($\chi$22=1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=--0.08; --0.70), depression (d=--0.11; --0.38), anxiety (d=--0.32; --0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts ($\beta$=--0.24, P=.03). Conclusions: Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts. Trial Registration: ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210 ", doi="10.2196/62782", url="https://mental.jmir.org/2025/1/e62782" } @Article{info:doi/10.2196/64959, author="Snipes, Cassandra and Dorner?Ciossek, Cornelia and Hare, D. Brendan and Besedina, Olya and Campellone, Tim and Petrova, Mariya and Lakhan, E. Shaheen and Pratap, Abhishek", title="Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies", journal="JMIR Ment Health", year="2025", month="Jan", day="27", volume="12", pages="e64959", keywords="therapeutic alliance", keywords="digital working alliance", keywords="experiential negative symptoms", keywords="schizophrenia", keywords="digital therapeutics", keywords="digital literacy", abstract="Background: Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality. Objective: This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia. Methods: Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (?12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies. Results: Of the enrolled participants, 94\% (46/49) and 86\% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71\%, 35/49; study 2: 80\%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2. Conclusions: A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms. Trial Registration: Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312 ", doi="10.2196/64959", url="https://mental.jmir.org/2025/1/e64959" } @Article{info:doi/10.2196/63548, author="Auf, Hassan and Svedberg, Petra and Nygren, Jens and Nair, Monika and Lundgren, E. Lina", title="The Use of AI in Mental Health Services to Support Decision-Making: Scoping Review", journal="J Med Internet Res", year="2025", month="Jan", day="24", volume="27", pages="e63548", keywords="artificial intelligence", keywords="AI", keywords="mental health", keywords="decision-making", keywords="shared decision-making", keywords="implementation", keywords="human-computer interaction", abstract="Background: Recent advancements in artificial intelligence (AI) have changed the care processes in mental health, particularly in decision-making support for health care professionals and individuals with mental health problems. AI systems provide support in several domains of mental health, including early detection, diagnostics, treatment, and self-care. The use of AI systems in care flows faces several challenges in relation to decision-making support, stemming from technology, end-user, and organizational perspectives with the AI disruption of care processes. Objective: This study aims to explore the use of AI systems in mental health to support decision-making, focusing on 3 key areas: the characteristics of research on AI systems in mental health; the current applications, decisions, end users, and user flow of AI systems to support decision-making; and the evaluation of AI systems for the implementation of decision-making support, including elements influencing the long-term use. Methods: A scoping review of empirical evidence was conducted across 5 databases: PubMed, Scopus, PsycINFO, Web of Science, and CINAHL. The searches were restricted to peer-reviewed articles published in English after 2011. The initial screening at the title and abstract level was conducted by 2 reviewers, followed by full-text screening based on the inclusion criteria. Data were then charted and prepared for data analysis. Results: Of a total of 1217 articles, 12 (0.99\%) met the inclusion criteria. These studies predominantly originated from high-income countries. The AI systems were used in health care, self-care, and hybrid care contexts, addressing a variety of mental health problems. Three types of AI systems were identified in terms of decision-making support: diagnostic and predictive AI, treatment selection AI, and self-help AI. The dynamics of the type of end-user interaction and system design were diverse in complexity for the integration and use of the AI systems to support decision-making in care processes. The evaluation of the use of AI systems highlighted several challenges impacting the implementation and functionality of the AI systems in care processes, including factors affecting accuracy, increase of demand, trustworthiness, patient-physician communication, and engagement with the AI systems. Conclusions: The design, development, and implementation of AI systems to support decision-making present substantial challenges for the sustainable use of this technology in care processes. The empirical evidence shows that the evaluation of the use of AI systems in mental health is still in its early stages, with need for more empirically focused research on real-world use. The key aspects requiring further investigation include the evaluation of the use of AI-supported decision-making from human-AI interaction and human-computer interaction perspectives, longitudinal implementation studies of AI systems in mental health to assess the use, and the integration of shared decision-making in AI systems. ", doi="10.2196/63548", url="https://www.jmir.org/2025/1/e63548" } @Article{info:doi/10.2196/64257, author="Alharbi, A. Abdullah and Aljerian, A. Nawfal and Binhotan, S. Meshary and Alghamdi, A. Hani and Alsultan, K. Ali and Arafat, S. Mohammed and Aldhabib, Abdulrahman and Alaska, A. Yasser and Alwahbi, B. Eid and Muaddi, A. Mohammed and Alqassim, Y. Ahmad and Horner, D. Ronnie", title="Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="24", volume="11", pages="e64257", keywords="digital health", keywords="mental health", keywords="health policy", keywords="epidemiology", keywords="Saudi Arabia", keywords="SMARC", keywords="health care transformation", keywords="e-referral", keywords="Saudi Medical Appointments and Referrals Centre", abstract="Background: Mental illness affects an estimated 25\% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2\%, yet 86.1\% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia's novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020?2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99\% (n=5918) were for patients aged 18?44 years, 63.93\% (n=6414) were for men, and 87.10\% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17\% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. ``Unavailable subspecialty'' was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems. ", doi="10.2196/64257", url="https://publichealth.jmir.org/2025/1/e64257" } @Article{info:doi/10.2196/66181, author="Vonderlin, Ruben and Boritz, Tali and Claus, Carola and Seny{\"u}z, B{\"u}sra and Mahalingam, Saskia and Tennenhouse, Rachel and Lis, Stefanie and Schmahl, Christian and Margraf, J{\"u}rgen and Teismann, Tobias and Kleindienst, Nikolaus and McMain, Shelley and Bohus, Martin", title="Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study", journal="JMIR Form Res", year="2025", month="Jan", day="14", volume="9", pages="e66181", keywords="dialectical behavior therapy", keywords="borderline personality disorder", keywords="online psychotherapy", keywords="virtual psychotherapy", keywords="telehealth", keywords="personality disorders", keywords="mental", keywords="psychotherapy", keywords="online", keywords="internet", keywords="telemedicine", keywords="psychiatry", keywords="psychiatric", keywords="acceptance", abstract="Background: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. Objective: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). Methods: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists' and patients' perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. Results: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80\% to 28\% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38\% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. Conclusions: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Trial Registration: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824 ", doi="10.2196/66181", url="https://formative.jmir.org/2025/1/e66181" } @Article{info:doi/10.2196/65912, author="Hossain, Tasnim Aniqa and Rahman, Hafizur Md and Manna, Maher Ridwana and Akter, Ema and Islam, Hasibul S. M. and Hossain, Alamgir Md and Ara, Tasnu and Usmani, Ghani Nasimul and Chandra, Pradip and Khan, Ahmed Maruf and Rahman, Mustafizur S. M. and Ahmed, Uddin Helal and Mozumder, Kamruzzaman Muhammad and Juthi, Mahmuda Jesmin and Shahrin, Fatema and Shams, Afrose Sadia and Afroze, Fahmida and Banu, Jahan Mukta and Ameen, Shafiqul and Jabeen, Sabrina and Ahmed, Anisuddin and Amin, Robed Mohammad and Arifeen, El Shams and Shomik, Sohel Mohammad and Rahman, Ehsanur Ahmed", title="Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="3", volume="8", pages="e65912", keywords="Wellbeing Centers", keywords="antepartum", keywords="postpartum", keywords="depression", keywords="anxiety", keywords="implementation", abstract="Background: Globally, 10\% of pregnant women and 13\% of postpartum women experience mental disorders. In Bangladesh, nearly 50\% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh's Non-Communicable Disease Control program initiated ``Wellbeing Centers,'' telemental health services in selected public hospitals. Objective: This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods: Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization's implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95\% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results: Almost all health care providers (165/168, 98.2\%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50\%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8\%), useful (909/911, 99.8\%), and enhanced access to mental health care (906/911, 99.5\%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95\% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4\% (705/911) of women experienced depression symptoms, and 76.7\% (699/911) experienced anxiety symptoms. About 51.8\% (472/911) experienced tiredness or lack of energy, 50.9\% (464/911) felt nervous, anxious, or on edge, 57.2\% (521/911) felt worried, and 3.8\% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95\% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers' services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions: To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. ", doi="10.2196/65912", url="https://pediatrics.jmir.org/2025/1/e65912" } @Article{info:doi/10.2196/60042, author="Radley, Jessica and Penhallow, Jessica and Wickersham, Alice and Morris, Anna and Colling, Craig and Downs, Johnny", title="Factors Affecting Usability and Acceptability of an Online Platform Used by Caregivers in Child and Adolescent Mental Health Services: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="26", volume="7", pages="e60042", keywords="child mental health", keywords="caregivers", keywords="digital technology", keywords="digital health", keywords="technology use", keywords="digital skill", keywords="digital literacy", keywords="digital divides", keywords="online systems", keywords="online survey", keywords="pediatric", keywords="mental health", keywords="usability", keywords="platform", keywords="survey", keywords="questionnaire", keywords="children", keywords="youth", keywords="adolescent", keywords="informal care", keywords="family care", keywords="acceptability", keywords="System Usability Scale", keywords="SUS", keywords="mobile phone", abstract="Background: Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the ``virtual waiting room'' module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources. Objective: This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics. Methods: A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE. Results: A total of 680 caregivers responded, of whom 45\% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98\%) used a mobile phone to access myHealthE, and many had not accessed the platform's full functionality, including the new ``virtual waiting room'' module. Household income was a significant predictor of caregivers' levels of comfort using technology; caregivers were 13\% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95\% CI 1.00?1.29). Themes generated from caregivers' feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual's needs. Conclusions: Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services. ", doi="10.2196/60042", url="https://pediatrics.jmir.org/2024/1/e60042" } @Article{info:doi/10.2196/55924, author="Loh, Yi Pei and Martinengo, Laura and Heaukulani, Creighton and Tan, Yang Xin and Hng, Moses and Cheah, Yin Yong and Morris, T. Robert J. and Tudor Car, Lorainne and Lee, Jimmy", title="Characteristics and Outcomes of mHealth Interventions in Psychosis: Systematic Mapping Review", journal="J Med Internet Res", year="2024", month="Dec", day="23", volume="26", pages="e55924", keywords="mHealth", keywords="digital health", keywords="mobile applications", keywords="psychosis", keywords="schizophrenia", keywords="schizophrenia spectrum", keywords="psychotic disorders", keywords="mapping review", abstract="Background: Mobile health (mHealth) interventions have gained popularity in augmenting psychiatric care for adults with psychosis. Interest has grown in leveraging mHealth to empower individuals living with severe mental illness and extend continuity of care beyond the hospital to the community. However, reported outcomes have been mixed, likely attributed in part to the intervention and adopted outcomes, which affected between-study comparisons. Objective: This study aimed to critically review outcome measures used to evaluate mHealth interventions for adults with psychosis in relation to the characteristics of mHealth interventions. Methods: A systematic mapping review was conducted. We searched PubMed, CINAHL, Embase, PsycINFO, and Cochrane Libraries from 1973 to the present. Selection criteria included randomized controlled studies of mHealth interventions in adults diagnosed with schizophrenia spectrum disorders. Reviewers worked in pairs to screen and extract data from included studies independently using a standardized form; disagreements were resolved by consensus with an independent reviewer. We report our findings in line with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A total of 1703 citations were screened; 29 publications reporting on 23 studies were included in this review. mHealth interventions for psychosis span a wide range, with psychological therapy being the most-deployed intervention (12/23, 52\%), followed by psychoeducation (8/23, 35\%) and active self-monitoring (8/23, 35\%). Several mHealth interventions for psychosis targeted multiple pillars of biopsychosocial well-being (10/23, 43\%); the bulk of interventions (16/23, 70\%) incorporated features promoting users' self-management. The majority of mHealth interventions were delivered through applications (14/23, 61\%) as the main medium and smartphones (17/23, 74\%) as the main channel of delivery. Interventions were primarily administered in the outpatient and community settings (16/23, 70\%); many were also blended with in-person sessions (11/23, 48\%) or guided remotely (6/23, 26\%) by persons, including health care providers or trained peer supporters. The severity of psychosis-related symptoms (21/23, 91\%) was the most prevalent outcome, of which positive symptoms (13/23, 57\%), mood and anxiety (10/23, 43\%), and overall psychopathology severity (9/23, 39\%) were most commonly measured. Patient-centric outcomes, including well-being (17/23, 74\%)---particularly quality of life (10/23, 43\%)---and user experience (15/23, 65\%), including feasibility (7/23, 30\%), acceptability (7/23, 30\%), and engagement (7/23, 26\%). Notably, outcome choices remained diverse despite stratification by type of mHealth intervention. Conclusions: mHealth interventions for psychosis encompass a wide range of modalities and use outcome measures that probe various social and behavioral determinants of health. These should be considered complex interventions, and a holistic evaluation approach combining clinical and patient-centric outcomes is recommended. ", doi="10.2196/55924", url="https://www.jmir.org/2024/1/e55924", url="http://www.ncbi.nlm.nih.gov/pubmed/39714907" } @Article{info:doi/10.2196/51567, author="Baee, Sonia and Eberle, W. Jeremy and Baglione, N. Anna and Spears, Tyler and Lewis, Elijah and Wang, Hongning and Funk, H. Daniel and Teachman, Bethany and E Barnes, Laura", title="Early Attrition Prediction for Web-Based Interpretation Bias Modification to Reduce Anxious Thinking: A Machine Learning Study", journal="JMIR Ment Health", year="2024", month="Dec", day="20", volume="11", pages="e51567", keywords="digital mental health intervention", keywords="attrition prediction", keywords="user engagement", keywords="cognitive bias modification", keywords="CBM-I", keywords="dropout rate", keywords="personalization", abstract="Background: Digital mental health is a promising paradigm for individualized, patient-driven health care. For example, cognitive bias modification programs that target interpretation biases (cognitive bias modification for interpretation [CBM-I]) can provide practice thinking about ambiguous situations in less threatening ways on the web without requiring a therapist. However, digital mental health interventions, including CBM-I, are often plagued with lack of sustained engagement and high attrition rates. New attrition detection and mitigation strategies are needed to improve these interventions. Objective: This paper aims to identify participants at a high risk of dropout during the early stages of 3 web-based trials of multisession CBM-I and to investigate which self-reported and passively detected feature sets computed from the participants interacting with the intervention and assessments were most informative in making this prediction. Methods: The participants analyzed in this paper were community adults with traits such as anxiety or negative thinking about the future (Study 1: n=252, Study 2: n=326, Study 3: n=699) who had been assigned to CBM-I conditions in 3 efficacy-effectiveness trials on our team's public research website. To identify participants at a high risk of dropout, we created 4 unique feature sets: self-reported baseline user characteristics (eg, demographics), self-reported user context and reactions to the program (eg, state affect), self-reported user clinical functioning (eg, mental health symptoms), and passively detected user behavior on the website (eg, time spent on a web page of CBM-I training exercises, time of day during which the exercises were completed, latency of completing the assessments, and type of device used). Then, we investigated the feature sets as potential predictors of which participants were at high risk of not starting the second training session of a given program using well-known machine learning algorithms. Results: The extreme gradient boosting algorithm performed the best and identified participants at high risk with macro--F1-scores of .832 (Study 1 with 146 features), .770 (Study 2 with 87 features), and .917 (Study 3 with 127 features). Features involving passive detection of user behavior contributed the most to the prediction relative to other features. The mean Gini importance scores for the passive features were as follows: .033 (95\% CI .019-.047) in Study 1; .029 (95\% CI .023-.035) in Study 2; and .045 (95\% CI .039-.051) in Study 3. However, using all features extracted from a given study led to the best predictive performance. Conclusions: These results suggest that using passive indicators of user behavior, alongside self-reported measures, can improve the accuracy of prediction of participants at a high risk of dropout early during multisession CBM-I programs. Furthermore, our analyses highlight the challenge of generalizability in digital health intervention studies and the need for more personalized attrition prevention strategies. ", doi="10.2196/51567", url="https://mental.jmir.org/2024/1/e51567", url="http://www.ncbi.nlm.nih.gov/pubmed/39705068" } @Article{info:doi/10.2196/59093, author="Zhang, Lin and Huang, Shuang and Liu, Sha and Huang, Yuanxiu and Chen, Shan and Hu, Jinsong and Xu, Mingzhong", title="Effectiveness of an Internet-Based Acceptance and Commitment Therapy Intervention for Reducing Psychological Distress in Health Care Professionals: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Dec", day="18", volume="26", pages="e59093", keywords="acceptance and commitment therapy", keywords="internet-based intervention", keywords="stress", keywords="anxiety", keywords="depression", keywords="burnout", keywords="health care professionals", keywords="randomized controlled trial", abstract="Background: Psychological distress is prevalent among health care professionals and can lead to poor-quality patient care. Internet-based acceptance and commitment therapy (iACT) is a promising intervention for improving mental health due to its low cost and easy access. However, there is limited evidence of its effectiveness in reducing health care professionals' psychological distress. Objective: This study aims to examine the effects of iACT on psychological distress (stress, anxiety, and depression) among health care professionals in China. Methods: From October 2022 to February 2023, a total of 108 health care professionals were recruited via WeChat and randomized into a 6-week iACT intervention program with therapist support (n=54) or waitlist control group (n=54). The intervention included 21 self-guided sessions combining teaching videos, mindfulness practices, and journal writing, followed by 7 live conferences to share experiences and discuss questions, all conducted via WeChat. Primary outcomes (stress, anxiety, and depression) and secondary outcomes (burnout and psychological flexibility) were collected using the Sojump platform, the most popular web-based survey platform in China. Generalized estimating equations were used to compare the outcomes between groups and assess the effects of group, time, and group-by-time interaction. Subgroup and sensitive analyses were performed to test the robustness of our findings across various groups. Results: Among the 108 health care professionals, 68 (63\%) completed the follow-up assessment at week 10, including 35 (64.8\%) in the iACT group and 33 (61.1\%) in the waitlist control group. Of the 54 participants in the iACT group, all attended at least 2 sessions, and 25 attended all 28 sessions. On average, participants attended 20 (71\%) sessions. The iACT group showed significant improvement in the Depression Anxiety and Stress Scales-21 total score (d=0.82, 95\% CI 0.39-1.26), and the effects were sustained for 4 weeks after the intervention (d=1.08, 95\% CI 0.57-1.59). Compared to the control group, the iACT group showed significantly lower scores in burnout at week 6 (d=1.42, 95\% CI 0.95-1.89) and week 10 (d=1.52, 95\% CI 0.98-2.06). The iACT group showed significantly higher psychological flexibility at week 6 (d=1.23, 95\% CI 0.77-1.69) and week 10 (d=1.15, 95\% CI 0.64-1.66). Conclusions: The iACT effectively decreased health care professionals' psychological distress and burnout and improved their psychological flexibility. Our findings provide implications and guidance for the development and broad implementation of iACT in health care settings to improve the mental health of health care professionals. Trial Registration: Chinese Clinical Trial Register ChiCTR2400093584; https://tinyurl.com/38werwsk ", doi="10.2196/59093", url="https://www.jmir.org/2024/1/e59093", url="http://www.ncbi.nlm.nih.gov/pubmed/39693127" } @Article{info:doi/10.2196/59785, author="Southwick, Lauren and Sharma, Meghana and Rai, Sunny and Beidas, S. Rinad and Mandell, S. David and Asch, A. David and Curtis, Brenda and Guntuku, Chandra Sharath and Merchant, M. Raina", title="Integrating Patient-Generated Digital Data Into Mental Health Therapy: Mixed Methods Analysis of User Experience", journal="JMIR Ment Health", year="2024", month="Dec", day="16", volume="11", pages="e59785", keywords="digital data", keywords="social media", keywords="psychotherapy", keywords="latent Dirichlet allocation", keywords="LDA", keywords="mobile phone", abstract="Background: Therapists and their patients increasingly discuss digital data from social media, smartphone sensors, and other online engagements within the context of psychotherapy. Objective: We examined patients' and mental health therapists' experiences and perceptions following a randomized controlled trial in which they both received regular summaries of patients' digital data (eg, dashboard) to review and discuss in session. The dashboard included data that patients consented to share from their social media posts, phone usage, and online searches. Methods: Following the randomized controlled trial, patient (n=56) and therapist (n=44) participants completed a debriefing survey after their study completion (from December 2021 to January 2022). Participants were asked about their experience receiving a digital data dashboard in psychotherapy via closed- and open-ended questions. We calculated descriptive statistics for closed-ended questions and conducted qualitative coding via NVivo (version 10; Lumivero) and natural language processing using the machine learning tool latent Dirichlet allocation to analyze open-ended questions. Results: Of 100 participants, nearly half (n=48, 49\%) described their experience with the dashboard as ``positive,'' while the other half noted a ``neutral'' experience. Responses to the open-ended questions resulted in three thematic areas (nine subcategories): (1) dashboard experience (positive, neutral or negative, and comfortable); (2) perception of the dashboard's impact on enhancing therapy (accountability, increased awareness over time, and objectivity); and (3) dashboard refinements (additional sources, tailored content, and privacy). Conclusions: Patients reported that receiving their digital data helped them stay ``accountable,'' while therapists indicated that the dashboard helped ``tailor treatment plans.'' Patient and therapist surveys provided important feedback on their experience regularly discussing dashboards in psychotherapy. Trial Registration: ClinicalTrials.gov NCT04011540; https://clinicaltrials.gov/study/NCT04011540 ", doi="10.2196/59785", url="https://mental.jmir.org/2024/1/e59785" } @Article{info:doi/10.2196/53280, author="Perdacher, Elke and Kavanagh, David and Sheffield, Jeanie and Dale, Penny and Heffernan, Edward", title="The Use of a Digital Well-Being App (Stay Strong App) With Indigenous People in Prison: Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="Dec", day="6", volume="11", pages="e53280", keywords="First Nations", keywords="Indigenous", keywords="digital mental health", keywords="e-mental health", keywords="mental health", keywords="social and emotional well-being", keywords="SEWB", keywords="prisoner", keywords="prison", abstract="Background: Indigenous Australians in custody experience much greater rates of poor mental health and well-being than those of the general community, and these problems are not adequately addressed. Digital mental health strategies offer innovative opportunities to address the problems, but little is known about their feasibility in or impact on this population. Objective: This study aims to conduct a pilot trial evaluating the impact of adding the Stay Strong app to mental health and well-being services for Indigenous women and men in custody. The trial compared immediate and 3-month delayed use of the app by the health service, assessing its effects on well-being, empowerment, and psychological distress at 3 and 6 months after the baseline. Methods: Indigenous participants were recruited from 3 high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed well-being (Warwick-Edinburgh Mental Wellbeing Scale), empowerment (Growth and Empowerment Measure [GEM]---giving total, 14-item Emotional Empowerment Scale, and 12 Scenarios scores), and psychological distress (Kessler Psychological Distress Scale). Intention-to-treat effects on these outcomes were analyzed using linear mixed models. Results: Substantial challenges in obtaining ethical and institutional approval for the trial were encountered, as were difficulties in timely recruitment and retention due to staff shortages and the release of participants from prison before follow-up assessments and an inability to follow up with participants after release. A total of 132 prisoners (age: mean 33, SD 8 y) were randomized into either an immediate (n=82) or a delayed treatment (n=52) group. However, only 56 (42.4\%) could be assessed at 3 months and 37 (28\%) at 6 months, raising questions concerning the representativeness of the results. Linear improvements over time were seen in all outcomes (GEM total: Cohen d=0.99; GEM 14-item Emotional Empowerment Scale: Cohen d=0.94; GEM 12 Scenarios: Cohen d=0.87; Warwick-Edinburgh Mental Wellbeing Scale: Cohen d=0.76; Kessler Psychological Distress Scale: Cohen d=0.49), but no differential effects for group or the addition of the Stay Strong app were found. Conclusions: We believe this to be Australia's first evaluation of a digital mental health app in prison and the first among Indigenous people in custody. While the study demonstrated that the use of a well-being app within a prison was feasible, staff shortages led to delayed recruitment and a consequent low retention, and significant beneficial effects of the app's use within a forensic mental health service were not seen. Additional staff resources and a longer intervention may be needed to allow a demonstration of satisfactory retention and impact in future research. Trial Registration: ANZCTR ACTRN12624001261505; https://www.anzctr.org.au/ACTRN12624001261505.aspx ", doi="10.2196/53280", url="https://mental.jmir.org/2024/1/e53280" } @Article{info:doi/10.2196/51470, author="Luo, Lingzi and Li, Gen and Tang, Weiming and Wu, Dan and Hall, Brian", title="Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Dec", day="2", volume="8", pages="e51470", keywords="COVID-19", keywords="mental health services", keywords="intention", keywords="mobile", keywords="digital", keywords="lockdowns", keywords="depression", keywords="anxiety", keywords="help-seeking", keywords="regression", keywords="applications", keywords="mHealth", keywords="WeChat", keywords="pandemic", keywords="social isolation", keywords="mental health", keywords="intent", keywords="outbreak", keywords="SARS-CoV-2", keywords="survey", keywords="usage", keywords="service", abstract="Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population's intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes--mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7\% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4\%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3\%, n=728). Only 10.9\% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19--related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. ", doi="10.2196/51470", url="https://formative.jmir.org/2024/1/e51470" } @Article{info:doi/10.2196/63743, author="M{\"u}nchenberg, Sarah Pauline and Yessimova, Dinara and Panteli, Dimitra and Kurth, Tobias", title="Digital Health Interventions for Informal Family Caregivers of People With First-Episode Psychosis: Systematic Review on User Experience and Effectiveness", journal="JMIR Ment Health", year="2024", month="Nov", day="28", volume="11", pages="e63743", keywords="first-episode psychosis", keywords="early psychosis", keywords="digital health interventions", keywords="telepsychiatry", keywords="informal caregivers", keywords="family caregivers", keywords="telehealth", keywords="severe mental disorders", keywords="psychosis", keywords="digital intervention", keywords="digital health", keywords="mental health", keywords="psychoeducation", keywords="mobile phone", abstract="Background: First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective: This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods: A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results: The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions--web-based, videoconferences, and mHealth--were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions: The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration: PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9 ", doi="10.2196/63743", url="https://mental.jmir.org/2024/1/e63743" } @Article{info:doi/10.2196/63234, author="Stefana, Alberto and Fusar-Poli, Paolo and Vieta, Eduard and Youngstrom, A. Eric", title="Effectiveness of a Novel Web-Based Intervention to Enhance Therapeutic Relationships and Treatment Outcomes in Adult Individual Psychotherapy: Randomized Controlled Trial and Analysis of Predictors of Dropouts", journal="JMIR Ment Health", year="2024", month="Nov", day="27", volume="11", pages="e63234", keywords="therapeutic relationship", keywords="real relationship", keywords="routine outcome monitoring", keywords="measurement-based care", keywords="patient-focused research", keywords="psychotherapy process", keywords="randomized controlled trial", keywords="RCT", keywords="psychotherapy", keywords="assessment", keywords="mental health", keywords="digital mental health", keywords="eHealth", keywords="self monitoring", keywords="outcomes research", keywords="digital health", keywords="health intervention", keywords="therapy", abstract="Background: Routine process and outcome monitoring interventions added to psychotherapy are known to improve treatment outcomes, although they vary in format and effectiveness. Objective: This study aimed to evaluate whether a therapist-independent, internet-based routine process monitoring and feedback system could significantly reduce psychological distress and enhance the quality of the therapeutic relationship compared with a treatment-as-usual control group among individuals already engaged in individual psychotherapy. Methods: We randomized 475 participants into either the intervention group, which received access to an internet-based routine process monitoring and feedback system in addition to psychotherapy, or the control group, which received only psychotherapy. The trial lasted for 10 weeks. Follow-up assessments at 5 weeks and 10 weeks used the Clinical Outcomes in Routine Evaluation-Outcome Measure as the primary outcome, with the Working Alliance Inventory-Short Revised and the Real Relationship Inventory-Client form as secondary outcomes. Results: Per-protocol analyses (n=166) showed that psychological distress decreased in both groups, but there was no significant advantage for the intervention group. The intervention group experienced a decline in the genuineness dimension score of the real relationship, with an effect size of d=--0.27, compared with d=0.01 in the control group. In the intervention group (but not in the control group), dropouts showed significantly lower real relationship levels (P=.002), working alliance quality (P=.051), and emotional disclosure (P=.01) compared with those who completed the study. Additionally, logistic regression revealed distinct predictors of dropout within the control group and intervention group. Conclusions: The findings do not provide conclusive evidence for the efficacy of the new internet-based intervention in enhancing self-monitoring and prompting reflection on patients' emotional responses to their therapists. However, the intervention appears to influence patients' perceptions of the genuineness dimension in the therapeutic relationship, warranting further investigation. We hypothesize that this alteration in the genuineness dimension could be attributed to the intervention facilitating a more realistic and accurate perception of the therapeutic relationship among participants. Trial Registration: ClinicalTrials.gov NCT06038747; https://clinicaltrials.gov/study/NCT06038747 International Registered Report Identifier (IRRID): RR2-10.2196/55369 ", doi="10.2196/63234", url="https://mental.jmir.org/2024/1/e63234" } @Article{info:doi/10.2196/60079, author="Woods, E. Cindy and Furst, Mary-Anne and Dissanayake, Manoj and Koerner, Jane and de Miquel, Carlota and Lukersmith, Sue and Rosenberg, Sebastian and Salvador-Carulla, Luis", title="Mental Health Care Navigation Tools in Australia: Infoveillance Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="22", volume="10", pages="e60079", keywords="digital health", keywords="infoveillance", keywords="mental health", keywords="mental health care", keywords="navigation tools", keywords="Australia", keywords="fragmentation", keywords="digital mental healthcare", keywords="web-based digital resources", keywords="diagnostic screening", keywords="accessibility", keywords="user friendly", abstract="Background: In response to the well-documented fragmentation within its mental health system, Australia has witnessed recently rapid expansion in the availability of digital mental health care navigation tools. These tools focus on assisting consumers to identify and access appropriate mental health care services, the proliferation of such varied web-based resources risks perpetuating further fragmentation and confusion for consumers. There is a pressing need to systematically assess the characteristics, comprehensiveness, and validity of these navigation tools, especially as demand for digital resources continues to escalate. Objective: This study aims to identify and describe the current landscape of Australian digital mental health care navigation tools, with a focus on assessing their comprehensiveness, identifying potential gaps, and the extent to which they meet the needs of various stakeholders. Methods: A comprehensive infoveillance approach was used to identify Australian digital mental health care navigation tools. This process involved a systematic web-based search complemented by consultations with subject matter experts. Identified navigation tools were independently screened by 2 authors, while data extraction was conducted by 3 authors. Extracted data were mapped to key domains and subdomains relevant to navigation tools. Results: From just a handful in 2020, by February 2024 this study identified 102 mental health care navigation tools across Australia. Primary Health Networks (n=37) and state or territory governments (n=21) were the predominant developers of these tools. While the majority of navigation tools were primarily designed for consumer use, many also included resources for health professionals and caregivers. Notably, no navigation tools were specifically designed for mental health care planners. Nearly all tools (except one) featured directories of mental health care services, although their functionalities varied: 27\% (n=27) provided referral information, 20\% (n=21) offered geolocated service maps, 12\% (n=12) included diagnostic screening capabilities, and 7\% (n=7) delineated care pathways. Conclusions: The variability of navigation tools designed to facilitate consumer access to mental health services could paradoxically contribute to further confusion. Despite the significant expansion of digital navigation tools in recent years, substantial gaps and challenges remain. These include inconsistencies in tool formats, resulting in variable information quality and validity; a lack of regularly updated service information, including wait times and availability for new clients; insufficient details on program exclusion criteria; and limited accessibility and user-friendliness. Moreover, the inclusion of self-assessment screening tools is infrequent, further limiting the utility of these resources. To address these limitations, we propose the development of a national directory of mental health navigation tools as a centralized resource, alongside a system to guide users toward the most appropriate tool for their individual needs. Addressing these issues will enhance consumer confidence and contribute to the overall accessibility, reliability, and utility of digital navigation tools in Australia's mental health system. ", doi="10.2196/60079", url="https://publichealth.jmir.org/2024/1/e60079" } @Article{info:doi/10.2196/65994, author="Hong, Minseok and Kang, Ri-Ra and Yang, Hun Jeong and Rhee, Jin Sang and Lee, Hyunju and Kim, Yong-gyom and Lee, KangYoon and Kim, HongGi and Lee, Sang Yu and Youn, Tak and Kim, Hyun Se and Ahn, Min Yong", title="Comprehensive Symptom Prediction in Inpatients With Acute Psychiatric Disorders Using Wearable-Based Deep Learning Models: Development and Validation Study", journal="J Med Internet Res", year="2024", month="Nov", day="13", volume="26", pages="e65994", keywords="digital phenotype", keywords="mental health monitoring", keywords="smart hospital", keywords="clinical decision support system", keywords="multitask learning", keywords="wearable sensor", keywords="local validation", keywords="mental health facility", keywords="deep learning", abstract="Background: Assessing the complex and multifaceted symptoms of patients with acute psychiatric disorders proves to be significantly challenging for clinicians. Moreover, the staff in acute psychiatric wards face high work intensity and risk of burnout, yet research on the introduction of digital technologies in this field remains limited. The combination of continuous and objective wearable sensor data acquired from patients with deep learning techniques holds the potential to overcome the limitations of traditional psychiatric assessments and support clinical decision-making. Objective: This study aimed to develop and validate wearable-based deep learning models to comprehensively predict patient symptoms across various acute psychiatric wards in South Korea. Methods: Participants diagnosed with schizophrenia and mood disorders were recruited from 4 wards across 3 hospitals and prospectively observed using wrist-worn wearable devices during their admission period. Trained raters conducted periodic clinical assessments using the Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale, and Young Mania Rating Scale. Wearable devices collected patients' heart rate, accelerometer, and location data. Deep learning models were developed to predict psychiatric symptoms using 2 distinct approaches: single symptoms individually (Single) and multiple symptoms simultaneously via multitask learning (Multi). These models further addressed 2 problems: within-subject relative changes (Deterioration) and between-subject absolute severity (Score). Four configurations were consequently developed for each scale: Single-Deterioration, Single-Score, Multi-Deterioration, and Multi-Score. Data of participants recruited before May 1, 2024, underwent cross-validation, and the resulting fine-tuned models were then externally validated using data from the remaining participants. Results: Of the 244 enrolled participants, 191 (78.3\%; 3954 person-days) were included in the final analysis after applying the exclusion criteria. The demographic and clinical characteristics of participants, as well as the distribution of sensor data, showed considerable variations across wards and hospitals. Data of 139 participants were used for cross-validation, while data of 52 participants were used for external validation. The Single-Deterioration and Multi-Deterioration models achieved similar overall accuracy values of 0.75 in cross-validation and 0.73 in external validation. The Single-Score and Multi-Score models attained overall R{\texttwosuperior} values of 0.78 and 0.83 in cross-validation and 0.66 and 0.74 in external validation, respectively, with the Multi-Score model demonstrating superior performance. Conclusions: Deep learning models based on wearable sensor data effectively classified symptom deterioration and predicted symptom severity in participants in acute psychiatric wards. Despite lower computational costs, Multi models demonstrated equivalent or superior performance to Single models, suggesting that multitask learning is a promising approach for comprehensive symptom prediction. However, significant variations were observed across wards, which present a key challenge for developing clinical decision support systems in acute psychiatric wards. Future studies may benefit from recurring local validation or federated learning to address generalizability issues. ", doi="10.2196/65994", url="https://www.jmir.org/2024/1/e65994" } @Article{info:doi/10.2196/64540, author="Becker, Elizabeth Molly and Stratton Levey, Nadine and Yeh, Y. Gloria and Giacino, Joseph and Iverson, Grant and Silverberg, Noah and Parker, A. Robert and McKinnon, Ellen and Siravo, Caitlin and Shah, Priyanca and Vranceanu, Ana-Maria and Greenberg, Jonathan", title="Preliminary Feasibility of a Novel Mind-Body Program to Prevent Persistent Concussion Symptoms Among Young Adults With Anxiety: Nonrandomized Open Pilot Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e64540", keywords="concussions", keywords="mind-body", keywords="preventions", keywords="young adults", keywords="feasibility", keywords="persistence", keywords="open pilot", keywords="mind-body program", keywords="preliminary feasibility", keywords="mild traumatic brain injuries", keywords="United States", keywords="adults", keywords="psychological factors", keywords="mind-body interventions", abstract="Background: Concussions are common, particularly among young adults, and often are associated with persistent, debilitating, and hard-to-treat symptoms. Anxiety and concussion symptoms often amplify each other, and growing evidence indicates that anxiety plays a key role in symptoms persistence after concussion. Targeting anxiety early after concussion may be a promising means of helping prevent persistent concussion symptoms in this population. We developed the Toolkit for Optimal Recovery after Concussion (TOR-C), the first mind-body program tailored for young adults with a recent concussion and anxiety, aiming to prevent persistent concussion symptoms. Objective: This study aims to conduct an open pilot of TOR-C to test preliminary feasibility, signal of change in measures, and treatment perceptions. Methods: Five young adults (aged 18-24 years) attended 4 weekly one-on-one live video sessions with a clinician. Participants completed questionnaires measuring treatment targets (ie, pain catastrophizing, mindfulness, fear avoidance, limiting behaviors, and all-or-nothing behaviors) and outcomes (ie, postconcussive symptoms, physical function, anxiety, depression, and pain) at baseline, immediately following the intervention, and 3 months after intervention completion. At the conclusion of the program, participants attended a qualitative interview and provided feedback about the program to help optimize study content and procedures. Results: Feasibility markers were excellent for credibility and expectancy (5/5, 100\% of participants scored above the credibility and expectancy scale midpoint), client satisfaction (4/5, 80\% of participants scored above the Client Satisfaction Questionnaire midpoint), therapist adherence (97\% adherence), acceptability of treatment (5/5, 100\% of participants attended 3 or more sessions), adherence to homework (87\% home practice completion), and feasibility of assessments (no measures fully missing). The feasibility of recruitment was good (5/7, 71\% of eligible participants agreed to participate). There were preliminary signals of improvements from pre-post comparisons in treatment targets (d=0.72-2.20) and outcomes (d=0.41-1.38), which were sustained after 3 months (d=0.38-2.74 and d=0.71-1.63 respectively). Exit interviews indicated overall positive perceptions of skills and highlighted barriers (eg, busyness) and facilitators (eg, accountability) to engagement. Conclusions: TOR-C shows preliminary feasibility, is associated with a signal of improvement in treatment targets and outcomes, and has the potential to support recovery from concussion. The quantitative findings along with the qualitative feedback obtained from the exit interviews will help optimize TOR-C in preparation for an upcoming randomized controlled trial of TOR-C versus an active control condition of health education for concussion recovery. International Registered Report Identifier (IRRID): RR2-10.2196/25746 ", doi="10.2196/64540", url="https://formative.jmir.org/2024/1/e64540" } @Article{info:doi/10.2196/51832, author="Hildebrand, Sophie Anne and Planert, Jari and Machulska, Alla and Margraf, Maria Lena and Roesmann, Kati and Klucken, Tim", title="Exploring Psychotherapists' Attitudes on Internet- and Mobile-Based Interventions in Germany: Thematic Analysis", journal="JMIR Form Res", year="2024", month="Nov", day="7", volume="8", pages="e51832", keywords="eHealth", keywords="psychotherapy", keywords="psychotherapists' perspectives", keywords="thematic analysis", keywords="internet- and mobile-based intervention", abstract="Background: In recent years, internet- and mobile-based interventions (IMIs) have become increasingly relevant in mental health care and have sparked societal debates. Psychotherapists' perspectives are essential for identifying potential opportunities for improvement, facilitating conditions, and barriers to the implementation of these interventions. Objective: This study aims to explore psychotherapists' perspectives on opportunities for improvement, facilitating conditions, and barriers to using IMIs. Methods: The study used a qualitative research design, utilizing open-ended items in a cross-sectional survey. A total of 350 psychotherapists were asked to provide their written opinions on various aspects of IMIs. Thematic analysis was conducted to analyze the data and identify core themes. Results: The analysis revealed 11 core themes related to the use of IMIs, which were categorized into 4 superordinate categories: ``Applicability,'' ``Treatment Resources,'' ``Technology,'' and ``Perceived Risks and Barriers.'' While many psychotherapists viewed IMIs as a valuable support for conventional psychotherapy, they expressed skepticism about using IMIs as a substitute. Several factors were perceived as hindrances to the applicability of IMIs in clinical practice, including technological issues, subjective concerns about potential data protection risks, a lack of individualization due to the manualized nature of most IMIs, and the high time and financial costs for both psychotherapists and patients. They expressed a desire for easily accessible information on evidence and programs to reduce the time and effort required for training and advocated for this information to be integrated into the conceptualization of new IMIs. Conclusions: The findings of this study emphasize the importance of considering psychotherapists' attitudes in the development, evaluation, and implementation of IMIs. This study revealed that psychotherapists recognized both the opportunities and risks associated with the use of IMIs, with most agreeing that IMIs serve as a tool to support traditional psychotherapy rather than as a substitute for it. Furthermore, it is essential to involve psychotherapists in discussions about IMIs specifically, as well as in the development of new methodologies in psychotherapy more broadly. Overall, this study can advance the use of IMIs in mental health care and contribute to the ongoing societal debate surrounding these interventions. ", doi="10.2196/51832", url="https://formative.jmir.org/2024/1/e51832" } @Article{info:doi/10.2196/48696, author="Nowels, Aideen Molly and McDarby, Meghan and Brody, Lilla and Kleiman, Evan and Sagui Henson, Sara and Castro Sweet, Cynthia and Kozlov, Elissa", title="Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study", journal="J Med Internet Res", year="2024", month="Nov", day="7", volume="26", pages="e48696", keywords="digital health", keywords="mental health", keywords="health care benefit", keywords="prediction", keywords="technology", keywords="digital mental health", keywords="employer-based", keywords="teletherapy", keywords="coaching", keywords="utilization", keywords="mobile phone", abstract="Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38\% using any self-directed digital mental health resources. Approximately 44\% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7\%). Those using only coaching or therapy (170/950, 17.9\%) and those using only self-directed digital mental health resources (126/950, 13.3\%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82\% (rate ratio [RR] 1.82, 95\% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80\% (RR 1.80, 95\% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95\% CI (1.03-1.05), and women had 23\% more self-directed digital resources interactions than men (RR 1.23, 95\% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming ``super users'' of all resources. ", doi="10.2196/48696", url="https://www.jmir.org/2024/1/e48696" } @Article{info:doi/10.2196/58068, author="Gorban, Carla and McKenna, Sarah and Chong, K. Min and Capon, William and Battisti, Robert and Crowley, Alison and Whitwell, Bradley and Ottavio, Antonia and Scott, M. Elizabeth and Hickie, B. Ian and Iorfino, Frank", title="Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study", journal="JMIR Ment Health", year="2024", month="Nov", day="6", volume="11", pages="e58068", keywords="digital navigator", keywords="digital coach", keywords="clinical technology specialist", keywords="mental health services", keywords="shared decision-making", keywords="lived experience", keywords="implementation", keywords="poor engagement", keywords="decision-making", keywords="mental health", keywords="digital mental health", keywords="digital mental health technology", doi="10.2196/58068", url="https://mental.jmir.org/2024/1/e58068" } @Article{info:doi/10.2196/54528, author="Nordberg, S. Samuel and Jaso-Yim, A. Brittany and Sah, Pratha and Schuler, Keke and Eyllon, Mara and Pennine, Mariesa and Hoyler, H. Georgia and Barnes, Ben J. and Murillo, Hong Lily and O'Dea, Heather and Orth, Laura and Rogers, Elizabeth and Welch, George and Peloquin, Gabrielle and Youn, Jeong Soo", title="Evaluating the Implementation and Clinical Effectiveness of an Innovative Digital First Care Model for Behavioral Health Using the RE-AIM Framework: Quantitative Evaluation", journal="J Med Internet Res", year="2024", month="Oct", day="30", volume="26", pages="e54528", keywords="digital mental health interventions", keywords="implementation", keywords="clinical effectiveness", keywords="practice-oriented research", keywords="access to care", abstract="Background: In the United States, innovation is needed to address the increasing need for mental health care services and widen the patient-to-provider ratio. Despite the benefits of digital mental health interventions (DMHIs), they have not been effective in addressing patients' behavioral health challenges as stand-alone treatments. Objective: This study evaluates the implementation and effectiveness of precision behavioral health (PBH), a digital-first behavioral health care model embedded within routine primary care that refers patients to an ecosystem of evidence-based DMHIs with strategically placed human support. Methods: Patient demographic information, triage visit outcomes, multidimensional patient-reported outcome measure, enrollment, and engagement with the DMHIs were analyzed using data from the electronic health record and vendor-reported data files. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate the implementation and clinical effectiveness outcomes of PBH. Results: PBH had a 47.58\% reach rate, defined as patients accepting the PBH referral from their behavioral health integrated clinician. PBH patients had high DMHI registration rates (79.62\%), high activation rates (76.54\%), and high retention rates at 15 days (57.69\%) and 30 days (44.58\%) compared to literature benchmarks. In total, 74.01\% (n=168) of patients showed clinical improvement, 22.47\% (n=51) showed no clinical change, and 3.52\% (n=8) showed clinical deterioration in symptoms. PBH had high adoption rates, with behavioral health integrated clinicians referring on average 4.35 (SD 0.46) patients to PBH per month and 90\%-100\% of clinicians (n=12) consistently referring at least 1 patient to PBH each month. A third (32\%, n=1114) of patients were offered PBH as a treatment option during their triage visit. Conclusions: PBH as a care model with evidence-based DMHIs, human support for patients, and integration within routine settings offers a credible service to support patients with mild to moderate mental health challenges. This type of model has the potential to address real-life access to care problems faced by health care settings. ", doi="10.2196/54528", url="https://www.jmir.org/2024/1/e54528" } @Article{info:doi/10.2196/58994, author="Kumar, Komal and Childs, W. Amber and Kohlmeier, Jonathan and Kroll, Elizabeth and Zant, Izabella and Stolzenbach, Stephanie and Fenkel, Caroline", title="Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative", journal="JMIR Form Res", year="2024", month="Oct", day="23", volume="8", pages="e58994", keywords="measurement-based care", keywords="MBC", keywords="remote", keywords="intensive outpatient program", keywords="IOP", keywords="mental health", keywords="implementation", abstract="Background: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. Objective: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. Methods: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. Results: The survey completion rate was 80.08\% (3216/4016) and 86.01\% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22\% and 29\% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Conclusions: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings. ", doi="10.2196/58994", url="https://formative.jmir.org/2024/1/e58994", url="http://www.ncbi.nlm.nih.gov/pubmed/39441653" } @Article{info:doi/10.2196/59512, author="Song, Meishu and Yang, Zijiang and Triantafyllopoulos, Andreas and Zhang, Zixing and Nan, Zhe and Tang, Muxuan and Takeuchi, Hiroki and Nakamura, Toru and Kishi, Akifumi and Ishizawa, Tetsuro and Yoshiuchi, Kazuhiro and Schuller, Bj{\"o}rn and Yamamoto, Yoshiharu", title="Empowering Mental Health Monitoring Using a Macro-Micro Personalization Framework for Multimodal-Multitask Learning: Descriptive Study", journal="JMIR Ment Health", year="2024", month="Oct", day="18", volume="11", pages="e59512", keywords="multimodal", keywords="multitask", keywords="daily mental health", keywords="mental health", keywords="monitoring", keywords="macro", keywords="micro", keywords="framework", keywords="personalization", keywords="strategies", keywords="prediction", keywords="emotional state", keywords="wristbands", keywords="smartphone", keywords="mobile phones", keywords="physiological", keywords="signals", keywords="speech data", keywords="", abstract="Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current noninvasive devices such as wristbands and smartphones are capable of collecting a wide range of data, which has not yet been fully used for mental health monitoring. Objective: This study aims to introduce a novel dataset for personalized daily mental health monitoring and a new macro-micro framework. This framework is designed to use multimodal and multitask learning strategies for improved personalization and prediction of emotional states in individuals. Methods: Data were collected from 298 individuals using wristbands and smartphones, capturing physiological signals, speech data, and self-annotated emotional states. The proposed framework combines macro-level emotion transformer embeddings with micro-level personalization layers specific to each user. It also introduces a Dynamic Restrained Uncertainty Weighting method to effectively integrate various data types for a balanced representation of emotional states. Several fusion techniques, personalization strategies, and multitask learning approaches were explored. Results: The proposed framework was evaluated using the concordance correlation coefficient, resulting in a score of 0.503. This result demonstrates the framework's efficacy in predicting emotional states. Conclusions: The study concludes that the proposed multimodal and multitask learning framework, which leverages transformer-based techniques and dynamic task weighting strategies, is superior for the personalized monitoring of mental health. The study indicates the potential of transforming daily mental health monitoring into a more personalized app, opening up new avenues for technology-based mental health interventions. ", doi="10.2196/59512", url="https://mental.jmir.org/2024/1/e59512", url="http://www.ncbi.nlm.nih.gov/pubmed/39422993" } @Article{info:doi/10.2196/56574, author="Ridout, J. Samuel and Ridout, K. Kathryn and Lin, Y. Teresa and Campbell, I. Cynthia", title="Clinical Use of Mental Health Digital Therapeutics in a Large Health Care Delivery System: Retrospective Patient Cohort Study and Provider Survey", journal="JMIR Ment Health", year="2024", month="Oct", day="2", volume="11", pages="e56574", keywords="digital therapeutics", keywords="depression", keywords="anxiety", keywords="mental health", keywords="retrospective cohort", keywords="electronic health record", keywords="adults", keywords="survey", keywords="recommendation", keywords="mobile phone", abstract="Background: While the number of digital therapeutics (DTx) has proliferated, there is little real-world research on the characteristics of providers recommending DTx, their recommendation behaviors, or the characteristics of patients receiving recommendations in the clinical setting. Objective: The aim of this study was to characterize the clinical and demographic characteristics of patients receiving DTx recommendations and describe provider characteristics and behaviors regarding DTx. Methods: This retrospective cohort study used electronic health record data from a large, integrated health care delivery system. Demographic and clinical characteristics of adult patients recommended versus not recommended DTx by a mental health provider between May 2020 and December 2021 were examined. A cross-sectional survey of mental health providers providing these recommendations was conducted in December 2022 to assess the characteristics of providers and recommendation behaviors related to DTx. Parametric and nonparametric tests were used to examine statistical significance between groups. Results: Of 335,250 patients with a mental health appointment, 53,546 (16\%) received a DTx recommendation. Patients recommended to DTx were younger, were of Asian or Hispanic race or ethnicity, were female, were without medical comorbidities, and had commercial insurance compared to those without a DTx recommendation (P<.001). More patients receiving a DTx recommendation had anxiety or adjustment disorder diagnoses, but less had depression, bipolar, or psychotic disorder diagnoses (P<.001) versus matched controls not recommended to DTx. Overall, depression and anxiety symptom scores were lower in patients recommended to DTx compared to matched controls not receiving a recommendation, although female patients had a higher proportion of severe depression and anxiety scores compared to male patients. Provider survey results indicated a higher proportion of nonprescribers recommended DTx to patients compared to prescribers (P=.008). Of all providers, 29.4\% (45/153) reported using the suggested internal electronic health record--based tools (eg, smart text) to recommend DTx, and of providers recommending DTx resources to patients, 64.1\% (98/153) reported they follow up with patients to inquire on DTx benefits. Only 38.4\% (58/151) of respondents report recommending specific DTx modules, and of those, 58.6\% (34/58) report following up on the impact of these specific modules. Conclusions: DTx use in mental health was modest and varied by patient and provider characteristics. Providers do not appear to actively engage with these tools and integrate them into treatment plans. Providers, while expressing interest in potential benefits from DTx, may view DTx as a passive strategy to augment traditional treatment for select patients. ", doi="10.2196/56574", url="https://mental.jmir.org/2024/1/e56574" } @Article{info:doi/10.2196/59939, author="Robinson, Athena and Flom, Megan and Forman-Hoffman, L. Valerie and Histon, Trina and Levy, Monique and Darcy, Alison and Ajayi, Toluwalase and Mohr, C. David and Wicks, Paul and Greene, Carolyn and Montgomery, M. Robert", title="Equity in Digital Mental Health Interventions in the United States: Where to Next?", journal="J Med Internet Res", year="2024", month="Sep", day="24", volume="26", pages="e59939", keywords="Digital Mental Health Interventions", keywords="mental health", keywords="health equity", keywords="access to health care", keywords="health plan implementations", doi="10.2196/59939", url="https://www.jmir.org/2024/1/e59939", url="http://www.ncbi.nlm.nih.gov/pubmed/39316436" } @Article{info:doi/10.2196/58198, author="Fitzpatrick, Skye and Crenshaw, O. Alexander and Donkin, Victoria and Collins, Alexis and Xiang, Angela and Earle, A. Elizabeth and Goenka, Kamya and Varma, Sonya and Bushe, Julianne and McFadden, Tara and Librado, Andrea and Monson, Candice", title="We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party?", journal="J Med Internet Res", year="2024", month="Sep", day="19", volume="26", pages="e58198", keywords="online interventions", keywords="self-help", keywords="digital interventions", keywords="mental health", keywords="psychotherapy", keywords="intervention desirability", doi="10.2196/58198", url="https://www.jmir.org/2024/1/e58198" } @Article{info:doi/10.2196/58462, author="Benda, Natalie and Desai, Pooja and Reza, Zayan and Zheng, Anna and Kumar, Shiveen and Harkins, Sarah and Hermann, Alison and Zhang, Yiye and Joly, Rochelle and Kim, Jessica and Pathak, Jyotishman and Reading Turchioe, Meghan", title="Patient Perspectives on AI for Mental Health Care: Cross-Sectional Survey Study", journal="JMIR Ment Health", year="2024", month="Sep", day="18", volume="11", pages="e58462", keywords="artificial intelligence", keywords="AI", keywords="mental health", keywords="patient perspectives", keywords="patients", keywords="public survey", keywords="application", keywords="applications", keywords="health care", keywords="health professionals", keywords="somatic issues", keywords="radiology", keywords="perinatal health", keywords="Black", keywords="professional relationship", keywords="patient-health", keywords="autonomy", keywords="risk", keywords="confidentiality", keywords="machine learning", keywords="digital mental health", keywords="computing", keywords="coding", keywords="mobile phone", abstract="Background: The application of artificial intelligence (AI) to health and health care is rapidly increasing. Several studies have assessed the attitudes of health professionals, but far fewer studies have explored the perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues, including those related to radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health care solutions, but broader perspectives toward AI for mental health care have been underexplored. Objective: This study aims to understand public perceptions regarding potential benefits of AI, concerns about AI, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health care. Methods: We conducted a 1-time cross-sectional survey with a nationally representative sample of 500 US-based adults. Participants provided structured responses on their perceived benefits, concerns, comfort, and values regarding AI for mental health care. They could also add free-text responses to elaborate on their concerns and values. Results: A plurality of participants (245/497, 49.3\%) believed AI may be beneficial for mental health care, but this perspective differed based on sociodemographic variables (all P<.05). Specifically, Black participants (odds ratio [OR] 1.76, 95\% CI 1.03-3.05) and those with lower health literacy (OR 2.16, 95\% CI 1.29-3.78) perceived AI to be more beneficial, and women (OR 0.68, 95\% CI 0.46-0.99) perceived AI to be less beneficial. Participants endorsed concerns about accuracy, possible unintended consequences such as misdiagnosis, the confidentiality of their information, and the loss of connection with their health professional when AI is used for mental health care. A majority of participants (80.4\%, 402/500) valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked who was responsible for the misdiagnosis of mental health conditions using AI, 81.6\% (408/500) of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of patients' information. Conclusions: Future work involving the use of AI for mental health care should investigate strategies for conveying the level of AI's accuracy, factors that drive patients' mental health risks, and how data are used confidentially so that patients can determine with their health professionals when AI may be beneficial. It will also be important in a mental health care context to ensure the patient--health professional relationship is preserved when AI is used. ", doi="10.2196/58462", url="https://mental.jmir.org/2024/1/e58462" } @Article{info:doi/10.2196/58939, author="Hall, L. Charlotte and G{\'o}mez Bergin, D. Aislinn and Rennick-Egglestone, Stefan", title="Research Into Digital Health Intervention for Mental Health: 25-Year Retrospective on the Ethical and Legal Challenges", journal="J Med Internet Res", year="2024", month="Sep", day="9", volume="26", pages="e58939", keywords="digital mental health intervention", keywords="research ethics", keywords="compliance", keywords="regulation", keywords="digital health", keywords="mobile health", keywords="mhealth", keywords="intervention", keywords="interventions", keywords="mental health", keywords="retrospective", keywords="ethical", keywords="legal", keywords="challenge", keywords="challenges", doi="10.2196/58939", url="https://www.jmir.org/2024/1/e58939" } @Article{info:doi/10.2196/56402, author="Darnell, Doyanne and Pierson, Andria and Tanana, J. Michael and Dorsey, Shannon and Boudreaux, D. Edwin and Are{\'a}n, A. Patricia and Comtois, Anne Katherine", title="Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training", journal="JMIR Form Res", year="2024", month="Sep", day="6", volume="8", pages="e56402", keywords="suicide prevention", keywords="hospital", keywords="training", keywords="e-learning", keywords="artificial intelligence", keywords="AI", keywords="task-shifting", keywords="quality assessment", keywords="fidelity", keywords="acceptability", keywords="feasibility", keywords="eLearning", keywords="suicide", keywords="quality", keywords="innovative", keywords="nurse", keywords="education training", keywords="safety planning", keywords="pilot study", keywords="virtual patient", keywords="web-based", keywords="role-play", keywords="microcounseling skills", keywords="United States", abstract="Background: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. Objective: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. Methods: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses' performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. Results: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94\%) and White (n=13, 72\%). Of the 17 nurses who started the training, 82\% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (?14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). Conclusions: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. International Registered Report Identifier (IRRID): RR2-10.2196/33695 ", doi="10.2196/56402", url="https://formative.jmir.org/2024/1/e56402" } @Article{info:doi/10.2196/56197, author="Mejsner, Buch Sofie and Aslaug, Jane and Bech, Mickael and Burau, Viola and Mark, Dorte and Vix{\o}, Kathrine and Westergaard, Louise Caroline and Fehsenfeld, Michael", title="Exploring New Models for Implementing Sustainable Integrated Health Access for People in Vulnerable Positions: Protocol for a Mixed Methods Multiple Case Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="23", volume="13", pages="e56197", keywords="health care organization", keywords="social inequality in health", keywords="vulnerable people", keywords="integrated health access", keywords="healthcare access", keywords="accessibility", keywords="healthcare", keywords="Europe", keywords="social inequalities", keywords="health inequalities", keywords="mental illness", keywords="inequality", keywords="Denmark", abstract="Background: Health care is a strongly universal right across European welfare states; however, social inequalities in health persist. This literature argues that health care organization is an important but overlooked determinant of social inequalities in health, as health systems buffer or amplify structural and individual health determinants. The Client-Centered Coordination Platform (3CP) model offers integrated health access to people with severe mental illness, through core groups of professionals from across health and social services. Objective: This study focuses on vulnerable people with severe mental health problems and aims to analyze how the model can give people with severe mental illness more integrated access to health and social care. This can form a stepping-stone for the upscaling of the 3CP model. Methods: We conduct a 5-year multiple case study of 3 municipalities in Denmark, where 3CP is being implemented. In a 1-year pilot study, we expect to gather quantitative registry data from the municipalities and the Central Denmark Region to explore the characteristics of people included in 3CP. We will also collect qualitative data, including 21 hours of observations; 36 interviews with users, professionals, and managers; and 3 focus groups across the 3 municipalities. In a subsequent, 4-year qualitative study, we aim to conduct 120 hours of observations, 120 interviews, and 24 focus groups. In parallel with the qualitative study, we will facilitate a cocreation process to develop tools for sustaining integrated health access. Results: As of January 2024, we have completed the individual interviews with users of 3CP and professionals and the focus groups. Individual interviews of managers will be conducted during the 1st quarter of 2024. The quantitative data are being collected. Conclusions: Inequality is one of the greatest challenges that European societies face. Understanding new and innovative approaches to integrated care may provide valuable solutions to the challenges posed. Especially understanding and designing health and social care systems that meet the needs and abilities of those users requiring them most, is vitally important to tackle inequality. International Registered Report Identifier (IRRID): DERR1-10.2196/56197 ", doi="10.2196/56197", url="https://www.researchprotocols.org/2024/1/e56197" } @Article{info:doi/10.2196/57990, author="Ramos, Nicolas Francisco and Bernstein, A. Rachel and Ezawa, D. Iony", title="Assessing Predictive Factors of Attitudes Toward Peer-Supported Mental Health Interventions in the Metaverse: Mixed Methods Study", journal="JMIR XR Spatial Comput", year="2024", month="Aug", day="22", volume="1", pages="e57990", keywords="metaverse", keywords="mental health intervention", keywords="consumer attitude", keywords="digital mental health intervention", keywords="virtual world", abstract="Background: The metaverse is a promising avenue for accessible, effective digital mental health treatments. However, general attitudes toward peer-supported metaverse mental health interventions (MMHIs) remain largely unexplored. Objective: This study examined the relation of sociodemographic, mental health, and technology factors in predicting attitudes toward MMHIs. Methods: We used a mixed methods design with a self-report online survey (N=545 participants) to assess participant attitudes toward MMHIs and sociodemographic, mental health, and technology factors. Ordinal logistic regression was used to examine predictors of general interest in peer-supported MMHIs and binary logistic regression to examine predictors of preference for MMHIs versus face-to-face interventions. Inductive content analysis was performed on 483 open-ended responses regarding intervention preference. Results: Older age (odds ratio [OR] 1.03, 95\% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.44, 95\% CI 1.25-1.66; P<.001), more positive mental help--seeking attitudes (OR 1.22, 95\% CI 1.06-1.42; P=.007), more online video game use (OR 1.26, 95\% CI 1.09-1.44; P=.001), and greater virtual reality experience (OR 1.55, 95\% CI 1.28-1.90; P<.001) were associated with greater odds of reporting more interest in MMHIs. Internet access was associated with greater odds of reporting less interest in MMHIs (OR 0.50, 95\% CI 0.30-0.84; P=.01). Hispanic ethnicity (OR 1.81, 95\% CI 1.13-2.90; P=.01), older age (OR 1.04, 95\% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.28, 95\% CI 1.09-1.51; P=.003), smartphone access (OR 10.46, 95\% CI 2.87-50.71; P<.001), higher self-reported video game use (OR 1.25, 95\% CI 1.05-1.48; P=.01), and more positive computer attitudes (OR 1.05, 95\% CI 1.01-1.10; P=.02) predicted greater odds of preference for MMHIs (versus face-to-face interventions), whereas the male gender (OR 0.43, 95\% CI 0.28-0.68; P<.001), internet access (OR 0.12, 95\% CI 0.02-0.40; P=.002), more positive mental help--seeking attitudes (OR 0.76, 95\% CI 0.62-0.92; P=.005), and moderately severe (OR 0.20, 95\% CI 0.07-0.51; P=.001) and severe (OR 0.26, 95\% CI 0.08-0.79; P=.02) levels of depression symptoms predicted lower odds of preference for MMHIs. Qualitative analysis revealed 14 themes describing reasons for intervention preference. Anonymity (133/483, 27.5\%), social aversion (38/483, 7.9\%), ease of use and accessibility (35/483, 7.2\%), anxiety (28/483, 5.8\%), and comfort (26/483, 5.4\%) tended to be endorsed by those preferring MMHIs. Ecological validity of social interactions (99/483, 20.5\%), ecological validity of interventions (75/483, 15.5\%), aversion/distrust toward technology (42/483, 8.7\%), impersonal quality (31/483, 6.4\%), and immersion/engagement (11/483, 2.3\%) tended to be endorsed by those who preferred face-to-face interventions. Mental health attitudes (28/483, 5.8\%), privacy (19/483, 3.9\%), and miscellaneous reasons (46/483, 9.5\%) were endorsed equally between preferences. Novelty (21/483, 4.3\%) was most cited by those who expressed no preference. Conclusions: This study identified several factors associated with attitudes toward peer-supported MMHIs, which may be leveraged to inform mental health outreach to interested populations. ", doi="10.2196/57990", url="https://xr.jmir.org/2024/1/e57990" } @Article{info:doi/10.2196/53794, author="Jackson, M. Hayley and Batterham, J. Philip and Calear, L. Alison and Ohan, L. Jeneva and Farrer, M. Louise", title="Skill Enactment Among University Students Using a Brief Video-Based Mental Health Intervention: Mixed Methods Study Within a Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="Aug", day="21", volume="11", pages="e53794", keywords="university students", keywords="young people", keywords="internet", keywords="computer-assisted therapy", keywords="engagement", keywords="skill enactment", keywords="depression", keywords="anxiety", keywords="randomized controlled trial", keywords="mobile phone", abstract="Background: Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions can increase students' access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (ie, skill enactment) or about the impact of skill enactment on outcomes. Objective: This study aims to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment influences symptoms of depression and anxiety (secondary aim). The study also qualitatively explored participants' experiences of, and motivations for, engaging with the therapeutic techniques. Methods: We analyzed data from a randomized controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants were recruited from universities across Australia and randomly assigned to 6 weeks of self-guided use of UVC-Lite (243/487, 49.9\%) or an attention-control program (244/487, 50.1\%). Quantitative data on skill enactment, depression, and anxiety were collected through baseline, postintervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention-group participants through open-ended questions during postintervention surveys (n=17, 59\%) and semistructured interviews (n=12, 41\%) after the intervention period concluded. Results: Mixed model repeated measures ANOVA demonstrated that the intervention did not significantly improve skill enactment (F3,215.36=0.50; P=.68). Skill enactment was also not found to influence change in symptoms of depression (F3,241.10=1.69; P=.17) or anxiety (F3,233.71=1.11; P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F1,541.87=134.61; P<.001; anxiety: F1,535.11=73.08; P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past. Conclusions: The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention's impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in digital mental health interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://tinyurl.com/7b9ar54r ", doi="10.2196/53794", url="https://mental.jmir.org/2024/1/e53794" } @Article{info:doi/10.2196/53672, author="Xian, Xuechang and Chang, Angela and Xiang, Yu-Tao and Liu, Tingchi Matthew", title="Debate and Dilemmas Regarding Generative AI in Mental Health Care: Scoping Review", journal="Interact J Med Res", year="2024", month="Aug", day="12", volume="13", pages="e53672", keywords="generative artificial intelligence", keywords="GAI", keywords="ChatGPT", keywords="mental health", keywords="scoping review", keywords="artificial intelligence", keywords="depression", keywords="anxiety", keywords="generative adversarial network", keywords="GAN", keywords="variational autoencoder", keywords="VAE", abstract="Background: Mental disorders have ranked among the top 10 prevalent causes of burden on a global scale. Generative artificial intelligence (GAI) has emerged as a promising and innovative technological advancement that has significant potential in the field of mental health care. Nevertheless, there is a scarcity of research dedicated to examining and understanding the application landscape of GAI within this domain. Objective: This review aims to inform the current state of GAI knowledge and identify its key uses in the mental health domain by consolidating relevant literature. Methods: Records were searched within 8 reputable sources including Web of Science, PubMed, IEEE Xplore, medRxiv, bioRxiv, Google Scholar, CNKI and Wanfang databases between 2013 and 2023. Our focus was on original, empirical research with either English or Chinese publications that use GAI technologies to benefit mental health. For an exhaustive search, we also checked the studies cited by relevant literature. Two reviewers were responsible for the data selection process, and all the extracted data were synthesized and summarized for brief and in-depth analyses depending on the GAI approaches used (traditional retrieval and rule-based techniques vs advanced GAI techniques). Results: In this review of 144 articles, 44 (30.6\%) met the inclusion criteria for detailed analysis. Six key uses of advanced GAI emerged: mental disorder detection, counseling support, therapeutic application, clinical training, clinical decision-making support, and goal-driven optimization. Advanced GAI systems have been mainly focused on therapeutic applications (n=19, 43\%) and counseling support (n=13, 30\%), with clinical training being the least common. Most studies (n=28, 64\%) focused broadly on mental health, while specific conditions such as anxiety (n=1, 2\%), bipolar disorder (n=2, 5\%), eating disorders (n=1, 2\%), posttraumatic stress disorder (n=2, 5\%), and schizophrenia (n=1, 2\%) received limited attention. Despite prevalent use, the efficacy of ChatGPT in the detection of mental disorders remains insufficient. In addition, 100 articles on traditional GAI approaches were found, indicating diverse areas where advanced GAI could enhance mental health care. Conclusions: This study provides a comprehensive overview of the use of GAI in mental health care, which serves as a valuable guide for future research, practical applications, and policy development in this domain. While GAI demonstrates promise in augmenting mental health care services, its inherent limitations emphasize its role as a supplementary tool rather than a replacement for trained mental health providers. A conscientious and ethical integration of GAI techniques is necessary, ensuring a balanced approach that maximizes benefits while mitigating potential challenges in mental health care practices. ", doi="10.2196/53672", url="https://www.i-jmr.org/2024/1/e53672" } @Article{info:doi/10.2196/47100, author="O'Shea, MJ Amy and Mulligan, Kailey and Carter, D. Knute and Haraldsson, Bjarni and Wray, M. Charlie and Shahnazi, Ariana and Kaboli, J. Peter", title="Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study", journal="J Med Internet Res", year="2024", month="Aug", day="8", volume="26", pages="e47100", keywords="broadband", keywords="telemedicine", keywords="Federal Communications Commission", keywords="veterans", keywords="United States Department of Veterans Affairs", keywords="internet", keywords="mental health care", keywords="veteran health", keywords="broadband access", keywords="web-based", keywords="digital", abstract="Background: The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized. Objective: This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA). Methods: Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use. Results: Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3\%, SD 12.5\% vs Microsoft mean 48.2\%, SD 18.1\%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70\%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95\% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95\% CI 6.78-7.81). This relationship held across all broadband access levels assessed. Conclusions: This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes. ", doi="10.2196/47100", url="https://www.jmir.org/2024/1/e47100" } @Article{info:doi/10.2196/51315, author="Oliver, Amy and Chandler, Ella and Gillard, A. Julia", title="Impact of Digital Inclusion Initiative to Facilitate Access to Mental Health Services: Service User Interview Study", journal="JMIR Ment Health", year="2024", month="Jul", day="26", volume="11", pages="e51315", keywords="digital exclusion", keywords="digital inclusion", keywords="video consultation", keywords="COVID-19", keywords="tablet loan scheme", keywords="mental health", keywords="telemedicine", keywords="digital divide", keywords="digital inequality", keywords="technology", abstract="Background: Digital exclusion, characterized by a lack of access to digital technology, connectivity, or digital skills, disproportionally affects marginalized groups. An important domain impacted by digital exclusion is access to health care. During COVID-19, health care services had to restrict face-to-face contact to limit the spread of the virus. The subsequent shift toward remote delivery of mental health care exacerbated the digital divide, with limited access to remote mental health care delivery. In response, Camden and Islington National Health Service Foundation Trust launched the innovative Digital Inclusion Scheme (DIS). Objective: This study aimed to examine the impact of facilitating digital inclusion in mental health access. Camden and Islington National Health Service Foundation Trust implemented the trust-wide DIS for service users who were digitally excluded, that is, were without devices or connectivity or reported poor digital skills. The scheme provided access to a loan digital device (a tablet), internet connectivity devices, and mobile data, as well as personalized digital skills support. Methods: The DIS went live in October 2021 and received 106 referrals by June 2022. Semistructured interviews were conducted with 12 service users to ask about their experience of accessing the DIS. A thematic analysis identified themes and subthemes relating to the extent of their digital exclusion before engaging with the scheme and the impact of accessing a scheme on their ability to engage with digital technology and well-being. Results: There were 10 major themes. A total of 6 themes were related to factors impacting the engagement with the scheme, including digital exclusion, relationship to the trust, the importance of personalized digital support, partnership working, device usability and accessibility, and personal circumstances. The remaining 4 themes spoke to the impact of accessing the scheme, including improved access to services, impact on well-being, financial implications, and a greater sense of empowerment. Conclusions: Participants reported an increased reliance on technology driving the need for digital inclusion; however, differences in motivation for engaging with the scheme were noted, as well as potential barriers, including lack of awareness, disability, and age. Overall, the experience of accessing the DIS was reported as positive, with participants feeling supported to access the digital world. The consequences of engaging with the scheme included greater perceived access to and control of physical and mental health care, improved well-being, and a greater sense of empowerment. An overview of the lessons learned are provided along with suggestions for other health care settings that are looking to implement similar schemes. ", doi="10.2196/51315", url="https://mental.jmir.org/2024/1/e51315" } @Article{info:doi/10.2196/55100, author="Lyzwinski, Lynnette and Mcdonald, Sheila and Zwicker, Jennifer and Tough, Suzanne", title="Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis", journal="JMIR Pediatr Parent", year="2024", month="Jun", day="25", volume="7", pages="e55100", keywords="mental health", keywords="knowledge translation", keywords="KT", keywords="flourishing", keywords="youth", keywords="teenagers", keywords="mindfulness", keywords="positive psychology", keywords="telehealth", keywords="implementation", keywords="knowledge dissemination", keywords="pandemic", keywords="COVID-19", keywords="service delivery", abstract="Background: The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective: The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. Methods: We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). Results: A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. Conclusions: There is an opportunity to reduce the barriers to implementing tele--mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele--mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation. ", doi="10.2196/55100", url="https://pediatrics.jmir.org/2024/1/e55100", url="http://www.ncbi.nlm.nih.gov/pubmed/38916946" } @Article{info:doi/10.2196/52801, author="Kramer, Joanna and Wilens, E. Timothy and Rao, Vinod and Villa, Richard and Yule, M. Amy", title="Feasibility of a 2-Part Substance Use Screener Self-Administered by Patients on Paper: Observational Study", journal="JMIR Form Res", year="2024", month="Jun", day="25", volume="8", pages="e52801", keywords="patient reported outcome measures", keywords="patient reported outcomes", keywords="substance use screening", keywords="paper and pencil screening", keywords="screening", keywords="tobacco", keywords="prescription medication", keywords="medication", keywords="substance use", keywords="care", keywords="mental health", keywords="symptoms", abstract="Background: Measurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. Objective: This study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener---the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)---on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual's responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. Methods: From August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. Results: A total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9\%) patients were male. They were predominantly Black (n=212, 41.8\%), White (n=152, 30\%), and non-Hispanic or non-Latino (n=403, 79.5\%). Most of the patients were publicly insured (n=411, 81.1\%). Among these 507 patients, 313 (61.7\%) completed the TAPS screener. Of these 313 patients, 76 (24.3\%) adhered to the instructions and 237 (75.7\%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70\%) answered more questions and 71 (30\%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6\%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. Conclusions: It was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented. ", doi="10.2196/52801", url="https://formative.jmir.org/2024/1/e52801", url="http://www.ncbi.nlm.nih.gov/pubmed/38916950" } @Article{info:doi/10.2196/48298, author="Roos, G. Lydia and Sagui-Henson, J. Sara and Castro Sweet, Cynthia and Welcome Chamberlain, E. Camille and Smith, J. Brooke", title="Improvement and Maintenance of Clinical Outcomes in a Digital Mental Health Platform: Findings From a Longitudinal Observational Real-World Study", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="24", volume="12", pages="e48298", keywords="digital mental health", keywords="employee health", keywords="depression", keywords="anxiety", keywords="well-being", keywords="mobile phone", abstract="Background: Digital mental health services are increasingly being provided by employers as health benefit programs that can improve access to and remove barriers to mental health care. Stratified care models, in particular, offer personalized care recommendations that can offer clinically effective interventions while conserving resources. Nonetheless, clinical evaluation is needed to understand their benefits for mental health and their use in a real-world setting. Objective: This study aimed to examine the changes in clinical outcomes (ie, depressive and anxiety symptoms and well-being) and to evaluate the use of stratified blended care among members of an employer-sponsored digital mental health benefit. Methods: In a large prospective observational study, we examined the changes in depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item Generalized Anxiety Disorder scale), and well-being (5-item World Health Organization Well-Being Index) for 3 months in 509 participants (mean age 33.9, SD 8.7 years; women: n=312, 61.3\%; men: n=175, 34.4\%; nonbinary: n=22, 4.3\%) who were newly enrolled and engaged in care with an employer-sponsored digital mental health platform (Modern Health Inc). We also investigated the extent to which participants followed the recommendations provided to them through a stratified blended care model. Results: Participants with elevated baseline symptoms of depression and anxiety exhibited significant symptom improvements, with a 37\% score improvement in depression and a 29\% score improvement in anxiety (P values <.001). Participants with baseline scores indicative of poorer well-being also improved over the study period (90\% score improvement; P=.002). Furthermore, over half exhibited clinical improvement or recovery for depressive symptoms (n=122, 65.2\%), anxiety symptoms (n=127, 59.1\%), and low well-being (n=82, 64.6\%). Among participants with mild or no baseline symptoms, we found high rates of maintenance for low depressive (n=297, 92.2\%) and anxiety (n=255, 86.7\%) symptoms and high well-being (n=344, 90.1\%). In total, two-thirds of the participants (n=343, 67.4\%) used their recommended care, 16.9\% (n=86) intensified their care beyond their initial recommendation, and 15.7\% (n=80) of participants underused care by not engaging with the highest level of care recommended to them. Conclusions: Participants with elevated baseline depressive or anxiety symptoms improved their mental health significantly from baseline to follow-up, and most participants without symptoms or with mild symptoms at baseline maintained their mental health over time. In addition, engagement patterns indicate that the stratified blended care model was efficient in matching individuals with the most effective and least costly care while also allowing them to self-determine their care and use combinations of services that best fit their needs. Overall, the results of this study support the clinical effectiveness of the platform for improving and preserving mental health and support the utility and effectiveness of stratified blended care models to improve access to and use of digitally delivered mental health services. ", doi="10.2196/48298", url="https://mhealth.jmir.org/2024/1/e48298", url="http://www.ncbi.nlm.nih.gov/pubmed/38913405" } @Article{info:doi/10.2196/56687, author="Wang, Ye and Shi, Changjing and Wang, Xinyun and Meng, Hua and Chen, Junqiang", title="The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis", journal="JMIR Form Res", year="2024", month="Jun", day="17", volume="8", pages="e56687", keywords="static characteristics of physicians", keywords="internet hospitals", keywords="telemedicine", keywords="statistical analysis", keywords="online consultation", keywords="web-based consultation", keywords="teleconsultation", keywords="physician", keywords="patient", abstract="Background: Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor's clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor's credentials and accomplishments patients prioritize during their selection process. Objective: Our primary aim is to delve deeper into the correlation between physicians' static characteristics---such as their qualifications, experiences, and profiles on the internet---and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction. Methods: We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors' internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice. Results: The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data ($\rho$=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001). Conclusions: Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction. ", doi="10.2196/56687", url="https://formative.jmir.org/2024/1/e56687", url="http://www.ncbi.nlm.nih.gov/pubmed/38885498" } @Article{info:doi/10.2196/57965, author="Nielsen, Stecher Martine and Steinsbekk, Aslak and N{\o}st, Hatlen Torunn", title="Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study", journal="JMIR Ment Health", year="2024", month="Jun", day="6", volume="11", pages="e57965", keywords="electronic health record", keywords="EHR", keywords="electronic health records", keywords="EHRs", keywords="electronic medical record", keywords="EMR", keywords="electronic medical records", keywords="EMRs", keywords="patient record", keywords="health record", keywords="health records", keywords="personal health record", keywords="PHR", keywords="online access to electronic health records", keywords="open notes", keywords="clinical notes", keywords="adolescent mental health care", keywords="adolescent mental health", keywords="child mental health", keywords="mental health", keywords="mental illness", keywords="mental illnesses", keywords="mental disorder", keywords="mental disorders", keywords="recommendations", keywords="Delphi study", keywords="digital mental health", keywords="e-health", keywords="eHealth", keywords="e--mental health", keywords="health care professionals", keywords="digital health care", abstract="Background: In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective: The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals' digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods: A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results: Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60\% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions: A total of 17 recommendations related to key aspects of health care professionals' digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice. ", doi="10.2196/57965", url="https://mental.jmir.org/2024/1/e57965" } @Article{info:doi/10.2196/44443, author="Weng, Huiqin Janice and Hu, Yanyan and Heaukulani, Creighton and Tan, Clarence and Chang, Kuiyu Julian and Phang, Sheng Ye and Rajendram, Priyanka and Tan, Mooi Weng and Loke, Chiong Wai and Morris, T. Robert J.", title="Mental Wellness Self-Care in Singapore With mindline.sg: A Tutorial on the Development of a Digital Mental Health Platform for Behavior Change", journal="J Med Internet Res", year="2024", month="Jun", day="4", volume="26", pages="e44443", keywords="digital mental health", keywords="artificial intelligence", keywords="AI", keywords="AI chatbot", keywords="digital therapeutics", keywords="mental health", keywords="mental wellness", keywords="mobile phone", abstract="Background: Singapore, like the rest of Asia, faces persistent challenges to mental health promotion, including stigma around unwellness and seeking treatment and a lack of trained mental health personnel. The COVID-19 pandemic, which created a surge in mental health care needs and simultaneously accelerated the adoption of digital health solutions, revealed a new opportunity to quickly scale innovative solutions in the region. Objective: In June 2020, the Singaporean government launched mindline.sg, an anonymous digital mental health resource website that has grown to include >500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an artificial intelligence (AI) chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. Methods: Website use is measured through click-level data analytics captured via Google Analytics and custom application programming interfaces, which in turn drive a customized analytics infrastructure based on the open-source platforms Titanium Database and Metabase. Unique, nonbounced (users that do not immediately navigate away from the site), engaged, and return users are reported. Results: In the 2 years following launch (July 1, 2020, through June 30, 2022), the website received >447,000 visitors (approximately 15\% of the target population of 3 million), 62.02\% (277,727/447,783) of whom explored the site or engaged with resources (referred to as nonbounced visitors); 10.54\% (29,271/277,727) of those nonbounced visitors returned. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.54\% (67,626/264,758) and 11.69\% (32,469/277,727) of nonbounced visitors. On mindline at work, the rates of nonbounced visitors who engaged extensively (ie, spent ?40 seconds exploring resources) and who returned were 51.56\% (22,474/43,588) and 13.43\% (5,853/43,588) over a year, respectively, compared to 30.9\% (42,829/138,626) and 9.97\% (13,822/138,626), respectively, on the generic mindline.sg site in the same year. Conclusions: The site has achieved desired reach and has seen a strong growth rate in the number of visitors, which required substantial and sustained digital marketing campaigns and strategic outreach partnerships. The site was careful to preserve anonymity, limiting the detail of analytics. The good levels of overall adoption encourage us to believe that mild to moderate mental health conditions and the social factors that underly them are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customization are widely and globally applicable. ", doi="10.2196/44443", url="https://www.jmir.org/2024/1/e44443", url="http://www.ncbi.nlm.nih.gov/pubmed/38833294" } @Article{info:doi/10.2196/55529, author="Batterham, J. Philip and Gulliver, Amelia and Heffernan, Cassandra and Calear, L. Alison and Werner-Seidler, Aliza and Turner, Alyna and Farrer, M. Louise and Chatterton, Lou Mary and Mihalopoulos, Cathrine and Berk, Michael", title="A Brief Workplace Training Program to Support Help-Seeking for Mental Ill-Health: Protocol for the Helipad Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="24", volume="13", pages="e55529", keywords="help seeking", keywords="mental health", keywords="workplace", keywords="employee", keywords="implementation", keywords="internet", keywords="psychiatry", keywords="psychology", keywords="mobile phone", abstract="Background: Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs. Objective: This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months. Methods: A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress. Results: Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024. Conclusions: If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376 International Registered Report Identifier (IRRID): PRR1-10.2196/55529 ", doi="10.2196/55529", url="https://www.researchprotocols.org/2024/1/e55529", url="http://www.ncbi.nlm.nih.gov/pubmed/38787608" } @Article{info:doi/10.2196/53894, author="Yardley, Elizabeth and Davis, Alice and Eldridge, Chris and Vasilakis, Christos", title="Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study", journal="JMIR Ment Health", year="2024", month="May", day="21", volume="11", pages="e53894", keywords="electronic health record", keywords="EHR", keywords="electronic health records", keywords="EHRs", keywords="health record", keywords="data science", keywords="secondary data analysis", keywords="mental health services", keywords="mental health", keywords="health information system", keywords="HIS", keywords="information system", keywords="information systems", keywords="process mining", keywords="flow", keywords="flows", keywords="path", keywords="pathway", keywords="pathways", keywords="delivery", keywords="visualization", abstract="Background: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to ``stepped care,'' in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. Objective: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. Methods: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. Results: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32\% (site 1: 1507/45,401) and 4.19\% (site 2: 527/12,590) of all patients experienced stepped care. Conclusions: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes. ", doi="10.2196/53894", url="https://mental.jmir.org/2024/1/e53894", url="http://www.ncbi.nlm.nih.gov/pubmed/38771630" } @Article{info:doi/10.2196/49050, author="Prydz, Beer Monica and Czajkowski, Olavi Nikolai and Eilertsen, Maja and R{\o}ysamb, Espen and Nes, Bang Ragnhild", title="A Web-Based Intervention Using ``Five Ways to Wellbeing'' to Promote Well-Being and Mental Health: Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="May", day="20", volume="11", pages="e49050", keywords="well-being", keywords="mental health promotion", keywords="intervention", keywords="web based", keywords="low cost", keywords="broad outreach", keywords="framework", keywords="web-based intervention", keywords="randomized controlled trial", keywords="effectiveness", abstract="Background: Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA). Objective: This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being--promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period. Methods: In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models. Results: After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2\% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95\% CI 0.03-0.23; P=.001), FS (b=0.19, 95\% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95\% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=--0.17, 95\% CI --0.30 to --0.04; P=.001) with an effect size (Cohen d) of --0.20. Conclusions: The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented. Trial Registration: ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871 ", doi="10.2196/49050", url="https://mental.jmir.org/2024/1/e49050", url="http://www.ncbi.nlm.nih.gov/pubmed/38767958" } @Article{info:doi/10.2196/42049, author="Schwab-Reese, Laura and Short, Caitlyn and Jacobs, Larel and Fingerman, Michelle", title="Rapport Building in Written Crisis Services: Qualitative Content Analysis", journal="J Med Internet Res", year="2024", month="May", day="15", volume="26", pages="e42049", keywords="empathy", keywords="crisis hotline", keywords="child maltreatment", keywords="text hotline", keywords="chat hotline", keywords="telehealth", keywords="digital empathy", keywords="counseling", keywords="child abuse", keywords="family violence", keywords="crisis", keywords="hotline", keywords="chat", keywords="tele", keywords="emotional dynamics", keywords="therapeutic relationships", keywords="therapy", keywords="content analysis", keywords="text", keywords="inductive", keywords="deductive", keywords="emotion", keywords="affect", keywords="emotional dynamic", keywords="counseling psychology", abstract="Background: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. Objective: This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. Methods: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. Results: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. Conclusions: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions. ", doi="10.2196/42049", url="https://www.jmir.org/2024/1/e42049", url="http://www.ncbi.nlm.nih.gov/pubmed/38748472" } @Article{info:doi/10.2196/57155, author="Smith, A. Katharine and Hardy, Amy and Vinnikova, Anastasia and Blease, Charlotte and Milligan, Lea and Hidalgo-Mazzei, Diego and Lambe, Sin{\'e}ad and Marzano, Lisa and Uhlhaas, J. Peter and Ostinelli, G. Edoardo and Anmella, Gerard and Zangani, Caroline and Aronica, Rosario and Dwyer, Bridget and Torous, John and Cipriani, Andrea", title="Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions", journal="JMIR Ment Health", year="2024", month="May", day="8", volume="11", pages="e57155", keywords="digital", keywords="mental health", keywords="severe mental illness", keywords="consensus", keywords="lived experience", keywords="ethics", keywords="user-centered design", keywords="patient and public involvement", keywords="mobile phone", abstract="Background: Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). Objective: An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. Methods: The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Results: Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. Conclusions: The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation. ", doi="10.2196/57155", url="https://mental.jmir.org/2024/1/e57155", url="http://www.ncbi.nlm.nih.gov/pubmed/38717799" } @Article{info:doi/10.2196/50303, author="Gotra, Milena and Lindberg, Katharine and Jasinski, Nicholas and Scarisbrick, David and Reilly, Shannon and Perle, Jonathan and Miller, Liv and Mahoney III, James", title="Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study", journal="JMIR Form Res", year="2024", month="Apr", day="29", volume="8", pages="e50303", keywords="COVID-19 pandemic", keywords="mental health", keywords="social worker", keywords="psychologist", keywords="neuropsychologist", keywords="academic medical center", keywords="community mental health", keywords="private practice", keywords="Veteran's Affairs hospital", keywords="longitudinal questionnaire study", keywords="COVID-19", keywords="implementation", keywords="telemental health", keywords="hybrid model", keywords="availability", abstract="Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81\% to 204/235, 87\%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25\%-50\% in 2020 to 3\%-7\% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78\% to 59\%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50\% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. ", doi="10.2196/50303", url="https://formative.jmir.org/2024/1/e50303", url="http://www.ncbi.nlm.nih.gov/pubmed/38683653" } @Article{info:doi/10.2196/51791, author="Lam, T. Lawrence and Lam, P. Mary K.", title="A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="Apr", day="23", volume="11", pages="e51791", keywords="mHealth", keywords="web-based intervention", keywords="mental health literacy", keywords="psychoeducation", keywords="randomized controlled trial", keywords="workplace", keywords="performance", keywords="worker", keywords="intervention", keywords="digital health", keywords="mental wellness", keywords="promote", keywords="well-being", keywords="mobile health", keywords="technology", abstract="Background: Workplace mental health is an important global health concern. Objectives: This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app. Methods: The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures. Results: Of the 456 participants in the trial, 236 (51.8\%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score. Conclusions: The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000464167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377176 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3748-y ", doi="10.2196/51791", url="https://mental.jmir.org/2024/1/e51791" } @Article{info:doi/10.2196/51779, author="Robertson, Ciara and Hibberd, Carina and Shepherd, Ashley and Johnston, Gordon", title="How a National Organization Works in Partnership With People Who Have Lived Experience in Mental Health Improvement Programs: Protocol for an Exploratory Case Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="19", volume="13", pages="e51779", keywords="partnership", keywords="engagement", keywords="case study", keywords="mental health", keywords="improvement", keywords="national program", keywords="quality improvement", abstract="Background: This is a research proposal for a case study to explore how a national organization works in partnership with people with lived experience in national mental health improvement programs. Quality improvement is considered a key solution to addressing challenges within health care, and in Scotland, there are significant efforts to use quality improvement as a means of improving health and social care delivery. In 2016, Healthcare Improvement Scotland (HIS) established the improvement hub, whose purpose is to lead national improvement programs that use a range of approaches to support teams and services. Working in partnership with people with lived experience is recognized as a key component of such improvement work. There is, however, little understanding of how this is manifested in practice in national organizations. To address gaps in evidence and strengthen a consistent approach, a greater understanding is required to improve partnership working. Objective: The aim of this study is to better understand how a national organization works in partnership with people who have lived experience with improvement programs in mental health services, exploring people's experiences of partnership working in a national organization. An exploratory case study approach will be used to address the research questions in relation to the Personality Disorder (PD) Improvement Programme: (1) How is partnership working described in the PD Improvement Programme? (2) How is partnership working manifested in practice in the PD Improvement Programme? and (3) What factors influence partnership working in the PD Improvement Programme? Methods: An exploratory case study approach will be used in relation to the PD Improvement Programme, led by HIS. This research will explore how partnership working with people with lived experience is described and manifested in practice, outlining factors influencing partnership working. Data will be gathered from various qualitative sources, and analysis will deepen an understanding of partnership working. Results: This study is part of a clinical doctorate program at the University of Stirling and is unfunded. Data collection was completed in October 2023; analysis is expected to be completed and results will be published in January 2025. Conclusions: This study will produce new knowledge on ways of working with people with lived experience and will have practical implications for all improvement-focused interventions. Although the main focus of the study is on national improvement programs, it is anticipated that this study will contribute to the understanding of how all national public service organizations work in partnership with people with lived experience of mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/51779 ", doi="10.2196/51779", url="https://www.researchprotocols.org/2024/1/e51779", url="http://www.ncbi.nlm.nih.gov/pubmed/38640479" } @Article{info:doi/10.2196/53726, author="Louch, Gemma and Berzins, Kathryn and Walker, Lauren and Wormald, Gemma and Blackwell, Kirstin and Stephens, Michael and Brown, Mark and Baker, John", title="Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool", journal="JMIR Form Res", year="2024", month="Apr", day="12", volume="8", pages="e53726", keywords="patient safety", keywords="mental health", keywords="patient involvement", keywords="qualitative", keywords="digital innovation", keywords="real time", keywords="monitoring", keywords="safety", keywords="develop", keywords="development", keywords="design", keywords="perception", keywords="perceptions", keywords="prototype", keywords="evidence scan", keywords="interview", keywords="interviews", keywords="logic model", keywords="programme theory", keywords="dashboard", keywords="dashboards", keywords="interface", abstract="Background: Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. Objective: This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. Methods: The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. Results: We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, ``getting worse'' or ``getting better''; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Conclusions: Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively. ", doi="10.2196/53726", url="https://formative.jmir.org/2024/1/e53726", url="http://www.ncbi.nlm.nih.gov/pubmed/38607663" } @Article{info:doi/10.2196/45959, author="Kosyluk, Kristin and Baeder, Tanner and Greene, Yeona Karah and Tran, T. Jennifer and Bolton, Cassidy and Loecher, Nele and DiEva, Daniel and Galea, T. Jerome", title="Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey", journal="JMIR Form Res", year="2024", month="Apr", day="12", volume="8", pages="e45959", keywords="chatbots", keywords="conversational agents", keywords="mental health", keywords="resources", keywords="screening", keywords="resource referral", keywords="stigma", keywords="label avoidance", keywords="survey", keywords="training", keywords="behavioral", keywords="COVID-19", keywords="pilot test", keywords="design", keywords="users", keywords="psychological distress", keywords="symptoms", abstract="Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians' responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users' demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7\%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. ", doi="10.2196/45959", url="https://formative.jmir.org/2024/1/e45959", url="http://www.ncbi.nlm.nih.gov/pubmed/38607665" } @Article{info:doi/10.2196/50018, author="Cho, Sohyun and Bastien, Laurianne and Petrovic, Julia and B{\"o}ke, Naz Bilun and Heath, L. Nancy", title="The Role of Mental Health Stigma in University Students' Satisfaction With Web-Based Stress Management Resources: Intervention Study", journal="JMIR Form Res", year="2024", month="Apr", day="4", volume="8", pages="e50018", keywords="help-seeking behavior", keywords="help-seeking", keywords="mental health services", keywords="mental health stigma", keywords="mental health", keywords="university students", keywords="web-based workshop", abstract="Background: University students frequently report elevated levels of stress and mental health difficulties. Thus, the need to build coping capacity on university campuses has been highlighted as critical to mitigating the negative effects of prolonged stress and distress among students. Since the COVID-19 pandemic, web-based stress management resources such as infographics and web-based workshops have been central to supporting university students' mental health and well-being. However, there is a lack of research on students' satisfaction with and uptake of these approaches. Furthermore, mental health stigma has been suggested to have not only fueled the emergence of these web-based approaches to stress management but may also influence students' help-seeking behaviors and their satisfaction with and uptake of these resources. Objective: This study explored potential differences in students' satisfaction and strategy use in response to an interactive infographic (an emerging resource delivery modality) presenting stress management strategies and a web-based workshop (a more common modality) presenting identical strategies. This study also examined the relative contribution of students' strategy use and family-based mental health stigma in predicting their sustained satisfaction with the 2 web-based stress management approaches. Methods: University students (N=113; mean age 20.93, SD 1.53 years; 100/113, 88.5\% women) completed our web-based self-report measure of family-based mental health stigma at baseline and were randomly assigned to either independently review an interactive infographic (n=60) or attend a synchronous web-based workshop (n=53). All participants reported their satisfaction with their assigned modality at postintervention (T1) and follow-up (T2) and their strategy use at T2. Results: Interestingly, a 2-way mixed ANOVA revealed no significant group {\texttimes} time interaction or main effect of group on satisfaction. However, there was a significant decrease in satisfaction from T1 to T2, despite relatively high levels of satisfaction being reported at both time points. In addition, a 1-way ANOVA revealed no significant difference in strategy use between groups. Results from a hierarchical multiple regression revealed that students' strategy use positively predicted T2 satisfaction in both groups. However, only in the web-based workshop group did family-based mental health stigma predict T2 satisfaction over and above strategy use. Conclusions: While both approaches were highly satisfactory over time, findings highlight the potential utility of interactive infographics since they are less resource-intensive than web-based workshops and students' satisfaction with them is not impacted by family-based mental health stigma. Moreover, although numerous intervention studies measure satisfaction at a single time point, this study highlights the need for tracking satisfaction over time following intervention delivery. These findings have implications for student service units in the higher education context, emphasizing the need to consider student perceptions of family-based mental health stigma and preferences regarding delivery format when designing programming aimed at bolstering students' coping capacity. ", doi="10.2196/50018", url="https://formative.jmir.org/2024/1/e50018", url="http://www.ncbi.nlm.nih.gov/pubmed/38573758" } @Article{info:doi/10.2196/49217, author="O'Sullivan, Shaunagh and McEnery, Carla and Cagliarini, Daniela and Hinton, X. Jordan D. and Valentine, Lee and Nicholas, Jennifer and Chen, A. Nicola and Castagnini, Emily and Lester, Jacqueline and Kanellopoulos, Esta and D'Alfonso, Simon and Gleeson, F. John and Alvarez-Jimenez, Mario", title="A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study", journal="JMIR Ment Health", year="2024", month="Apr", day="1", volume="11", pages="e49217", keywords="digital intervention", keywords="blended care", keywords="youth mental health", keywords="transdiagnostic intervention", keywords="psychotic disorders", keywords="borderline personality disorder", keywords="digital health", keywords="mobile phone", abstract="Background: Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people's preferences and calls for integration of these services, current mental health services rarely offer blended models of care. Objective: This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. Methods: A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83\%) of the 18 clinicians, were conducted after the intervention. Results: eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25\% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93\% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians' competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. Conclusions: eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services. ", doi="10.2196/49217", url="https://mental.jmir.org/2024/1/e49217", url="http://www.ncbi.nlm.nih.gov/pubmed/38557432" } @Article{info:doi/10.2196/56002, author="Gautam, Kamal and Aguilar, Camille and Paudel, Kiran and Dhakal, Manisha and Wickersham, A. Jeffrey and Acharya, Bibhav and Sapkota, Sabitri and Deuba, Keshab and Shrestha, Roman", title="Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study", journal="JMIR Hum Factors", year="2024", month="Mar", day="29", volume="11", pages="e56002", keywords="mental health", keywords="MSM", keywords="mHealth", keywords="smartphone apps", keywords="digital health", keywords="Nepal", keywords="gay", keywords="homosexual", keywords="homosexuality", keywords="men who have sex with men", keywords="focus group", keywords="focus groups", keywords="qualitative", keywords="barrier", keywords="barriers", keywords="thematic", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", abstract="Background: Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. Objective: This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. Methods: We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. Results: Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)--friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. Conclusions: The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups. ", doi="10.2196/56002", url="https://humanfactors.jmir.org/2024/1/e56002", url="http://www.ncbi.nlm.nih.gov/pubmed/38551632" } @Article{info:doi/10.2196/51667, author="Dimitropoulos, Gina and Lindenbach, David and Potestio, Melissa and Mogan, Tom and Richardson, Amanda and Anderson, Alida and Heintz, Madison and Moskovic, Karen and Gondziola, Jason and Bradley, Jessica and LaMonica, M. Haley and Iorfino, Frank and Hickie, Ian and Patten, B. Scott and Arnold, D. Paul", title="Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures", journal="JMIR Res Protoc", year="2024", month="Mar", day="20", volume="13", pages="e51667", keywords="learning health system", keywords="stratified care", keywords="patient-reported outcome measures", keywords="mental health", keywords="emerging adults", keywords="protocol papers", keywords="pragmatic clinical trials", keywords="e-mental health", keywords="RE-AIM", keywords="Reach, Effectiveness, Adoption, Implementation, and Maintenance", keywords="implementation science", keywords="adult", keywords="health system", keywords="treatment", keywords="implementation", keywords="acceptability", keywords="measurement-based care", abstract="Background: Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies. Objective: The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults. Methods: This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services. Results: This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes. Conclusions: This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care. International Registered Report Identifier (IRRID): PRR1-10.2196/51667 ", doi="10.2196/51667", url="https://www.researchprotocols.org/2024/1/e51667", url="http://www.ncbi.nlm.nih.gov/pubmed/38506921" } @Article{info:doi/10.2196/50177, author="Griffiths, Lowri Si{\^a}n and Murray, K. Graham and Logeswaran, Yanakan and Ainsworth, John and Allan, M. Sophie and Campbell, Niyah and Drake, J. Richard and Katshu, Haq Mohammad Zia Ul and Machin, Matthew and Pope, A. Megan and Sullivan, A. Sarah and Waring, Justin and Bogatsu, Tumelo and Kane, Julie and Weetman, Tyler and Johnson, Sonia and Kirkbride, B. James and Upthegrove, Rachel", title="Implementing and Evaluating a National Integrated Digital Registry and Clinical Decision Support System in Early Intervention in Psychosis Services (Early Psychosis Informatics Into Care): Co-Designed Protocol", journal="JMIR Res Protoc", year="2024", month="Mar", day="19", volume="13", pages="e50177", keywords="Early Intervention in Psychosis", keywords="digital registry", keywords="clinical decision support system", keywords="participatory co-design", keywords="participatory", keywords="co-design", keywords="registry", keywords="psychosis", keywords="mental health", keywords="psychiatry", keywords="decision support", keywords="study protocol", abstract="Background: Early intervention in psychosis (EIP) services are nationally mandated in England to provide multidisciplinary care to people experiencing first-episode psychosis, which disproportionately affects deprived and ethnic minority youth. Quality of service provision varies by region, and people from historically underserved populations have unequal access. In other disease areas, including stroke and dementia, national digital registries coupled with clinical decision support systems (CDSSs) have revolutionized the delivery of equitable, evidence-based interventions to transform patient outcomes and reduce population-level disparities in care. Given psychosis is ranked the third most burdensome mental health condition by the World Health Organization, it is essential that we achieve the same parity of health improvements. Objective: This paper reports the protocol for the program development phase of this study, in which we aimed to co-design and produce an evidence-based, stakeholder-informed framework for the building, implementation, piloting, and evaluation of a national integrated digital registry and CDSS for psychosis, known as EPICare (Early Psychosis Informatics into Care). Methods: We conducted 3 concurrent work packages, with reciprocal knowledge exchange between each. In work package 1, using a participatory co-design framework, key stakeholders (clinicians, academics, policy makers, and patient and public contributors) engaged in 4 workshops to review, refine, and identify a core set of essential and desirable measures and features of the EPICare registry and CDSS. Using a modified Delphi approach, we then developed a consensus of data priorities. In work package 2, we collaborated with National Health Service (NHS) informatics teams to identify relevant data currently captured in electronic health records, understand data retrieval methods, and design the software architecture and data model to inform future implementation. In work package 3, observations of stakeholder workshops and individual interviews with representative stakeholders (n=10) were subject to interpretative qualitative analysis, guided by normalization process theory, to identify factors likely to influence the adoption and implementation of EPICare into routine practice. Results: Stage 1 of the EPICare study took place between December 2021 and September 2022. The next steps include stage 2 building, piloting, implementation, and evaluation of EPICare in 5 demonstrator NHS Trusts serving underserved and diverse populations with substantial need for EIP care in England. If successful, this will be followed by stage 3, in which we will seek NHS adoption of EPICare for rollout to all EIP services in England. Conclusions: By establishing a multistakeholder network and engaging them in an iterative co-design process, we have identified essential and desirable elements of the EPICare registry and CDSS; proactively identified and minimized potential challenges and barriers to uptake and implementation; and addressed key questions related to informatics architecture, infrastructure, governance, and integration in diverse NHS Trusts, enabling us to proceed with the building, piloting, implementation, and evaluation of EPICare. International Registered Report Identifier (IRRID): DERR1-10.2196/50177 ", doi="10.2196/50177", url="https://www.researchprotocols.org/2024/1/e50177", url="http://www.ncbi.nlm.nih.gov/pubmed/38502175" } @Article{info:doi/10.2196/55205, author="Poudyal, Anubhuti and Lewis, Delta-Marie and Taha, Sarah and Martinez, J. Alyssa and Magoun, Lauren and Ho, Xian Y. and Carmio, Natali and Naslund, A. John and Sanchez, Katherine and Lesh, Neal and Patel, Vikram", title="Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study", journal="JMIR Form Res", year="2024", month="Mar", day="11", volume="8", pages="e55205", keywords="digital technology", keywords="mental health", keywords="depression", keywords="task sharing", keywords="nonspecialist providers", keywords="peer supervision", keywords="therapy quality", abstract="Background: The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. Objective: We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. Methods: We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. Results: A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83\%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. Conclusions: We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States. ", doi="10.2196/55205", url="https://formative.jmir.org/2024/1/e55205", url="http://www.ncbi.nlm.nih.gov/pubmed/38466971" } @Article{info:doi/10.2196/48168, author="Jabir, Ishqi Ahmad and Lin, Xiaowen and Martinengo, Laura and Sharp, Gemma and Theng, Yin-Leng and Tudor Car, Lorainne", title="Attrition in Conversational Agent--Delivered Mental Health Interventions: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Feb", day="27", volume="26", pages="e48168", keywords="conversational agent", keywords="chatbot", keywords="mental health", keywords="mHealth", keywords="attrition", keywords="dropout", keywords="mobile phone", keywords="artificial intelligence", keywords="AI", keywords="systematic review", keywords="meta-analysis", keywords="digital health interventions", abstract="Background: Conversational agents (CAs) or chatbots are computer programs that mimic human conversation. They have the potential to improve access to mental health interventions through automated, scalable, and personalized delivery of psychotherapeutic content. However, digital health interventions, including those delivered by CAs, often have high attrition rates. Identifying the factors associated with attrition is critical to improving future clinical trials. Objective: This review aims to estimate the overall and differential rates of attrition in CA-delivered mental health interventions (CA interventions), evaluate the impact of study design and intervention-related aspects on attrition, and describe study design features aimed at reducing or mitigating study attrition. Methods: We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science, and conducted a gray literature search on Google Scholar in June 2022. We included randomized controlled trials that compared CA interventions against control groups and excluded studies that lasted for 1 session only and used Wizard of Oz interventions. We also assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool 2.0. Random-effects proportional meta-analysis was applied to calculate the pooled dropout rates in the intervention groups. Random-effects meta-analysis was used to compare the attrition rate in the intervention groups with that in the control groups. We used a narrative review to summarize the findings. Results: The systematic search retrieved 4566 records from peer-reviewed databases and citation searches, of which 41 (0.90\%) randomized controlled trials met the inclusion criteria. The meta-analytic overall attrition rate in the intervention group was 21.84\% (95\% CI 16.74\%-27.36\%; I2=94\%). Short-term studies that lasted ?8 weeks showed a lower attrition rate (18.05\%, 95\% CI 9.91\%- 27.76\%; I2=94.6\%) than long-term studies that lasted >8 weeks (26.59\%, 95\% CI 20.09\%-33.63\%; I2=93.89\%). Intervention group participants were more likely to attrit than control group participants for short-term (log odds ratio 1.22, 95\% CI 0.99-1.50; I2=21.89\%) and long-term studies (log odds ratio 1.33, 95\% CI 1.08-1.65; I2=49.43\%). Intervention-related characteristics associated with higher attrition include stand-alone CA interventions without human support, not having a symptom tracker feature, no visual representation of the CA, and comparing CA interventions with waitlist controls. No participant-level factor reliably predicted attrition. Conclusions: Our results indicated that approximately one-fifth of the participants will drop out from CA interventions in short-term studies. High heterogeneities made it difficult to generalize the findings. Our results suggested that future CA interventions should adopt a blended design with human support, use symptom tracking, compare CA intervention groups against active controls rather than waitlist controls, and include a visual representation of the CA to reduce the attrition rate. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022341415; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42022341415 ", doi="10.2196/48168", url="https://www.jmir.org/2024/1/e48168", url="http://www.ncbi.nlm.nih.gov/pubmed/38412023" } @Article{info:doi/10.2196/47504, author="Kallakuri, Sudha and Gara, Sridevi and Godi, Mahesh and Yatirajula, Kanaka Sandhya and Paslawar, Srilatha and Daniel, Mercian and Peiris, David and Maulik, Kumar Pallab", title="Learnings From Implementation of Technology-Enabled Mental Health Interventions in India: Implementation Report", journal="JMIR Med Inform", year="2024", month="Feb", day="15", volume="12", pages="e47504", keywords="mental health", keywords="technological interventions", keywords="digital health", keywords="community intervention", keywords="implementation", keywords="eHealth", keywords="India", keywords="Asia", keywords="development", keywords="health technology", abstract="Background: Recent years have witnessed an increase in the use of technology-enabled interventions for delivering mental health care in different settings. Technological solutions have been advocated to increase access to care, especially in primary health care settings in low- and middle-income countries, to facilitate task-sharing given the lack of trained mental health professionals. Objective: This report describes the experiences and challenges faced during the development and implementation of technology-enabled interventions for mental health among adults and adolescents in rural and urban settings of India. Methods: A detailed overview of the technological frameworks used in various studies, including the Systematic Medical Appraisal and Referral Treatment (SMART) Mental Health pilot study, SMART Mental Health cluster randomized controlled trial, and Adolescents' Resilience and Treatment Needs for Mental Health in Indian Slums (ARTEMIS) study, is provided. This includes the mobile apps that were used to collect data and the use of the database to store the data that were collected. Based on the experiences faced, the technological enhancements and adaptations made at the mobile app and database levels are described in detail. Implementation (Results): Development of descriptive analytics at the database level; enabling offline and online data storage modalities; customizing the Open Medical Record System platform to suit the study requirements; modifying the encryption settings, thereby making the system more secure; and merging different apps for simultaneous data collection were some of the enhancements made across different projects. Conclusions: Technology-enabled interventions prove to be a useful solution to cater to large populations in low-resource settings. The development of mobile apps is subject to the context and the area where they would be implemented. This paper outlines the need for careful testing using an iterative process that may support future research using similar technology. Trial Registration: SMART Mental Health trial: Clinical Trial Registry India CTRI/2018/08/015355; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MjMyNTQ=\&Enc=\&userName=CTRI/2018/08/015355. ARTEMIS trial: Clinical Trial Registry India CTRI/2022/02/040307; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDcxMTE=\&Enc=\&userName=CTRI/2022/02/040307 ", doi="10.2196/47504", url="https://medinform.jmir.org/2024/1/e47504", url="http://www.ncbi.nlm.nih.gov/pubmed/38358790" } @Article{info:doi/10.2196/51126, author="Schwarz, Julian and Meier-Diedrich, Eva and Neumann, Katharina and Heinze, Martin and Eisenmann, Yvonne and Thoma, Samuel", title="Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study", journal="JMIR Ment Health", year="2024", month="Feb", day="5", volume="11", pages="e51126", keywords="open notes", keywords="patient-clinician relations", keywords="electronic health record", keywords="clinical notes", keywords="visit notes", keywords="patient participation", keywords="online record access", keywords="mental illness", keywords="patient portal", keywords="mental health", keywords="qualitative interview", keywords="patient education", abstract="Background: Over the past few years, online record access (ORA) has been established through secure patient portals in various countries, allowing patients to access their health data, including clinical notes (``open notes''). Previous research indicates that ORA in mental health, particularly among patients with severe mental illness (SMI), has been rarely offered. Little is known about the expectations and motivations of patients with SMI when reading what their clinicians share via ORA. Objective: The aim of this study is to explore the reasons why patients with SMI consider or reject ORA and whether sociodemographic characteristics may influence patient decisions. Methods: ORA was offered to randomly selected patients at 3 university outpatient clinics in Brandenburg, Germany, which exclusively treat patients with SMI. Within the framework of a mixed methods evaluation, qualitative interviews were conducted with patients who chose to participate in ORA and those who declined, aiming to explore the underlying reasons for their decisions. The interviews were transcribed and analyzed using thematic analysis. Sociodemographic characteristics of patients were examined using descriptive statistics to identify predictors of acceptance or rejection of ORA. Results: Out of 103 included patients, 58\% (n=60) wished to read their clinical notes. The reasons varied, ranging from a desire to engage more actively in their treatment to critically monitoring it and using the accessible data for third-party purposes. Conversely, 42\% (n=43) chose not to use ORA, voicing concerns about possibly harming the trustful relationship with their clinicians as well as potential personal distress or uncertainty arising from reading the notes. Practical barriers such as a lack of digital literacy or suspected difficult-to-understand medical language were also named as contributing factors. Correlation analysis revealed that the majority of patients with depressive disorder desired to read the clinical notes (P<.001), while individuals with psychotic disorders showed a higher tendency to decline ORA (P<.05). No significant group differences were observed for other patient groups or characteristics. Conclusions: The adoption of ORA is influenced by a wide range of motivational factors, while patients also present a similar variety of reasons for declining its use. The results emphasize the urgent need for knowledge and patient education regarding factors that may hinder the decision to use ORA, including its practical usage, its application possibilities, and concerns related to data privacy. Further research is needed to explore approaches for adequately preparing individuals with SMI to transition from their inherent interest to active engagement with ORA. Trial Registration: German Clinical Trial Register DRKS00030188; https://drks.de/search/en/trial/DRKS00030188 ", doi="10.2196/51126", url="https://mental.jmir.org/2024/1/e51126", url="http://www.ncbi.nlm.nih.gov/pubmed/38315523" } @Article{info:doi/10.2196/50977, author="Smith, Helm Ashley and Touchett, Hilary and Chen, Patricia and Fletcher, Terri and Arney, Jennifer and Hogan, Julianna and Wassef, Miryam and Cloitre, Marylene and Lindsay, A. Jan", title="Patient Satisfaction With a Coach-Guided, Technology-Based Mental Health Treatment: Qualitative Interview Study and Theme Analysis", journal="JMIR Ment Health", year="2024", month="Feb", day="2", volume="11", pages="e50977", keywords="coaching", keywords="digital treatment", keywords="interview", keywords="mental health", keywords="patient satisfaction", keywords="PTSD", keywords="qualitative assessment", keywords="qualitative methods", keywords="sentiment analysis", keywords="technology-based", keywords="telehealth", keywords="trauma", keywords="veterans", keywords="video telehealth", keywords="web-based treatment", abstract="Background: Technology-based mental health interventions address barriers rural veterans face in accessing care, including provider scarcity and distance from the hospital or clinic. webSTAIR is a 10-module, web-based treatment based on Skills Training in Affective and Interpersonal Regulation, designed to treat posttraumatic stress disorder and depression in individuals exposed to trauma. Previous work has demonstrated that webSTAIR is acceptable to participants and effective at reducing symptoms of posttraumatic stress disorder and depression when delivered synchronously or asynchronously (over 5 or 10 sessions). Objective: This study explored factors that lead to greater patient satisfaction with webSTAIR, a web-based, coach-guided intervention. Methods: We analyzed qualitative interview data to identify themes related to patient satisfaction with webSTAIR delivered with synchronous video-based coaching. Results: Four themes emerged from the data: (1) coaching provides accountability and support, (2) self-pacing offers value that meets individual needs, (3) participants like the comfort and convenience of the web-based format, and (4) technical issues were common but not insurmountable. Conclusions: We conclude that participants valued the accountability, flexibility, and convenience of tech-based interventions with video-delivered coaching. ", doi="10.2196/50977", url="https://mental.jmir.org/2024/1/e50977", url="http://www.ncbi.nlm.nih.gov/pubmed/38306167" } @Article{info:doi/10.2196/48703, author="Basnet, Syaron and Chaiton, Michael", title="Effectiveness of the Wellness Together Canada Portal as a Digital Mental Health Intervention in Canada: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jan", day="30", volume="13", pages="e48703", keywords="Wellness Together Portal", keywords="randomized trial", keywords="COVID-19", keywords="mental health", keywords="digital health", keywords="digital intervention", keywords="substance use", keywords="portal", keywords="effectiveness", keywords="well-being", abstract="Background: The Wellness Together Canada (WTC) portal is a digital mental health intervention that was developed in response to an unprecedented rise in mental health and substance use concerns due to the COVID-19 pandemic, with funding from the Government of Canada. It is a mental health and substance use website to support people across Canada providing digital interventions and services at no cost. Two million people have visited the WTC portal over the course of 1 year since launching; however, rigorous evaluation of this potential solution to access to mental health care during and after the COVID-19 pandemic is urgently required. Objective: This study aims to better understand the effectiveness of the existing digital interventions in improving population mental health in Canada. Methods: The Let's Act on Mental Health study is designed as a longitudinal fully remote, equally randomized (1:1), double-blind, alternative intervention--controlled, parallel-group randomized controlled trial to be conducted between October 2023 and April 2024 with a prospective follow-up study period of 26 weeks. This trial will evaluate whether a digital intervention such as the WTC improves population mental health trajectories over time. Results: The study was approved by the research ethics board of CAMH (Centre for Addiction and Mental Health, Toronto, Ontario, Canada). It is ongoing and participant recruitment is underway. As of August 2023, a total of 453 participants in the age group of 18-72 years have participated, of whom 70\% (n=359) are female. Conclusions: This initiative provides a unique opportunity to match people's specific unmet mental health and substance use needs to evidence-based digital interventions. ", doi="10.2196/48703", url="https://www.researchprotocols.org/2024/1/e48703", url="http://www.ncbi.nlm.nih.gov/pubmed/38289642" } @Article{info:doi/10.2196/49099, author="Dimitropoulos, Gina and Bassi, M. Emilie and Bright, S. Katherine and Gondziola, Jason and Bradley, Jessica and Fersovitch, Melanie and Stamp, Leanne and LaMonica, M. Haley and Iorfino, Frank and Gaskell, Tanya and Tomlinson, Sara and Johnson, Wyatt David", title="Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders", journal="JMIR Ment Health", year="2024", month="Jan", day="17", volume="11", pages="e49099", keywords="electronic mental health", keywords="eMH", keywords="digital mental health", keywords="youth and young adult mental health", keywords="secondary schools", keywords="implementation science", keywords="qualitative descriptive methods", keywords="mental health platform", keywords="mental health", keywords="mobile phone", abstract="Background: Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. Objective: The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. Methods: Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. Results: Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. Conclusions: Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase. ", doi="10.2196/49099", url="https://mental.jmir.org/2024/1/e49099", url="http://www.ncbi.nlm.nih.gov/pubmed/38231558" } @Article{info:doi/10.2196/54202, author="Veldmeijer, Lars and Terlouw, Gijs and Van Os, Jim and Van 't Veer, Job and Boonstra, Nynke", title="The Frequency of Design Studies Targeting People With Psychotic Symptoms and Features in Mental Health Care Innovation: Secondary Analysis of a Systematic Review", journal="JMIR Ment Health", year="2024", month="Jan", day="9", volume="11", pages="e54202", keywords="design approaches", keywords="design", keywords="innovation", keywords="innovative", keywords="innovate", keywords="innovations", keywords="psychiatry", keywords="mental health care", keywords="mental health", keywords="mental illness", keywords="mental disease", keywords="involvement", keywords="service users", keywords="people with lived experience", keywords="people with lived experiences", keywords="lived experience", keywords="lived experiences", keywords="co-creation", keywords="cocreation", keywords="psychosis", keywords="psychotic", keywords="schizophrenia", keywords="schizoid", keywords="schizotypal", keywords="paranoia", keywords="neurosis", keywords="hallucinosis", keywords="hallucination", keywords="hallucinations", doi="10.2196/54202", url="https://mental.jmir.org/2024/1/e54202", url="http://www.ncbi.nlm.nih.gov/pubmed/38194249" } @Article{info:doi/10.2196/43882, author="Ehrt-Sch{\"a}fer, Yamina and Rusmir, Milan and Vetter, Johannes and Seifritz, Erich and M{\"u}ller, Mario and Kleim, Birgit", title="Feasibility, Adherence, and Effectiveness of Blended Psychotherapy for Severe Mental Illnesses: Scoping Review", journal="JMIR Ment Health", year="2023", month="Dec", day="26", volume="10", pages="e43882", keywords="blended psychotherapy", keywords="severe mental illnesses", keywords="digital health intervention", keywords="e-mental health", keywords="scoping review", abstract="Background: Blended psychotherapy (bPT) combines face-to-face psychotherapy with digital interventions to enhance the effectiveness of mental health treatment. The feasibility and effectiveness of bPT have been demonstrated for various mental health issues, although primarily for patients with higher levels of functioning. Objective: This scoping review aims to investigate the feasibility, adherence, and effectiveness of bPT for the treatment of patients with severe mental illnesses (SMIs). Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted searches in PubMed, MEDLINE, Embase, PsycINFO, and PsycArticles for studies published until March 23, 2023. Results: Out of 587 screened papers, we incorporated 25 studies encompassing 23 bPT interventions, involving a total of 2554 patients with SMI. The intervention formats and research designs exhibited significant variation. Our findings offer preliminary evidence supporting the feasibility of bPT for SMI, although there is limited research on adherence. Nevertheless, the summarized studies indicated promising attrition rates, spanning from 0\% to 37\%, implying a potential beneficial impact of bPT on adherence to SMI treatment. The quantity of evidence on the effects of bPT for SMI was limited and challenging to generalize. Among the 15 controlled trials, 4 concluded that bPT interventions were effective compared with controls. However, it is noteworthy that 2 of these studies used the same study population, and the control groups exhibited significant variations. Conclusions: Overall, our review suggests that while bPT appears promising as a treatment method, further research is necessary to establish its effectiveness for SMI. We discuss considerations for clinical implementation, directions, and future research. ", doi="10.2196/43882", url="https://mental.jmir.org/2023/1/e43882", url="http://www.ncbi.nlm.nih.gov/pubmed/38147373" } @Article{info:doi/10.2196/47840, author="Wang, Bo and Kristiansen, Eli and Fagerlund, Johansen Asbj{\o}rn and Zanaboni, Paolo and H{\"a}gglund, Maria and B{\"a}rk{\aa}s, Annika and Kujala, Sari and Cajander, {\AA}sa and Blease, Charlotte and Kharko, Anna and Huvila, Isto and Kane, Bridget and Johansen, Alise Monika", title="Users' Experiences With Online Access to Electronic Health Records in Mental and Somatic Health Care: Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Dec", day="25", volume="25", pages="e47840", keywords="patient empowerment", keywords="online access to electronic health records", keywords="patient-accessible electronic health record", keywords="patient access", keywords="user perspective", keywords="psychiatry", keywords="electronic health record", keywords="health data", keywords="patient portal", keywords="online records access", abstract="Background: Patient-accessible electronic health records (PAEHRs) hold promise for empowering patients, but their impact may vary between mental and somatic health care. Medical professionals and ethicists have expressed concerns about the potential challenges of PAEHRs for patients, especially those receiving mental health care. Objective: This study aims to investigate variations in the experiences of online access to electronic health records (EHRs) among persons receiving mental and somatic health care, as well as to understand how these experiences and perceptions vary among those receiving mental health care at different levels of point of care. Methods: Using Norwegian data from the NORDeHEALTH 2022 Patient Survey, we conducted a cross-sectional descriptive analysis of service use and perceptions of perceived mistakes, omissions, and offensive comments by mental and somatic health care respondents. Content analysis was used to analyze free-text responses to understand how respondents experienced the most serious errors in their EHR. Results: Among 9505 survey participants, we identified 2008 mental health care respondents and 7086 somatic health care respondents. A higher percentage of mental health care respondents (1385/2008, 68.97\%) reported that using PAEHR increased their trust in health care professionals compared with somatic health care respondents (4251/7086, 59.99\%). However, a significantly larger proportion (P<.001) of mental health care respondents (976/2008, 48.61\%) reported perceiving errors in their EHR compared with somatic health care respondents (1893/7086, 26.71\%). Mental health care respondents also reported significantly higher odds (P<.001) of identifying omissions (758/2008, 37.75\%) and offensive comments (729/2008, 36.3\%) in their EHR compared with the somatic health care group (1867/7086, 26.35\% and 826/7086, 11.66\%, respectively). Mental health care respondents in hospital inpatient settings were more likely to identify errors (398/588, 67.7\%; P<.001) and omissions (251/588, 42.7\%; P<.001) than those in outpatient care (errors: 422/837, 50.4\% and omissions: 336/837, 40.1\%; P<.001) and primary care (errors: 32/100, 32\% and omissions: 29/100, 29\%; P<.001). Hospital inpatients also reported feeling more offended (344/588, 58.5\%; P<.001) by certain content in their EHR compared with respondents in primary (21/100, 21\%) and outpatient care (287/837, 34.3\%) settings. Our qualitative findings showed that both mental and somatic health care respondents identified the most serious errors in their EHR in terms of medical history, communication, diagnosis, and medication. Conclusions: Most mental and somatic health care respondents showed a positive attitude toward PAEHRs. However, mental health care respondents, especially those with severe and chronic concerns, expressed a more critical attitude toward certain content in their EHR compared with somatic health care respondents. A PAEHR can provide valuable information and foster trust, but it requires careful attention to the use of clinical terminology to ensure accurate, nonjudgmental documentation, especially for persons belonging to health care groups with unique sensitivities. ", doi="10.2196/47840", url="https://www.jmir.org/2023/1/e47840", url="http://www.ncbi.nlm.nih.gov/pubmed/38145466" } @Article{info:doi/10.2196/50636, author="van Doorn, Marilon and Monsanto, Anne and Wang, Lu Chen and Verfaillie, J. Sander C. and van Amelsvoort, J. Th{\'e}r{\`e}se A. M. and Popma, Arne and Jaspers, M. Monique W. and {\"O}ry, Ferko and Alvarez-Jimenez, Mario and Gleeson, F. John and Nieman, H. Dorien", title="The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study", journal="JMIR Mhealth Uhealth", year="2023", month="Dec", day="13", volume="11", pages="e50636", keywords="indicative prevention", keywords="youth mental health", keywords="Moderated Online Social Therapy", keywords="MOST+", keywords="eHealth", keywords="well-being", keywords="early detection and intervention", keywords="Engage Young People Early", keywords="ENYOY", abstract="Background: To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. Objective: This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. Methods: Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54\% and the dropout rate 62.6\% (82/131). Results: The primary analysis (77/131, 58.8\%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; $\eta$p2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9\%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; $\eta$p2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P?.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38\% (39/102) of cases, no change in 54.9\% (56/102) of cases, and worsening in 5.9\% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50\% (51/102), 43.1\% (44/102), and 6.9\% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5\% (77/102) of cases for distress and 89.2\% (91/102) for functioning. Conclusions: This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03315-x ", doi="10.2196/50636", url="https://mhealth.jmir.org/2023/1/e50636", url="http://www.ncbi.nlm.nih.gov/pubmed/38090802" } @Article{info:doi/10.2196/53293, author="Person, Cheryl and O'Connor, Nicola and Koehler, Lucy and Venkatachalam, Kartik and Gaveras, Georgia", title="Evaluating Clinical Outcomes in Patients Being Treated Exclusively via Telepsychiatry: Retrospective Data Analysis", journal="JMIR Form Res", year="2023", month="Dec", day="8", volume="7", pages="e53293", keywords="telepsychiatry", keywords="PHQ-8", keywords="GAD-7", keywords="clinical outcomes", keywords="rural", keywords="commercial insurance", keywords="telehealth", keywords="depression", keywords="anxiety", keywords="telemental health", keywords="psychiatry", keywords="Generalized Anxiety Disorder-7", keywords="Patient Health Questionnaire-8", abstract="Background: Depression and anxiety are highly prevalent conditions in the United States. Despite the availability of suitable therapeutic options, limited access to high-quality psychiatrists represents a major barrier to treatment. Although telepsychiatry has the potential to improve access to psychiatrists, treatment efficacy in the telepsychiatry model remains unclear. Objective: Our primary objective was to determine whether there was a clinically meaningful change in 1 of 2 validated outcome measures of depression and anxiety---the Patient Health Questionnaire--8 (PHQ-8) or the Generalized Anxiety Disorder--7 (GAD-7)---after receiving at least 8 weeks of treatment in an outpatient telepsychiatry setting. Methods: We included treatment-seeking patients enrolled in a large outpatient telepsychiatry service that accepts commercial insurance. All analyzed patients completed the GAD-7 and PHQ-8 prior to their first appointment and at least once after 8 weeks of treatment. Treatments included comprehensive diagnostic evaluation, supportive psychotherapy, and medication management. Results: In total, 1826 treatment-seeking patients were evaluated for clinically meaningful changes in GAD-7 and PHQ-8 scores during treatment. Mean treatment duration was 103 (SD 34) days. At baseline, 58.8\% (1074/1826) and 60.1\% (1097/1826) of patients exhibited at least moderate anxiety and depression, respectively. In response to treatment, mean change for GAD-7 was --6.71 (95\% CI --7.03 to --6.40) and for PHQ-8 was --6.85 (95\% CI --7.18 to --6.52). Patients with at least moderate symptoms at baseline showed a 45.7\% reduction in GAD-7 scores and a 43.1\% reduction in PHQ-8 scores. Effect sizes for GAD-7 and PHQ-8, as measured by Cohen d for paired samples, were d=1.30 (P<.001) and d=1.23 (P<.001), respectively. Changes in GAD-7 and PHQ-8 scores correlated with the type of insurance held by the patients. Greatest reductions in scores were observed among patients with commercial insurance (45\% and 43.9\% reductions in GAD-7 and PHQ-8 scores, respectively). Although patients with Medicare did exhibit statistically significant reductions in GAD-7 and PHQ-8 scores from baseline (P<.001), these improvements were attenuated compared to those in patients with commercial insurance (29.2\% and 27.6\% reduction in GAD-7 and PHQ-8 scores, respectively). Pairwise comparison tests revealed significant differences in treatment responses in patients with Medicare versus commercial insurance (P<.001). Responses were independent of patient geographic classification (urban vs rural; P=.48 for GAD-7 and P=.07 for PHQ-8). The finding that treatment efficacy was comparable among rural and urban patients indicated that telepsychiatry is a promising approach to overcome treatment disparities that stem from geographical constraints. Conclusions: In this large retrospective data analysis of treatment-seeking patients using a telepsychiatry platform, we found robust and clinically significant improvement in depression and anxiety symptoms during treatment. The results provide further evidence that telepsychiatry is highly effective and has the potential to improve access to psychiatric care. ", doi="10.2196/53293", url="https://formative.jmir.org/2023/1/e53293", url="http://www.ncbi.nlm.nih.gov/pubmed/37991899" } @Article{info:doi/10.2196/49894, author="Wang, Yi and Yu, Yide and Liu, Yue and Ma, Yan and Pang, Cheong-Iao Patrick", title="Predicting Patients' Satisfaction With Mental Health Drug Treatment Using Their Reviews: Unified Interchangeable Model Fusion Approach", journal="JMIR Ment Health", year="2023", month="Dec", day="5", volume="10", pages="e49894", keywords="artificial intelligence", keywords="AI", keywords="mental disorder", keywords="psychotherapy effectiveness", keywords="deep learning", keywords="machine learning", keywords="natural language processing", keywords="NLP", keywords="data imbalance", keywords="model fusion", abstract="Background: After the COVID-19 pandemic, the conflict between limited mental health care resources and the rapidly growing number of patients has become more pronounced. It is necessary for psychologists to borrow artificial intelligence (AI)--based methods to analyze patients' satisfaction with drug treatment for those undergoing mental illness treatment. Objective: Our goal was to construct highly accurate and transferable models for predicting the satisfaction of patients with mental illness with medication by analyzing their own experiences and comments related to medication intake. Methods: We extracted 41,851 reviews in 20 categories of disorders related to mental illnesses from a large public data set of 161,297 reviews in 16,950 illness categories. To discover a more optimal structure of the natural language processing models, we proposed the Unified Interchangeable Model Fusion to decompose the state-of-the-art Bidirectional Encoder Representations from Transformers (BERT), support vector machine, and random forest (RF) models into 2 modules, the encoder and the classifier, and then reconstruct fused ``encoder+classifer'' models to accurately evaluate patients' satisfaction. The fused models were divided into 2 categories in terms of model structures, traditional machine learning--based models and neural network--based models. A new loss function was proposed for those neural network--based models to overcome overfitting and data imbalance. Finally, we fine-tuned the fused models and evaluated their performance comprehensively in terms of F1-score, accuracy, $\kappa$ coefficient, and training time using 10-fold cross-validation. Results: Through extensive experiments, the transformer bidirectional encoder+RF model outperformed the state-of-the-art BERT, MentalBERT, and other fused models. It became the optimal model for predicting the patients' satisfaction with drug treatment. It achieved an average graded F1-score of 0.872, an accuracy of 0.873, and a $\kappa$ coefficient of 0.806. This model is suitable for high-standard users with sufficient computing resources. Alternatively, it turned out that the word-embedding encoder+RF model showed relatively good performance with an average graded F1-score of 0.801, an accuracy of 0.812, and a $\kappa$ coefficient of 0.695 but with much less training time. It can be deployed in environments with limited computing resources. Conclusions: We analyzed the performance of support vector machine, RF, BERT, MentalBERT, and all fused models and identified the optimal models for different clinical scenarios. The findings can serve as evidence to support that the natural language processing methods can effectively assist psychologists in evaluating the satisfaction of patients with drug treatment programs and provide precise and standardized solutions. The Unified Interchangeable Model Fusion provides a different perspective on building AI models in mental health and has the potential to fuse the strengths of different components of the models into a single model, which may contribute to the development of AI in mental health. ", doi="10.2196/49894", url="https://mental.jmir.org/2023/1/e49894", url="http://www.ncbi.nlm.nih.gov/pubmed/38051580" } @Article{info:doi/10.2196/47895, author="Gliske, Kate and Ballard, Jaime and Berry, R. Katie and Killian, Michael and Kroll, Elizabeth and Fenkel, Caroline", title="Reduction of Mental Health--Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis", journal="JMIR Form Res", year="2023", month="Nov", day="9", volume="7", pages="e47895", keywords="mental health", keywords="emergency room", keywords="emergency department", keywords="ED", keywords="readmission", keywords="intensive outpatient treatment", keywords="IOP", keywords="pediatric", keywords="youth", keywords="young adult", keywords="emergency", keywords="evaluation", keywords="sexual identity", keywords="race", keywords="ethnicity", keywords="care", keywords="outpatient", keywords="treatment", abstract="Background: Pediatric mental health emergency department (ED) visits are increasing at 6\% to 10\% per year, at substantial cost, while 13\% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth's mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED's in order to prevent readmissions. Objective: The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Methods: Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6\%) of clients were adolescents and the rest were young adults (300/707, 42.4\%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9\% female; 196/687, 28.5\% male; and 65/669, 9.7\% nonbinary) and sexual orientation (248/635, 39.1\% heterosexual; 137/635, 21.6\% bisexual; 80/635, 10.9\% pansexual; and 170/635, 26.8\% other sexual orientation) and represented several racial (9/481, 1.9\% Asian; 48/481, 10\% Black; 9/481, 1.9\% Indigenous; 380/481, 79\% White; and 35/481, 7.2\% other) and ethnic identities (112/455, 24.6\% Hispanic and 28/455, 6.2\% other ethnic identity). Results: Mental health--related ED admissions significantly decreased between intake and 3 months after discharge, such that 94\% (65/69) of clients with a recent history of mental health--related ED admissions at IOP intake reported no mental health--related ED admissions at 3 months after discharge from treatment ($\chi$21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. Conclusions: This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults. ", doi="10.2196/47895", url="https://formative.jmir.org/2023/1/e47895", url="http://www.ncbi.nlm.nih.gov/pubmed/37943600" } @Article{info:doi/10.2196/50208, author="Archibald, Mandy and Makinde, Sharifat and Tongol, Nicole and Levasseur-Puhach, Sydney and Roos, Leslie", title="Experiences and Priorities in Youth and Family Mental Health: Protocol for an Arts-Based Priority-Setting Focus Group Study", journal="JMIR Res Protoc", year="2023", month="Nov", day="7", volume="12", pages="e50208", keywords="arts-based methods", keywords="priority setting", keywords="mental health", keywords="eHealth", keywords="arts-based", keywords="art-based", keywords="preference", keywords="preferences", keywords="perspective", keywords="perspectives", keywords="opinion", keywords="opinions", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="immigrant", keywords="immigrants", keywords="native", keywords="natives", keywords="aboriginal", keywords="aboriginals", keywords="Indigenous", keywords="digital health", keywords="telehealth", keywords="telemedicine", abstract="Background: During the COVID-19 pandemic, eHealth services enabled providers to reach families despite widespread social distancing restrictions. However, their rapid adoption often occurred without community partners' involvement and without an understanding of how they prioritize aspects of their mental health and associated service provision, both of which promote family and community-centered health care delivery. Establishing priorities in health care is essential for developing meaningful and reliable health services. As such, there is an urgent need to understand how eHealth service users, especially families who may have historically faced oppression and systemic barriers to service access, can best benefit from them. Arts-based approaches can elicit an understanding of priorities by providing an engaging and expressive means of moving beyond readily expressible discursive language and stimulating meaningful dialogue reflective of participants' lived experiences. Objective: The purpose of this research is to determine the priorities and preferences of youth; parents or caregivers; newcomers and immigrants; and Indigenous community members regarding the use of eHealth in supporting their mental health using an innovative arts-based priority-setting method. Methods: This study uses a mixed-methods approach combining qualitative, quantitative, and arts-based research. It follows a survey used to identify key knowledge partners who are interested in improving eHealth services for mental health support in Manitoba, Canada. Knowledge partners interested in group-based priority setting will be contacted to participate. We will facilitate approximately two focus groups across each subgroup of youth, parents or caregivers, newcomers or immigrants, and Indigenous community members using an integrative, quantitatively anchored arts-based method termed the ``Circle of Importance'' to understand participants' mental health priorities and how eHealth or technology may support their mental well-being. The Circle of Importance involves placing small objects, whose meaning is determined by participants, on a visual board with concentric circles that correspond to a 5-point Likert scale of importance. Following each focus group, we will evaluate participants' and focus group facilitators' experiences of the Circle of Importance using a survey and follow-up structured in-person interviews to garner how we can improve the arts-based approach used in the focus groups. Results: The PRIME (Partnering for Research Innovation in Mental Health through eHealth Excellence) theme received institutional ethics approval on August 23, 2023. Data collection is projected for August 2023, with follow-up focus groups occurring in early 2024 as required. Data analysis will occur immediately following data collection. Conclusions: Findings will directly inform a multiyear applied research agenda for PRIME aimed at improving mental health services through engaging key knowledge partners. The results may inform how arts-based methods in a priority setting can reflect aspects of experience beyond the capacities of qualitative or quantitative methods alone, and whether this approach aligns well with a positive experience of research participation. International Registered Report Identifier (IRRID): PRR1-10.2196/50208 ", doi="10.2196/50208", url="https://www.researchprotocols.org/2023/1/e50208", url="http://www.ncbi.nlm.nih.gov/pubmed/37934557" } @Article{info:doi/10.2196/47841, author="B{\"a}rk{\aa}s, Annika and Kharko, Anna and Blease, Charlotte and Cajander, {\AA}sa and Johansen Fagerlund, Asbj{\o}rn and Huvila, Isto and Johansen, Alise Monika and Kane, Bridget and Kujala, Sari and Moll, Jonas and Rexhepi, Hanife and Scandurra, Isabella and Wang, Bo and H{\"a}gglund, Maria", title="Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients: Results from a Nationwide Survey in Sweden", journal="J Med Internet Res", year="2023", month="Nov", day="3", volume="25", pages="e47841", keywords="electronic health records", keywords="EHR", keywords="mental health", keywords="mental health care", keywords="national survey", keywords="online records access", keywords="open notes", keywords="ORA", keywords="patient-accessible electronic health record", keywords="PAEHR", keywords="patients", keywords="user experiences", abstract="Background: Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. Objective: The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. Methods: Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. Results: Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65\%, and non-MHC 3311/9203, 35.98\%), omissions (1089/3131, 34.78\%, and non-MHC 2427/9203, 26.37\%) and offenses (1183/3131, 37.78\%, and non-MHC 1616/9203, 17.56\%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13\%, and non-MHC 1366/9203, 41.26\%) and omission (MHC 622/3131, 57.12\%, and non-MHC 1329/9203, 54.76\%) were ``very important,'' but most did nothing to correct them (MHC 792/3131, 41.29\%, and non-MHC 1838/9203, 42.17\%). Most of the respondents identified as women in both groups. Conclusions: About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records. ", doi="10.2196/47841", url="https://www.jmir.org/2023/1/e47841", url="http://www.ncbi.nlm.nih.gov/pubmed/37921861" } @Article{info:doi/10.2196/46826, author="Williams, Jess A. and Freed, Maureen and Theofanopoulou, Nikki and Daud{\'e}n Roquet, Claudia and Klasnja, Predrag and Gross, James and Schleider, Jessica and Slovak, Petr", title="Feasibility, Perceived Impact, and Acceptability of a Socially Assistive Robot to Support Emotion Regulation With Highly Anxious University Students: Mixed Methods Open Trial", journal="JMIR Ment Health", year="2023", month="Oct", day="31", volume="10", pages="e46826", keywords="emotion regulation", keywords="students", keywords="anxiety", keywords="digital intervention", keywords="mixed-methods", abstract="Background: Mental health difficulties among university students have been rising rapidly over the last decade, and the demand for university mental health services commonly far exceeds available resources. Digital interventions are seen as one potential solution to these challenges. However, as in other mental health contexts, digital programs often face low engagement and uptake, and the field lacks usable, engaging, evidence-supported mental health interventions that may be used flexibly when students need them most. Objective: The aim of this study is to investigate the feasibility and acceptability of a new, in situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in situ support for emotion regulation (ER)---a well-known transdiagnostic construct---directly in the moments when individuals are facing emotionally challenging situations. A secondary aim is to consider the perceived impact of Purrble on youth mental health, as reported by students over a 7-week deployment. Methods: A mixed methods open trial was conducted with 78 under- and postgraduate students at Oxford University. Participants were recruited based on moderate to high levels of anxiety measured by Generalized Anxiety Disorder-7 at baseline (mean 16.09, SD 3.03). All participants had access to Purrble for 7 weeks during the spring term with data on their perceived anxiety, emotion dysregulation, ER self-efficacy, and engagement with the intervention collected at baseline (pre), week 4 (mid), and week 8 (postintervention). Qualitative responses were also collected at the mid- and postintervention points. Results: The findings demonstrated a sustained engagement with Purrble over the 7-week period, with the acceptability further supported by the qualitative data indicating that students accepted Purrble and that Purrble was well-integrated into their daily routines. Exploratory quantitative data analysis indicated that Purrble was associated with reductions in student anxiety (dz=0.96, 95\% CI 0.62-1.29) and emotion dysregulation (dz=0.69, 95\% CI 0.38-0.99), and with an increase in ER self-efficacy (dz=--0.56, 95\% CI --0.86 to --0.26). Conclusions: This is the first trial of a simple physical intervention that aims to provide ongoing ER support to university students. Both quantitative and qualitative data suggest that Purrble is an acceptable and feasible intervention among students, the engagement with which can be sustained at a stable level across a 7-week period while retaining a perceived benefit for those who use it (n=32, 61\% of our sample). The consistency of use is particularly promising given that there was no clinician engagement or further support provided beyond Purrble being delivered to the students. These results show promise for an innovative intervention model, which could be complementary to the existing interventions. ", doi="10.2196/46826", url="https://mental.jmir.org/2023/1/e46826", url="http://www.ncbi.nlm.nih.gov/pubmed/37906230" } @Article{info:doi/10.2196/48112, author="Rosansky, A. Joseph and Okst, Kayley and Tepper, C. Miriam and Baumgart Schreck, Ana and Fulwiler, Carl and Wang, S. Philip and Schuman-Olivier, Zev", title="Participants' Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study", journal="JMIR Ment Health", year="2023", month="Oct", day="26", volume="10", pages="e48112", keywords="COVID-19 pandemic", keywords="digital psychiatry", keywords="early identification", keywords="integrative medicine", keywords="mental wellness", keywords="mindfulness", keywords="population mental health", keywords="prevention", keywords="stratified care", abstract="Background: The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system's patient population. Objective: This program evaluation was conducted to explore participants' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. Methods: We examined participants' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. Results: The program enrolled 903 participants (664/903, 73.5\% female; 556/903, 61.6\% White; 113/903, 12.5\% Black; 84/903, 9.3\% Asian; 7/903, 0.8\% Native; 36/903, 4\% other; and 227/903, 25.1\% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69\%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95\% CI 1.14-2.84; P=.01). Participants' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95\% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. Conclusions: CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects. ", doi="10.2196/48112", url="https://mental.jmir.org/2023/1/e48112", url="http://www.ncbi.nlm.nih.gov/pubmed/37883149" } @Article{info:doi/10.2196/46494, author="Xu, Yi and Yang, Hongshen and Jin, Zhou and Xiang, Jian and Xu, Haiyun and Pokay, Huang Yili and Mao, Haibo and Cai, Xugong and Wu, Yili and Wang, Baofeng Deborah", title="Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation", journal="JMIR Form Res", year="2023", month="Oct", day="26", volume="7", pages="e46494", keywords="adolescents", keywords="digital mental health clinic", keywords="emotional distress", keywords="mental health service", keywords="secondary school", abstract="Background: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. Objective: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. Methods: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. Results: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. Conclusions: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended. ", doi="10.2196/46494", url="https://formative.jmir.org/2023/1/e46494", url="http://www.ncbi.nlm.nih.gov/pubmed/37883144" } @Article{info:doi/10.2196/48365, author="Ryan, T. Arthur and Stearns-Yoder, A. Kelly and Brenner, A. Lisa", title="Real-World User Demographics of Three Web-Based Digital Mental Health Interventions Provided by the US Department of Veterans Affairs: Observational Study Using Web Analytics Data", journal="JMIR Form Res", year="2023", month="Oct", day="18", volume="7", pages="e48365", keywords="digital intervention", keywords="unguided", keywords="web-based", keywords="internet-delivered", keywords="mental health", keywords="veterans", keywords="Google Analytics", keywords="insomnia", keywords="anger", keywords="depression", keywords="mobile phone", abstract="Background: Unguided digital mental health interventions (UDMHIs) have the potential to provide low-cost and effective mental health care at scale. Controlled trials have demonstrated the efficacy of UDMHIs to address mental health symptoms and conditions. However, few previous publications have described the demographics of real-world users of UDMHIs that are freely available to the public. The US Department of Veterans Affairs has created and hosts several UDMHIs on its Veteran Training Portal website. These web-based, free-to-use, and publicly available UDMHIs include Path to Better Sleep, Anger and Irritability Management Skills, and Moving Forward, which focus on insomnia, problematic anger, and depression symptoms, respectively. Objective: This study aimed to examine the user demographics of these 3 UDMHIs in the year 2021. In addition, it aimed to compare the age and gender distribution of the users of those 3 UDMHIs with one another and with the age and gender distribution of the total US veteran population. Methods: Google Analytics was used to collect user data for each of the 3 UDMHIs. The age and gender distribution of the users of each UDMHI was compared with that of the other UDMHIs as well as with that of the overall US veteran population using chi-square tests. Information on the total number of users, the country they were in, and the devices they used to access the UDMHIs was also collected and reported. Results: In 2021, the 3 UDMHIs together recorded 29,306 unique users. The estimated age range and gender were available for 24.12\% (7068/29,306) of those users. Each UDMHI's age and gender distribution significantly differed from that of the other UDMHIs and from that of the overall US veteran population (P<.001 on all chi-square tests). Women and younger age groups were overrepresented among UDMHI users compared with the overall US veteran population. The majority of devices used to access the UDMHIs were desktop or laptop devices, although a substantial proportion of devices used were mobile devices (10,199/29,752, 34.28\%). Most users (27,789/29,748, 93.41\%) were located in the United States, with users from Canada, the United Kingdom, and Australia accounting for another 2.61\% (775/29,748) of total users. Conclusions: Our use of Google Analytics data provided useful information about the users of 3 free and publicly available UDMHIs provided by the US Department of Veterans Affairs. Although our findings should be considered in light of the limitations of autonomously collected web analytics data, they still offer useful information for health care policy makers, administrators, and UDMHI developers. ", doi="10.2196/48365", url="https://formative.jmir.org/2023/1/e48365", url="http://www.ncbi.nlm.nih.gov/pubmed/37851501" } @Article{info:doi/10.2196/48843, author="Hamlin, Matilda and Holm{\'e}n, Joacim and Wentz, Elisabet and Aiff, Harald and Ali, Lilas and Steingrimsson, Steinn", title="Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis", journal="JMIR Ment Health", year="2023", month="Oct", day="11", volume="10", pages="e48843", keywords="major depressive disorder", keywords="digital psychiatry", keywords="mobile app", keywords="adherence", keywords="antidepressant", keywords="antidepressants", keywords="depressive", keywords="depression", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="experience", keywords="interview", keywords="interviews", keywords="medication", keywords="prescribe", keywords="prescription", keywords="dose", abstract="Background: Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. Objective: The aim of this study was to determine patients' experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. Methods: This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. Results: In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5\%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app's ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app's content and requested tailored content. Conclusions: The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results. ", doi="10.2196/48843", url="https://mental.jmir.org/2023/1/e48843", url="http://www.ncbi.nlm.nih.gov/pubmed/37819697" } @Article{info:doi/10.2196/48362, author="Tsirmpas, Charalampos and Nikolakopoulou, Maria and Kaplow, Sharon and Andrikopoulos, Dimitrios and Fatouros, Panagiotis and Kontoangelos, Konstantinos and Papageorgiou, Charalabos", title="A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="11", volume="7", pages="e48362", keywords="precision medicine", keywords="internet-based intervention", keywords="mobile apps", keywords="major depressive disorder", keywords="anxiety disorders", keywords="attention-deficit/hyperactivity disorder", keywords="personalized medicine", keywords="comorbidity", keywords="quality of life", keywords="mobile phone", abstract="Background: A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms. Objective: This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants' engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels. Methods: This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire--9, Generalized Anxiety Disorder--7, and Barkley Adult ADHD Rating Scale--IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability. Results: The study retention rate was 97\% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2\% (P<.001; r=0.89) in depressive symptoms and 46.4\% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57\% and 18/30, 60\%, respectively) of the participants. This was followed by an average increase of 23\% (P<.001; r=0.78) and 20\% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5. Conclusions: The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy. ", doi="10.2196/48362", url="https://formative.jmir.org/2023/1/e48362", url="http://www.ncbi.nlm.nih.gov/pubmed/37819688" } @Article{info:doi/10.2196/47433, author="Taher, Rayan and Hsu, Che-Wei and Hampshire, Chloe and Fialho, Carolina and Heaysman, Clare and Stahl, Daniel and Shergill, Sukhi and Yiend, Jenny", title="The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations", journal="JMIR Ment Health", year="2023", month="Oct", day="9", volume="10", pages="e47433", keywords="digital", keywords="digital therapeutics", keywords="mental health", keywords="psychological", keywords="safety", keywords="risk", keywords="negative effects", keywords="harm", keywords="adverse event", keywords="risk mitigation", keywords="mobile phone", abstract="Background: Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as face-to-face therapies, pose risks to patients. A safe intervention is considered one in which the measured benefits outweigh the identified and mitigated risks. Objective: This study aims to review the literature to assess how DMHIs assess safety, what risks are reported, and how they are mitigated in both the research and postmarket phases and building on existing recommendations for assessing, reporting, and mitigating safety in the DMHI and standardizing practice. Methods: PsycINFO, Embase, and MEDLINE databases were searched for studies that addressed the safety of DMHIs. The inclusion criteria were any study that addressed the safety of a clinical DMHI, even if not as a main outcome, in an adult population, and in English. As the outcome data were mainly qualitative in nature, a meta-analysis was not possible, and qualitative analysis was used to collate the results. Quantitative results were synthesized in the form of tables and percentages. To illustrate the use of a single common safety metric across studies, we calculated odds ratios and CIs, wherever possible. Results: Overall, 23 studies were included in this review. Although many of the included studies assessed safety by actively collecting adverse event (AE) data, over one-third (8/23, 35\%) did not assess or collect any safety data. The methods and frequency of safety data collection varied widely, and very few studies have performed formal statistical analyses. The main treatment-related reported AE was symptom deterioration. The main method used to mitigate risk was exclusion of high-risk groups. A secondary web-based search found that 6 DMHIs were available for users or patients to use (postmarket phase), all of which used indications and contraindications to mitigate risk, although there was no evidence of ongoing safety review. Conclusions: The findings of this review show the need for a standardized classification of AEs, a standardized method for assessing AEs to statically analyze AE data, and evidence-based practices for mitigating risk in DMHIs, both in the research and postmarket phases. This review produced 7 specific, measurable, and achievable recommendations with the potential to have an immediate impact on the field, which were implemented across ongoing and future research. Improving the quality of DMHI safety data will allow meaningful assessment of the safety of DMHIs and confidence in whether the benefits of a new DMHI outweigh its risks. Trial Registration: PROSPERO CRD42022333181; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=333181 ", doi="10.2196/47433", url="https://mental.jmir.org/2023/1/e47433", url="http://www.ncbi.nlm.nih.gov/pubmed/37812471" } @Article{info:doi/10.2196/44502, author="Oudin, Antoine and Maatoug, Redwan and Bourla, Alexis and Ferreri, Florian and Bonnot, Olivier and Millet, Bruno and Schoeller, F{\'e}lix and Mouchabac, St{\'e}phane and Adrien, Vladimir", title="Digital Phenotyping: Data-Driven Psychiatry to Redefine Mental Health", journal="J Med Internet Res", year="2023", month="Oct", day="4", volume="25", pages="e44502", keywords="digital phenotype", keywords="empowerment", keywords="mental health", keywords="personalized medicine", keywords="psychiatry", doi="10.2196/44502", url="https://www.jmir.org/2023/1/e44502", url="http://www.ncbi.nlm.nih.gov/pubmed/37792430" } @Article{info:doi/10.2196/45409, author="Eustis, H. Elizabeth and LoPresti, Jessica and Aguilera, Adrian and Schueller, M. Stephen", title="Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components", journal="J Med Internet Res", year="2023", month="Oct", day="3", volume="25", pages="e45409", keywords="technology", keywords="mobile health", keywords="mHealth", keywords="mental health", keywords="cultural responsivity", keywords="human support", keywords="mobile phone", doi="10.2196/45409", url="https://www.jmir.org/2023/1/e45409", url="http://www.ncbi.nlm.nih.gov/pubmed/37788050" } @Article{info:doi/10.2196/46491, author="Green, B. James and Rodriguez, Joey and Keshavan, Matcheri and Lizano, Paulo and Torous, John", title="Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="3", volume="7", pages="e46491", keywords="psychosis", keywords="digital health", keywords="digital mental health", keywords="coordinated specialty care", keywords="digital navigator", keywords="clinical high risk", keywords="schizophrenia", keywords="implementation science", keywords="technology", keywords="mobile phone", abstract="Background: Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. Objective: In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Methods: Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode--psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. Results: In total, 5 patients (ASPIRE: n=3, 60\%; CEDAR: n=2, 40\%) were included: 3 (60\%) White individuals, 2 (40\%) male and 2 (40\%) female patients, and 1 (20\%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Conclusions: Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care. ", doi="10.2196/46491", url="https://formative.jmir.org/2023/1/e46491", url="http://www.ncbi.nlm.nih.gov/pubmed/37788066" } @Article{info:doi/10.2196/46473, author="Forman-Hoffman, L. Valerie and Pirner, C. Maddison and Flom, Megan and Kirvin-Quamme, Andrew and Durden, Emily and Kissinger, A. Jennifer and Robinson, Athena", title="Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study", journal="JMIR Form Res", year="2023", month="Sep", day="27", volume="7", pages="e46473", keywords="adoption", keywords="anxiety", keywords="chatbot", keywords="cognitive behavioral therapy", keywords="conversational agent", keywords="CBT", keywords="depression", keywords="digital health", keywords="medically underserved area", keywords="mental health", keywords="mhealth", keywords="mobile app", keywords="mobile health", keywords="mobile phone", keywords="mood", keywords="psychotherapy", keywords="relational agent", keywords="rural", keywords="satisfaction", keywords="smartphone app", keywords="smartphone", keywords="underserved", keywords="usage", keywords="vulnerable", abstract="Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10\%) or rural (3/255, 1\%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39\% (99/255) resided in an MUA and 55\% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale?10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent--guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 ", doi="10.2196/46473", url="https://formative.jmir.org/2023/1/e46473", url="http://www.ncbi.nlm.nih.gov/pubmed/37756047" } @Article{info:doi/10.2196/47691, author="Xiang, Xiaoling and Kayser, Jay and Ash, Samson and Zheng, Chuxuan and Sun, Yihang and Weaver, Addie and Dunkle, Ruth and Blackburn, A. James and Halavanau, Alex and Xue, Jia and Himle, A. Joseph", title="Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study", journal="JMIR Aging", year="2023", month="Sep", day="19", volume="6", pages="e47691", keywords="internet-based cognitive behavioral therapy", keywords="usability", keywords="geriatric depression", keywords="community-engaged research", keywords="web-based", keywords="geriatrics", keywords="geriatric", keywords="depression", keywords="psychotherapy", keywords="mental health", keywords="older adults", keywords="older adult", keywords="cognitive behavioral therapy", keywords="CBT", keywords="design", keywords="development", keywords="community", keywords="user centered design", keywords="digital health", keywords="aging", keywords="old age", keywords="digital mental health", keywords="web-based health", keywords="internet", abstract="Background: Homebound older adults are a high-risk group for depression. However, many of them face barriers to accessing evidence-supported mental health treatments. Digital mental health interventions can potentially improve treatment access, but few web-based interventions are explicitly tailored for depression in older adults. Objective: This paper describes the development process of Empower@Home, a web-delivered intervention for depression in homebound older adults that is based on cognitive behavioral therapy, and reports on the outcomes of usability studies. Methods: Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through secondary data analysis, demographic and health profiles from administrative data, and interviews and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs. Field testing was conducted with 4 end users to detect additional usability issues. Results: Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of 9 sessions, including psychoeducation and an introduction to cognitive behavioral therapy skills and tools through short video clips, in-session exercises, an animated storyline, and weekly out-of-session home practice. A printed workbook accompanies the web-based lessons. In comparative usability testing (N=10), Empower@Home received a System Usability Scale score of 78 (SD 7.4), which was significantly higher than the 2 comparator programs (t9=3.28; P=.005 and t9=2.78; P=.011). Most participants, 80\% (n=8), preferred Empower@Home over the comparators. In the longitudinal field test (n=4), all participants reported liking the program procedures and feeling confident in performing program-related tasks. The single-subject line graph showed an overall downward trend in their depression scores over time, offering an encouraging indication of the intervention's potential effects. Conclusions: Collaboration with community stakeholders and careful consideration of potential implementation issues during the design process can result in more usable, engaging, and effective digital mental health interventions. ", doi="10.2196/47691", url="https://aging.jmir.org/2023/1/e47691", url="http://www.ncbi.nlm.nih.gov/pubmed/37725423" } @Article{info:doi/10.2196/45161, author="Chong, K. Min and Hickie, B. Ian and Cross, P. Shane and McKenna, Sarah and Varidel, Mathew and Capon, William and Davenport, A. Tracey and LaMonica, M. Haley and Sawrikar, Vilas and Guastella, Adam and Naismith, L. Sharon and Scott, M. Elizabeth and Iorfino, Frank", title="Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study", journal="JMIR Form Res", year="2023", month="Sep", day="8", volume="7", pages="e45161", keywords="clinical staging", keywords="digital health solution", keywords="online diagnosis", keywords="service transformation", keywords="staged care", keywords="stratified care", keywords="youth mental health", abstract="Background: As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. Objective: The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. Methods: We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. Results: Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72\% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement ($\kappa$=0.67; P<.001). The algorithm demonstrated an accuracy of 91\% (95\% CI 86\%-95\%; P=.03), a sensitivity of 80\%, a specificity of 93\%, and an F1-score of 73\%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. Conclusions: This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11\% and 27\% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention. ", doi="10.2196/45161", url="https://formative.jmir.org/2023/1/e45161", url="http://www.ncbi.nlm.nih.gov/pubmed/37682588" } @Article{info:doi/10.2196/49384, author="Huffman, Landry and Lawrence-Sidebottom, Darian and Huberty, Jennifer and Beatty, Clare and Roots, Monika and Roots, Kurt and Parikh, Amit and Guerra, Rachael", title="Satisfaction, Perceived Usefulness, and Therapeutic Alliance as Correlates of Participant Engagement in a Pediatric Digital Mental Health Intervention: Cross-Sectional Questionnaire Study", journal="JMIR Form Res", year="2023", month="Sep", day="6", volume="7", pages="e49384", keywords="service satisfaction", keywords="satisfaction", keywords="patient-provider", keywords="adolescent", keywords="child", keywords="children", keywords="youth", keywords="mental health", keywords="perceived usefulness", keywords="internet-based coaching", keywords="coach", keywords="coaching", keywords="internet-based therapy", keywords="collaborative care", keywords="digital mental health intervention", keywords="engagement", abstract="Background: Although evidence suggests that digital mental health interventions (DMHIs) are effective alternatives to traditional mental health care, participant engagement continues to be an issue, especially for pediatric DMHIs. Extant studies of DMHIs among adults suggest that participants' satisfaction, perceived usefulness, and therapeutic alliance are closely tied to engagement. However, these associations have not been investigated among children and adolescents involved in DMHIs. Objective: To address these gaps in extant DMHI research, the purpose of this study was to (1) develop and implement a measure to assess satisfaction, perceived usefulness, and therapeutic alliance among children and adolescents participating in a DMHI and (2) investigate satisfaction, perceived usefulness, and therapeutic alliance as correlates of children's and adolescents' engagement in the DMHI. Methods: Members (children and adolescents) of a pediatric DMHI who had completed at least one session with a care provider (eg, coach or therapist) were eligible for inclusion in the study. Adolescent members and caregivers of children completed a survey assessing satisfaction with service, perceived usefulness of care, and therapeutic alliance with care team members. Results: This study provides evidence for the reliability and validity of an adolescent- and caregiver-reported user experience assessment in a pediatric DMHI. Moreover, our findings suggest that adolescents' and caregivers' satisfaction and perceived usefulness are salient correlates of youths' engagement with a DMHI. Conclusions: This study provides valuable preliminary evidence that caregivers' satisfaction and perceived usefulness are salient correlates of youths' engagement with a DMHI. Although further research is required, these findings offer preliminary evidence that caregivers play a critical role in effectively increasing engagement among children and adolescents involved in DMHIs. ", doi="10.2196/49384", url="https://formative.jmir.org/2023/1/e49384", url="http://www.ncbi.nlm.nih.gov/pubmed/37672321" } @Article{info:doi/10.2196/46590, author="Veldmeijer, Lars and Terlouw, Gijs and Van Os, Jim and Van Dijk, Olga and Van 't Veer, Job and Boonstra, Nynke", title="The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review", journal="JMIR Ment Health", year="2023", month="Jul", day="25", volume="10", pages="e46590", keywords="design approaches", keywords="innovation", keywords="psychiatry", keywords="mental health care", keywords="involvement", keywords="service users", keywords="people with lived experience", keywords="cocreation", keywords="mobile phone", abstract="Background: Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. Objective: In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. Methods: The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. Results: We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants' continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. Conclusions: This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner. ", doi="10.2196/46590", url="https://mental.jmir.org/2023/1/e46590", url="http://www.ncbi.nlm.nih.gov/pubmed/37490326" } @Article{info:doi/10.2196/46200, author="Wolitzky-Taylor, Kate and LeBeau, Richard and Arnaudova, Inna and Barnes-Horowitz, Nora and Gong-Guy, Elizabeth and Fears, Scott and Congdon, Eliza and Freimer, Nelson and Craske, Michelle", title="A Novel and Integrated Digitally Supported System of Care for Depression and Anxiety: Findings From an Open Trial", journal="JMIR Ment Health", year="2023", month="Jul", day="24", volume="10", pages="e46200", keywords="depression", keywords="anxiety", keywords="cognitive behavioral therapy", keywords="digital mental health", keywords="stratified models of care", keywords="model of care", keywords="care model", keywords="depressive", keywords="mental health", keywords="CBT", keywords="psychotherapy", keywords="university", keywords="postsecondary", keywords="student", keywords="college", keywords="service delivery", keywords="care system", keywords="system of care", keywords="mHealth", keywords="eHealth", keywords="online support", keywords="student mental health", abstract="Background: The global burden of anxiety and depression has created an urgent need for scalable approaches to increase access to evidence-based mental health care. The Screening and Treatment for Anxiety and Depression (STAND) system of care was developed to meet this need through the use of internet-connected devices for assessment and provision of treatment. STAND triages to level of care (monitoring only, digital therapy with coaches, digital therapy assisted by clinicians in training, and clinical care) and then continuously monitors symptoms to adapt level of care. Triaging and adaptation are based on symptom severity and suicide risk scores obtained from computerized adaptive testing administered remotely. Objective: This article discusses how the STAND system of care improves upon current clinical paradigms, and presents preliminary data on feasibility, acceptability, and effectiveness of STAND in a sample of US-based university students. Methods: US-based university students were recruited and enrolled in an open trial of the STAND system of care. Participants were triaged based on initial symptom severity derived from a computerized adaptive test and monitored over 40 weeks on anxiety, depression, and suicide risk to inform treatment adaptation and evaluate preliminary effectiveness. Results: Nearly 5000 students were screened and 516 received care. Depression and anxiety severity scores improved across all tiers (P<.001 in all cases). Suicide risk severity improved in the highest tier (ie, clinical care; P<.001). Acceptability and feasibility were demonstrated. Conclusions: STAND is a feasible and acceptable model of care that can reach large numbers of individuals. STAND showed preliminary effectiveness on all primary outcome measures. Current directions to improve STAND are described. ", doi="10.2196/46200", url="https://mental.jmir.org/2023/1/e46200", url="http://www.ncbi.nlm.nih.gov/pubmed/37486735" } @Article{info:doi/10.2196/46849, author="Wrightson-Hester, Aimee-Rose and Anderson, Georgia and Dunstan, Joel and McEvoy, M. Peter and Sutton, J. Christopher and Myers, Bronwyn and Egan, Sarah and Tai, Sara and Johnston-Hollitt, Melanie and Chen, Wai and Gedeon, Tom and Mansell, Warren", title="An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series", journal="JMIR Hum Factors", year="2023", month="Jul", day="21", volume="10", pages="e46849", keywords="mental health", keywords="conversational agents", keywords="chatbots", keywords="young people", keywords="acceptability", keywords="feasibility", keywords="co-design", keywords="artificial therapist", keywords="artificial intelligence", keywords="youth", keywords="child", keywords="adolescent", keywords="chatbot", keywords="Manage Your Life Online", keywords="MYLO", keywords="support", keywords="mobile phone", abstract="Background: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems. Objective: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems. Methods: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements. Results: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants' problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks. Conclusions: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants' symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial. ", doi="10.2196/46849", url="https://humanfactors.jmir.org/2023/1/e46849", url="http://www.ncbi.nlm.nih.gov/pubmed/37477969" } @Article{info:doi/10.2196/44747, author="Durocher, Keri and Shin, Danielle Hwayeon and Lo, Brian and Chen, Sheng and Ma, Clement and Strudwick, Gillian", title="Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Jul", day="19", volume="10", pages="e44747", keywords="mental health", keywords="patient portal", keywords="mixed methods", keywords="interprofessional collaboration", keywords="communication", keywords="self-empowerment", keywords="nursing informatics", keywords="digital health", abstract="Background: Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship. Objective: This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients. Methods: This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal. Results: For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution. Conclusions: Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients' narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025508 ", doi="10.2196/44747", url="https://humanfactors.jmir.org/2023/1/e44747", url="http://www.ncbi.nlm.nih.gov/pubmed/37467024" } @Article{info:doi/10.2196/47459, author="Steiner, Artur and Farmer, Jane and Kamstra, Peter and Carlisle, Karen and McCosker, Anthony and Kilpatrick, Sue", title="Online Mental Health Forums and Rural Resilience: Mixed Methods Study and Logic Model", journal="JMIR Ment Health", year="2023", month="Jun", day="28", volume="10", pages="e47459", keywords="online forums", keywords="personal resilience", keywords="mental health", keywords="rurality", keywords="logic model", abstract="Background: Rural mental health is a growing area of concern internationally, and online mental health forums offer a potential response to addressing service gaps in rural communities. Objective: The objective of this study was to explore and identify pathways by which online peer support mental health forums help to build resilience for rural residents experiencing mental ill-health by contributing to overcoming their specific contextual challenges. Methods: We developed a Theoretical Resilience Framework and applied it to 3000 qualitative posts from 3 Australian online mental health forums and to data from 30 interviews with rural forum users. Results: Drawing on the findings and an abductive approach, a logic model was developed to illustrate links between the resilience resources built and enabling features of forums that make them spaces that facilitate resilience. Conclusions: The study demonstrated that online forums make valuable contributions to social well-being and access to a range of timely support services for rural people experiencing mental ill-health, and, while doing so, involve users in the processes of resilience building. The study provides a new way for practitioners to frame the work of and value produced by forums. It gives a logic model that can be used in evaluation and audit as it facilitates a causal framing of how forums, as an intervention, link with resilience outcomes. Ultimately, the study contributes to developing new knowledge about how rural resilience building can be conceptualized and measured while showing how forums are part of contemporary health service provision in rural places. ", doi="10.2196/47459", url="https://mental.jmir.org/2023/1/e47459", url="http://www.ncbi.nlm.nih.gov/pubmed/37379080" } @Article{info:doi/10.2196/44687, author="Rennick-Egglestone, Stefan and Newby, Chris and Robinson, Clare and Yeo, Caroline and Ng, Fiona and Elliott, A. Rachel and Ali, Yasmin and Llewellyn-Beardsley, Joy and Pomberth, Scott and Harrison, Julian and Gavan, P. Sean and Cuijpers, Pim and Priebe, Stefan and Hall, L. Charlotte and Slade, Mike", title="Differences Between Online Trial Participants Who Have Used Statutory Mental Health Services and Those Who Have Not: Analysis of Baseline Data From 2 Pragmatic Trials of a Digital Health Intervention", journal="J Med Internet Res", year="2023", month="Jun", day="27", volume="25", pages="e44687", keywords="open recruitment", keywords="service use", keywords="nonservice use", keywords="online intervention", keywords="online trial", keywords="mobile phone", abstract="Background: Digital health interventions (DHIs) are an established element of mental health service provision internationally. Regulators have positioned the best practice standard of evidence as an interventional study with a comparator reflective of standard care, often operationalized as a pragmatic trial. DHIs can extend health provision to those not currently using mental health services. Hence, for external validity, trials might openly recruit a mixture of people who have used mental health services and people who have not. Prior research has demonstrated phenomenological differences in mental health experience between these groups. Some differences between service users and nonservice users might influence the change created by DHIs; hence, research should systematically examine these differences to inform intervention development and evaluation work. This paper analyzes baseline data collected in the NEON (Narrative Experiences Online; ie, for people with experience of psychosis) and NEON-O (NEON for other [eg, nonpsychosis] mental health problems) trials. These were pragmatic trials of a DHI that openly recruited people who had used specialist mental health services and those who had not. All participants were experiencing mental health distress. NEON Trial participants had experienced psychosis in the previous 5 years. Objective: This study aims to identify differences in baseline sociodemographic and clinical characteristics associated with specialist mental health service use for NEON Trial and NEON-O Trial participants. Methods: For both trials, hypothesis testing was used to compare baseline sociodemographic and clinical characteristics of participants in the intention-to-treat sample who had used specialist mental health services and those who had not. Bonferroni correction was applied to significance thresholds to account for multiple testing. Results: Significant differences in characteristics were identified in both trials. Compared with nonservice users (124/739, 16.8\%), NEON Trial specialist service users (609/739, 82.4\%) were more likely to be female (P<.001), older (P<.001), and White British (P<.001), with lower quality of life (P<.001) and lower health status (P=.002). There were differences in geographical distribution (P<.001), employment (P<.001; more unemployment), current mental health problems (P<.001; more psychosis and personality disorders), and recovery status (P<.001; more recovered). Current service users were more likely to be experiencing psychosis than prior service users. Compared with nonservice users (399/1023, 39\%), NEON-O Trial specialist service users (614/1023, 60.02\%) had differences in employment (P<.001; more unemployment) and current mental health problems (P<.001; more personality disorders), with lower quality of life (P<.001), more distress (P<.001), less hope (P<.001), less empowerment (P<.001), less meaning in life (P<.001), and lower health status (P<.001). Conclusions: Mental health service use history was associated with numerous differences in baseline characteristics. Investigators should account for service use in work to develop and evaluate interventions for populations with mixed service use histories. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04428-6 ", doi="10.2196/44687", url="https://www.jmir.org/2023/1/e44687", url="http://www.ncbi.nlm.nih.gov/pubmed/37368471" } @Article{info:doi/10.2196/44688, author="Brantnell, Anders and Temiz, Serdar and Baraldi, Enrico and Woodford, Joanne and von Essen, Louise", title="Barriers to and Facilitators of the Implementation of Digital Mental Health Interventions as Perceived by Primary Care Decision Makers: Content Analysis of Structured Open-Ended Survey Data", journal="JMIR Hum Factors", year="2023", month="Jun", day="26", volume="10", pages="e44688", keywords="digital mental health", keywords="implementation", keywords="barriers", keywords="facilitators", keywords="internet-based cognitive behavioral therapy", keywords="survey", keywords="decision makers", abstract="Background: Digital mental health represents a way to increase access to evidence-based psychological support. However, the implementation of digital mental health in routine health care practice is limited, with few studies focusing on implementation. Accordingly, there is a need to better understand the barriers to and facilitators of implementing digital mental health. Existing studies have mainly focused on the viewpoints of patients and health professionals. Currently, there are few studies about barriers and facilitators from the perspective of primary care decision makers, that is, the persons responsible for deciding whether a given digital mental health intervention should be implemented in a primary care organization. Objective: The objectives were to identify and describe barriers to and facilitators of the implementation of digital mental health as perceived by primary care decision makers, evaluate the relative importance of different barriers and facilitators, and compare barriers and facilitators reported by primary care decision makers who have versus have not implemented digital mental health interventions. Methods: A web-based self-report survey was conducted with primary care decision makers responsible for the implementation of digital mental health in primary care organizations in Sweden. Answers to 2 open-ended questions about barriers and facilitators were analyzed through summative and deductive content analysis. Results: The survey was completed by 284 primary care decision makers---59 (20.8\%) decision makers representing implementers (ie, organizations that offered digital mental health interventions) and 225 (79.2\%) respondents representing nonimplementers (ie, organizations that did not offer digital mental health interventions). Overall, 90\% (53/59) of the implementers and 98.7\% (222/225) of the nonimplementers identified barriers, and 97\% (57/59) of the implementers and 93.3\% (210/225) of the nonimplementers identified facilitators. Altogether, 29 barriers and 20 facilitators of implementation were identified related to guidelines; patients; health professionals; incentives and resources; capacity for organizational change; and social, political, and legal factors. The most prevalent barriers were related to incentives and resources, whereas the most prevalent facilitators were related to the capacity for organizational change. Conclusions: A number of barriers and facilitators were identified that could influence the implementation of digital mental health from the perspective of primary care decision makers. Implementers and nonimplementers identified many common barriers and facilitators, but they differ in terms of certain barriers and facilitators. Common and differing barriers and facilitators identified by implementers and nonimplementers may be important to address when planning for the implementation of digital mental health interventions. For instance, financial incentives and disincentives (eg, increased costs) are the most frequently mentioned barrier and facilitator, respectively, by nonimplementers, but not by implementers. One way to facilitate implementation could be to provide more information to nonimplementers about the actual costs related to the implementation of digital mental health. ", doi="10.2196/44688", url="https://humanfactors.jmir.org/2023/1/e44688", url="http://www.ncbi.nlm.nih.gov/pubmed/37358902" } @Article{info:doi/10.2196/45949, author="Nogueira-Leite, Diogo and Diniz, Miguel Jos{\'e} and Cruz-Correia, Ricardo", title="Mental Health Professionals' Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Jun", day="2", volume="10", pages="e45949", keywords="mobile health", keywords="mHealth", keywords="health policy", keywords="mental health", keywords="digital health", keywords="apps", keywords="psychiatrists", keywords="psychologists", keywords="technology acceptance", keywords="adoption", keywords="government regulation", abstract="Background: Digital health apps are among the most visible facets of the ongoing digital transition in health care, with mental health--focused apps as one of the main therapeutic areas. However, concerns regarding their scientific robustness drove regulators to establish evaluation procedures, with Germany's Digitale Gesundheitsanwendungen program pioneering in app prescription with costs covered by statutory health insurance. Portugal gathers a set of conditions and requirements that position it as an excellent test bed for digital health apps. Its daunting mental health landscape reinforces the potential interest in new interventions. To understand if they would be acceptable, we need to understand the supply side's attitudes and perceptions toward them, that is, those of psychiatrists and psychologists. Objective: This study aims to understand the attitudes and expectations of psychiatrists and psychologists toward digital mental health apps (DMHAs) in the Portuguese context, as well as perceived benefits, barriers, and actions to support their adoption. Methods: We conducted a 2-stage sequential mixed methods study. Stage 1 consisted of a cross-sectional web survey adapted to the Portuguese context that was delivered to mental health professionals and psychologists. Stage 2 complemented the insights of the web survey results with a key opinion leader analysis. Results: A total of 160 complete survey responses were recorded, most of which were from psychologists. This is the most extensive study on mental health professionals' attitudes and perceptions of DMHAs in Portugal. A total of 87.2\% (136/156) of the respondents supported the opportunity to prescribe DMHAs. Increased health literacy (139/160, 86.9\%), wider adherence to treatment (137/160, 85.6\%), and proper disease management (127/160, 79.4\%) were the most frequently agreed upon benefits of DMHAs. However, only less than half (68/156, 43.6\%) of the respondents planned to prescribe or recommend DMHAs, with psychologists being more favorable than psychiatrists. Professionals faced substantial barriers, such as a lack of information on DMHAs (154/160, 96.3\%), the level of initial training effort (115/160, 71.9\%), and the need for adjustments of clinical processes and records (113/160, 70.6\%). Professionals reported that having more information on the available apps and their suitability for health objectives (151/160, 94.4\%), more scientific evidence of the validity of the apps as a health intervention (147/160, 91.9\%), and established recommendations of apps by specific clinical guidelines or professional societies (145/160, 90.6\%) would be essential to foster adoption. Conclusions: More information about DMHAs regarding their clinical validity and how they work is necessary so that such an intervention can be adopted in Portugal. Recommendations from professional and scientific societies, as well as from governmental bodies, are strongly encouraged. Although the benefits of and the barriers to using these apps are consensual, more evidence, along with further promotion of mental health professionals' digital literacy, is needed. International Registered Report Identifier (IRRID): RR2-10.2196/41040 ", doi="10.2196/45949", url="https://humanfactors.jmir.org/2023/1/e45949", url="http://www.ncbi.nlm.nih.gov/pubmed/37266977" } @Article{info:doi/10.2196/40163, author="Lyzwinski, Nathalie Lynnette and Elgendi, Mohamed and Menon, Carlo", title="The Use of Photoplethysmography in the Assessment of Mental Health: Scoping Review", journal="JMIR Ment Health", year="2023", month="May", day="29", volume="10", pages="e40163", keywords="photoplethysmography", keywords="PPG", keywords="mental health", keywords="depression", keywords="anxiety", keywords="suicide", keywords="mobile phone", abstract="Background: With the rise in mental health problems globally, mobile health provides opportunities for timely medical care and accessibility. One emerging area of mobile health involves the use of photoplethysmography (PPG) to assess and monitor mental health. Objective: In recent years, there has been an increase in the use of PPG-based technology for mental health. Therefore, we conducted a review to understand how PPG has been evaluated to assess a range of mental health and psychological problems, including stress, depression, and anxiety. Methods: A scoping review was performed using PubMed and Google Scholar databases. Results: A total of 24 papers met the inclusion criteria and were included in this review. We identified studies that assessed mental health via PPG using finger- and face-based methods as well as smartphone-based methods. There was variation in study quality. PPG holds promise as a potential complementary technology for detecting changes in mental health, including depression and anxiety. However, rigorous validation is needed in diverse clinical populations to advance PPG technology in tackling mental health problems. Conclusions: PPG holds promise for assessing mental health problems; however, more research is required before it can be widely recommended for clinical use. ", doi="10.2196/40163", url="https://mental.jmir.org/2023/1/e40163", url="http://www.ncbi.nlm.nih.gov/pubmed/37247209" } @Article{info:doi/10.2196/45718, author="Zhao, Xin and Stadnick, A. Nicole and Ceballos-Corro, Eduardo and Castro Jr, Jorge and Mallard-Swanson, Kera and Palomares, J. Kristina and Eikey, Elizabeth and Schneider, Margaret and Zheng, Kai and Mukamel, B. Dana and Schueller, M. Stephen and Sorkin, H. Dara", title="Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses", journal="JMIR Form Res", year="2023", month="May", day="16", volume="7", pages="e45718", keywords="digital mental health", keywords="mobile health", keywords="mHealth", keywords="implementation readiness", keywords="implementation science", keywords="qualitative analyses", keywords="mobile phone", abstract="Background: Digital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts. Objective: This paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors. Methods: This study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework. Results: On the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate. Conclusions: The successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor). ", doi="10.2196/45718", url="https://formative.jmir.org/2023/1/e45718", url="http://www.ncbi.nlm.nih.gov/pubmed/37191975" } @Article{info:doi/10.2196/44412, author="Carrotte, Elise and Hopgood, Fincina and Blanchard, Michelle and Groot, Christopher and Phillips, Lisa", title="A New Podcast for Reducing Stigma Against People Living With Complex Mental Health Issues: Co-design Study", journal="JMIR Form Res", year="2023", month="May", day="5", volume="7", pages="e44412", keywords="mental illness stigma", keywords="co-design", keywords="podcasting", keywords="participatory methods", keywords="attitude change", abstract="Background: Mental illness stigma refers to damaging stereotypes and emotional responses around the experience of mental health issues. Media-based interventions have the potential to reduce the public's stigmatizing attitudes by improving mental health literacy, emotional appeal, and the intimacy of address. As audio-based media facilitating storytelling, podcasts show potential for reducing stigma; however, it is unclear what features could make a podcast effective or engaging. Objective: The Co-Design and Anti-Stigma Podcast Research (CASPR) study aimed to collaborate with key target audience members to inform the development of a new podcast. This podcast primarily aims to reduce listeners' stigmatizing attitudes toward people living with complex mental health issues. Methods: This study was adapted from Experience-Based Co-Design methodology. The first part, information gathering, involved a web-based mixed methods survey with 629 Australian podcast listeners to explore their interest and concerns around podcasts. Then, a series of focus groups were held with a purposive sample of 25 participants to explore the potential benefits and challenges of the podcast format. Focus group participants included people with lived experience of complex mental health issues, media and communications professionals, health care professionals, and people interested in workplace mental health. The second part, co-design, constituted 3 meetings of a co-design committee with 10 participants drawn from the focus groups to design the podcast using brainstorming and decision-making activities. Results: Most survey respondents (537/629, 85.3\%) indicated a willingness to listen to a podcast about experiences of mental illness stigma; participants indicated preference for semistructured episodes and a mixture of light and serious content. Focus group participants identified potential challenges with appealing to listeners, making the content emotionally resonant and engaging, and translation to listeners' attitude change. The co-design committee collaborated to achieve consensus on the focus of individual episodes: domains where stigma and discrimination are common, such as workplaces and health care settings; the structure of individual episodes: storyboards that centralize guests with lived experience, featuring explicit discussions around stigma and discrimination; and overarching content principles, including a sincere, empathetic, and hopeful tone; using plain language; having clear calls to action; and providing listener resources. Conclusions: The co-design process informed a podcast design that features lived experience narratives with an explicit focus on stigma and discrimination, highlighting the realities of stigma while acknowledging progress in the space and how listeners can contribute toward social change. This study allowed for an in-depth discussion around the strengths and limitations of such a podcast according to different target audience members. The co-design committee designed key elements of a podcast that has the potential to minimize the limitations of the format while embracing the benefits of podcast-based storytelling. Once produced, the podcast will be evaluated for its impact on attitude change. ", doi="10.2196/44412", url="https://formative.jmir.org/2023/1/e44412", url="http://www.ncbi.nlm.nih.gov/pubmed/37145860" } @Article{info:doi/10.2196/40722, author="Simmons, A. Christina and Moretti, E. Abigail and Lobo, F. Andrea and Tremoulet, D. Patrice", title="Direct Support Professionals' Perspectives on Using Technology to Help Support Adults With Autism Spectrum Disorder: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Apr", day="25", volume="7", pages="e40722", keywords="technology", keywords="data collection", keywords="documentation", keywords="direct support professionals", keywords="autism", keywords="mobile phone", abstract="Background: Documentation is a critical responsibility for direct support professionals (DSPs) who work with adults with autism spectrum disorder (ASD); however, it contributes significantly to their workload. Targeted efforts must be made to mitigate the burden of necessary data collection and documentation, which contributes to high DSP turnover rates and poor job satisfaction. Objective: This mixed methods study aimed to explore how technology could assist DSPs who work with adults with ASD and prioritize aspects of technology that would be most useful for future development efforts. Methods: In the first study, 15 DSPs who worked with adults with ASD participated in 1 of the 3 online focus groups. The topics included daily tasks, factors that would influence the adoption of technology, and how DSPs would like to interact with technologies to provide information about their clients. Responses were thematically analyzed across focus groups and ranked by salience. In the second study, 153 DSPs across the United States rated the usefulness of technology features and data entry methods and provided qualitative responses on their concerns regarding the use of technology for data collection and documentation. Quantitative responses were ranked based on their usefulness across participants, and rank-order correlations were calculated between different work settings and age groups. The qualitative responses were thematically analyzed. Results: In study 1, participants described difficulties with paper-and-pencil data collection, noted benefits and concerns about using technology instead, identified benefits and concerns about particular technology features, and specified work-environment factors that impact data collection. In study 2, participants rated multiple features of technology as useful, with the highest usefulness percentages endorsed for task views (ie, by shift, client, and DSP), logging completed tasks, and setting reminders for specific tasks. Participants also rated most data entry methods (eg, typing on a phone or tablet, typing on a keyboard, and choosing from options on a touch screen) as useful. Rank-order correlations indicated that the usefulness of technology features and data entry methods differed across work settings and age groups. Across both studies, DSPs cited some concerns with technology, such as confidentiality, reliability and accuracy, complexity and efficiency, and data loss from technology failure. Conclusions: Understanding the challenges faced by DSPs who work with adults with ASD, and their thoughts about using technology to meet those challenges, represents an essential first step toward developing technology solutions that can increase DSPs' effectiveness and job satisfaction. The survey results indicate that technology innovations should incorporate multiple features to account for different needs across DSPs, settings, and age groups. Future research should explore barriers to adopting data collection and documentation tools and elicit input from agency directors, families, and others interested in reviewing data about adults with ASD. ", doi="10.2196/40722", url="https://formative.jmir.org/2023/1/e40722", url="http://www.ncbi.nlm.nih.gov/pubmed/37097738" } @Article{info:doi/10.2196/46154, author="Huffman, Goodgame Landry and Lawrence-Sidebottom, Darian and Huberty, Jennifer and Roots, Monika and Roots, Kurt and Parikh, Amit and Guerra, Rachael and Weiser, Jaclyn", title="Using Digital Measurement--Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data", journal="JMIR Pediatr Parent", year="2023", month="Apr", day="20", volume="6", pages="e46154", keywords="digital mental health intervention", keywords="anxiety", keywords="depression", keywords="child", keywords="adolescent", keywords="collaborative care", keywords="mental health", keywords="caregiver", keywords="pediatric", keywords="youth", keywords="demographic", keywords="health outcome", keywords="retrospective", keywords="treatment", keywords="e-mental health", keywords="symptoms", abstract="Background: A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. Objective: This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Methods: Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Results: Among children and adolescents participating in care with Bend Health Inc, 73\% (72/98) exhibited improvements in anxiety symptoms and 73\% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement. Conclusions: As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc. ", doi="10.2196/46154", url="https://pediatrics.jmir.org/2023/1/e46154", url="http://www.ncbi.nlm.nih.gov/pubmed/37079366" } @Article{info:doi/10.2196/43956, author="Yeo, GeckHong and Loo, Gladys and Oon, Matt and Pang, Rachel and Ho, Dean", title="A Digital Peer Support Platform to Translate Online Peer Support for Emerging Adult Mental Well-being: Randomized Controlled Trial", journal="JMIR Ment Health", year="2023", month="Apr", day="18", volume="10", pages="e43956", keywords="mental health", keywords="digital health", keywords="peer support intervention", keywords="peer emotional disclosure", keywords="randomized controlled trial", abstract="Background: Emerging adulthood (ages 19 to 25 years) is a developmental phase that is marked by increased mental health conditions, especially depression and anxiety. A growing body of work indicates that digital peer emotional support has positive implications for the psychological functioning of emerging adults. There is burgeoning interest among health care professionals, educational stakeholders, and policy makers in understanding the implementation and clinical effectiveness, as well as the associated mechanism of change, of digital peer support as an intervention. Objective: This randomized controlled trial (RCT) examined the effectiveness of a digital peer support intervention over a digital platform---Acceset---for emerging adult psychological well-being with 3 primary aims. First, we evaluated the implementation effectiveness of digital peer support training for individuals providing support (befrienders) and of the digital platform for peer support. Second, we assessed the clinical outcomes of digital peer support in terms of the intervening effect on emerging adult psychological well-being. Third, we investigated the mechanism of change linking the digital peer support intervention to emerging adult psychological well-being. Methods: This RCT involving 100 emerging adults from the National University of Singapore follows the published protocol for this trial. Results: This RCT found effectiveness in digital peer support training---specifically, befrienders' peer support responses demonstrating significantly higher post- than pretraining scores in selfhood (posttraining score: mean 62.83, SD 10.18, and SE 1.72; pretraining score: mean 54.86, SD 7.32, and SE 1.24; t34=3.88; P<.001). The digital peer support intervention demonstrated clinical effectiveness in enhancing selfhood, compassion, and mindfulness and lowering depressive and anxiety symptoms among seekers in the intervention group after the intervention (mean 7.15, SD 5.14; SE 0.88) than among seekers in the waitlist control group before the intervention (mean 11.75, SD 6.72; SE 0.89; t89=3.44; P<.001). The effect of the intervention on seekers' psychological well-being was sustained beyond the period of the intervention. The mechanism of change revealed that seekers' engagement with the intervention had both immediate and prospective implications for their psychological well-being. Conclusions: This RCT of a digital peer support intervention for emerging adult psychological well-being harnesses the interventional potential of 4 components of psychological well-being and elucidated a mechanism of change. By incorporating and validating the digital features and process of a peer support platform, our RCT provides the parameters and conditions for deploying an effective and novel digital peer support intervention for emerging adult psychological well-being in real-world settings. Trial Registration: ClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676 ", doi="10.2196/43956", url="https://mental.jmir.org/2023/1/e43956", url="http://www.ncbi.nlm.nih.gov/pubmed/36756843" } @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/10.2196/40429, author="Westheimer, Lin Jessa and Moukaddam, Nidal and Lindsay, A. Jan and Sabharwal, Ashutosh and Najafi, Bijan and Iacobelli, A. Peter and Boland, J. Robert and Patriquin, A. Michelle", title="Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals", journal="JMIR Ment Health", year="2023", month="Apr", day="6", volume="10", pages="e40429", keywords="digital transformation", keywords="user-centered design", keywords="innovation", keywords="implementation science", keywords="user acceptability", keywords="wearables", keywords="mental health", keywords="implementation", keywords="technology implementation", doi="10.2196/40429", url="https://mental.jmir.org/2023/1/e40429", url="http://www.ncbi.nlm.nih.gov/pubmed/37023415" } @Article{info:doi/10.2196/43293, author="Anmella, Gerard and Sanabra, Miriam and Prim{\'e}-Tous, Mireia and Seg{\'u}, Xavier and Cavero, Myriam and Morilla, Ivette and Grande, Iria and Ruiz, Victoria and Mas, Ariadna and Mart{\'i}n-Villalba, In{\'e}s and Caballo, Alejandro and Esteva, Julia-Parisad and Rodr{\'i}guez-Rey, Arturo and Piazza, Flavia and Valdesoiro, Jos{\'e} Francisco and Rodriguez-Torrella, Claudia and Espinosa, Marta and Virgili, Giulia and Sorroche, Carlota and Ruiz, Alicia and Solanes, Aleix and Radua, Joaquim and Also, Antonieta Mar{\'i}a and Sant, Elisenda and Murgui, Sandra and Sans-Corrales, Mireia and H Young, Allan and Vicens, Victor and Blanch, Jordi and Caballeria, Elsa and L{\'o}pez-Pelayo, Hugo and L{\'o}pez, Clara and Oliv{\'e}, Victoria and Pujol, Laura and Quesada, Sebastiana and Sol{\'e}, Brisa and Torrent, Carla and Mart{\'i}nez-Aran, Anabel and Guarch, Joana and Navin{\'e}s, Ricard and Murru, Andrea and Fico, Giovanna and de Prisco, Michele and Oliva, Vicenzo and Amoretti, Silvia and Pio-Carrino, Casimiro and Fern{\'a}ndez-Canseco, Mar{\'i}a and Villegas, Marta and Vieta, Eduard and Hidalgo-Mazzei, Diego", title="Vickybot, a Chatbot for Anxiety-Depressive Symptoms and Work-Related Burnout in Primary Care and Health Care Professionals: Development, Feasibility, and Potential Effectiveness Studies", journal="J Med Internet Res", year="2023", month="Apr", day="3", volume="25", pages="e43293", keywords="primary care", keywords="health care workers", keywords="depression", keywords="anxiety", keywords="symptom", keywords="burnout", keywords="digital", keywords="smartphone", keywords="chatbot", keywords="primary care digital support tool in mental health", keywords="PRESTO", abstract="Background: Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution. Objective: We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers. Methods: Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores. Results: Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76\% female; mean age 36.5, SD 9.7 years) received 98.8\% of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76\% [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100\% (34/34) presenting anxiety symptoms, 94\% (32/34) depressive symptoms, and 65\% (22/34) work-related burnout. In addition, 27\% (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t8=1.000; P=.34) or depressive (t8=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=?2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9\% (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible. Conclusions: The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required. ", doi="10.2196/43293", url="https://www.jmir.org/2023/1/e43293", url="http://www.ncbi.nlm.nih.gov/pubmed/36719325" } @Article{info:doi/10.2196/42610, author="Nataliansyah, Muska M. and Merchant, S. Kimberly A. and Vakkalanka, Priyanka J. and Mack, Luke and Parsons, Seth and Ward, M. Marcia", title="Virtual Partnership Addressing Mental Health Crises: Mixed Methods Study of a Coresponder Program in Rural Law Enforcement", journal="JMIR Ment Health", year="2023", month="Mar", day="20", volume="10", pages="e42610", keywords="mental health", keywords="telehealth", keywords="rural health", keywords="coresponder model", keywords="implementation", keywords="mixed methods", keywords="community", keywords="technology", keywords="virtual care", abstract="Background: A mental health crisis can create challenges for individuals, families, and communities. This multifaceted issue often involves different professionals from law enforcement and health care systems, which may lead to siloed and suboptimal care. The virtual crisis care (VCC) program was developed to provide rural law enforcement with access to behavioral health professionals and facilitated collaborative care via telehealth technology. Objective: This study was designed to evaluate the implementation and use of a VCC program from a telehealth hub for law enforcement in rural areas. Methods: This study used a mixed methods approach. The quantitative data came from the telehealth hub's electronic record system. The qualitative data came from in-depth interviews with law enforcement in the 18 counties that adopted the VCC program. Results: Across the 181 VCC encounters, the telehealth hub's recommended disposition and the actual disposition were similar for remaining in place (n=141, 77.9\%, and n=137, 75.7\%, respectively), voluntary admission (n=9, 5.0\%, and n=10, 5.5\%, respectively), and involuntary committal (IVC; n=27, 14.9\%, and n=19, 10.5\%, respectively). Qualitative insights related to the VCC program's implementation, use, benefits, and challenges were identified, providing a comprehensive view of the virtual partnership between rural law enforcement and behavioral health professionals. Conclusions: Use of a VCC program likely averts unnecessary IVCs. Law enforcement interviews affirmed the positive impact of VCC due to its ease of use and the benefits it provides to the individuals in need, the first responders involved, law enforcement resources, and the community. ", doi="10.2196/42610", url="https://mental.jmir.org/2023/1/e42610", url="http://www.ncbi.nlm.nih.gov/pubmed/36939827" } @Article{info:doi/10.2196/41758, author="Zhu, Shimin and Tse, Samson and Chan, Ling Ko and Lee, Paul and Cheng, Qijin and Sun, Jessica", title="Examination of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Study Protocol of a 3-Arm Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Mar", day="17", volume="12", pages="e41758", keywords="growth mindset", keywords="fixed mindset", keywords="mental health", keywords="secondary school students, brief intervention, belief-in-change", abstract="Background: Anxiety disorders are the most common mental disorders worldwide. In Hong Kong, 7\% of adolescents are diagnosed with anxiety disorders, and 1 in every 4 secondary school students reports clinical-level anxiety symptoms. However, 65\% of them do not access services. Long waitlists in public services, the high cost of private services, or the fear of being stigmatized can hinder service access. The high prevalence of anxiety and low intervention uptake indicate a pressing need to develop timely, scalable, and potent interventions suitable for adolescents. Single-session interventions (SSIs) have the potential to be scalable interventions for diagnosable or subclinical psychopathology in adolescents. Providing precise and context-adapted intervention is the key to achieving intervention efficacy. Objective: This study aims to compare the effectiveness of three SSIs: single-session intervention of growth mindset on negative emotions (SIGMA), SSI of growth mindset of personality (SSI-GP), and active control, in reducing adolescent anxiety. Methods: Adolescents (N=549, ages 12-16 years) from secondary schools will be randomized to 1 of 3 intervention conditions: the SIGMA, SSI-GP, or active control. The implementation of each intervention is approximately 45 minutes in length. Adolescent participants will report anxiety symptoms (primary outcome), perceived control, hopelessness, attitude toward help-seeking, and psychological well-being at preintervention, the 2-week follow-up, and the 8-week follow-up. A pilot test has confirmed the feasibility and acceptability of SIGMA among adolescents. We hypothesized that SIGMA and SSI-GP will result in a larger reduction in anxiety symptoms than the control intervention during the posttest and 8-week follow-up period. We also predict that SIGMA will have a more significant effect than SSI-GP. We will use the intention-to-treat principle and linear regression-based maximum likelihood multilevel models for data analysis. Results: This study will be conducted from December 2022 to December 2023, with results expected to be available in January 2024. Conclusions: This protocol introduces the implementation content and strategies of growth mindset SSIs (consists of 2 forms: SIGMA and SSI-GP) among school students. The study will provide evidence on the efficacy of different growth mindset SSIs for adolescent anxiety. It will also establish implementation strategies for self-administrative SSIs among school students, which can serve as a pioneer implementation of a scalable and self-accessible brief intervention to improve the well-being of young people. Trial Registration: ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880 International Registered Report Identifier (IRRID): PRR1-10.2196/41758 ", doi="10.2196/41758", url="https://www.researchprotocols.org/2023/1/e41758", url="http://www.ncbi.nlm.nih.gov/pubmed/36930199" } @Article{info:doi/10.2196/44830, author="Dalcin, Taylor Arlene and Yuan, T. Christina and Jerome, J. Gerald and Goldsholl, Stacy and Minahan, Eva and Gennusa, Joseph and Fink, Tyler and Gudzune, A. Kimberly and Daumit, Lois Gail and Dickerson, Faith and Thompson, A. David and Wang, Nae-Yuh and Martino, Steve", title="Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies", journal="JMIR Res Protoc", year="2023", month="Mar", day="16", volume="12", pages="e44830", keywords="motivational interviewing", keywords="training", keywords="cardiovascular disease", keywords="lifestyle interventions", keywords="community mental health", abstract="Background: Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. Objective: We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. Methods: Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study's target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners' attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. Results: The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. Conclusions: This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/44830 ", doi="10.2196/44830", url="https://www.researchprotocols.org/2023/1/e44830", url="http://www.ncbi.nlm.nih.gov/pubmed/36927501" } @Article{info:doi/10.2196/43049, author="Vandamme, Jan and Beerten, Gabri{\"e}l Simon and Cr{\`e}vecoeur, Jonas and Van den Bulck, Steve and Aertgeerts, Bert and Delvaux, Nicolas and Van Pottelbergh, Gijs and Vermandere, Mieke and Tops, Laura and Neyens, Thomas and Vaes, Bert", title="The Impact of the COVID-19 Pandemic on the Registration and Care Provision of Mental Health Problems in General Practice: Registry-Based Study", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="10", volume="9", pages="e43049", keywords="COVID-19", keywords="mental health", keywords="care provision", keywords="general practice", keywords="socioeconomic status", abstract="Background: The impact of the COVID-19 pandemic on mental health in general practice remains uncertain. Several studies showed an increase in terms of mental health problems during the pandemic. In Belgium, especially during the first waves of the pandemic, access to general practice was limited. Specifically, it is unclear how this impacted not only the registration of mental health problems itself but also the care for patients with an existing mental health problem. Objective: This study aimed to know the impact of the COVID-19 pandemic on (1) the incidence of newly registered mental health problems and (2) the provision of care for patients with mental health problems in general practice, both using a pre--COVID-19 baseline. Methods: The prepandemic volume of provided care (care provision) for patients with mental health problems was compared to that from 2020-2021 by using INTEGO, a Belgian general practice morbidity registry. Care provision was defined as the total number of new registrations in a patient's electronic medical record. Regression models evaluated the association of demographic factors and care provision in patients with mental health problems, both before and during the pandemic. Results: During the COVID-19 pandemic as compared to before the COVID-19 pandemic, the incidence of registered mental health problems showed a fluctuating course, with a sharp drop in registrations during the first wave. Registrations for depression and anxiety increased, whereas the incidence of registered eating disorders, substance abuse, and personality problems decreased. During the 5 COVID-19 waves, the overall incidence of registered mental health problems dropped during the wave and rose again when measures were relaxed. A relative rise of 8.7\% and 40\% in volume of provided care, specifically for patients with mental health problems, was seen during the first and second years of the COVID-19 pandemic, respectively. Care provision for patients with mental health problems was higher in older patients, male patients, patients living in center cities (centrumsteden), patients with lower socioeconomic status (SES), native Belgian patients, and patients with acute rather than chronic mental health problems. Compared to prepandemic care provision, a reduction of 10\% was observed in people with a low SES. Conclusions: This study showed (1) a relative overall increase in the registrations of mental health problems in general practice and (2) an increase in care provision for patients with mental health problems in the first 2 years of the COVID-19 pandemic. Low SES remained a determining factor for more care provision, but care provision dropped significantly in people with mental health problems with a low SES. Our findings suggest that the pandemic in Belgium was also largely a ``syndemic,'' affecting different layers of the population disproportionately. ", doi="10.2196/43049", url="https://publichealth.jmir.org/2023/1/e43049", url="http://www.ncbi.nlm.nih.gov/pubmed/36599160" } @Article{info:doi/10.2196/40104, author="Ryan, Thomas Arthur and Brenner, Anne Lisa and Ulmer, S. Christi and Mackintosh, Margaret-Anne and Greene, J. Carolyn", title="The Use of Evaluation Panels During the Development of a Digital Intervention for Veterans Based on Cognitive Behavioral Therapy for Insomnia: Qualitative Evaluation Study", journal="JMIR Form Res", year="2023", month="Mar", day="6", volume="7", pages="e40104", keywords="cognitive behavioral therapy for insomnia", keywords="CBT-I", keywords="insomnia", keywords="digital mental health intervention", keywords="digital MH intervention", keywords="internet-delivered", keywords="veterans", keywords="Path to Better Sleep", abstract="Background: Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). Objective: We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. Methods: A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists' feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. Results: The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course's sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. Conclusions: The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers. ", doi="10.2196/40104", url="https://formative.jmir.org/2023/1/e40104", url="http://www.ncbi.nlm.nih.gov/pubmed/36877553" } @Article{info:doi/10.2196/44940, author="Chiauzzi, Emil and Robinson, Athena and Martin, Kate and Petersen, Carl and Wells, Nicole and Williams, Andre and Gleason, Margaret Mary", title="A Relational Agent Intervention for Adolescents Seeking Mental Health Treatment: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Mar", day="3", volume="12", pages="e44940", keywords="adolescent", keywords="digital health", keywords="cognitive behavioral therapy", keywords="CBT", keywords="chatbot", keywords="feasibility", keywords="therapeutic alliance", keywords="depression", keywords="anxiety", keywords="relational agent", keywords="mental health care", keywords="intervention", keywords="agent", keywords="youth", keywords="teenager", keywords="mental health", keywords="treatment", keywords="protocol", keywords="randomized controlled trial", keywords="acceptability", keywords="telehealth", keywords="outcome", keywords="utility", abstract="Background: Unmet pediatric mental health (MH) needs are growing as rates of pediatric depression and anxiety dramatically increase. Access to care is limited by multiple factors, including a shortage of clinicians trained in developmentally specific, evidence-based services. Novel approaches to MH care delivery, including technology-leveraged and readily accessible options, need to be evaluated in service of expanding evidence-based services to youths and their families. Preliminary evidence supports the use of Woebot, a relational agent that digitally delivers guided cognitive behavioral therapy (CBT) through a mobile app, for adults with MH concerns. However, no studies have evaluated the feasibility and acceptability of such app-delivered relational agents specifically for adolescents with depression and/or anxiety within an outpatient MH clinic, nor compared them to other MH support services. Objective: This paper describes the protocol for a randomized controlled trial evaluating the feasibility and acceptability of an investigational device, Woebot for Adolescents (W-GenZD), within an outpatient MH clinic for youths presenting with depression and/or anxiety. The study's secondary aim will compare the clinical outcomes of self-reported depressive symptoms with W-GenZD and a telehealth-delivered CBT-based skills group (CBT-group). Tertiary aims will evaluate additional clinical outcomes and therapeutic alliance between adolescents in W-GenZD and the CBT-group. Methods: Participants include youths aged 13-17 years with depression and/or anxiety seeking care from an outpatient MH clinic at a children's hospital. Eligible youths will have no recent safety concerns or complex comorbid clinical diagnoses; have no concurrent individual therapy; and, if on medications, are on stable doses, based on clinical screening and as well as study-specific criteria. Results: Recruitment began in May 2022. As of December 8, 2022, we have randomized 133 participants. Conclusions: Establishing the feasibility and acceptability of W-GenZD within an outpatient MH clinical setting will add to the field's current understanding of the utility and implementation considerations of this MH care service modality. The study will also evaluate the noninferiority of W-GenZD against the CBT-group. Findings may also have implications for patients, families, and providers looking for additional MH support options for adolescents seeking help for their depression and/or anxiety. Such options expand the menu of supports for youths with lower-intensity needs as well as possibly reduce waitlists and optimize clinician deployment toward more severe cases. Trial Registration: ClinicalTrials.gov NCT05372913; https://clinicaltrials.gov/ct2/show/NCT05372913 International Registered Report Identifier (IRRID): DERR1-10.2196/44940 ", doi="10.2196/44940", url="https://www.researchprotocols.org/2023/1/e44940", url="http://www.ncbi.nlm.nih.gov/pubmed/36867455" } @Article{info:doi/10.2196/43062, author="Shroff, Akash and Roulston, Chantelle and Fassler, Julia and Dierschke, A. Nicole and Todd, Pedro Jennifer San and R{\'i}os-Herrera, {\'A}mbar and Plastino, A. Kristen and Schleider, Lee Jessica", title="A Digital Single-Session Intervention Platform for Youth Mental Health: Cultural Adaptation, Evaluation, and Dissemination", journal="JMIR Ment Health", year="2023", month="Feb", day="14", volume="10", pages="e43062", keywords="single-session intervention", keywords="cultural adaptation", keywords="web-based intervention", keywords="adolescents", keywords="mobile phone", abstract="Background: Despite the proliferation of evidence-based digital mental health programs for young people, their low uptake and inconsistent implementation preclude them from benefiting youths at scale. Identifying effective implementation strategies for evidence-based supports is especially critical in regions where treatment access is lowest owing to mental health provider shortages. Objective: The goal of this academic-community partnership, funded by the City of San Antonio Metropolitan Health District, was to culturally adapt, disseminate, and gauge the acceptability and utility of an evidence-based digital mental health platform---Project Youth Empowerment and Support (YES)---among English- and Spanish-speaking youths living in south Texas. Methods: Project YES is an open-access, anonymous platform containing 3 evidence-based, self-guided interventions for youth mental health. Project YES was culturally adapted via focus groups and co-design sessions with San Antonio youths with lived experience of depression and anxiety; translated into Spanish; and disseminated throughout San Antonio, Texas, via community and school partnerships. Results: During the project period (April 2021 to December 2021), 1801 San Antonio youths began and 894 (49.64\%) of them completed a 30-minute, single-session intervention within Project YES (aged 11-17 years; n=718, 39.87\% male; n=961, 53.36\% female; and n=3, 0.17\% intersex; n=1477, 82.01\% Hispanic; n=77, 4.28\% non-Hispanic White; n=113, 6.27\% Black; n=28, 1.55\% Asian; and n=93, 5.16\% other). This completion rate (49.64\%) surpassed those previously observed for Project YES (eg, 34\% when disseminated via social media). San Antonio youths rated Project YES as highly acceptable across all metrics, both in English and Spanish. In addition, the youths who completed Project YES---ENGLISH reported significant improvements in hopelessness (Cohen d=0.33; P<001), self-hate (Cohen d=0.27; P<001), and perceived agency (Cohen d=0.25; P<001) from before to after the intervention, and the youths who completed Project YES---SPANISH reported significant improvements in self-hate (Cohen d=0.37; P=.049) from before to after the intervention. Conclusions: The results indicate that Project YES---an open-access, free, and anonymous web-based single-session intervention platform---is an acceptable, accessible, and applicable mental health support for English- and Spanish-speaking San Antonio youths. ", doi="10.2196/43062", url="https://mental.jmir.org/2023/1/e43062", url="http://www.ncbi.nlm.nih.gov/pubmed/36787180" } @Article{info:doi/10.2196/43401, author="G{\'o}mez-Restrepo, Carlos and Romero, Rumbo Jose Alejandro and Rodriguez, Martha and Ospina-Pinillos, Laura and Stanislaus Sureshkumar, Diliniya and Priebe, Stefan and Bird, Victoria", title="Effectiveness of a Patient-Centered Assessment With a Solution-Focused Approach (DIALOG-A) in the Routine Care of Colombian Adolescents With Depression and Anxiety: Protocol for a Multicenter Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Feb", day="8", volume="12", pages="e43401", keywords="randomised controlled trial", keywords="adolescent", keywords="mental health", keywords="depression", keywords="anxiety", keywords="telemedicine", keywords="primary health care", keywords="Colombia", abstract="Background: Colombia is a middle-income country in South America, which has historically had high rates of mental health problems, coupled with a scarcity of mental health care. There is growing concern for the mental health of the adolescent population within this region. There is a significant treatment gap for young people, especially those living in the most vulnerable areas. DIALOG+ is a low-cost patient-centered intervention that can potentially improve the delivery of care and quality of life for adolescents with mental health problems. Objective: This exploratory randomized controlled trial aims to evaluate the effectiveness, acceptability, and feasibility of an adapted version of the DIALOG+ intervention (DIALOG-A) in the community treatment of Colombian adolescents with depression and anxiety. Methods: In total, 18 clinicians and 108 adolescents will be recruited from primary health care services in Bogota and Duitama, Colombia. Clinicians will be randomized 2:1 to either the intervention (12 clinicians:72 adolescents) or control group (6 clinicians:36 adolescents). In the intervention arm, clinicians will use DIALOG-A with adolescents once per month over 6 months. The control arm will continue to receive routine care. Outcomes will be measured at baseline, 6 months, and 9 months following randomization. Semistructured interviews with all clinicians and a subset of adolescents in the intervention arm will be conducted at the end of the intervention period. Quantitative and qualitative analysis of the data will be conducted. Results: Trial recruitment was completed toward the end of October 2022, and follow-up is anticipated to last through to October 2023. Conclusions: This is the first study to test an adapted resource-orientated intervention (DIALOG-A) in the treatment of adolescents with depression and anxiety attending primary care services. If the results are positive, DIALOG-A can be implemented in the routine care of adolescents with these mental health problems and provide valuable insight to other middle-income countries. Trial Registration: ISRCTN Registry ISRCTN13980767; https://www.isrctn.com/ISRCTN13980767?q=ISRCTN13980767 International Registered Report Identifier (IRRID): DERR1-10.2196/43401 ", doi="10.2196/43401", url="https://www.researchprotocols.org/2023/1/e43401", url="http://www.ncbi.nlm.nih.gov/pubmed/36753329" } @Article{info:doi/10.2196/39334, author="Chorney, Jill and Johnson Emberly, Debbie and Jeffrey, Jennifer and Hundert, Amos and Pakkanlilar, Onur and Abidi, Sabina and Bagnell, Alexa and Brennan, Maureen and Campbell, Anne Leslie and Clark, Sharon and Bradley, Kristina and Ross, Olivia", title="Implementation of a Knowledge Management System in Mental Health and Addictions: Mixed Methods Case Study", journal="JMIR Form Res", year="2023", month="Feb", day="6", volume="7", pages="e39334", keywords="mental health", keywords="knowledge management", keywords="information", keywords="technology", keywords="capacity building", abstract="Background: Mental health and addictions (MHA) care is complex and individualized and requires coordination across providers and areas of care. Knowledge management is an essential facilitator and common challenge in MHA services. Objective: This paper aimed to describe the development of a knowledge management system (KMS) and the associated processes in 1 MHA program. We also aimed to examine the uptake and use, satisfaction, and feedback on implementation among a group of pilot testers. Methods: This project was conducted as a continuous quality-improvement initiative. Integrated stakeholder engagement was used to scope the content and design the information architecture to be implemented using a commercially available knowledge management platform. A group of 30 clinical and administrative staff were trained and tested with the KMS over a period of 10 weeks. Feedback was collected via surveys and focus groups. System analytics were used to characterize engagement. The content, design, and full-scale implementation planning of the KMS were refined based on the results. Results: Satisfaction with accessing the content increased from baseline to after the pilot. Most testers indicated that they would recommend the KMS to a colleague, and satisfaction with KMS functionalities was high. A median of 7 testers was active each week, and testers were active for a median of 4 days over the course of the pilot. Focus group themes included the following: the KMS was a solution to problems for staff members, functionality of the KMS was important, quality content matters, training was helpful and could be improved, and KMS access was required to be easy and barrier free. Conclusions: Knowledge management is an ongoing need in MHA services, and KMSs hold promise in addressing this need. Testers in 1 MHA program found a KMS that is easy to use and would recommend it to colleagues. Opportunities to improve implementation and increase uptake were identified. Future research is needed to understand the impact of KMSs on quality of care and organizational efficiency. ", doi="10.2196/39334", url="https://formative.jmir.org/2023/1/e39334", url="http://www.ncbi.nlm.nih.gov/pubmed/36745489" } @Article{info:doi/10.2196/39422, author="Engdahl, Patrik and Svedberg, Petra and Lex{\'e}n, Annika and Tj{\"o}rnstrand, Carina and Strid, Catharina and Bejerholm, Ulrika", title="Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study", journal="JMIR Form Res", year="2023", month="Jan", day="18", volume="7", pages="e39422", keywords="co-design", keywords="mental health", keywords="mobile health", keywords="return-to-work", keywords="supported employment", abstract="Background: Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders' needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. Objective: This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. Methods: A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study's findings. Results: The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users' strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. Conclusions: Stakeholders' experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources. ", doi="10.2196/39422", url="https://formative.jmir.org/2023/1/e39422", url="http://www.ncbi.nlm.nih.gov/pubmed/36652285" } @Article{info:doi/10.2196/37569, author="Pollmanns, Johannes and Gro{\ss}garten, Karlheinz and Wolff, K. Julia and Nolting, Hans-Dieter and Graf, Clarissa and Bergmann, Frank and Nelles, Gereon", title="A Stepped Health Services Intervention to Improve Care for Mental and Neurological Diseases: Protocol for a Prospective Cohort Trial", journal="JMIR Res Protoc", year="2023", month="Jan", day="17", volume="12", pages="e37569", keywords="mental health", keywords="neurology", keywords="quality of care", keywords="organization of health services", keywords="primary care", keywords="mental disorder", keywords="intervention", keywords="neurological disease", keywords="healthcare system", keywords="accessibility", keywords="therapy", abstract="Background: Mental and neurological disorders cause a large proportion of morbidity burden and require adequate health care structures. However, deficits in the German health care system like long waiting times for access to specialized care and a lack of coordination between health care providers lead to suboptimal quality of care and elevated health care costs. Objective: To overcome these deficits, we implement and evaluate a unique stepped and coordinated model of care (the Neurologisch-psychiatrische und psychotherapeutische Versorgung [NPPV] program) for patients with mental and neurological diseases. Methods: Patients included in the program receive an appropriate treatment according to medical needs in a multiprofessional network of ambulatory health care providers. The therapy is coordinated by a managing physician and complemented by additional therapy modules, such as group therapy, internet-based cognitive behavioral therapy, and a case management. Statutory health insurance (SHI) routine data and data from a longitudinal patient survey will be used to compare the program with regular care and evaluate SHI expenditures and patient-related outcomes. A health care provider survey will evaluate the quality of structure and processes and provider satisfaction. Finally, an analysis of ambulatory claims data and drug prescription data will be used to evaluate if health care providers follow a needs-led approach in therapy. Ethics approval for this trial was obtained from the ethics committee of the chamber of physicians in North Rhine (September 13, 2017, reference No. 2017287). Results: Patient enrollment of NPPV ended in September 2021. Data analysis has been completed in 2022. The results of this study will be disseminated through scientific publications, academic conferences, and a publicly available report to the German Federal Joint Committee, which is expected to be available in the first half of 2023. Conclusions: The NPPV program is the first intervention to implement a stepped model of care for both mental and neurological diseases in Germany. The analysis of several data sources and a large sample size (more than 14,000 patients) enable a comprehensive evaluation of the NPPV program. Trial Registration: German Clinical Trials Register DRKS00022754; https://tinyurl.com/3mx9pz5z. International Registered Report Identifier (IRRID): DERR1-10.2196/37569 ", doi="10.2196/37569", url="https://www.researchprotocols.org/2023/1/e37569", url="http://www.ncbi.nlm.nih.gov/pubmed/36649065" } @Article{info:doi/10.2196/40330, author="Choukou, Mohamed-Amine and Olatoye, Funminiyi and Urbanowski, Reg and Caon, Maurizio and Monnin, Caroline", title="Digital Health Technology to Support Health Care Professionals and Family Caregivers Caring for Patients With Cognitive Impairment: Scoping Review", journal="JMIR Ment Health", year="2023", month="Jan", day="11", volume="10", pages="e40330", keywords="digital health", keywords="behavior change", keywords="mental health", keywords="cognitive impairment", abstract="Background: Digital health technology is a promising way of supporting health care providers and family caregivers as they care for patients with cognitive impairment. Objective: This scoping review aimed to portray the use of digital health technology to assist health care providers and family caregivers in caring for patients with cognitive impairment who live in the community or in a facility. Methods: We conducted a scoping review of peer-reviewed scientific articles available in MEDLINE, PsycINFO, Scopus, and CINAHL with Full Text, as well as gray literature available in preprint servers, theses depositories, and various national and international dementia organizations' websites. The search yielded 975 articles, of which we included 7 (0.7\%) in the review. Results: Of the 7 interventions included in the retrieved manuscripts, 2 (29\%) were digital calendar reminder systems to support activities of daily living and medication management; 2 (29\%) were apps on tablet devices to simulate the presence of family before therapy interventions; 1 (14\%) was a social robot used in therapeutic sessions to include elements of musicotherapy, reminiscence, cognitive games, and relaxation; 1 (14\%) was a commercially available computer system that provides access to various recreational leisure activities; and 1 (14\%) was a web-based self-management support system that helps family caregivers to deal with behavior changes in a relative with dementia. Of the 7 articles, only 1 (14\%) reported on the use of a behavior change theory, namely a comprehensive process model of engagement coupled with cognitive stimulation therapy. Conclusions: Literature on the topic is scarce, recent, and heterogeneous. There is a clear need for a theoretical framework to conceptualize and govern the use of behavior change models that incorporate technology for patients with cognitive impairment. ", doi="10.2196/40330", url="https://mental.jmir.org/2023/1/e40330", url="http://www.ncbi.nlm.nih.gov/pubmed/36630174" } @Article{info:doi/10.2196/40773, author="H{\o}gsdal, Helene and Kaiser, Sabine and Kyrrestad, Henriette", title="Adolescents' Assessment of Two Mental Health--Promoting Mobile Apps: Results of Two User Surveys", journal="JMIR Form Res", year="2023", month="Jan", day="6", volume="7", pages="e40773", keywords="mental health app", keywords="mobile app", keywords="mental health", keywords="mental health promotion", keywords="cyberbullying", keywords="adolescents", keywords="user satisfaction", keywords="system usability", keywords="app quality", keywords="mental health intervention", keywords="health promotion", keywords="app usability", keywords="user experience", abstract="Background: The importance of mental health promotion is irrevocable and is especially important at a young age. More mental health-promoting mobile apps have been developed in the last few years. However, their usability and quality have been rarely assessed. Objective: The aim of this study is to investigate how adolescents assess the usability, quality, and potential goal achievement of Opp and NettOpp. Opp is a universal mental health--promoting mobile app aimed at 13- to 19-year-olds, and NettOpp is a mobile app for children and adolescents between 11 to 16 years of age that have experienced negative incidents online. Methods: A total of 45 adolescents tested either Opp (n=30) or NettOpp (n=15) for a period of 3 weeks and answered a questionnaire. The System Usability Scale (SUS) was used to measure the usability of the apps. A SUS score above 70 indicates acceptable usability. Items from the Mobile Application Rating Scale were adapted for study purposes and used to measure the quality and perceived goal achievement that Opp and NettOpp might have on adolescents' knowledge, attitudes, and intention to change behavior. Furthermore, adolescents could answer an open comment question. Results: Opp had a mean SUS score of 80.37 (SD 9.27), and NettOpp's mean SUS score was 80.33 (SD 10.30). In the overall evaluation, Opp and NettOpp were given a mean score of 3.78 (SD 0.42) and 4.20 (SD 0.56), respectively, on a 5-point scale, where 5 was best. Most adolescents who evaluated Opp rated that the app would increase knowledge about mental health and help young people deal with stress and difficult emotions or situations. Most adolescents who evaluated NettOpp agreed that the app would increase awareness and knowledge about cyberbullying, change attitudes toward cyberbullying, and motivate them to address cyberbullying. Some adolescents stated that Opp was difficult to navigate and consisted of too much text. Some of the adolescents that tested NettOpp stated that the app had crashed and that the design was a bit childish. Conclusions: All in all, this study indicates that Opp and NettOpp have good usability and that adolescents are satisfied with both apps. It also indicates that the potential goal achievement of the apps, for example, increasing knowledge about mental health (Opp) or cyberbullying (NettOpp) is promising. While there are some comments from the users that are more difficult to solve (eg, Opp is too text-based), some comments helped improve the apps (eg, that the app crashed). Overall, the user evaluation provided valuable knowledge about how adolescents assess Opp and NettOpp. However, more extensive effectiveness studies are necessary to measure their actual goal achievement. ", doi="10.2196/40773", url="https://formative.jmir.org/2023/1/e40773", url="http://www.ncbi.nlm.nih.gov/pubmed/36607734" } @Article{info:doi/10.2196/38296, author="Adeane, Emily and Gibson, Kerry", title="Using Web-Based Content to Connect Young People With Real-life Mental Health Support: Qualitative Interview Study", journal="JMIR Form Res", year="2023", month="Jan", day="4", volume="7", pages="e38296", keywords="young people", keywords="mental health", keywords="online help seeking", keywords="internet", keywords="mental health services", keywords="digital interviews", abstract="Background: Young people experience high rates of mental health problems but make insufficient use of the formal services available to them. As young people are heavy users of the internet, there may be an untapped potential to use web-based content to encourage this hard-to-reach population to make better use of face-to-face mental health services. However, owing to the vast range of content available and the complexities in how young people engage with it, it is difficult to know what web-based content is most likely to resonate with this age group and facilitate their engagement with professional support. Objective: This study aimed to identify the types of web-based content young people identified as more likely to prompt youth engagement with mental health services. Methods: This study used a qualitative design conducted within a social constructionist epistemology that recognized the importance of youth empowerment in mental health. Digital interviews using WhatsApp instant messenger were conducted with 37 young people aged 16-23 years who participated as ``expert informants'' on the priorities and practices of youth in web-based spaces. The data were analyzed using reflexive thematic analysis to identify the types of web-based content that participants believed would encourage young people to reach out to a face-to-face mental health service for support. Results: The analysis generated 3 main themes related to the research question. First, participants noted that a lack of information about available services and how they worked prevented young people from engaging with face-to-face mental health services. They proposed web-based content that provided clear information about relevant mental health services and how to access them. They also suggested the use of both text and video to provide young people with greater insight into how face-to-face counseling might work. Second, participants recommended content dedicated to combating misconceptions about mental health and negative portrayals of mental health services and professionals that are prevalent in their web-based spaces. They suggested content that challenged the stigma surrounding mental health and help seeking and highlighted the value of mental health services. Finally, participants suggested that young people would be more likely to respond to ``relatable'' digital stories of using mental health services, recounted in the context of a personal connection with someone they trusted. Conclusions: This study offers recommendations for professionals and service providers on how to better engage young people with real-life mental health support using web-based content. Web-based content can be used to challenge some of the barriers that continue to prevent young people from accessing face-to-face mental health services and underlines the importance of including young people's voices in the design of web-based mental health content. ", doi="10.2196/38296", url="https://formative.jmir.org/2023/1/e38296", url="http://www.ncbi.nlm.nih.gov/pubmed/36598810" } @Article{info:doi/10.2196/36806, author="Atik, Ece and Sch{\"u}ckes, Magnus and Apolin{\'a}rio-Hagen, Jennifer", title="Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study", journal="JMIR Ment Health", year="2022", month="Dec", day="30", volume="9", number="12", pages="e36806", keywords="blended cognitive behavioral therapy", keywords="bCBT", keywords="cognitive behavioral therapy", keywords="digital health", keywords="mental health", keywords="internet", keywords="mobile app", keywords="blended psychotherapy", keywords="depression", keywords="user perspectives", keywords="mobile phone", abstract="Background: Blended cognitive behavioral therapy (bCBT)---the combination of digital elements and face-to-face psychotherapy---has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. Objective: This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. Methods: We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. Results: Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. Conclusions: Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists. ", doi="10.2196/36806", url="https://mental.jmir.org/2022/12/e36806", url="http://www.ncbi.nlm.nih.gov/pubmed/36583934" } @Article{info:doi/10.2196/40933, author="Sun, Sijin and Zhang, Zheyuan and Tian, Mu and Mougenot, Celine and Glozier, Nick and Calvo, A. Rafael", title="Preferences for a Mental Health Support Technology Among Chinese Employees: Mixed Methods Approach", journal="JMIR Hum Factors", year="2022", month="Dec", day="22", volume="9", number="4", pages="e40933", keywords="mental health", keywords="digital health", keywords="workplace", keywords="China", abstract="Background: Workplace mental health is under-studied in China, making it difficult to design effective interventions. To encourage the engagement with interventions, it is crucial to understand employees' motivation toward seeking help through technologies. Objective: This study aimed to understanding how Chinese employees view digital mental health support technology and how mental health support technology could be designed to boost the motivation of Chinese employees to use it. Methods: A mixed methods approach was used. In total, 458 Chinese employees (248/458, 54\% female) in 5 industries (manufacturing, software, medical, government, and education) responded to a survey, and 14 employees and 5 managers were interviewed. Results: Government data and employee responses showed that mental health support in China is limited. In the workplace, Chinese employees experience a lower sense of autonomy satisfaction compared with competence and relatedness. Although managers and employees try to empathize with those who have mental health issues, discrimination and the stigma of mental illness are rife in Chinese workplaces. Digital technologies are perceived as a potential medium for mental health interventions; however, privacy is a major concern. Conclusions: The results of this study demonstrated the potential of self-help digital mental health support for Chinese employees. Interdisciplinary cooperation between design engineers and mental health researchers can contribute toward understanding the issues that engage or disengage users with digital mental health interventions. ", doi="10.2196/40933", url="https://humanfactors.jmir.org/2022/4/e40933", url="http://www.ncbi.nlm.nih.gov/pubmed/36548027" } @Article{info:doi/10.2196/34893, author="Gonzales, Sarah and Okusaga, O. Olaoluwa and Reuteman-Fowler, Corey J. and Oakes, M. Megan and Brown, N. Jamie and Moore, Scott and Lewinski, A. Allison and Rodriguez, Cristin and Moncayo, Norma and Smith, A. Valerie and Malone, Shauna and List, Justine and Cho, Y. Raymond and Jeffreys, S. Amy and Bosworth, B. Hayden", title="Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study", journal="JMIR Form Res", year="2022", month="Dec", day="22", volume="6", number="12", pages="e34893", keywords="ABILIFY MYCITE", keywords="digital medicine", keywords="adherence", keywords="aripiprazole", keywords="Veterans", keywords="qualitative methods", keywords="mental illness", keywords="mental health", keywords="medication", keywords="mobile phone", abstract="Background: Suboptimal medication adherence is a significant problem for patients with serious mental illness. Measuring medication adherence through subjective and objective measures can be challenging, time-consuming, and inaccurate. Objective: The primary purpose of this feasibility and acceptability study was to evaluate the impact of a digital medicine system (DMS) among Veterans (patients) with serious mental illness as compared with treatment as usual (TAU) on medication adherence. Methods: This open-label, 2-site, provider-randomized trial assessed aripiprazole refill adherence in Veterans with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. We randomized 26 providers such that their patients either received TAU or DMS for a period of 90 days. Semistructured interviews with patients and providers were used to examine the feasibility and acceptability of using the DMS. Results: We enrolled 46 patients across 2 Veterans Health Administration sites: 21 (46\%) in DMS and 25 (54\%) in TAU. There was no difference in the proportion of days covered by medication refill over 3 and 6 months (0.82, SD 0.24 and 0.75, SD 0.26 in DMS vs 0.86, SD 0.19 and 0.82, SD 0.21 in TAU, respectively). The DMS arm had 0.85 (SD 0.20) proportion of days covered during the period they were engaged with the DMS (mean 144, SD 100 days). Interviews with patients (n=14) and providers (n=5) elicited themes salient to using the DMS. Patient findings described the positive impact of the DMS on medication adherence, challenges with the DMS patch connectivity and skin irritation, and challenges with the DMS app that affected overall use. Providers described an overall interest in using a DMS as an objective measure to support medication adherence in their patients. However, providers described challenges with the DMS dashboard and integrating DMS data into their workflow, which decreased the usability of the DMS for providers. Conclusions: There was no observed difference in refill rates. Among those who engaged in the DMS arm, the proportion of days covered by refills were relatively high (mean 0.85, SD 0.20). The qualitative analyses highlighted areas for further refinement of the DMS. Trial Registration: ClinicalTrials.gov NCT03881449; https://clinicaltrials.gov/ct2/show/NCT03881449 ", doi="10.2196/34893", url="https://formative.jmir.org/2022/12/e34893", url="http://www.ncbi.nlm.nih.gov/pubmed/36548028" } @Article{info:doi/10.2196/40065, author="Fortuna, Karen and Hill, Julia and Chalker, Samantha and Ferron, Joelle", title="Certified Peer Support Specialists Training in Technology and Delivery of Digital Peer Support Services: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Dec", day="7", volume="6", number="12", pages="e40065", keywords="digital peer support", keywords="mHealth", keywords="COVID-19", keywords="mental health", keywords="remote service", keywords="remote mental health", keywords="telehealth", keywords="peer support", keywords="psychological health", abstract="Background: When the COVID-19 pandemic lockdown measures were instituted, the wide-scale necessity for remote mental health care increased among professional clinicians, such as psychiatrists, psychologists, social workers, and certified peer support (CPS) specialists. Factors contributing to increased demand include concern for the safety of loved ones, the safety of oneself, overall well-being, unemployment, and loneliness for older individuals. While demand continues to increase and a shortage of mental health professionals persists, understanding the training, technology, media, and delivery of digital peer support services can facilitate community-based support services to assist patients in coping with mental health symptoms between clinical encounters with licensed professionals. Digital peer support consists of asynchronous and synchronous, live or automated, peer support services such as applications, social media, and phone calls. Objective: The purpose of this cross-sectional study is to determine how digital peer support is delivered, by which technologies it is delivered, and how certified digital peer supporters are trained within the United States to inform future delivery of digital peer support. Methods: We used an online cross-sectional self-report survey developed alongside certified peer specialists. The study included questions regarding the types of peer support training and the delivery methods used within their practices. We advertised the survey through a certified peer support specialist listserve, Facebook, and Twitter. Results: Certified peer specialists provide mutual social emotional support to those with a similar mental health condition. Of certified peer specialists trained in CPS, the majority of CPS specialists were trained in peer support (418/426, 98.1\%). Peer support specialists deliver services via telephone calls (182/293, 62.1\%), via videoconference-based services (160/293, 54.6\%), via SMS text messages (123/293, 42\%), via smartphone apps (68/293, 23.2\%), and via social media (65/293, 22.2\%). Certified peer specialists deliver services through virtual reality (11/293, 3.8\%) and through video games (6/293, 2\%). Virtual reality and video games may represent emerging technologies to develop and deliver community-based support. Conclusions: This study examined the modes of digital peer support intervention as well as the training and demographic background of peer supporters. Given the demand for mental health care, digital peer support emerges as one option to increase access. These results suggest that CPS specialists commonly use SMS text messaging, phone calls, and videoconferences to engage in peer support. Less frequently, they may use diverse modes such as apps, social media, and video games. It is important to consider the backgrounds of peer supporters and the mediums of communication to best accommodate areas where access to peer support is emerging. Larger longitudinal studies and a variety of experimental designs may be considered to understand the efficacy of digital interventions and digital peer support training to direct optimal care. ", doi="10.2196/40065", url="https://formative.jmir.org/2022/12/e40065", url="http://www.ncbi.nlm.nih.gov/pubmed/36476983" } @Article{info:doi/10.2196/41601, author="Van Tiem, Jen and Wirtz, Elizabeth and Suiter, Natalie and Heeren, Amanda and Fuhrmeister, Lindsey and Fortney, John and Reisinger, Heather and Turvey, Carolyn", title="The Implementation of Measurement-Based Care in the Context of Telemedicine: Qualitative Study", journal="JMIR Ment Health", year="2022", month="Nov", day="24", volume="9", number="11", pages="e41601", keywords="telehealth", keywords="patient-reported outcome measures", keywords="measurement-based care", keywords="health information technology", keywords="data visualization", abstract="Background: The Measurement Based Care in Mental Health Initiative launched by the Department of Veterans Affairs in 2016 is an example of an evidence-based practice that uses patient-reported outcome measures (PROMs) to improve patient outcomes. The acceptance of measurement-based care (MBC) among Veterans Affairs providers is relatively high. However, there are barriers to MBC for telehealth providers. Health information technologies might afford opportunities to address some of the barriers related to the uptake of MBC. Objective: This paper reports on an implementation effort to integrate MBC into mental health care telehealth practice using eHealth solutions. Methods: Qualitative data were generated from 22 semistructured interviews with psychiatrists (n=4), psychologists (n=3), social workers (n=3), nurses (n=6), a pharmacist (n=1), and administrative staff (n=5) who provide telemental health care through a community-based outpatient clinic in the rural Midwestern United States. The interviews were conducted during the pilot phase of an implementation initiative to increase the adoption of MBC by revising clinic workflows to integrate the use of eHealth technologies. Data were analyzed using thematic analysis. Results: Time burden and workflow issues were the most common barrier to provider adoption of MBC; sharing and reviewing pencil-and-paper measures and results in the same room was no longer possible in novel telehealth workflows necessitated by the COVID-19 pandemic. Providers voiced concerns about how long it would take to collect, adequately score, interpret, share, and document the PROMs during the telehealth visit. Concerns about time might also correspond to a gap in providers' familiarity with these assessments, greater comfort in assessing symptoms through clinical interviews, and being accustomed to using the assessments as screening tools more so than longitudinal outcome measures. Capacities associated with eHealth technologies may address workflow concerns and promote providers' understanding and use of the measures as tracking tools. Conclusions: The need to use limited appointment time well was a top priority for telemental health providers. eHealth technologies provided operative supports that protect time in appointments by shifting when and how PROMs are collected. Bolstering providers' familiarity with how to use PROMs in the course of treatment may impact providers' buy-in by encouraging them to reconsider how sharing and acting on PROMs could be time well spent. ", doi="10.2196/41601", url="https://mental.jmir.org/2022/11/e41601", url="http://www.ncbi.nlm.nih.gov/pubmed/36422884" } @Article{info:doi/10.2196/39079, author="Blattert, Lisa and Armbruster, Christoph and Buehler, Eva and Heiberger, Andrea and Augstein, Patrick and Kaufmann, Sarina and Reime, Birgit and ", title="Health Needs for Suicide Prevention and Acceptance of e-Mental Health Interventions in Adolescents and Young Adults: Qualitative Study", journal="JMIR Ment Health", year="2022", month="Nov", day="23", volume="9", number="11", pages="e39079", keywords="suicide prevention", keywords="e-mental health", keywords="peer support", keywords="adolescents and young adults", keywords="health needs", keywords="acceptance", keywords="qualitative data analysis", keywords="suicide", keywords="mental health", keywords="teens", keywords="adolescent", keywords="young adult", keywords="vulnerable", keywords="behavior", keywords="Germany", keywords="rural", keywords="intervention", keywords="formative", keywords="digital", keywords="online", abstract="Background: Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy. Objective: The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions. Methods: This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016). Results: Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness. Conclusions: The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account. ", doi="10.2196/39079", url="https://mental.jmir.org/2022/11/e39079", url="http://www.ncbi.nlm.nih.gov/pubmed/36416884" } @Article{info:doi/10.2196/37394, author="Ader, Leonie and Schick, Anita and Simons, Claudia and Delespaul, Philippe and Myin-Germeys, Inez and Vaessen, Thomas and Reininghaus, Ulrich", title="Positive Affective Recovery in Daily Life as a Momentary Mechanism Across Subclinical and Clinical Stages of Mental Disorder: Experience Sampling Study", journal="JMIR Ment Health", year="2022", month="Nov", day="23", volume="9", number="11", pages="e37394", keywords="experience sampling methodology", keywords="ecological momentary assessment", keywords="trajectory", keywords="transdiagnostic", keywords="resilience", keywords="stress reactivity", keywords="psychosis", keywords="depression", abstract="Background: Identifying momentary risk and protective mechanisms may enhance our understanding and treatment of mental disorders. Affective stress reactivity is one mechanism that has been reported to be altered in individuals with early and later stages of mental disorder. Additionally, initial evidence suggests individuals with early and enduring psychosis may have an extended recovery period of negative affect in response to daily stressors (ie, a longer duration until affect reaches baseline levels after stress), but evidence on positive affective recovery as a putative protective mechanism remains limited. Objective: This study aimed to investigate trajectories of positive affect in response to stress across the continuum of mental disorder in a transdiagnostic sample. Methods: Using the Experience Sampling Method, minor activity-, event-, and overall stress and positive affect were assessed 10 times a day, with time points approximately 90 minutes apart on six consecutive days in a pooled data set including 367 individuals with a mental disorder, 217 individuals at risk for a severe mental disorder, and 227 controls. Multilevel analysis and linear contrasts were used to investigate trajectories of positive affect within and between groups. Results: Baseline positive affect differed across groups, and we observed stress reactivity in positive affect within each group. We found evidence for positive affective recovery after reporting activity- or overall stress within each group. While controls recovered to baseline positive affect about 90 minutes after stress, patients and at-risk individuals required about 180 minutes to recover. However, between-group differences in the affective recovery period fell short of significance (all P>.05). Conclusions: The results provide first evidence that positive affective recovery may be relevant within transdiagnostic subclinical and clinical stages of mental disorder, suggesting that it may be a potential target for mobile health interventions fostering resilience in daily life. ", doi="10.2196/37394", url="https://mental.jmir.org/2022/11/e37394", url="http://www.ncbi.nlm.nih.gov/pubmed/36416883" } @Article{info:doi/10.2196/39080, author="Cant{\`u}, Filippo and Biagianti, Bruno and Lisi, Ilaria and R Zanier, Elisa and Bottino, Nicola and Fornoni, Chiara and Gallo, Francesca and Ginex, Valeria and Tombola, Valentina and Zito, Silvana and Colombo, Elisa and Stocchetti, Nino and Brambilla, Paolo", title="Psychotherapeutic and Psychiatric Intervention in Patients With COVID-19 and Their Relatives: Protocol for the DigiCOVID Trial", journal="JMIR Res Protoc", year="2022", month="Nov", day="16", volume="11", number="11", pages="e39080", keywords="telepsychiatry", keywords="telemedicine", keywords="COVID-19", keywords="mental health", keywords="digital mental health", keywords="digital support", keywords="clinical outcome", keywords="telehealth", keywords="psychiatric health", keywords="health intervention", abstract="Background: The COVID-19 pandemic is negatively impacting the mental health of both patients with COVID-19 and the general population. As current guidelines are limiting in-person contacts to reduce the spread of the virus, the development of a digital approach to implement in psychiatric and psychological consultations is needed. In this paper, we present the DigiCOVID protocol, a digital approach to offer remote, personalized psychological and psychiatric support to former or current patients with COVID-19 and their relatives. Objective: The main goal of this project is to evaluate the feasibility, acceptability, and usability of the DigiCOVID protocol. Furthermore, we also aim to assess the impact of the abovementioned protocol by means of pre-post changes in psychological clinical variables. Methods: Participants undergo an initial telephonic screening to ensure inclusion criteria are met. Secondly, participants complete a video-assisted neuropsychological IQ test as well as web-based self-reports of health and general well-being. Participants are then assigned to a psychotherapist who offers 8 teletherapy sessions. At the end of the therapy cycle, the web-based questionnaires are administered for a posttreatment evaluation. Results: As of April 2022, we enrolled a total of 122 participants, of which 94 have completed neuropsychological tests and web-based questionnaires. Conclusions: Our study aims at testing the feasibility and preliminary efficacy of DigiCOVID, a remote telemedicine protocol for the improvement of psychological and psychiatric health in patients with COVID-19 and their relatives. To date, the approach used seems to be feasible and highly customizable to patients' needs, and therefore, the DigiCOVID protocol might pave the way for future telepsychiatry-based interventions. Trial Registration: ClinicalTrials.gov NCT05231018; https://clinicaltrials.gov/ct2/show/NCT05231018?term=NCT05231018 \&draw=2\&rank=1 International Registered Report Identifier (IRRID): DERR1-10.2196/39080 ", doi="10.2196/39080", url="https://www.researchprotocols.org/2022/11/e39080", url="http://www.ncbi.nlm.nih.gov/pubmed/36228130" } @Article{info:doi/10.2196/33676, author="Sterling, Andrew William and Sobolev, Michael and Van Meter, Anna and Guinart, Daniel and Birnbaum, L. Michael and Rubio, M. Jose and Kane, M. John", title="Digital Technology in Psychiatry: Survey Study of Clinicians", journal="JMIR Form Res", year="2022", month="Nov", day="10", volume="6", number="11", pages="e33676", keywords="digital psychiatry", keywords="passive monitoring technology", keywords="digital phenotype", keywords="psychiatry", keywords="mental health", keywords="clinicians", keywords="clinician perspectives", keywords="digital health", keywords="physicians", keywords="psychiatrists", abstract="Background: Digital technology has the potential?to transform psychiatry, but its adoption has been?limited. The proliferation of telepsychiatry during the COVID-19 pandemic has increased the urgency of optimizing technology for clinical practice. Understanding clinician attitudes and preferences is crucial to?effective implementation and patient benefit. Objective: Our objective was to elicit clinician perspectives on emerging digital technology. Methods: Clinicians in a large psychiatry department (inpatient and outpatient) were invited to complete a web-based survey about their attitudes toward digital technology in practice, focusing on implementation, clinical benefits, and expectations about patients' attitudes. The survey consisted of 23 questions that could be answered on either a 3-point or 5-point Likert scale. We report the frequencies and percentages of responses. Results: In total, 139 clinicians completed the survey---they represent a variety of years of experience, credentials, and diagnostic subspecialties (response rate 69.5\%). Overall, 83.4\% (n=116) of them stated that digital data could improve their practice, and 23.0\% (n=32) of responders reported that they had viewed patients' profiles on social media. Among anticipated benefits, clinicians rated symptom self-tracking (n=101, 72.7\%) as well as clinical intervention support (n=90, 64.7\%) as most promising. Among anticipated challenges, clinicians mostly expressed concerns over greater time demand (n=123, 88.5\%) and whether digital data would be actionable (n=107, 77\%). Furthermore, 95.0\% (n=132) of clinicians expected their patients to share digital data. Conclusions: Overall, clinicians reported a positive attitude toward the use of digital data to not only improve patient outcomes but also highlight significant barriers that implementation would need to overcome. Although clinicians' self-reported attitudes about digital technology may not necessarily translate into behavior, our results suggest that technologies that reduce clinician burden and are easily interpretable have the greatest likelihood of uptake. ", doi="10.2196/33676", url="https://formative.jmir.org/2022/11/e33676", url="http://www.ncbi.nlm.nih.gov/pubmed/36355414" } @Article{info:doi/10.2196/38743, author="Ludin, Nicola and Holt-Quick, Chester and Hopkins, Sarah and Stasiak, Karolina and Hetrick, Sarah and Warren, Jim and Cargo, Tania", title="A Chatbot to Support Young People During the COVID-19 Pandemic in New Zealand: Evaluation of the Real-World Rollout of an Open Trial", journal="J Med Internet Res", year="2022", month="Nov", day="4", volume="24", number="11", pages="e38743", keywords="COVID-19", keywords="youth", keywords="chatbots", keywords="adolescent mental health", keywords="dialog-based intervention", keywords="digital mental health", abstract="Background: The number of young people in New Zealand (Aotearoa) who experience mental health challenges is increasing. As those in Aotearoa went into the initial COVID-19 lockdown, an ongoing digital mental health project was adapted and underwent rapid content authoring to create the Aroha chatbot. This dynamic digital support was designed with and for young people to help manage pandemic-related worry. Objective: Aroha was developed to provide practical evidence-based tools for anxiety management using cognitive behavioral therapy and positive psychology. The chatbot included practical ideas to maintain social and cultural connection, and to stay active and well. Methods: Stay-at-home orders under Aotearoa's lockdown commenced on March 20, 2020. By leveraging previously developed chatbot technology and broader existing online trial infrastructure, the Aroha chatbot was launched promptly on April 7, 2020. Dissemination of the chatbot for an open trial was via a URL, and feedback on the experience of the lockdown and the experience of Aroha was gathered via online questionnaires and a focus group, and from community members. Results: In the 2 weeks following the launch of the chatbot, there were 393 registrations, and 238 users logged into the chatbot, of whom 127 were in the target age range (13-24 years). Feedback guided iterative and responsive content authoring to suit the dynamic situation and motivated engineering to dynamically detect and react to a range of conversational intents. Conclusions: The experience of the implementation of the Aroha chatbot highlights the feasibility of providing timely event-specific digital mental health support and the technology requirements for a flexible and enabling chatbot architectural framework. ", doi="10.2196/38743", url="https://www.jmir.org/2022/11/e38743", url="http://www.ncbi.nlm.nih.gov/pubmed/36219754" } @Article{info:doi/10.2196/40946, author="Kremer, Lisanne and Lipprandt, Myriam and R{\"o}hrig, Rainer and Breil, Bernhard", title="Examining Mental Workload Relating to Digital Health Technologies in Health Care: Systematic Review", journal="J Med Internet Res", year="2022", month="Oct", day="28", volume="24", number="10", pages="e40946", keywords="mental workload", keywords="mental workload measurement", keywords="assessment", keywords="health care professional", keywords="health information system(s)", keywords="digital health technology", keywords="systematic review", abstract="Background: The workload in health care is increasing and hence, mental health issues are on the rise among health care professionals (HCPs). The digitization of patient care could be related to the increase in stress levels. It remains unclear whether the health information system or systems and digital health technologies (DHTs) being used in health care relieve the professionals or whether they represent a further burden. The mental construct that best describes this burden of technologies is mental workload (MWL). The measurement methods of MWL are particularly relevant in this sensitive setting. Objective: This review aimed to address 2 different but related objectives: identifying the factors that contribute to the MWL of HCPs when using DHT and examining and exploring the applied assessments for the measurement of MWL with a special focus on eye tracking. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement, we conducted a systematic review and processed a literature search in the following databases: MEDLINE (PubMed), Web of Science, Academic Search Premier and CINAHL (EBSCO), and PsycINFO. Studies were eligible if they assessed the MWL of HCPs related to DHT. The review was conducted as per the following steps: literature search, article selection, data extraction, quality assessment (using the Standard Quality Assessment Criteria for Evaluation Primary Research Papers From a Variety of Fields [QualSyst]), data analysis, and data synthesis (narrative and tabular). The process was performed by 2 reviewers (in cases of disagreement, a third reviewer was involved). Results: The literature search process resulted in 25 studies that fit the inclusion criteria and examined the MWL of health care workers resulting from the use of DHT in health care settings. Most studies had sample sizes of 10-50 participants, were conducted in the laboratory, and had quasi-experimental or cross-sectional designs. The main results can be grouped into two categories: assessment methods and factors related to DHT that contribute to MWL. Most studies applied subjective methods for the assessment of MWL. Eye tracking did not play a major role in the selected studies. The factors contributing to a higher MWL were clustered into organizational and systemic factors. Conclusions: Our review of 25 papers shows a diverse assessment approach toward the MWL of HCPs related to DHT as well as 2 groups of relevant contributing factors to MWL. Our results are limited in terms of interpretability and causality due to methodological weaknesses of the included studies and may be limited by some shortcomings in the search process. Future research should concentrate on adequate assessments of the MWL of HCPs dependent on the setting, the evaluation of quality criteria, and further assessment of the contributing factors to MWL. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?ID=CRD42021233271 ", doi="10.2196/40946", url="https://www.jmir.org/2022/10/e40946", url="http://www.ncbi.nlm.nih.gov/pubmed/36306159" } @Article{info:doi/10.2196/38067, author="Danieli, Morena and Ciulli, Tommaso and Mousavi, Mahed Seyed and Silvestri, Giorgia and Barbato, Simone and Di Natale, Lorenzo and Riccardi, Giuseppe", title="Assessing the Impact of Conversational Artificial Intelligence in the Treatment of Stress and Anxiety in Aging Adults: Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Sep", day="23", volume="9", number="9", pages="e38067", keywords="mental health care", keywords="conversational artificial intelligence", keywords="mobile health", keywords="mHealth", keywords="personal health care agent", abstract="Background: While mental health applications are increasingly becoming available for large populations of users, there is a lack of controlled trials on the impacts of such applications. Artificial intelligence (AI)-empowered agents have been evaluated when assisting adults with cognitive impairments; however, few applications are available for aging adults who are still actively working. These adults often have high stress levels related to changes in their work places, and related symptoms eventually affect their quality of life. Objective: We aimed to evaluate the contribution of TEO (Therapy Empowerment Opportunity), a mobile personal health care agent with conversational AI. TEO promotes mental health and well-being by engaging patients in conversations to recollect the details of events that increased their anxiety and by providing therapeutic exercises and suggestions. Methods: The study was based on a protocolized intervention for stress and anxiety management. Participants with stress symptoms and mild-to-moderate anxiety received an 8-week cognitive behavioral therapy (CBT) intervention delivered remotely. A group of participants also interacted with the agent TEO. The participants were active workers aged over 55 years. The experimental groups were as follows: group 1, traditional therapy; group 2, traditional therapy and mobile health (mHealth) agent; group 3, mHealth agent; and group 4, no treatment (assigned to a waiting list). Symptoms related to stress (anxiety, physical disease, and depression) were assessed prior to treatment (T1), at the end (T2), and 3 months after treatment (T3), using standardized psychological questionnaires. Moreover, the Patient Health Questionnaire-8 and General Anxiety Disorders-7 scales were administered before the intervention (T1), at mid-term (T2), at the end of the intervention (T3), and after 3 months (T4). At the end of the intervention, participants in groups 1, 2, and 3 filled in a satisfaction questionnaire. Results: Despite randomization, statistically significant differences between groups were present at T1. Group 4 showed lower levels of anxiety and depression compared with group 1, and lower levels of stress compared with group 2. Comparisons between groups at T2 and T3 did not show significant differences in outcomes. Analyses conducted within groups showed significant differences between times in group 2, with greater improvements in the levels of stress and scores related to overall well-being. A general worsening trend between T2 and T3 was detected in all groups, with a significant increase in stress levels in group 2. Group 2 reported higher levels of perceived usefulness and satisfaction. Conclusions: No statistically significant differences could be observed between participants who used the mHealth app alone or within the traditional CBT setting. However, the results indicated significant differences within the groups that received treatment and a stable tendency toward improvement, which was limited to individual perceptions of stress-related symptoms. Trial Registration: ClinicalTrials.gov NCT04809090; https://clinicaltrials.gov/ct2/show/NCT04809090 ", doi="10.2196/38067", url="https://mental.jmir.org/2022/9/e38067", url="http://www.ncbi.nlm.nih.gov/pubmed/36149730" } @Article{info:doi/10.2196/34602, author="Yeo, GeckHong and Chang, Weining and Lee, Neng Li and Oon, Matt and Ho, Dean", title="A Digital Peer Support Platform to Translate Web-Based Peer Support for Emerging Adult Mental Well-being: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Sep", day="20", volume="11", number="9", pages="e34602", keywords="mental health", keywords="digital health", keywords="peer support intervention", keywords="peer emotional disclosure", keywords="randomized controlled trial", abstract="Background: Mental health issues among emerging adults (aged 19-25 years) on a global scale have underscored the need to address their widespread experiences of depression and anxiety. As a result of the COVID-19 pandemic, emerging studies are being directed toward the development and deployment of digital peer emotional disclosure and support for the psychological well-being of emerging adults. However, it is important to explore the implementation and clinical effectiveness, as well as associated mechanisms of change, for optimal approaches in conducting digital peer support interventions for emerging adults' psychological well-being. Objective: We describe a randomized controlled trial to evaluate the implementation and clinical effectiveness of Acceset, a digital peer support intervention to address emerging adult mental well-being. The intervention has 2 components. First, the digital peer support training equips befrienders (ie, peers who provide support) to harness 4 components of psychological well-being---mattering, selfhood, compassion, and mindfulness---to provide effective peer support for seekers (ie, peers who seek support). Second, Acceset incorporates psychological well-being digital markers and harnesses community engagement to drive emotional disclosure among peers. Methods: A total of 100 participants (aged 19-25 years) from the National University of Singapore will be recruited and randomized into 2 arms. In arm 1 (n=50), the seekers will use Acceset with befrienders (n=30) as well as moderators (n=30) for 3 weeks. Arm 2 comprises a wait-listed control group (n=50). A questionnaire battery will be used to monitor seekers and befrienders at 4 time points. These include baseline (before the intervention), 3 weeks (end of the intervention), and 6 and 9 weeks (carryover effect measurement). Implementation outcomes of the intervention will involve evaluation of the training curriculum with respect to adoption and fidelity as well as user acceptability of the Acceset platform and its feasibility for broader deployment. Clinical outcomes will include mattering, selfhood, compassion, mindfulness, perceived social support, and psychological well-being scores. Results: This protocol received National University of Singapore Institutional Ethics Review Board approval in October 2021. Recruitment will commence in January 2022. We expect data collection and analyses to be completed in June 2022. Preliminary findings are expected to be published in December 2022. The Cohen d index will be used for effect size estimation with a .05 (95\% reliability) significance level and 80\% power. Conclusions: This protocol considers a novel digital peer support intervention---Acceset---that incorporates components and digital markers of emerging adult mental well-being. Through the validation of the Acceset intervention, this study defines the parameters and conditions for digital peer support interventions for emerging adults. Trial Registration: ClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676 International Registered Report Identifier (IRRID): PRR1-10.2196/34602 ", doi="10.2196/34602", url="https://www.researchprotocols.org/2022/9/e34602", url="http://www.ncbi.nlm.nih.gov/pubmed/36125855" } @Article{info:doi/10.2196/39787, author="Peipert, Allison and Krendl, C. Anne and Lorenzo-Luaces, Lorenzo", title="Waiting Lists for Psychotherapy and Provider Attitudes Toward Low-Intensity Treatments as Potential Interventions: Survey Study", journal="JMIR Form Res", year="2022", month="Sep", day="16", volume="6", number="9", pages="e39787", keywords="psychotherapy", keywords="CBT", keywords="cognitive behavioral therapy", keywords="behavior therapy", keywords="digital mental health", keywords="self-help", keywords="support group", keywords="mental health", keywords="digital health", keywords="eHealth", keywords="low-intensity intervention", keywords="survey", keywords="waiting list", keywords="health system", keywords="health care delivery", keywords="health care professional", keywords="care provider", keywords="bibliotherapy", keywords="attitude", keywords="perception", keywords="digital intervention", keywords="web-based intervention", keywords="depression", keywords="anxiety", keywords="mental disorder", abstract="Background: Common mental disorders, including depression and anxiety, are leading causes of disability worldwide. Digital mental health interventions, such as web-based self-help and other low-intensity treatments (LITs) that are not digital (eg, bibliotherapy), have the potential to reach many individuals by circumventing common barriers present in traditional mental health care. It is unclear how often LITs are used in clinical practice, or whether providers would be interested in their use for treatment waiting lists. Objective: The aims of this study were to (1) describe current practices for treatment waiting lists, (2) describe providers' attitudes toward digital and nondigital LITs for patients on a waiting list, and (3) explore providers' willingness to use digital and nondigital LITs and their decisions to learn about them. Methods: We surveyed 141 practicing mental health care providers (eg, therapists and psychologists) and provided an opportunity for them to learn about LITs. Results: Most participants reported keeping a waiting list. Few participants reported currently recommending digital or nondigital LITs, though most were willing to use at least one for patients on their waiting list. Attitudes toward digital and nondigital LITs were neutral to positive. Guided digital and nondigital LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Most participants selected to access additional information on LITs, with the most popular being web-based self-help. Conclusions: Results suggest providers are currently not recommending LITs for patients on treatment waiting lists but would be willing to recommend them. Future work should explore barriers and facilitators to implementing digital and nondigital LITs for patients on treatment waiting lists. ", doi="10.2196/39787", url="https://formative.jmir.org/2022/9/e39787", url="http://www.ncbi.nlm.nih.gov/pubmed/36112400" } @Article{info:doi/10.2196/37712, author="Eliacin, Johanne and Burgess, J. Diana and Rollins, L. Angela and Patterson, Scott and Damush, Teresa and Bair, J. Matthew and Salyers, P. Michelle and Spoont, Michele and Slaven, E. James and O'Connor, Caitlin and Walker, Kiara and Zou, S. Denise and Austin, Emily and Akins, John and Miller, James and Chinman, Matthew and Matthias, S. Marianne", title="Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study", journal="JMIR Res Protoc", year="2022", month="Sep", day="6", volume="11", number="9", pages="e37712", keywords="Veterans", keywords="health care disparities", keywords="intervention", keywords="mental health", keywords="patient engagement", keywords="shared decision-making", keywords="patient navigation", abstract="Background: Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. Objective: The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. Methods: This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. Results: Participants (N=50) were Veterans who were mostly male (n=31, 62\%) and self-identified as non-Hispanic (n=44, 88\%) and Black (n=35, 70\%) with a median age of 45 to 54 years. Most had at least some college education, and 32\% (16/50) had completed ?4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. Conclusions: Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. Trial Registration: ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771 International Registered Report Identifier (IRRID): DERR1-10.2196/37712 ", doi="10.2196/37712", url="https://www.researchprotocols.org/2022/9/e37712", url="http://www.ncbi.nlm.nih.gov/pubmed/36066967" } @Article{info:doi/10.2196/37851, author="Jardine, Jacinta and Bowman, Robert and Doherty, Gavin", title="Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review", journal="J Med Internet Res", year="2022", month="Aug", day="30", volume="24", number="8", pages="e37851", keywords="readiness for change", keywords="stages of change", keywords="digital", keywords="motivation", keywords="engagement", keywords="uptake", keywords="mental health", keywords="mental illness", keywords="mobile phone", abstract="Background: Psychological therapy is an effective treatment method for mental illness; however, many people with mental illness do not seek treatment or drop out of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating global problem of mental illness. Attitudinal barriers, such as a lack of motivation, are a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible and scalable solutions; however, little is known about the range of interventions being used and their feasibility as a means to increase engagement with therapy. Objective: This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. Methods: A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, Embase, ACM Guide to Computing Literature, and IEEE Xplore Digital Library from January 1, 2006, to November 30, 2021. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. Results: A total of 45 publications met the inclusion criteria. The conditions included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling, and psychosis. Almost half of the interventions (22/48, 46\%) were web-based programs; the other formats included screening tools, videos, apps, and websites. The components of the interventions included psychoeducation, symptom assessment and feedback, information on treatment options and referrals, client testimonials, expectation management, and pro-con lists. Regarding feasibility, of the 16 controlled studies, 7 (44\%) measuring actual behavior or action showed evidence of intervention effectiveness compared with controls, 7 (44\%) found no differences, and 2 (12\%) indicated worse behavioral outcomes. In general, the outcomes were mixed and inconclusive owing to variations in trial designs, control types, and outcome measures. Conclusions: Digital interventions to enhance readiness for psychological therapy are broad and varied. Although these easily accessible digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses toward engaging in treatment for mental health difficulties suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area. ", doi="10.2196/37851", url="https://www.jmir.org/2022/8/e37851", url="http://www.ncbi.nlm.nih.gov/pubmed/36040782" } @Article{info:doi/10.2196/37061, author="Tonn, Peter and Seule, Lea and Degani, Yoav and Herzinger, Shani and Klein, Amit and Schulze, Nina", title="Digital Content-Free Speech Analysis Tool to Measure Affective Distress in Mental Health: Evaluation Study", journal="JMIR Form Res", year="2022", month="Aug", day="30", volume="6", number="8", pages="e37061", keywords="mobile health", keywords="mHealth", keywords="depression", keywords="assessment", keywords="voice analysis", keywords="evaluation", keywords="speech", keywords="speech analysis", keywords="tool", keywords="distress", keywords="mental health", keywords="mood", keywords="diagnosis", keywords="measurement", keywords="questionnaire", keywords="mobile phone", abstract="Background: Mood disorders and depression are pervasive and significant problems worldwide. These represent severe health and emotional impairments for individuals and a considerable economic and social burden. Therefore, fast and reliable diagnosis and appropriate treatment are of great importance. Verbal communication can clarify the speaker's mental state---regardless of the content, via speech melody, intonation, and so on. In both everyday life and clinical conditions, a listener with appropriate previous knowledge or a trained specialist can grasp helpful knowledge about the speaker's psychological state. Using automated speech analysis for the assessment and tracking of patients with mental health issues opens up the possibility of remote, automatic, and ongoing evaluation when used with patients' smartphones, as part of the current trends toward the increasing use of digital and mobile health tools. Objective: The primary aim of this study is to evaluate the measurements of the presence or absence of depressive mood in participants by comparing the analysis of noncontentual speech parameters with the results of the Patient Health Questionnaire-9. Methods: This proof-of-concept study included participants in different affective phases (with and without depression). The inclusion criteria included a neurological or psychiatric diagnosis made by a specialist and fluent use of the German language. The measuring instrument was the VoiceSense digital voice analysis tool, which enables the analysis of 200 specific speech parameters based on machine learning and the assessment of the findings using Patient Health Questionnaire-9. Results: A total of 292 psychiatric and voice assessments were performed with 163 participants (males: n=47, 28.8\%) aged 15 to 82 years. Of the 163 participants, 87 (53.3\%) were not depressed at the time of assessment, and 88 (53.9\%) participants had clinically mild to moderate depressive phases. Of the 163 participants, 98 (32.5\%) showed subsyndromal symptoms, and 19 (11.7\%) participants were severely depressed. In the speech analysis, a clear differentiation between the individual depressive levels, as seen in the Patient Health Questionnaire-9, was also shown, especially the clear differentiation between nondepressed and depressed participants. The study showed a Pearson correlation of 0.41 between clinical assessment and noncontentual speech analysis (P<.001). Conclusions: The use of speech analysis shows a high level of accuracy, not only in terms of the general recognition of a clinically relevant depressive state in the participants. Instead, there is a high degree of agreement regarding the extent of depressive impairment with the assessment of experienced clinical practitioners. From our point of view, the application of the noncontentual analysis system in everyday clinical practice makes sense, especially with the idea of a quick and unproblematic assessment of the state of mind, which can even be carried out without personal contact. Trial Registration: ClinicalTrials.gov NCT03700008; https://clinicaltrials.gov/ct2/show/NCT03700008 ", doi="10.2196/37061", url="https://formative.jmir.org/2022/8/e37061", url="http://www.ncbi.nlm.nih.gov/pubmed/36040767" } @Article{info:doi/10.2196/39846, author="Sadeh-Sharvit, Shiri and Rego, A. Simon and Jefroykin, Samuel and Peretz, Gal and Kupershmidt, Tomer", title="A Comparison Between Clinical Guidelines and Real-World Treatment Data in Examining the Use of Session Summaries: Retrospective Study", journal="JMIR Form Res", year="2022", month="Aug", day="16", volume="6", number="8", pages="e39846", keywords="Empirically based practices", keywords="natural language processing", keywords="psychotherapy", keywords="behavioral therapy", keywords="adherence", keywords="treatment fidelity", keywords="clinical training", keywords="real-world data", keywords="real-world study", abstract="Background: Although behavioral interventions have been found to be efficacious and effective in randomized clinical trials for most mental illnesses, the quality and efficacy of mental health care delivery remains inadequate in real-world settings, partly owing to suboptimal treatment fidelity. This ``therapist drift'' is an ongoing issue that ultimately reduces the effectiveness of treatments; however, until recently, there have been limited opportunities to assess adherence beyond large randomized controlled trials. Objective: This study explored therapists' use of a standard component that is pertinent across most behavioral treatments---prompting clients to summarize their treatment session as a means for consolidating and augmenting their understanding of the session and the treatment plan. Methods: The data set for this study comprised 17,607 behavioral treatment sessions administered by 322 therapists to 3519 patients in 37 behavioral health care programs across the United States. Sessions were captured by a therapy-specific artificial intelligence (AI) platform, and an automatic speech recognition system transcribed the treatment meeting and separated the data to the therapist and client utterances. A search for possible session summary prompts was then conducted, with 2 psychologists validating the text that emerged. Results: We found that despite clinical recommendations, only 54 (0.30\%) sessions included a summary. Exploratory analyses indicated that session summaries mostly addressed relationships (n=27), work (n=20), change (n=6), and alcohol (n=5). Sessions with meeting summaries were also characterized by greater therapist interventions and included greater use of validation, complex reflections, and proactive problem-solving techniques. Conclusions: To the best of our knowledge, this is the first study to assess a large, diverse data set of real-world treatment practices. Our findings provide evidence that fidelity with the core components of empirically designed psychological interventions is a challenge in real-world settings. The results of this study can inform the development of machine learning and AI algorithms and offer nuanced, timely feedback to providers, thereby improving the delivery of evidence-based practices and quality of mental health care services and facilitating better clinical outcomes in real-world settings. ", doi="10.2196/39846", url="https://formative.jmir.org/2022/8/e39846", url="http://www.ncbi.nlm.nih.gov/pubmed/35972782" } @Article{info:doi/10.2196/39516, author="Six, G. Stephanie and Byrne, A. Kaileigh and Aly, Heba and Harris, W. Maggie", title="The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Aug", day="9", volume="9", number="8", pages="e39516", keywords="depression", keywords="mental health apps", keywords="customization", keywords="personalization", keywords="cognitive behavioral therapy", keywords="avatars", keywords="mobile phone", abstract="Background: Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. Objective: The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)--based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. Methods: College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one's own preferences and use of one's name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. Results: Of the 94 enrolled participants, 83 (88\%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47\%) and no customization (44/83, 53\%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=?0.312, P=.02; connection: r=?0.305, P=.02; and lack of relatability: r=0.338, P=.01). Conclusions: These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. Trial Registration: Open Science Framework t28gm; https://osf.io/t28gm ", doi="10.2196/39516", url="https://mental.jmir.org/2022/8/e39516", url="http://www.ncbi.nlm.nih.gov/pubmed/35943788" } @Article{info:doi/10.2196/34514, author="Ma, S. Jennifer and O'Riordan, Megan and Mazzer, Kelly and Batterham, J. Philip and Bradford, Sally and K{\~o}lves, Kairi and Titov, Nickolai and Klein, Britt and Rickwood, J. Debra", title="Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study", journal="JMIR Hum Factors", year="2022", month="Aug", day="5", volume="9", number="3", pages="e34514", keywords="consumer", keywords="community", keywords="help-seeker", keywords="perspective", keywords="technology", keywords="artificial intelligence", keywords="crisis", keywords="support", keywords="acceptability", abstract="Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline's crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline's crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline's crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline's crisis support service and use such services (odds ratio 1.48-1.66, 99\% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. ", doi="10.2196/34514", url="https://humanfactors.jmir.org/2022/3/e34514", url="http://www.ncbi.nlm.nih.gov/pubmed/35930334" } @Article{info:doi/10.2196/35206, author="Rosen, Marlene and Betz, T. Linda and Montag, Christian and Kannen, Christopher and Kambeitz, Joseph", title="Transdiagnostic Psychopathology in a Help-Seeking Population of an Early Recognition Center for Mental Disorders: Protocol for an Experience Sampling Study", journal="JMIR Res Protoc", year="2022", month="Aug", day="1", volume="11", number="8", pages="e35206", keywords="help-seeking population", keywords="phenotyping", keywords="ecological momentary assessment", keywords="symptom networks", keywords="transdiagnositc psychiatry", keywords="prevention", keywords="early intervention", keywords="psychiatry", keywords="mental health", abstract="Background: Prevention in psychiatry provides a promising way to address the burden of mental illness. However, established approaches focus on specific diagnoses and do not address the heterogeneity and manifold potential outcomes of help-seeking populations that present at early recognition services. Conceptualizing the psychopathology manifested in help-seeking populations from a network perspective of interacting symptoms allows transdiagnostic investigations beyond binary disease categories. Furthermore, modern technologies such as smartphones facilitate the application of the Experience Sampling Method (ESM). Objective: This study is a combination of ESM with network analyses to provide valid insights beyond the established assessment instruments in a help-seeking population. Methods: We will examine 75 individuals (aged 18-40 years) of the help-seeking population of the Cologne early recognition center. For a maximally naturalistic sample, only minimal exclusion criteria will be applied. We will collect data for 14 days using a mobile app to assess 10 transdiagnostic symptoms (ie, depressive, anxious, and psychotic symptoms) as well as distress level 5 times a day. With these data, we will generate average group-level symptom networks and personalized symptom networks using a 2-step multilevel vector autoregressive model. Additionally, we will explore associations between symptom networks and sociodemographic, risk, and resilience factors, as well as psychosocial functioning. Results: The protocol was designed in February 2020 and approved by the Ethics Committee of the University Hospital Cologne in October 2020. The protocol was reviewed and funded by the K{\"o}ln Fortune program in September 2020. Data collection began in November 2020 and was completed in November 2021. Of the 258 participants who were screened, 93 (36\%) fulfilled the inclusion criteria and were willing to participate in the study. Of these 93 participants, 86 (92\%) completed the study. The first results are expected to be published in 2022. Conclusions: This study will provide insights about the feasibility and utility of the ESM in a help-seeking population of an early recognition center. Providing the first explorative phenotyping of transdiagnostic psychopathology in this population, our study will contribute to the innovation of early recognition in psychiatry. The results will help pave the way for prevention and targeted early intervention in a broader patient group, and thus, enable greater intended effects in alleviating the burden of psychiatric disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/35206 ", doi="10.2196/35206", url="https://www.researchprotocols.org/2022/8/e35206", url="http://www.ncbi.nlm.nih.gov/pubmed/35916702" } @Article{info:doi/10.2196/34168, author="Bastien, Laurianne and Boke, Naz Bilun and Mettler, Jessica and Zito, Stephanie and Di Genova, Lina and Romano, Vera and Lewis, P. Stephen and Whitley, Rob and Iyer, N. Srividya and Heath, L. Nancy", title="Peer-Presented Versus Mental Health Service Provider--Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Jul", day="22", volume="9", number="7", pages="e34168", keywords="web-based mental health outreach", keywords="resilience building", keywords="university student", keywords="peer-presented", keywords="mental health service provider--presented", keywords="mental health", keywords="outreach", keywords="resilience", keywords="student", keywords="service provider", keywords="randomized controlled trial", abstract="Background: University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students' mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. Objective: Thus, the overarching goal of this study was to evaluate a mental health service provider--presented versus peer-presented web-based mental health resilience--building video outreach program against a wait-list comparison group. Methods: Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8\% women) who were randomly assigned to one of the intervention groups (mental health service provider--presented: 69/217, 31.8\%; peer-presented: 73/217, 33.6\%) or the wait-list comparison group (75/217, 34.6\%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider--presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). Results: Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider--presented and peer-presented programs were rated very highly and at comparable levels. Conclusions: Thus, findings suggest that a web-based mental health resilience--building video outreach program may be acceptable for university students regardless of it being mental health service provider--presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. Trial Registration: ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592 ", doi="10.2196/34168", url="https://mental.jmir.org/2022/7/e34168", url="http://www.ncbi.nlm.nih.gov/pubmed/35762935" } @Article{info:doi/10.2196/39217, author="Fialk, Amanda and Connors, Alexa and Cerrito, Brianna and Jones, Karee and Buono, Frank", title="The Impact of SARS-CoV-2 (COVID-19) on the Acuity of Mental Health--Related Diagnosis at Admission for Young Adults in New York City and Washington, DC: Observational Study", journal="JMIR Form Res", year="2022", month="Jul", day="14", volume="6", number="7", pages="e39217", keywords="COVID-19", keywords="young adults", keywords="mental health treatment", keywords="anxiety", keywords="depression", keywords="youth", keywords="mental health", keywords="Qualtrics", keywords="psychometric properties", keywords="gender", keywords="mental health service", keywords="quality of life", abstract="Background: The COVID-19 pandemic has required restrictive measures to mitigate transmission of the virus. Evidence has demonstrated increased generalized anxiety and depression among young adults due to the COVID-19 pandemic. However, minimal research has examined the longitudinal effect of COVID-19 over the course of time and its impact on anxiety and depression. Additionally, age and gender have been found to play a significant role on individuals' mental health, with young adults and women particularly at risk. Objective: The aim of this study was to examine the impact of the COVID-19 pandemic on anxiety and depression upon admissions to treatment. Methods: This was an observational study that was completed longitudinally in which the grouping variable split the time interval into five equal groups for assessments over each period of time. A total of 112 young adults (aged 18-25 years) were recruited for the study. Participants completed assessments online through a Qualtrics link. Results: Psychometric properties of the admission assessments were uniformly highly statistically significant. There was a significant difference in generalized anxiety between the group-1 and group-3 time intervals. No significant difference was found across the time intervals for depression. Differences in predicting the impact of the psychometrics scores were found with respect to gender. Only the ability to participate and the quality-of-life subfactor of the Functional Assessment of Chronic Illness Therapy (FACIT) assessment were significant. Conclusions: This study sought to understand the impact that COVID-19 has had on young adults seeking mental health services during the pandemic. Gender emerged as a clear significant factor contributing to increased anxiety in young adults seeking mental health services during the pandemic. These findings have critical importance to ensuring the potential treatment success rate of clients, while providing an overarching understanding of the impact of the pandemic and establishing clinical recommendations for the treatment of individuals who are seeking out treatment. ", doi="10.2196/39217", url="https://formative.jmir.org/2022/7/e39217", url="http://www.ncbi.nlm.nih.gov/pubmed/35767688" } @Article{info:doi/10.2196/36757, author="Colombo, Paola and Busti Ceccarelli, Silvia and Pacchiarini, Stefano and Cribellati, Stefano and Molteni, Massimo", title="A Web Platform for Standardized Data Acquisition, Processing, and Export in the Child Psychopathology Clinical Routine (MedicalBIT): Design and Implementation Study", journal="JMIR Form Res", year="2022", month="Jul", day="11", volume="6", number="7", pages="e36757", keywords="digital health", keywords="big data", keywords="developmental psychopathology", keywords="neurodevelopmental disorders", keywords="digital data", keywords="digital innovation", keywords="mental health", keywords="screening tool", keywords="children", keywords="psychopathology", keywords="web platform", keywords="digital intervention", keywords="clinical outcome", abstract="Background: The rapid extent of digital innovation for the collection of data has transformed the way in which health professionals collect, share, and analyze health information for better clinical decision-making and health care. In the last decade, there has been an increased interest in telemedicine by mental health agencies; the gap between the need for care and both diagnosis and treatment is wide, and digital technology could play an important role in filling this gap. However, there are limited data on the effectiveness of the clinical process and cost-effectiveness of most telemedicine applications. Objective: This study examined the implementation of the first Italian online, web-based, comprehensive screening tool and described the screening and diagnostic process through the interactive web platform in a child psychopathology clinic. This is a feasibility study that aims to present the design and implementation of the best practices to improve patient experiences and clinical outcomes. Moreover, the paper evaluates the platform with qualitative and quantitative measures. Methods: We planned, designed, and implemented a web-based system to collect, store, and manage clinical data. The platform was developed by a multidisciplinary team composed of researchers, clinicians, and informatics professionals through different steps. First, we defined the clinical information to be collected. A number of measures were chosen, tapping several clinical risk areas such as neurodevelopmental disorders and emotional and behavioral problems. The web application architecture and process were then designed. The three phases of process design are described in detail: design of the input interface, processing design, and design of the output interface. Finally, the system has been implemented and evaluated. Based on indicators recommended by the National Quality Forum and the Italian National Guidelines, we evaluated the quality of the system and used quantitative measures that were replicable and comparable over time. Results: We present the implemented architecture and features of Medea Information and Clinical Assessment On-Line (MedicalBIT), and we provide performance measures for the data collected between October 2018 and June 2021. The measured concepts pertain to four domains: access to care, financial impact/cost, experience, and effectiveness. Conclusions: In this study, we present the successful implementation of an innovative digital tool. The findings of this study show that the implemented web-based platform appears to be an efficient, cost-effective, and feasible way to improve digital care in the field of child psychiatry. ", doi="10.2196/36757", url="https://formative.jmir.org/2022/7/e36757", url="http://www.ncbi.nlm.nih.gov/pubmed/35816380" } @Article{info:doi/10.2196/40147, author="Eckardt, Peter Jens", title="Urgency for Digital Technologies to Support Caregivers. Comment on ``Telehealth-Based Psychoeducation for Caregivers: The Family Intervention in Recent-Onset Schizophrenia Treatment Study''", journal="JMIR Ment Health", year="2022", month="Jun", day="30", volume="9", number="6", pages="e40147", keywords="schizophrenia", keywords="family psychoeducation", keywords="caregiver burden", keywords="recent-onset schizophrenia", keywords="telehealth", doi="10.2196/40147", url="https://mental.jmir.org/2022/6/e40147", url="http://www.ncbi.nlm.nih.gov/pubmed/35771612" } @Article{info:doi/10.2196/36521, author="Darnell, Doyanne and Pullmann, D. Michael and Hull, D. Thomas and Chen, Shiyu and Are{\'a}n, Patricia", title="Predictors of Disengagement and Symptom Improvement Among Adults With Depression Enrolled in Talkspace, a Technology-Mediated Psychotherapy Platform: Naturalistic Observational Study", journal="JMIR Form Res", year="2022", month="Jun", day="22", volume="6", number="6", pages="e36521", keywords="depression", keywords="psychotherapy", keywords="disengagement", keywords="internet", keywords="web-based", keywords="technology-mediated psychotherapy", abstract="Background: Depression is a common psychiatric condition with an estimated lifetime prevalence for major depression of 16.6\% in the US adult population and is effectively treated through psychotherapy. The widespread availability of the internet and personal devices such as smartphones are changing the landscape of delivery of psychotherapy; however, little is known about whether and for whom this type of therapy is beneficial, and whether having synchronous video-based sessions provides additional benefits to clients above and beyond messaging-based therapy. Objective: This study examined the outcomes associated with the use of a digital platform (Talkspace) for technology-mediated psychotherapy. We examined the duration of client engagement in therapy and client depression score trajectories over 16 weeks. We explored the association of client characteristics, therapist characteristics, and service plan type with time-to-disengagement and trajectories of change in depression scores. Methods: This naturalistic observational study assessed data collected routinely by the platform between January 2016 and January 2018 and examined psychotherapy outcomes among a large representative sample of adult clients with clinically significant depression. Treatment disengagement was defined as a lack of client-initiated communication for more than 4 weeks. Clients completed the Patient Health Questionnaire-8 item (PHQ-8) at intake and every 3 weeks via an in-app survey. Cox regression analysis was used to examine the time until and predictors of disengagement. Changes in depression scores and predictors of change over time were examined using mixed-effects regression. Results: The study included 5890 clients and 1271 therapists. Client scores on the PHQ-8 declined over time, with the average client improving from a score of 15 to below the clinical cutoff of 10 by week 6. At the same time point, 37\% of clients had disengaged from the therapy. When combined into a final Cox regression model, those who were more likely to disengage were clients aged 18 to 25 years versus those aged ?50 years (odds ratio [OR] 0.82, 95\% CI 0.74-0.9; P<.001), had higher education (OR 1.14, 95\% CI 1.06-1.22; P<.001), had been in therapy before (OR 1.09, 95\% CI 1.02-1.17; P=.01), and were living with a partner but unmarried versus single (OR 1.14, 95\% CI 1.02-1.27; P=.02). Having a therapist with >10 years of experience was related to lower odds of disengagement (OR 0.87, 95\% CI 0.8-0.94; P=.01). When combined into a final regression model predicting improvement in depression scores over time, clients showing more improvement were those with an associate's degree or higher (linear estimate=?0.07, P=.002) and higher intake PHQ-8 scores (estimate=3.73, P<.001). There were no differences based on the plan type. Conclusions: Our findings add to the growing literature showing the benefits of technology-mediated psychotherapy over a relatively brief period (16 weeks). ", doi="10.2196/36521", url="https://formative.jmir.org/2022/6/e36521", url="http://www.ncbi.nlm.nih.gov/pubmed/35731563" } @Article{info:doi/10.2196/31029, author="Mukhiya, Kumar Suresh and Lamo, Yngve and Rabbi, Fazle", title="A Reference Architecture for Data-Driven and Adaptive Internet-Delivered Psychological Treatment Systems: Software Architecture Development and Validation Study", journal="JMIR Hum Factors", year="2022", month="Jun", day="20", volume="9", number="2", pages="e31029", keywords="software architecture", keywords="adaptive system", keywords="IDPT system", keywords="health care systems", keywords="ICBT", keywords="adaptive strategies", keywords="personalized therapies", keywords="reference architecture", abstract="Background: Internet-delivered psychological treatment (IDPT) systems are software applications that offer psychological treatments via the internet. Such IDPT systems have become one of the most commonly practiced and widely researched forms of psychotherapy. Evidence shows that psychological treatments delivered by IDPT systems can be an effective way of treating mental health morbidities. However, current IDPT systems have high dropout rates and low user adherence. The primary reason is that the current IDPT systems are not flexible, adaptable, and personalized as they follow a fixed tunnel-based treatment architecture. A fixed tunnel-based architecture follows predefined, sequential treatment content for every patient, irrespective of their context, preferences, and needs. Moreover, current IDPT systems have poor interoperability, making it difficult to reuse and share treatment materials. There is a lack of development and documentation standards, conceptual frameworks, and established (clinical) guidelines for such IDPT systems. As a result, several ad hoc forms of IDPT models exist. Consequently, developers and researchers have tended to reinvent new versions of IDPT systems, making them more complex and less interoperable. Objective: This study aimed to design, develop, and evaluate a reference architecture (RA) for adaptive systems that can facilitate the design and development of adaptive, interoperable, and reusable IDPT systems. Methods: This study was conducted in collaboration with a large interdisciplinary project entitled INTROMAT (Introducing Mental Health through Adaptive Technology), which brings together information and communications technology researchers, information and communications technology industries, health researchers, patients, clinicians, and patients' next of kin to reach its vision. First, we investigated previous studies and state-of-the-art works based on the project's problem domain and goals. On the basis of the findings from these investigations, we identified 2 primary gaps in current IDPT systems: lack of adaptiveness and limited interoperability. Second, we used model-driven engineering and Domain-Driven Design techniques to design, develop, and validate the RA for building adaptive, interoperable, and reusable IDPT systems to address these gaps. Third, based on the proposed RA, we implemented a prototype as the open-source software. Finally, we evaluated the RA and open-source implementation using empirical (case study) and nonempirical approaches (software architecture analysis method, expert evaluation, and software quality attributes). Results: This paper outlines an RA that supports flexible user modeling and the adaptive delivery of treatments. To evaluate the proposed RA, we developed an open-source software based on the proposed RA. The open-source framework aims to improve development productivity, facilitate interoperability, increase reusability, and expedite communication with domain experts. Conclusions: Our results showed that the proposed RA is flexible and capable of adapting interventions based on patients' needs, preferences, and context. Furthermore, developers and researchers can extend the proposed RA to various health care interventions. ", doi="10.2196/31029", url="https://humanfactors.jmir.org/2022/2/e31029", url="http://www.ncbi.nlm.nih.gov/pubmed/35723905" } @Article{info:doi/10.2196/37585, author="Munson, A. Sean and Friedman, C. Emily and Osterhage, Katie and Allred, Ryan and Pullmann, D. Michael and Are{\'a}n, A. Patricia and Lyon, R. Aaron and ", title="Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis", journal="J Med Internet Res", year="2022", month="Jun", day="14", volume="24", number="6", pages="e37585", keywords="evidence-based psychosocial interventions", keywords="usability", keywords="implementation strategies", keywords="mental health", keywords="human-centered design", keywords="implementation science", abstract="Background: People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies. Objective: This study aimed to identify and categorize usability issues in EBPIs and their implementation strategies. Methods: We adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health---funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies. Results: The 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues. Conclusions: Usability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies. International Registered Report Identifier (IRRID): RR2-10.2196/14990 ", doi="10.2196/37585", url="https://www.jmir.org/2022/6/e37585", url="http://www.ncbi.nlm.nih.gov/pubmed/35700016" } @Article{info:doi/10.2196/35591, author="Vial, St{\'e}phane and Boudhra{\^a}, Sana and Dumont, Mathieu", title="Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review", journal="JMIR Ment Health", year="2022", month="Jun", day="7", volume="9", number="6", pages="e35591", keywords="design", keywords="human-centered design", keywords="user experience", keywords="mental health", keywords="digital mental health", abstract="Background: Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development. Objective: The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research. Methods: An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies. Results: A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41\%), codesign (6/27, 22\%), user-centered design (5/27, 19\%), or a specific design method (5/27, 19\%). Just over half (15/27, 56\%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27\% (8/30) of all the included studies explicitly mentioned the presence of designers on their team. Conclusions: Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research. ", doi="10.2196/35591", url="https://mental.jmir.org/2022/6/e35591", url="http://www.ncbi.nlm.nih.gov/pubmed/35671081" } @Article{info:doi/10.2196/30065, author="Pearson, Rahel and Carl, Emily and Creech, K. Suzannah", title="Computerized Psychological Interventions in Veterans and Service Members: Systematic Review of Randomized Controlled Trials", journal="J Med Internet Res", year="2022", month="Jun", day="3", volume="24", number="6", pages="e30065", keywords="computer", keywords="digital", keywords="internet", keywords="interventions", keywords="veterans", keywords="service members", keywords="review", keywords="mobile phone", abstract="Background: Computerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings. Objective: In this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research. Methods: Systematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non--computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes. Results: This review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79\%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes. Conclusions: Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment. ", doi="10.2196/30065", url="https://www.jmir.org/2022/6/e30065", url="http://www.ncbi.nlm.nih.gov/pubmed/35657663" } @Article{info:doi/10.2196/35086, author="Pinto da Costa, Mariana and ", title="An Intervention to Connect Patients With Psychosis and Volunteers via Smartphone (the Phone Pal): Development Study", journal="JMIR Form Res", year="2022", month="Jun", day="2", volume="6", number="6", pages="e35086", keywords="intervention", keywords="intervention development", keywords="digital mental health", keywords="psychosis", keywords="severe mental illness", keywords="volunteering", keywords="volunteer", keywords="mental health", keywords="mental illness", keywords="development", keywords="design", keywords="user centered design", keywords="smartphone", keywords="mobile phone", keywords="mobile health", keywords="mHealth", keywords="MRC framework", keywords="Medical Research Council framework", abstract="Background: Intervention development is a critical stage. However, evidence indicates that the substandard reporting of intervention details is widespread. Objective: This study aimed to provide an overview of the guiding frameworks, methodology, and stages for the design and construction of a new complex intervention---the Phone Pal. Methods: The intervention development process followed the Medical Research Council framework for developing complex interventions as well as the person-based approach. The intervention was developed following the evidence synthesis of a literature review, a focus group study, and a survey after consultation and input from advisory groups with a range of stakeholders, including patients, volunteers, clinicians, and academics. Results: The developed logic model outlines the contextual factors, intervention, mechanisms of change, and short- and long-term outcomes. The operationalized intervention required matching 1 patient with 1 volunteer to communicate with each other through a smartphone via SMS text messages, WhatsApp messages or email, and audio or video calls. Each participant was encouraged to communicate with their match at least once per week for a 12-week period using informal conversation. Conclusions: The systematic process and theoretically sound strategy through which this intervention was developed can provide insights to future researchers on the reality of developing and preparing the operationalization of a digital intervention using multiple components. ", doi="10.2196/35086", url="https://formative.jmir.org/2022/6/e35086", url="http://www.ncbi.nlm.nih.gov/pubmed/35653171" } @Article{info:doi/10.2196/35159, author="Philippe, J. Tristan and Sikder, Naureen and Jackson, Anna and Koblanski, E. Maya and Liow, Eric and Pilarinos, Andreas and Vasarhelyi, Krisztina", title="Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review", journal="JMIR Ment Health", year="2022", month="May", day="12", volume="9", number="5", pages="e35159", keywords="digital health", keywords="telepsychology", keywords="computer-assisted therapy", keywords="online therapy", keywords="mobile applications", keywords="mobile apps", keywords="telemedicine", keywords="telepsychiatry", keywords="virtual reality exposure therapy", keywords="mental health", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of?mental health conditions. Objective: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. Methods: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. Results: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52\%) of research involved the treatment of substance use disorders, 29\% focused on mood, anxiety, and traumatic stress disorders, and >5\% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions. ", doi="10.2196/35159", url="https://mental.jmir.org/2022/5/e35159", url="http://www.ncbi.nlm.nih.gov/pubmed/35551058" } @Article{info:doi/10.2196/34655, author="Scheutzow, Johanna and Attoe, Chris and Harwood, Joshua", title="Acceptability of Web-Based Mental Health Interventions in the Workplace: Systematic Review", journal="JMIR Ment Health", year="2022", month="May", day="11", volume="9", number="5", pages="e34655", keywords="acceptability", keywords="e-mental health", keywords="online mental health interventions", keywords="occupational online interventions", keywords="employees", keywords="mobile phone", abstract="Background: Web-based interventions have proven to be effective not only in clinical populations but also in the occupational setting. Recent studies conducted in the work environment have focused on the effectiveness of these interventions. However, the role of employees' acceptability of web-based interventions and programs has not yet enjoyed a similar level of attention. Objective: The objective of this systematic review was to conduct the first comprehensive study on employees' level of acceptability of web-based mental health interventions based on direct and indirect measures, outline the utility of different types of web-based interventions for work-related mental health issues, and build a research base in the field. Methods: The search was conducted between October 2018 and July 2019 and allowed for any study design. The studies used either qualitative or quantitative data sources. The web-based interventions were generally aimed at supporting employees with their mental health issues. The study characteristics were outlined in a table as well as graded based on their quality using a traffic light schema. The level of acceptability was individually rated using commonly applied methods, including percentile quartiles ranging from low to very high. Results: A total of 1303 studies were identified through multiple database searches and additional resources, from which 28 (2\%) were rated as eligible for the synthesis. The results of employees' acceptability levels were mixed, and the studies were very heterogeneous in design, intervention characteristics, and population. Approximately 79\% (22/28) of the studies outlined acceptability measures from high to very high, and 54\% (15/28) of the studies reported acceptability levels from low to moderate (overlap when studies reported both quantitative and qualitative results). Qualitative studies also provided insights into barriers and preferences, including simple and tailored application tools as well as the preference for nonstigmatized language. However, there were multiple flaws in the methodology of the studies, such as the blinding of participants and personnel. Conclusions: The results outline the need for further research with more homogeneous acceptability studies to draw a final conclusion. However, the underlying results show that there is a tendency toward general acceptability of web-based interventions in the workplace, with findings of general applicability to the use of web-based mental health interventions. ", doi="10.2196/34655", url="https://mental.jmir.org/2022/5/e34655", url="http://www.ncbi.nlm.nih.gov/pubmed/35544305" } @Article{info:doi/10.2196/30716, author="Bell, H. Imogen and Thompson, Andrew and Valentine, Lee and Adams, Sophie and Alvarez-Jimenez, Mario and Nicholas, Jennifer", title="Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey", journal="JMIR Ment Health", year="2022", month="May", day="11", volume="9", number="5", pages="e30716", keywords="adolescent", keywords="youth mental health", keywords="mental health", keywords="attitude", keywords="digital technology", keywords="internet-based interventions", keywords="digital mental health", keywords="mental health services", keywords="clinician", keywords="mobile phone", abstract="Background: There is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies. Objective: This study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients' mental health. Methods: Youth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients. Results: A total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99\%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3\% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80\%) and video chat (69/76, 91\%) commonly in clinical practice and found them to be helpful. Approximately 50\% (296/609) of the young people used mental health apps, which was significantly less than the clinicians ($\chi$23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100\% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88\% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy. Conclusions: Technology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health. ", doi="10.2196/30716", url="https://mental.jmir.org/2022/5/e30716", url="http://www.ncbi.nlm.nih.gov/pubmed/35544295" } @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/10.2196/36203, author="Leo, J. Ashwin and Schuelke, J. Matthew and Hunt, M. Devyani and Miller, Philip J. and Are{\'a}n, A. Patricia and Cheng, L. Abby", title="Digital Mental Health Intervention Plus Usual Care Compared With Usual Care Only and Usual Care Plus In-Person Psychological Counseling for Orthopedic Patients With Symptoms of Depression or Anxiety: Cohort Study", journal="JMIR Form Res", year="2022", month="May", day="4", volume="6", number="5", pages="e36203", keywords="digital health", keywords="mental health", keywords="depression", keywords="anxiety", keywords="chronic pain", keywords="musculoskeletal", keywords="orthopedic", abstract="Background: Depression and anxiety frequently coexist with chronic musculoskeletal pain and can negatively impact patients' responses to standard orthopedic treatments. Nevertheless, mental health is not routinely addressed in the orthopedic care setting. If effective, a digital mental health intervention may be a feasible and scalable method of addressing mental health in an orthopedic setting. Objective: We aimed to compare 2-month changes in mental and physical health between orthopedic patients who received a digital mental health intervention in addition to usual orthopedic care, those who received usual orthopedic care only (without a specific mental health intervention), and those who received in-person care with a psychologist as part of their orthopedic treatment plan. Methods: In this single-center retrospective cohort study involving ancillary analysis of a pilot feasibility study, 2-month self-reported health changes were compared between a cohort of orthopedic patients who received access to a digital mental health intervention (Wysa) and 2 convenience sample comparison cohorts (patients who received usual orthopedic care without a specific mental health intervention and patients who received in-person care with a psychologist as part of their orthopedic treatment plan). All patients were 18 years or older and reported elevated symptoms of depression or anxiety at an orthopedic clinic visit (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression or Anxiety score ?55). The digital intervention was a multi-component mobile app that used chatbot technology and text-based access to human counselors to provide cognitive behavioral therapy, mindfulness training, and sleep tools, among other features, with an emphasis on behavioral activation and pain acceptance. Outcomes of interest were between-cohort differences in the 2-month longitudinal changes in PROMIS Depression and Anxiety scores (primary outcomes) and PROMIS Pain Interference and Physical Function scores (secondary outcomes). Results: Among 153 patients (mean age 55, SD 15 years; 128 [83.7\%] female; 51 patients per cohort), patients who received the digital mental health intervention showed clinically meaningful improvements at the 2-month follow-up for all PROMIS measures (mean longitudinal improvement 2.8-3.7 points; P?.02). After controlling for age and BMI, the improvements in PROMIS Depression, Pain Interference, and Physical Function were meaningfully greater than longitudinal changes shown by patients who received usual orthopedic care (mean between-group difference 2.6-4.8 points; P?.04). Improvements in PROMIS Physical Function were also meaningfully greater than longitudinal changes shown by patients who received in-person psychological counseling (mean between-group difference 2.4 points; P=.04). Conclusions: Patients who received a digital mental health intervention as part of orthopedic care reported greater 2-month mean improvements in depression, pain interference, and physical function than patients who received usual orthopedic care. They also reported a greater mean improvement in physical function and comparable improvements in depression, anxiety, and pain interference compared with orthopedic patients who received in-person psychological counseling. ", doi="10.2196/36203", url="https://formative.jmir.org/2022/5/e36203", url="http://www.ncbi.nlm.nih.gov/pubmed/35507387" } @Article{info:doi/10.2196/35048, author="Yeager, M. Carolyn and Benight, C. Charles", title="Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study", journal="JMIR Ment Health", year="2022", month="May", day="2", volume="9", number="5", pages="e35048", keywords="engagement", keywords="digital health", keywords="digital mental health intervention", keywords="social cognitive theory", keywords="SCT", keywords="self-efficacy", keywords="outcome expectations", keywords="trauma", keywords="posttraumatic stress disorder", keywords="PTSD", abstract="Background: Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. Objective: The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. Methods: A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). Results: Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit ($\chi$22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90\% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90\% CI 0.040-0.064), indicating that engagement self-efficacy ($\beta$=.35; P<.001) and outcome expectations ($\beta$=.37; P<.001) were significant predictors of engagement (R2=39\%). The overall indirect effect between engagement and PTSD symptom reduction was significant ($\beta$=--.065; P<.001; 90\% CI --0.071 to --0.058). This relationship was serially mediated by both skill activation self-efficacy ($\beta$=.80; P<.001) and trauma coping self-efficacy ($\beta$=.40; P<.001), which predicted a reduction in PTSD symptoms ($\beta$=?.20; P=.02). Conclusions: The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies---skill activation and trauma coping---proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs. ", doi="10.2196/35048", url="https://mental.jmir.org/2022/5/e35048", url="http://www.ncbi.nlm.nih.gov/pubmed/35499857" } @Article{info:doi/10.2196/25249, author="Polhemus, Ashley and Novak, Jan and Majid, Shazmin and Simblett, Sara and Morris, Daniel and Bruce, Stuart and Burke, Patrick and Dockendorf, F. Marissa and Temesi, Gergely and Wykes, Til", title="Data Visualization for Chronic Neurological and Mental Health Condition Self-management: Systematic Review of User Perspectives", journal="JMIR Ment Health", year="2022", month="Apr", day="28", volume="9", number="4", pages="e25249", keywords="digital health", keywords="remote measurement technology", keywords="neurology", keywords="mental health", keywords="data visualization", keywords="user-centered design", abstract="Background: Remote measurement technologies (RMT) such as mobile health devices and apps are increasingly used by those living with chronic neurological and mental health conditions. RMT enables real-world data collection and regular feedback, providing users with insights about their own conditions. Data visualizations are an integral part of RMT, although little is known about visualization design preferences from the perspectives of those living with chronic conditions. Objective: The aim of this review was to explore the experiences and preferences of individuals with chronic neurological and mental health conditions on data visualizations derived from RMT to manage health. Methods: In this systematic review, we searched peer-reviewed literature and conference proceedings (PubMed, IEEE Xplore, EMBASE, Web of Science, Association for Computing Machinery Computer-Human Interface proceedings, and the Cochrane Library) for original papers published between January 2007 and September 2021 that reported perspectives on data visualization of people living with chronic neurological and mental health conditions. Two reviewers independently screened each abstract and full-text article, with disagreements resolved through discussion. Studies were critically appraised, and extracted data underwent thematic synthesis. Results: We identified 35 eligible publications from 31 studies representing 12 conditions. Coded data coalesced into 3 themes: desire for data visualization, impact of visualizations on condition management, and visualization design considerations. Data visualizations were viewed as an integral part of users' experiences with RMT, impacting satisfaction and engagement. However, user preferences were diverse and often conflicting both between and within conditions. Conclusions: When used effectively, data visualizations are valuable, engaging components of RMT. They can provide structure and insight, allowing individuals to manage their own health more effectively. However, visualizations are not ``one-size-fits-all,'' and it is important to engage with potential users during visualization design to understand when, how, and with whom the visualizations will be used to manage health. ", doi="10.2196/25249", url="https://mental.jmir.org/2022/4/e25249", url="http://www.ncbi.nlm.nih.gov/pubmed/35482368" } @Article{info:doi/10.2196/33080, author="Cloitre, Marylene and Amspoker, Bush Amber and Fletcher, L. Terri and Hogan, B. Julianna and Jackson, Christie and Jacobs, Adam and Shammet, Rayan and Speicher, Sarah and Wassef, Miryam and Lindsay, Jan", title="Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study", journal="JMIR Ment Health", year="2022", month="Apr", day="27", volume="9", number="4", pages="e33080", keywords="PTSD", keywords="depression", keywords="veterans", keywords="blended therapy", keywords="iCBT", keywords="web-based", keywords="webSTAIR", keywords="noninferiority", keywords="mental health", keywords="digital health", abstract="Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. ", doi="10.2196/33080", url="https://mental.jmir.org/2022/4/e33080", url="http://www.ncbi.nlm.nih.gov/pubmed/35475777" } @Article{info:doi/10.2196/34005, author="Egan, A. Luke and Mulcahy, Mary and Tuqiri, Karen and Gatt, M. Justine", title="A Web-Based Well-being Program for Health Care Workers (Thrive): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Apr", day="21", volume="11", number="4", pages="e34005", keywords="well-being", keywords="Composure, Own-worth, Mastery, Positivity, Achievement, and Satisfaction for Wellbeing", keywords="COMPAS-W", keywords="mental health", keywords="resilience", keywords="health care", keywords="hospital", keywords="brain", keywords="neuroscience", keywords="online", keywords="randomized controlled trial", keywords="RCT", abstract="Background: Mental health has come to be understood as not merely the absence of mental illness but also the presence of mental well-being, and recent interventions have sought to increase well-being in various populations. A population that deserves particular attention is that of health care workers, whose occupations entail high levels of stress, especially given the ongoing COVID-19 pandemic. A neuroscience-based web-based well-being program for health care workers---the Thrive program---has been newly developed to promote habits and activities that contribute to brain health and overall mental well-being. Objective: This paper describes the protocol for a randomized controlled trial whose objective is to evaluate the Thrive program in comparison with an active control condition to measure whether the program is effective at increasing well-being and decreasing symptoms of psychological distress in health care workers at a designated Australian hospital. Methods: The trial will comprise two groups (intervention vs active control) and 4 measurement occasions over a 12-week period. A survey will be administered in each of weeks 0, 4, 8, and 12, and the well-being program will be delivered in weeks 1-7 (via web-based video presentations or digital pamphlets). Each of the 4 surveys will comprise a range of questionnaires to measure well-being, psychological distress, and other key variables. The planned analyses will estimate group-by-time interaction effects to test the hypothesis that mental health will increase over time in the intervention condition relative to the active control condition. Results: The Thrive program was delivered to a small number of wards at the hospital between February 2021 and July 2021, and it will be delivered to the remaining wards from October 2021 to December 2021. A power calculation has recommended a sample size of at least 200 participants in total. A linear mixed model will be used to estimate the interaction effects. Conclusions: This trial seeks to evaluate a new web-based well-being program for health care workers at a major public hospital. It will contribute to the growing body of research on mental well-being and ways to promote it. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000027819; https://tinyurl.com/58wwjut9 International Registered Report Identifier (IRRID): DERR1-10.2196/34005 ", doi="10.2196/34005", url="https://www.researchprotocols.org/2022/4/e34005", url="http://www.ncbi.nlm.nih.gov/pubmed/35451973" } @Article{info:doi/10.2196/36094, author="Guemghar, Imane and Pires de Oliveira Padilha, Paula and Abdel-Baki, Amal and Jutras-Aswad, Didier and Paquette, Jesseca and Pomey, Marie-Pascale", title="Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review", journal="JMIR Ment Health", year="2022", month="Apr", day="19", volume="9", number="4", pages="e36094", keywords="social robots", keywords="socially assistive robots", keywords="SARs", keywords="mental health", keywords="mental health services", keywords="dementia", keywords="autism spectrum disorder", keywords="schizophrenia", keywords="depression", keywords="scoping review", abstract="Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O'Malley's framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. ", doi="10.2196/36094", url="https://mental.jmir.org/2022/4/e36094", url="http://www.ncbi.nlm.nih.gov/pubmed/35438639" } @Article{info:doi/10.2196/32492, author="Mueser, T. Kim and Achtyes, D. Eric and Gogate, Jagadish and Mancevski, Branislav and Kim, Edward and Starr, Lynn H.", title="Telehealth-Based Psychoeducation for Caregivers: The Family Intervention in Recent-Onset Schizophrenia Treatment Study", journal="JMIR Ment Health", year="2022", month="Apr", day="15", volume="9", number="4", pages="e32492", keywords="schizophrenia", keywords="family psychoeducation", keywords="caregiver burden", keywords="recent-onset schizophrenia", keywords="telehealth", abstract="Background: Schizophrenia is a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not been well explored, particularly for early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based psychoeducation for caregivers on either patient or caregiver outcomes. Objective: The Family Intervention in Recent-Onset Schizophrenia Treatment (FIRST) study is a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers, which is designed to evaluate the effect of telehealth-based, caregiver-focused, study-provided psychoeducation versus usual care (UC) on patient treatment failure (TF). The impact of study-provided psychoeducation on caregiver burden is also investigated. Methods: Eligible patients and their designated caregivers were randomly assigned to either the study-provided psychoeducation (?16 sessions of telehealth-based psychoeducation over 6 months) or UC group, stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). The major TF events (ie, psychiatric hospitalization or intervention, arrest or incarceration, and suicide attempts) were assessed at 3, 6, and 12 months after baseline. A proportional means model using mean cumulative function was used to assess between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was assessed using the Involvement Evaluation Questionnaire and 12-item Short Form Health Survey. Results: A total of 148 pairs of participants were enrolled in the study, of whom 96 (64.9\%) patients and 94 (63.5\%) caregivers completed the 12-month follow-up. The mean number of sessions in the study-provided psychoeducation group was 7.7 (SD 5.9). No differences were observed between the study-provided psychoeducation and UC groups in patient outcomes (rates of TF: 70\% vs 67\%; P=.90) or measures of caregiver burden (assessment of caregiver distress and physical and mental health). However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate than in those who received oral antipsychotics at all time points. Although the FIRST study did not meet the primary end point, several key lessons were identified to inform future caregiver-focused, telehealth-based FP interventions. Lack of study-provided psychoeducation, focus on caregiver-only intervention, difficulties with enrollment, and caregiver--treatment team coordination may have affected the outcomes of the FIRST study. Conclusions: Key insights from the FIRST study suggest the potential importance of supporting sufficient caregiver engagement; communication between clinicians, patients, and family members regarding treatment plans; and solidifying the relationship between clinicians providing psychoeducation to the caregiver and patient treatment team. Trial Registration: ClinicalTrials.gov NCT02600741; http://clinicaltrials.gov/ct2/show/NCT02600741 ", doi="10.2196/32492", url="https://mental.jmir.org/2022/4/e32492", url="http://www.ncbi.nlm.nih.gov/pubmed/35436231" } @Article{info:doi/10.2196/26438, author="Korpilahti-Leino, Tarja and Luntamo, Terhi and Ristkari, Terja and Hinkka-Yli-Salom{\"a}ki, Susanna and Pulkki-R{\aa}back, Laura and Waris, Otto and Matinolli, Hanna-Maria and Sinokki, Atte and Mori, Yuko and Fukaya, Mami and Yamada, Yuko and Sourander, Andre", title="Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study", journal="J Med Internet Res", year="2022", month="Apr", day="13", volume="24", number="4", pages="e26438", keywords="adolescent", keywords="anxiety", keywords="child", keywords="cognitive behavioral therapy", keywords="coping", keywords="COVID-19", keywords="Internet", keywords="mental health", keywords="parents", keywords="web-based", abstract="Background: The COVID-19 pandemic has had a major impact on families' daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children's anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let's Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6\%) completed the program's 7 themes, and 189 (31.4\%) completed the postintervention survey. Most (138/189, 73.0\%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6\%) and their children's anxiety (157/189, 83.1\%). The majority (157/189, 83.1\%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0\%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. ", doi="10.2196/26438", url="https://www.jmir.org/2022/4/e26438", url="http://www.ncbi.nlm.nih.gov/pubmed/35138265" } @Article{info:doi/10.2196/33473, author="Mullarkey, Michael and Dobias, Mallory and Sung, Jenna and Ahuvia, Isaac and Shumake, Jason and Beevers, Christopher and Schleider, Jessica", title="Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Apr", day="12", volume="9", number="4", pages="e33473", keywords="anxiety", keywords="COVID-19", keywords="single-session intervention", keywords="SSI", keywords="perceived control", keywords="intervention", keywords="mental health", keywords="control", keywords="online intervention", keywords="telemedicine", keywords="telehealth", keywords="scalable", abstract="Background: Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental health care. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. Objective: Our registered report evaluated a no-therapist, single-session, online intervention targeting perceived control over anxiety in the COVID-19 context against a placebo intervention encouraging handwashing. We tested whether the intervention could (1) decrease generalized anxiety and increase perceived control over anxiety and (2) achieve this without decreasing social-distancing intentions. Methods: We tested these questions using a between-subjects design in a weighted-probability sample of US adults recruited via a closed online platform (ie, Prolific). All outcomes were indexed via online self-report questionnaires. Results: Of 522 randomized individuals, 500 (95.8\%) completed the baseline survey and intervention. Intent-to-treat analyses using all randomized participants (N=522) found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d=--0.06 (95\% CI --0.27 to 0.15; P=.48), effects on perceived control were d=0.04 (95\% CI --0.08 to 0.16; P=.48), and effects on social-distancing intentions were d=--0.02 (95\% CI --0.23 to 0.19; P=.83). Conclusions: Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions, including the challenge of targeting perceived control over anxiety, are discussed. Trial Registration: ClinicalTrials.gov NCT04459455; https://clinicaltrials.gov/show/NCT04459455 ", doi="10.2196/33473", url="https://mental.jmir.org/2022/4/e33473", url="http://www.ncbi.nlm.nih.gov/pubmed/35230962" } @Article{info:doi/10.2196/32558, author="Mendes-Santos, Cristina and Nunes, Francisco and Weiderpass, Elisabete and Santana, Rui and Andersson, Gerhard", title="Understanding Mental Health Professionals' Perspectives and Practices Regarding the Implementation of Digital Mental Health: Qualitative Study", journal="JMIR Form Res", year="2022", month="Apr", day="12", volume="6", number="4", pages="e32558", keywords="barriers", keywords="digital mental health", keywords="drivers", keywords="implementation", keywords="internet interventions", keywords="psychotherapy", keywords="technology acceptance and adoption", keywords="mental health professionals", keywords="Portugal", keywords="European Union", keywords="EU", abstract="Background: Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices. Objective: This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices. Methods: A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)---psychologists and psychiatrists---was conducted. The transcribed interviews were thematically analyzed. Results: Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals' perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals. Conclusions: The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals. ", doi="10.2196/32558", url="https://formative.jmir.org/2022/4/e32558", url="http://www.ncbi.nlm.nih.gov/pubmed/35412459" } @Article{info:doi/10.2196/32157, author="Perdacher, Elke and Kavanagh, David and Sheffield, Jeanie and Healy, Karyn and Dale, Penny and Heffernan, Edward", title="Using the Stay Strong App for the Well-being of Indigenous Australian Prisoners: Feasibility Study", journal="JMIR Form Res", year="2022", month="Apr", day="8", volume="6", number="4", pages="e32157", keywords="First Nation", keywords="Indigenous", keywords="digital mental health", keywords="e-mental health", keywords="mental health", keywords="social and emotional well-being", keywords="SEWB", keywords="prisoner", keywords="prison", keywords="mobile phone", abstract="Background: The gap between mental health needs and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, is most marked in the prison population. Indigenous people are overrepresented in Australian prisons. In prison, this group experiences mental disorders to a greater degree than non-Indigenous prisoners. This group has also been found to experience mental disorder at a higher rate than Indigenous people in the community. In addition to pre-existing determinants of poor mental health, these high prevalence rates may reflect poor engagement in mainstream interventions or the efficacy of available interventions. In community populations, the use of digital mental health resources may help to increase access to well-being support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies of these tools needs to be addressed. Objective: The aim of this study is to determine the feasibility of the Stay Strong app as a digital well-being and mental health tool for use by Indigenous people in prison. Methods: Dual government agency (health and corrective services) precondition requirements of implementation were identified and resolved. This was essential given that the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Then, acceptability at a practice level was tested using postuse qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program. All Indigenous Mental Health Intervention Program practitioners (10/37, 27\%) and client participants who had completed their second follow-up (review of the Stay Strong app; 27/37, 73\%) during the study period were invited to participate. Results: Owing to the innovative nature of this project, identifying and resolving the precondition requirements of implementation was challenging but provided support for the implementation of the app in practice. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: satisfaction with the current Stay Strong app, supported client goal setting, increased client self-insight, improved client empowerment, cultural appropriateness, enhanced engagement, ease of use, problems with using an Android emulator, and recommendations to improve personalization. Conclusions: The Stay Strong Custody Project is a pioneering example of digital mental health tools being implemented within Australian prisons. Using the app within high-security prison settings was found to be feasible at both strategic and practice levels. Feedback from both clients and practitioners supported the use of the app as a culturally safe digital mental health and well-being tool for Aboriginal and Torres Strait Islander people in prison. ", doi="10.2196/32157", url="https://formative.jmir.org/2022/4/e32157", url="http://www.ncbi.nlm.nih.gov/pubmed/35394444" } @Article{info:doi/10.2196/29211, author="O'Sullivan, Shaunagh and Schmaal, Lianne and D'Alfonso, Simon and Toenders, Jo Yara and Valentine, Lee and McEnery, Carla and Bendall, Sarah and Nelson, Barnaby and Gleeson, F. John and Alvarez-Jimenez, Mario", title="Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis", journal="JMIR Ment Health", year="2022", month="Apr", day="7", volume="9", number="4", pages="e29211", keywords="digital intervention", keywords="digital health", keywords="youth mental health", keywords="psychotic disorders", keywords="clustering", keywords="usage metrics", keywords="log data", keywords="social networking", abstract="Background: Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in use makes it difficult to determine which components lead to improved treatment outcomes. Objective: This study aims to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention for first-episode psychosis that incorporates therapeutic content and social networking, along with clinical, vocational, and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective is to compare each user profile with young people receiving treatment as usual (TAU). Methods: Participants comprised 82 young people (aged 16-27 years) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. In addition, 6-month use data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression, and anxiety were assessed at baseline and 6-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes and between each user profile with TAU. Results: A total of 3 user profiles were identified based on the following system use metrics: low use, maintained use of social components, and maintained use of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F2,51=3.58; P=.04), negative symptoms (F2,51=4.45; P=.02), and overall psychiatric symptom severity (F2,50=3.23; P=.048) compared with the other user profiles. This group also showed improvements in social functioning (F1,62=4.68; P=.03), negative symptoms (F1,62=14.61; P<.001), and overall psychiatric symptom severity (F1,63=5.66; P=.02) compared with the TAU group. Conversely, the maintained social group showed increases in anxiety compared with the TAU group (F1,57=7.65; P=.008). No differences were found between the low use group and the TAU group on treatment outcomes. Conclusions: Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social use and low use outcomes were broadly comparable with TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits. ", doi="10.2196/29211", url="https://mental.jmir.org/2022/4/e29211", url="http://www.ncbi.nlm.nih.gov/pubmed/35389351" } @Article{info:doi/10.2196/36217, author="Jaworski, K. Beth and Taylor, Katherine and Ramsey, M. Kelly and Heinz, J. Adrienne and Steinmetz, Sarah and Owen, E. Jason and Tsai, Jack and Pietrzak, H. Robert", title="Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel", journal="JMIR Ment Health", year="2022", month="Apr", day="5", volume="9", number="4", pages="e36217", keywords="COVID-19", keywords="coronavirus", keywords="mobile app", keywords="mHealth", keywords="digital health", keywords="mental health", keywords="public mental health", keywords="stress", keywords="coping", keywords="older adults", keywords="veterans", abstract="Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective: The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2\% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3\% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results: We found that most US veterans (81.5\%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3\% of eligible participants, n=34), 50\% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions: The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan. ", doi="10.2196/36217", url="https://mental.jmir.org/2022/4/e36217", url="http://www.ncbi.nlm.nih.gov/pubmed/35245204" } @Article{info:doi/10.2196/34283, author="Graziani, Grant and Kunkle, Sarah and Shih, Emily", title="Resilience in 2021---Descriptive Analysis of Individuals Accessing Virtual Mental Health Services: Retrospective Observational Study", journal="JMIR Form Res", year="2022", month="Mar", day="31", volume="6", number="3", pages="e34283", keywords="mental health", keywords="resilience", keywords="adaptability", keywords="measures", keywords="digital health", keywords="virtual health", keywords="psychiatry", keywords="demographic", keywords="depression", keywords="anxiety", keywords="symptom", keywords="support", keywords="treatment", abstract="Background: Psychological resilience has been extensively studied by developmental researchers, and there is a growing body of literature regarding its role in psychiatry and psychopathology research and practice. This study contributes to this growing literature by providing real-world evidence on the relationship between resilience and clinical symptoms among a large sample of employed Americans. Objective: This study aimed to describe resilience levels in individuals accessing Ginger, a virtual mental health system, in addition to the association of resilience with demographic characteristics, baseline depression, and anxiety symptoms. Methods: We conducted a retrospective observational study of 9165 members who signed up for Ginger and completed a baseline survey between January 1 and August 5, 2021. We used multivariate regression models to test for associations between baseline resilience and other member characteristics. Results: Baseline resilience scores centered on a mean of 23.84 (SD 6.56) and median of 24 (IQR 8) out of 40, with 81.0\% (7424/9165) of the sample having low resilience at baseline. Despite having relatively higher resilience scores, members with no or mild depression or anxiety still had low resilience scores on average. Self-reported suicidal ideation was associated with lower resilience. Conclusions: Overall, members had low baseline resilience, similar to resilience levels observed in trauma survivors in prior studies. Younger members and those with higher levels of depression and anxiety at intake reported lower levels of resilience at baseline. Notably, members with no or mild depression or anxiety still had low resilience scores on average, suggesting a need for mental health support among individuals who might not typically be recommended for treatment based on traditional clinical assessments, such as the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder scale (GAD-7). Two suggestions for topics of future research are to develop treatment recommendations based on the Connor-Davidson Resilience Scale and to understand the interaction between resilience levels and symptom-based outcome measures, such as the PHQ-9 and the GAD-7. ", doi="10.2196/34283", url="https://formative.jmir.org/2022/3/e34283", url="http://www.ncbi.nlm.nih.gov/pubmed/35357309" } @Article{info:doi/10.2196/30754, author="Hanano, Maria and Rith-Najarian, Leslie and Boyd, Meredith and Chavira, Denise", title="Measuring Adherence Within a Self-Guided Online Intervention for Depression and Anxiety: Secondary Analyses of a Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Mar", day="28", volume="9", number="3", pages="e30754", keywords="self-guided", keywords="adherence", keywords="depression", keywords="anxiety", keywords="online intervention", abstract="Background: Self-guided online interventions offer users the ability to participate in an intervention at their own pace and address some traditional service barriers (eg, attending in-person appointments, cost). However, these interventions suffer from high dropout rates, and current literature provides little guidance for defining and measuring online intervention adherence as it relates to clinical outcomes. Objective: This study aims to develop and test multiple measures of adherence to a specific self-guided online intervention, as guided by best practices from the literature. Methods: We conducted secondary analyses on data from a randomized controlled trial of an 8-week online cognitive behavioral program that targets depression and anxiety in college students. We defined multiple behavioral and attitudinal adherence measures at varying levels of effort (ie, low, moderate, and high). Linear regressions were run with adherence terms predicting improvement in the primary outcome measure, the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Results: Of the 947 participants, 747 initiated any activity and 449 provided posttest data. Results from the intent-to-treat sample indicated that high level of effort for behavioral adherence significantly predicted symptom change (F4,746=17.18, P<.001; and $\beta$=--.26, P=.04). Moderate level of effort for attitudinal adherence also significantly predicted symptom change (F4,746=17.25, P<.001; and $\beta$=--.36, P=.03). Results differed in the initiators-only sample, such that none of the adherence measures significantly predicted symptom change (P=.09-.27). Conclusions: Our findings highlight the differential results of dose-response models testing adherence measures in predicting clinical outcomes. We summarize recommendations that might provide helpful guidance to future researchers and intervention developers aiming to investigate online intervention adherence. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/ct2/show/NCT04361045 ", doi="10.2196/30754", url="https://mental.jmir.org/2022/3/e30754", url="http://www.ncbi.nlm.nih.gov/pubmed/35343901" } @Article{info:doi/10.2196/29384, author="Ritola, Ville and Lipsanen, Olavi Jari and Pihlaja, Satu and Gummerus, Eero-Matti and Stenberg, Jan-Henry and Saarni, Suoma and Joffe, Grigori", title="Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study", journal="J Med Internet Res", year="2022", month="Mar", day="24", volume="24", number="3", pages="e29384", keywords="CBT", keywords="iCBT", keywords="cognitive behavioral therapy", keywords="routine care", keywords="generalized anxiety disorder", keywords="internet", keywords="web-based", keywords="digital health", keywords="mental health", abstract="Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1\%) of 12 sessions, and 44.1\% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95\% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95\% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95\% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95\% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7--measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ?10, approximately 421 (47.1\%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital--iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients. ", doi="10.2196/29384", url="https://www.jmir.org/2022/3/e29384", url="http://www.ncbi.nlm.nih.gov/pubmed/35323119" } @Article{info:doi/10.2196/29114, author="Tatham, Iona and Clarke, Ellisiv and Grieve, Ann Kelly and Kaushal, Pulkit and Smeddinck, Jan and Millar, Barron Evelyn and Sharma, Narain Aditya", title="Process and Outcome Evaluations of Smartphone Apps for Bipolar Disorder: Scoping Review", journal="J Med Internet Res", year="2022", month="Mar", day="23", volume="24", number="3", pages="e29114", keywords="child and adolescent mental health", keywords="scoping review", keywords="bipolar disorder", keywords="mental health", abstract="Background: Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated. Objective: This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies. Methods: A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD. Results: Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD. Conclusions: Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD. ", doi="10.2196/29114", url="https://www.jmir.org/2022/3/e29114", url="http://www.ncbi.nlm.nih.gov/pubmed/35319470" } @Article{info:doi/10.2196/33092, author="Ainslie, Marcy and Brunette, F. Mary and Capozzoli, Michelle", title="Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis", journal="JMIR Ment Health", year="2022", month="Mar", day="21", volume="9", number="3", pages="e33092", keywords="telemedicine", keywords="mental health", keywords="serious mental illness", keywords="retention", keywords="mental illness", keywords="telehealth", abstract="Background: Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. Objective: We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. Methods: We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25\%), medium (25\%-75\%), or high (>75\%) use. Results: A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9\% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95\% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95\% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95\% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95\% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95\% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. Conclusions: The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness. ", doi="10.2196/33092", url="https://mental.jmir.org/2022/3/e33092", url="http://www.ncbi.nlm.nih.gov/pubmed/35311673" } @Article{info:doi/10.2196/31727, author="Mamdouh, Mostafa and Tai, Yeung Andy Man and Westenberg, Nicolas Jean and Shams, Farhud and Jang, Kerry and Badawy, Adel and Elsawi, Houssam and Krausz, Michael", title="Egyptian Students Open to Digital Mental Health Care: Cross-Sectional Survey", journal="JMIR Form Res", year="2022", month="Mar", day="21", volume="6", number="3", pages="e31727", keywords="students", keywords="youth", keywords="eMental health", keywords="Arab countries", keywords="mental health care", keywords="eHealth solutions", keywords="youth mental health", keywords="mental health", keywords="youth engagement", keywords="young adults", keywords="EMH", keywords="therapy", keywords="emotional support", keywords="barriers", keywords="mobile phone", abstract="Background: In Egypt, the shortage of mental health services, particularly for adolescents and young adults, is apparent. Electronic mental health (EMH) has been proposed as a solution to bridge the gap and better address the needs of young people. However, EMH is new to Egypt and its acceptability among target populations is crucial to its implementation and success. Objective: The objective of this study is to explore the interest of Egyptian youth in EMH, identify perceived barriers to EMH, and inform the design of EMH tools to best address the needs of youth. Methods: A web-based cross-sectional survey was distributed among medical students at Tanta University in Egypt. Chi-square and one-way analysis of variance tests were performed for inferential analyses using a significance level of .05. Results: Of the 707 individuals who completed the survey (90.9\% response rate), 60.5\% (428) were female, 62\% (438) lived in urban and suburban areas, and the mean age of the sample was 20.5 (SD 1.8) years. The vast majority of participants (522/707, 73.8\%) had already used the internet to find information about mental health problems, but the information was unsatisfactory for about half of them (386/707, 54.6\%). Almost all students reported that they would prefer web-based therapy if EMH were available through a trustworthy national web-based platform for youth mental health (601/707, 85\%). Students believed that emotional difficulties, social support, and coping strategies were the main topics that EMH should help with. The most common perceived barriers for EMH use in Egypt were concerns about privacy (382/707, 54\%) and a lack of technology literacy and unfamiliarity with EMH (352/707, 50\%). Conclusions: EMH is a promising strategy for addressing gaps in the mental health care for young people. To construct and implement a digital system of care that addresses the unique needs and preferences of youth, adolescents and young adults should be involved in the co-development and design. ", doi="10.2196/31727", url="https://formative.jmir.org/2022/3/e31727", url="http://www.ncbi.nlm.nih.gov/pubmed/35311692" } @Article{info:doi/10.2196/30966, author="Cederberg, Matilda and Als{\'e}n, Sara and Ali, Lilas and Ekman, Inger and Glise, Kristina and Jonsdottir, H. Ingibj{\"o}rg and Gyllensten, Hanna and Swedberg, Karl and Fors, Andreas", title="Effects of a Person-Centered eHealth Intervention for Patients on Sick Leave Due to Common Mental Disorders (PROMISE Study): Open Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Mar", day="15", volume="9", number="3", pages="e30966", keywords="depression", keywords="anxiety", keywords="stress", keywords="patient-centered care", keywords="person-centered care", keywords="telehealth", keywords="mHealth", keywords="sickness absence", keywords="intervention", keywords="randomized controlled trial", keywords="mobile phone", abstract="Background: Sick leave due to common mental disorders (CMDs) is a public health problem in several countries, including Sweden. Given that symptom relief does not necessarily correspond to return to work, health care interventions focusing on factors that have proven important to influence the return to work process, such as self-efficacy, are warranted. Self-efficacy is also a central concept in person-centered care. Objective: The aim of this study is to evaluate the effects of a person-centered eHealth intervention for patients on sick leave due to CMDs. Methods: A randomized controlled trial of 209 patients allocated to either a control group (107/209, 51.2\%) or an intervention group (102/209, 48.8\%) was conducted. The control group received usual care, whereas the intervention group received usual care with the addition of a person-centered eHealth intervention. The intervention was built on person-centered care principles and consisted of telephone support and a web-based platform. The primary outcome was a composite score of changes in general self-efficacy (GSE) and level of sick leave at the 6-month follow-up. An intention-to-treat analysis included all participants, and a per-protocol analysis consisted of those using both the telephone support and the web-based platform. Results: At the 3-month follow-up, in the intention-to-treat analysis, more patients in the intervention group improved on the composite score than those in the control group (20/102, 19.6\%, vs 10/107, 9.3\%; odds ratio [OR] 2.37, 95\% CI 1.05-5.34; P=.04). At the 6-month follow-up, the difference was no longer significant between the groups (31/100, 31\%, vs 25/107, 23.4\%; OR 1.47, 95\% CI 0.80-2.73; P=.22). In the per-protocol analysis, a significant difference was observed between the intervention and control groups at the 3-month follow-up (18/85, 21.2\%, vs 10/107, 9.3\%; OR 2.6, 95\% CI 1.13-6.00; P=.02) but not at 6 months (30/84, 35.7\%, vs 25/107, 23.4\%; OR 1.8, 95\% CI 0.97-3.43; P=.06). Changes in GSE drove the effects in the composite score, but the intervention did not affect the level of sick leave. Conclusions: A person-centered eHealth intervention for patients on sick leave due to CMDs improved GSE but did not affect the level of sick leave. Trial Registration: ClinicalTrials.gov NCT03404583; https://clinicaltrials.gov/ct2/show/NCT03404583 ", doi="10.2196/30966", url="https://mental.jmir.org/2022/3/e30966", url="http://www.ncbi.nlm.nih.gov/pubmed/35289756" } @Article{info:doi/10.2196/31106, author="Cheah, Wen-Ting and Hwang, Jwu-Jia and Hong, Sheng-Yi and Fu, Li-Chen and Chang, Yu-Ling and Chen, Ta-Fu and Chen, I-An and Chou, Chun-Chen", title="A Digital Screening System for Alzheimer Disease Based on a Neuropsychological Test and a Convolutional Neural Network: System Development and Validation", journal="JMIR Med Inform", year="2022", month="Mar", day="9", volume="10", number="3", pages="e31106", keywords="Alzheimer disease", keywords="mild cognitive impairment", keywords="screening system", keywords="convolutional neural network", keywords="Rey-Osterrieth Complex Figure", abstract="Background: Alzheimer disease (AD) and other types of dementia are now considered one of the world's most pressing health problems for aging people worldwide. It was the seventh-leading cause of death, globally, in 2019. With a growing number of patients with dementia and increasing costs for treatment and care, early detection of the disease at the stage of mild cognitive impairment (MCI) will prevent the rapid progression of dementia. In addition to reducing the physical and psychological stress of patients' caregivers in the long term, it will also improve the everyday quality of life of patients. Objective: The aim of this study was to design a digital screening system to discriminate between patients with MCI and AD and healthy controls (HCs), based on the Rey-Osterrieth Complex Figure (ROCF) neuropsychological test. Methods: The study took place at National Taiwan University between 2018 and 2019. In order to develop the system, pretraining was performed using, and features were extracted from, an open sketch data set using a data-driven deep learning approach through a convolutional neural network. Later, the learned features were transferred to our collected data set to further train the classifier. The first data set was collected using pen and paper for the traditional method. The second data set used a tablet and smart pen for data collection. The system's performance was then evaluated using the data sets. Results: The performance of the designed system when using the data set that was collected using the traditional pen and paper method resulted in a mean area under the receiver operating characteristic curve (AUROC) of 0.913 (SD 0.004) when distinguishing between patients with MCI and HCs. On the other hand, when discriminating between patients with AD and HCs, the mean AUROC was 0.950 (SD 0.003) when using the data set that was collected using the digitalized method. Conclusions: The automatic ROCF test scoring system that we designed showed satisfying results for differentiating between patients with AD and MCI and HCs. Comparatively, our proposed network architecture provided better performance than our previous work, which did not include data augmentation and dropout techniques. In addition, it also performed better than other existing network architectures, such as AlexNet and Sketch-a-Net, with transfer learning techniques. The proposed system can be incorporated with other tests to assist clinicians in the early diagnosis of AD and to reduce the physical and mental burden on patients' family and friends. ", doi="10.2196/31106", url="https://medinform.jmir.org/2022/3/e31106", url="http://www.ncbi.nlm.nih.gov/pubmed/35262497" } @Article{info:doi/10.2196/33060, author="LaMonica, M. Haley and Iorfino, Frank and Lee, Yeeun Grace and Piper, Sarah and Occhipinti, Jo-An and Davenport, A. Tracey and Cross, Shane and Milton, Alyssa and Ospina-Pinillos, Laura and Whittle, Lisa and Rowe, C. Shelley and Dowling, Mitchell and Stewart, Elizabeth and Ottavio, Antonia and Hockey, Samuel and Cheng, Sze Vanessa Wan and Burns, Jane and Scott, M. Elizabeth and Hickie, B. Ian", title="Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy", journal="JMIR Ment Health", year="2022", month="Mar", day="9", volume="9", number="3", pages="e33060", keywords="mental health", keywords="technology", keywords="co-design", keywords="participatory research", keywords="health care reform", keywords="stakeholder participation", keywords="mobile phone", abstract="Background: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users' needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. Objective: Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. Methods: Participating health care organizations included the following: Open Arms--Veterans \& Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation's National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. Results: Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. Conclusions: Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care. ", doi="10.2196/33060", url="https://mental.jmir.org/2022/3/e33060", url="http://www.ncbi.nlm.nih.gov/pubmed/34974414" } @Article{info:doi/10.2196/34601, author="Coleshill, James Matthew and Baldwin, Peter and Black, Melissa and Newby, Jill and Shrestha, Tanya and Haffar, Sam and Mills, Llewellyn and Stensel, Andrew and Cockayne, Nicole and Tennant, Jon and Harvey, Samuel and Christensen, Helen", title="The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19", journal="JMIR Res Protoc", year="2022", month="Mar", day="9", volume="11", number="3", pages="e34601", keywords="blended care", keywords="mental health", keywords="burnout", keywords="health care workers", keywords="COVID-19", keywords="health care service", keywords="health service", abstract="Background: The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement. Objective: The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN. Methods: The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy. Results: The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected. Conclusions: TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/34601 ", doi="10.2196/34601", url="https://www.researchprotocols.org/2022/3/e34601", url="http://www.ncbi.nlm.nih.gov/pubmed/35148269" } @Article{info:doi/10.2196/29250, author="Schriger, H. Simone and Klein, R. Melanie and Last, S. Briana and Fernandez-Marcote, Sara and Dallard, Natalie and Jones, Bryanna and Beidas, S. Rinad", title="Community Mental Health Clinicians' Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2022", month="Mar", day="3", volume="5", number="1", pages="e29250", keywords="telehealth", keywords="COVID-19", keywords="evidence-based practice", keywords="community mental health", keywords="trauma-focused cognitive behavioral therapy", keywords="implementation science", keywords="youth mental health", abstract="Background: In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians' experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective: We examined community mental health clinicians' perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods: We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists' responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results: Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions: First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services. ", doi="10.2196/29250", url="https://pediatrics.jmir.org/2022/1/e29250", url="http://www.ncbi.nlm.nih.gov/pubmed/35023839" } @Article{info:doi/10.2196/25238, author="Zheng, Fuhao and Wang, Ling and Zeng, Zhaonan and Wu, Siying", title="International Technologies on Prevention and Treatment of Neurological and Psychiatric Diseases: Bibliometric Analysis of Patents", journal="JMIR Ment Health", year="2022", month="Feb", day="22", volume="9", number="2", pages="e25238", keywords="neurological diseases", keywords="psychiatric diseases", keywords="patent", keywords="bibliometric analysis", keywords="prevention", keywords="treatment", abstract="Background: Neurological and psychiatric disorders are serious and expensive global public health problems. Therefore, exploring effective intervention technologies plays an important role in improving patients' clinical symptoms and social functions, as well as reducing medical burden. Objective: The aim of this study is to analyze and summarize the key new technologies and innovative development trends witnessed globally for neurological illness and psychiatric disorders by mining the relevant patent data. Methods: A bibliometric analysis was conducted on patent applications, priority countries, main patentees, hot technologies, and other patent information on neurological and psychiatric disorders, revealing the current situation along with the trend of technology development in this field. Results: In recent years, inventions and innovations related to neurological and psychiatric diseases have become very active, with China being the largest patent priority country. Of the top patent holders, Visicu (headquartered in the United States) is the leader. The distribution of patent holders in China remains relatively scattered, with no monopoly organization at present. Global technologies on neurological illness and psychiatric disorders are mainly concentrated around A61B (diagnosis, surgery, and identification). Conclusions: This paper analyzed and summarized the key new technologies and global innovative development trends of neurological and psychiatric diseases by mining the relevant patent data, and provides practical references and research perspectives for the prevention and treatment of the aforesaid diseases. ", doi="10.2196/25238", url="https://mental.jmir.org/2022/2/e25238", url="http://www.ncbi.nlm.nih.gov/pubmed/35191849" } @Article{info:doi/10.2196/28502, author="Schroeder, H. Alexandra and Bogie, M. Bryce J. and Rahman, T. Tabassum and Th{\'e}rond, Alexandra and Matheson, Hannah and Guimond, Synthia", title="Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review", journal="JMIR Ment Health", year="2022", month="Feb", day="18", volume="9", number="2", pages="e28502", keywords="auditory verbal hallucinations", keywords="cognitive remediation", keywords="functional outcomes", keywords="neurocognition", keywords="paranoia", keywords="psychosis", keywords="schizophrenia", keywords="social skills", keywords="virtual reality (VR)", keywords="vocational skills", abstract="Background: Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear. Objective: This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research. Methods: This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study. Results: A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22\%) studies used a cognitive remediation intervention, 4 (22\%) studies used a social skills intervention, 3 (17\%) studies used a vocational skills intervention, and 7 (39\%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance. Conclusions: VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life. ", doi="10.2196/28502", url="https://mental.jmir.org/2022/2/e28502", url="http://www.ncbi.nlm.nih.gov/pubmed/35179501" } @Article{info:doi/10.2196/28233, author="Lynham, Joanne Amy and Jones, R. Ian and Walters, R. James T.", title="Web-Based Cognitive Testing in Psychiatric Research: Validation and Usability Study", journal="J Med Internet Res", year="2022", month="Feb", day="10", volume="24", number="2", pages="e28233", keywords="cognition", keywords="mental health", keywords="online", keywords="digital", keywords="assessment", keywords="validation", keywords="memory", keywords="attention", keywords="mobile phone", abstract="Background: Cognitive impairments are features of many psychiatric disorders and affect functioning. A barrier to cognitive research on psychiatric disorders is the lack of large cross-disorder data sets. However, the collection of cognitive data can be logistically challenging and expensive. Web-based collection may be an alternative; however, little is known about who does and does not complete web-based cognitive assessments for psychiatric research. Objective: The aims of this study are to develop a web-based cognitive battery for use in psychiatric research, validate the battery against the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, and compare the characteristics of the participants who chose to take part with those of the individuals who did not participate. Methods: Tasks were developed by The Many Brains Project and selected to measure the domains specified by the MATRICS initiative. We undertook a cross-validation study of 65 participants with schizophrenia, bipolar disorder, depression, or no history of psychiatric disorders to compare the web-based tasks with the MATRICS Consensus Cognitive Battery. Following validation, we invited participants from 2 large ongoing genetic studies, which recruited participants with psychiatric disorders to complete the battery and evaluated the demographic and clinical characteristics of those who took part. Results: Correlations between web-based and MATRICS tasks ranged between 0.26 and 0.73. Of the 961 participants, 887 (92.3\%) completed at least one web-based task, and 644 (67\%) completed all tasks, indicating adequate completion rates. Predictors of web-based participation included being female (odds ratio [OR] 1.3, 95\% CI 1.07-1.58), ethnicity other than White European (OR 0.66, 95\% CI 0.46-0.96), higher levels of education (OR 1.19, 95\% CI 1.11-1.29), diagnosis of an eating disorder (OR 2.17, 95\% CI 1.17-4) or depression and anxiety (OR 5.12, 95\% CI 3.38-7.83), and absence of a diagnosis of schizophrenia (OR 0.59, 95\% CI 0.35-0.94). Lower performance on the battery was associated with poorer functioning (B=?1.76, SE 0.26; P<.001). Conclusions: Our findings offer valuable insights into the advantages and disadvantages of testing cognitive function remotely for mental health research. ", doi="10.2196/28233", url="https://www.jmir.org/2022/2/e28233", url="http://www.ncbi.nlm.nih.gov/pubmed/35142640" } @Article{info:doi/10.2196/31146, author="Shen, X. Francis and Silverman, C. Benjamin and Monette, Patrick and Kimble, Sara and Rauch, L. Scott and Baker, T. Justin", title="An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint", journal="J Med Internet Res", year="2022", month="Feb", day="9", volume="24", number="2", pages="e31146", keywords="digital phenotyping", keywords="computataional psychiatry", keywords="ethics", keywords="law", keywords="privacy", keywords="informed consent", abstract="Background: Psychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data---on location, movement, email and text communications, and social media---with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI). Objective: The goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols. Methods: We explored the ELSI of digital health research in psychiatry, with a particular focus on what we label ``deep phenotyping'' psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue. Results: Consistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (``the Ethics Checklist''). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report. Conclusions: Deep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey. ", doi="10.2196/31146", url="https://www.jmir.org/2022/2/e31146", url="http://www.ncbi.nlm.nih.gov/pubmed/35138261" } @Article{info:doi/10.2196/31018, author="Skaczkowski, Gemma and van der Kruk, Shannen and Loxton, Sophie and Hughes-Barton, Donna and Howell, Cate and Turnbull, Deborah and Jensen, Neil and Smout, Matthew and Gunn, Kate", title="Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review", journal="JMIR Ment Health", year="2022", month="Feb", day="8", volume="9", number="2", pages="e31018", keywords="web-based interventions", keywords="depression", keywords="anxiety", keywords="suicide", keywords="well-being", keywords="mental health", keywords="technology", keywords="access to health care", abstract="Background: A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. Objective: This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. Results: Overall, 52 eligible programs were identified, of which 9 (17\%) addressed depression, 15 (29\%) addressed anxiety, 13 (25\%) addressed general mental well-being, and 13 (25\%) addressed multiple issues. Only 4\% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11\% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44\% to 100\%, with a total average score of 85\%. Conclusions: There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist. ", doi="10.2196/31018", url="https://mental.jmir.org/2022/2/e31018", url="http://www.ncbi.nlm.nih.gov/pubmed/35133281" } @Article{info:doi/10.2196/27675, author="Drissi, Nidal and Ouhbi, Sofia and Amiri, Leena and Al Mugaddam, Fadwa and Jan, K. Reem and Isomursu, Minna", title="A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study", journal="JMIR Form Res", year="2022", month="Feb", day="7", volume="6", number="2", pages="e27675", keywords="mental health", keywords="digital health", keywords="eHealth", keywords="connected health", keywords="mHealth", keywords="perceptions", keywords="attitudes", keywords="framework", keywords="design", keywords="UAE", keywords="mental health care professionals", keywords="Arab culture", abstract="Background: Connected mental health (CMH) is a field presenting information and communications technology--based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people's attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption. Objective: The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature. Methods: A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework. Results: On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users' health and data safety considerations, including users' suitability testing, confidentiality, and ensuring MHP integrity. Conclusions: CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects. ", doi="10.2196/27675", url="https://formative.jmir.org/2022/2/e27675", url="http://www.ncbi.nlm.nih.gov/pubmed/35129458" } @Article{info:doi/10.2196/32988, author="Freebairn, Louise and Occhipinti, Jo-An and Song, C. Yun Ju and Skinner, Adam and Lawson, Kenny and Lee, Yeeun Grace and Hockey, J. Samuel and Huntley, Samantha and Hickie, B. Ian", title="Participatory Methods for Systems Modeling of Youth Mental Health: Implementation Protocol", journal="JMIR Res Protoc", year="2022", month="Feb", day="7", volume="11", number="2", pages="e32988", keywords="participatory system modeling", keywords="youth mental health", keywords="co-design", keywords="public health systems research", keywords="mental health services", abstract="Background: Despite significant investment, mental health issues remain a leading cause of death among young people globally. Sophisticated decision analysis methods are needed to better understand the dynamic and multisector drivers of youth mental health. System modeling can help explore complex issues such as youth mental health and inform strategies to effectively respond to local needs and achieve lasting improvements. The advantages of engaging stakeholders in model development processes have long been recognized; however, the methods for doing so are often not well-described. Objective: This paper aims to describe the participatory procedures that will be used to support systems modeling for national multisite implementation. The Right Care, First Time, Where You Live research program will focus on regional youth mental health applications of systems modeling in 8 different sites across Australia. Methods: The participatory model development approach involves an iterative process of engaging with a range of participants, including people with lived experience of mental health issues. Their knowledge of the local systems, pathways, and drivers is combined with the academic literature and data to populate the models and validate their structure. The process centers around 3 workshops where participants interact and actively engage in group model-building activities to define, refine, and validate the systems models. This paper provides a detailed blueprint for the implementation of this process for mental health applications. Results: The participatory modeling methods described in this paper will be implemented at 2 sites per year from 2022 to 2025. The 8 selected sites have been chosen to capture variations in important factors, including determinants of mental health issues and access to services. Site engagement commenced in August 2021, and the first modeling workshops are scheduled to commence in February 2022. Conclusions: Mental health system decision makers require tools to help navigate complex environments and leverage interdisciplinary problem-solving. Systems modeling can mobilize data from diverse sources to explore a range of scenarios, including the impact of interventions in different combinations and contexts. Involving stakeholders in the model development process ensures that the model findings are context-relevant and fit-for-purpose to inform decision-making. International Registered Report Identifier (IRRID): PRR1-10.2196/32988 ", doi="10.2196/32988", url="https://www.researchprotocols.org/2022/2/e32988", url="http://www.ncbi.nlm.nih.gov/pubmed/35129446" } @Article{info:doi/10.2196/23965, author="Althumiri, A. Nora and Basyouni, H. Mada and BinDhim, F. Nasser", title="Consistency and Sensitivity Evaluation of the Saudi Arabia Mental Health Surveillance System (MHSS): Hypothesis Generation and Testing", journal="JMIR Form Res", year="2022", month="Feb", day="3", volume="6", number="2", pages="e23965", keywords="mental health", keywords="evaluation", keywords="screening", keywords="surveillance", keywords="data quality", keywords="surveillance system quality", keywords="surveillance system evaluation", abstract="Background: Public health surveillance systems should be evaluated periodically, and the evaluation should include recommendations for improving the system's quality and efficiency. Each surveillance system may have a unique situation in which evaluating its quality depends on its methodology, aims, and other factors, such as the frequency of repeating the survey in the case of survey-based surveillance. Objective: As the consistency of the surveillance system to capture demographic data and its sensitivity to monitor the intended health-related event are important indicators of the quality of the surveillance system, the aim of this article is to evaluate the Saudi Arabia Mental Health Surveillance System (MHSS) in terms of consistency and sensitivity via the scientific hypothesis testing process. Methods: The quality of the MHSS was assessed by examining (1) the consistency of the main demographic variables and (2) the sensitivity to changes in score between the 2 mental health screening tools used in the MHSS and between the 3 waves collected in 3 consecutive months. The assessment uses all data collected via the MHSS between May 2020 and July 2020. The first null hypothesis predicted there were differences between the distributions of the demographic variables between the 3 waves. The second predicted there were no differences between the scores of the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7) between the 3 waves. Results: In terms of sampling variables (age, gender, and region), there were no significant differences between the 3 waves in age, using one-way ANOVA, nor in gender and region, using the chi-square test. In addition, there were no significant differences between the 3 waves in all other demographic variables, except in the income variable. However, in terms of the PHQ-9 score, the one-way ANOVA (F2,12334=8.05; P<.001) showed significant differences between waves. Similarly, significant differences between waves were found in the GAD-7 score (F2,12334=7.09; P=.001). Conclusions: The MHSS showed a consistent distribution of the sample demographic variables, while being sensitive to the changes in mental health scores across waves. The MHSS can generate an acceptable level of consistency and sensitivity to monitor mental health trends. International Registered Report Identifier (IRRID): RR2-10.2196/23748 ", doi="10.2196/23965", url="https://formative.jmir.org/2022/2/e23965", url="http://www.ncbi.nlm.nih.gov/pubmed/35113027" } @Article{info:doi/10.2196/32368, author="Vlake, H. Johan and van Bommel, Jasper and Wils, Evert-Jan and Bienvenu, Joe and Hellemons, E. Merel and Korevaar, IM Tim and Schut, FC Anna and Labout, AM Joost and Schreuder, LH Lois and van Bavel, P. Marten and Gommers, Diederik and van Genderen, E. Michel", title="Intensive Care Unit--Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Jan", day="31", volume="24", number="1", pages="e32368", keywords="SARS-CoV-2", keywords="intensive care", keywords="post-intensive care syndrome", keywords="virtual reality", keywords="quality of life", keywords="satisfaction", keywords="COVID-19", abstract="Background: Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective: This study aimed to explore the effects of ICU-VR on mental health and on patients' perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods: This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results: Eighty-nine patients (median age 58 years; 63 males, 70\%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=--2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=--3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81\% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions: ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR's widespread availability and application during follow-up. Trial Registration: Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05271-z ", doi="10.2196/32368", url="https://www.jmir.org/2022/1/e32368", url="http://www.ncbi.nlm.nih.gov/pubmed/34978530" } @Article{info:doi/10.2196/32832, author="Hennemann, Severin and Kuhn, Sebastian and Witth{\"o}ft, Michael and Jungmann, M. Stefanie", title="Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients", journal="JMIR Ment Health", year="2022", month="Jan", day="31", volume="9", number="1", pages="e32832", keywords="mHealth", keywords="symptom checker", keywords="diagnostics", keywords="mental disorders", keywords="psychotherapy", keywords="mobile phone", abstract="Background: Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. Objective: This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists' diagnoses based on structured clinical interviews. Methods: Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada--check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. Results: A total of 49 patients (30/49, 61\% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA's first condition suggestion in 51\% (25/49; 95\% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69\% (34/49; 95\% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA's first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71\% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. Conclusions: Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments. ", doi="10.2196/32832", url="https://mental.jmir.org/2022/1/e32832", url="http://www.ncbi.nlm.nih.gov/pubmed/35099395" } @Article{info:doi/10.2196/26049, author="Buck, Benjamin and Nguyen, Janelle and Porter, Shelan and Ben-Zeev, Dror and Reger, M. Greg", title="FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study", journal="JMIR Ment Health", year="2022", month="Jan", day="28", volume="9", number="1", pages="e26049", keywords="mHealth", keywords="veterans", keywords="schizophrenia", keywords="serious mental illness", keywords="mobile phone", abstract="Background: Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). Objective: This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. Methods: A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. Results: Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94\%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. Conclusions: The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population. ", doi="10.2196/26049", url="https://mental.jmir.org/2022/1/e26049", url="http://www.ncbi.nlm.nih.gov/pubmed/35089151" } @Article{info:doi/10.2196/31712, author="Freyer-Adam, Jennis and Baumann, Sophie and Bischof, Gallus and Staudt, Andreas and Goeze, Christian and Gaertner, Beate and John, Ulrich", title="Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Jan", day="28", volume="9", number="1", pages="e31712", keywords="brief alcohol intervention", keywords="electronic", keywords="eHealth", keywords="digital", keywords="motivational interviewing", keywords="socioeconomic status", keywords="equity", keywords="social inequality", keywords="transtheoretical model", keywords="moderator", keywords="mental health", keywords="public health", keywords="alcohol interventions", keywords="digital intervention", keywords="digital health intervention", keywords="alcohol use", abstract="Background: Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated. Objective: We aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants' socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed). Methods: Patients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81\% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89\% (345/387) and 83\% (292/354) received at least two doses of intervention, and 72\% (280/387) and 54\% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling. Results: The efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps?.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95\% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95\% CI 0.24--0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps?.31). Conclusions: Computer-based and in-person BAI worked equally well independent of the patient's level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status. Trial Registration: ClinicalTrials.gov NCT01291693; https://clinicaltrials.gov/ct2/show/NCT01291693 ", doi="10.2196/31712", url="https://mental.jmir.org/2022/1/e31712", url="http://www.ncbi.nlm.nih.gov/pubmed/35089156" } @Article{info:doi/10.2196/32430, author="Rosenberg, M. Benjamin and Kodish, Tamar and Cohen, D. Zachary and Gong-Guy, Elizabeth and Craske, G. Michelle", title="A Novel Peer-to-Peer Coaching Program to Support Digital Mental Health: Design and Implementation", journal="JMIR Ment Health", year="2022", month="Jan", day="26", volume="9", number="1", pages="e32430", keywords="peer support", keywords="digital mental health", keywords="university students", keywords="college students", keywords="training and supervision", keywords="scalable psychological interventions", doi="10.2196/32430", url="https://mental.jmir.org/2022/1/e32430", url="http://www.ncbi.nlm.nih.gov/pubmed/35080504" } @Article{info:doi/10.2196/29559, author="Possemato, Kyle and Wu, Justina and Greene, Carolyn and MacQueen, Rex and Blonigen, Daniel and Wade, Michael and Owen, Jason and Keane, Terence and Brief, Deborah and Lindley, Steven and Prins, Annabel and Mackintosh, Margaret-Anne and Carlson, Eve", title="Web-Based Problem-solving Training With and Without Peer Support in Veterans With Unmet Mental Health Needs: Pilot Study of Feasibility, User Acceptability, and Participant Engagement", journal="J Med Internet Res", year="2022", month="Jan", day="13", volume="24", number="1", pages="e29559", keywords="problem-solving training", keywords="mHealth", keywords="peer specialists", keywords="veterans", abstract="Background: eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. Objective: This pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. Methods: Veterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35\%), peer-supported Moving Forward (27/81, 33\%), or waitlist control (26/81, 32\%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment. Results: Automated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46\% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. Conclusions: Enrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training. Trial Registration: ClinicalTrials.gov NCT03555435; http://clinicaltrials.gov/ct2/show/NCT03555435 ", doi="10.2196/29559", url="https://www.jmir.org/2022/1/e29559", url="http://www.ncbi.nlm.nih.gov/pubmed/35023846" } @Article{info:doi/10.2196/27939, author="Currie, L. Cheryl and Larouche, Richard and Voss, Lauren M. and Trottier, Maegan and Spiwak, Rae and Higa, Erin and Scott, R. David and Tallow, Treena", title="Effectiveness of Live Health Professional--Led Group eHealth Interventions for Adult Mental Health: Systematic Review of Randomized Controlled Trials", journal="J Med Internet Res", year="2022", month="Jan", day="11", volume="24", number="1", pages="e27939", keywords="systematic review", keywords="telemedicine", keywords="eHealth", keywords="mHealth", keywords="e-therapy", keywords="mobile interventions", keywords="internet", keywords="adult", keywords="mental health", keywords="anxiety", keywords="depression", keywords="substance use", keywords="bereavement", keywords="physical activity", keywords="CBT", keywords="psychotherapy", keywords="group", keywords="synchronous", keywords="videoconference", keywords="teleconference", abstract="Background: The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. Objective: This systematic review aims to assess experimental evidence for the effectiveness of live health professional--led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. Methods: Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. Results: Of the 4099 identified studies, 21 (0.51\%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional--led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional--led group contact had more robust effects on adult mental health. Risk of bias was high in 91\% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. Conclusions: Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. Trial Registration: PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=187551 International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01479-3 ", doi="10.2196/27939", url="https://www.jmir.org/2022/1/e27939", url="http://www.ncbi.nlm.nih.gov/pubmed/34878409" } @Article{info:doi/10.2196/32220, author="B{\o}nes, Erlend and Granja, Concei{\c{c}}{\~a}o and Solvoll, Terje", title="Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study", journal="J Med Internet Res", year="2022", month="Jan", day="10", volume="24", number="1", pages="e32220", keywords="mental health", keywords="FACT", keywords="electronic health records", keywords="eHealth", keywords="FACT implementation", keywords="EHR", keywords="implementation", keywords="assessment", keywords="model", keywords="community", keywords="treatment", keywords="policy", keywords="regulation", keywords="infrastructure", keywords="literature", keywords="challenge", keywords="intervention", abstract="Background: Flexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway. Objective: The objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams. Methods: We have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway. Results: FACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams. Conclusions: Weaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers. ", doi="10.2196/32220", url="https://www.jmir.org/2022/1/e32220", url="http://www.ncbi.nlm.nih.gov/pubmed/35006087" } @Article{info:doi/10.2196/32422, author="Sutherland, Stephanie and Jeong, Dahn and Cheng, Michael and St-Jean, Mireille and Jalali, Alireza", title="Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study", journal="JMIR Form Res", year="2022", month="Jan", day="7", volume="6", number="1", pages="e32422", keywords="mental health", keywords="Canada", keywords="qualitative research", keywords="caregiver", keywords="family physician", keywords="mentorship", abstract="Background: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers' willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. Objective: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. Methods: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. Results: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician's office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son's or daughter's mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. Conclusions: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other's perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives. ", doi="10.2196/32422", url="https://formative.jmir.org/2022/1/e32422", url="http://www.ncbi.nlm.nih.gov/pubmed/34994704" } @Article{info:doi/10.2196/31367, author="Kruzan, Payne Kaylee and Meyerhoff, Jonah and Biernesser, Candice and Goldstein, Tina and Reddy, Madhu and Mohr, C. David", title="Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach", journal="JMIR Ment Health", year="2021", month="Dec", day="24", volume="8", number="12", pages="e31367", keywords="user-centered design", keywords="intervention", keywords="suicide", keywords="nonsuicidal self-injury", keywords="lived experience", keywords="technology-enabled services", keywords="digital intervention", keywords="engagement", keywords="mobile phone", abstract="Background: The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. Objective: We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). Methods: We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. Results: In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. Conclusions: UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions. ", doi="10.2196/31367", url="https://mental.jmir.org/2021/12/e31367", url="http://www.ncbi.nlm.nih.gov/pubmed/34951602" } @Article{info:doi/10.2196/32932, author="Goulding, H. Evan and Dopke, A. Cynthia and Michaels, Tania and Martin, R. Clair and Khiani, A. Monika and Garborg, Christopher and Karr, Chris and Begale, Mark", title="A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Protocol Development for an Expert System to Provide Adaptive User Feedback", journal="JMIR Form Res", year="2021", month="Dec", day="24", volume="5", number="12", pages="e32932", keywords="adaptive", keywords="personalized", keywords="self-management", keywords="smartphone", keywords="behavioral intervention technology", keywords="mHealth", keywords="bipolar disorder", keywords="depression", keywords="mania", abstract="Background: Bipolar disorder is a severe mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment, adjunctive psychotherapy can improve outcomes. However, access to therapy is limited. Smartphones and other technologies can increase access to therapeutic strategies that enhance self-management while simultaneously augmenting care by providing adaptive delivery of content to users as well as alerts to providers to facilitate clinical care communication. Unfortunately, while adaptive interventions are being developed and tested to improve care, information describing the components of adaptive interventions is often not published in sufficient detail to facilitate replication and improvement of these interventions. Objective: To contribute to and support the improvement and dissemination of technology-based mental health interventions, we provide a detailed description of the expert system for adaptively delivering content and facilitating clinical care communication for LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder. Methods: Information from empirically supported psychotherapies for bipolar disorder, health psychology behavior change theories, and chronic disease self-management models was combined with user-centered design data and psychiatrist feedback to guide the development of the expert system. Results: Decision points determining the timing of intervention option adaptation were selected to occur daily and weekly based on self-report data for medication adherence, sleep duration, routine, and wellness levels. These data were selected for use as the tailoring variables determining which intervention options to deliver when and to whom. Decision rules linking delivery of options and tailoring variable thresholds were developed based on existing literature regarding bipolar disorder clinical status and psychiatrist feedback. To address the need for treatment adaptation with varying clinical statuses, decision rules for a clinical status state machine were developed using self-reported wellness rating data. Clinical status from this state machine was incorporated into hierarchal decision tables that select content for delivery to users and alerts to providers. The majority of the adaptive content addresses sleep duration, medication adherence, managing signs and symptoms, building and utilizing support, and keeping a regular routine, as well as determinants underlying engagement in these target behaviors as follows: attitudes and perceptions, knowledge, support, evaluation, and planning. However, when problems with early warning signs, symptoms, and transitions to more acute clinical states are detected, the decision rules shift the adaptive content to focus on managing signs and symptoms, and engaging with psychiatric providers. Conclusions: Adaptive mental health technologies have the potential to enhance the self-management of mental health disorders. The need for individuals with bipolar disorder to engage in the management of multiple target behaviors and to address changes in clinical status highlights the importance of detailed reporting of adaptive intervention components to allow replication and improvement of adaptive mental health technologies for complex mental health problems. ", doi="10.2196/32932", url="https://formative.jmir.org/2021/12/e32932", url="http://www.ncbi.nlm.nih.gov/pubmed/34951598" } @Article{info:doi/10.2196/30482, author="Martinez, Kim and Men{\'e}ndez-Men{\'e}ndez, Isabel Maria and Bustillo, Andres", title="Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review", journal="JMIR Serious Games", year="2021", month="Dec", day="16", volume="9", number="4", pages="e30482", keywords="serious games", keywords="depression", keywords="anxiety", keywords="children", keywords="adolescents", keywords="virtual reality", keywords="mental health", keywords="detection", keywords="awareness", keywords="prevention", keywords="therapy", abstract="Background: Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. Objective: This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. Methods: The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. Results: A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. Conclusions: The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology. ", doi="10.2196/30482", url="https://games.jmir.org/2021/4/e30482", url="http://www.ncbi.nlm.nih.gov/pubmed/34927589" } @Article{info:doi/10.2196/26814, author="P{\'e}rez, Carola J. and Fern{\'a}ndez, Olga and C{\'a}ceres, Cristi{\'a}n and Carrasco, E. {\'A}lvaro and Moessner, Markus and Bauer, Stephanie and Espinosa-Duque, Daniel and Gloger, Sergio and Krause, Mariane", title="An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Dec", day="16", volume="8", number="12", pages="e26814", keywords="depression", keywords="e-mental health", keywords="blended care", keywords="internet", abstract="Background: Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. Objective: The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider--assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center's internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. Results: Of the 84 participants in the intervention group, 5 participants (6\%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1\%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91\%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54\% (45/84) for the intervention group versus 39\% (32/83) for the control group (P=.07). Conclusions: The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients' limited use of the online platform. Trial Registration: ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467 ", doi="10.2196/26814", url="https://mental.jmir.org/2021/12/e26814", url="http://www.ncbi.nlm.nih.gov/pubmed/34927594" } @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/10.2196/17185, author="Milgrom, Jeannette and Danaher, G. Brian and Seeley, R. John and Holt, J. Christopher and Holt, Charlene and Ericksen, Jennifer and Tyler, S. Milagra and Gau, M. Jeff and Gemmill, W. Alan", title="Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster", journal="J Med Internet Res", year="2021", month="Dec", day="8", volume="23", number="12", pages="e17185", keywords="postnatal depression", keywords="postpartum depression", keywords="postnatal anxiety", keywords="postpartum anxiety", keywords="cognitive behavioral therapy", keywords="internet intervention", keywords="web-based intervention", keywords="randomized controlled trial", keywords="online intervention", keywords="treatment", keywords="mobile phone", abstract="Background: Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. Objective: This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). Methods: In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6\%), FTF-CBT (39/116, 33.6\%), or a treatment-as-usual (TAU) control condition (38/116, 32.8\%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. Results: Of the 116 participants, 107 (92.2\%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6\% and 47.7\% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. Conclusions: In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683\&isReview=true ", doi="10.2196/17185", url="https://www.jmir.org/2021/12/e17185", url="http://www.ncbi.nlm.nih.gov/pubmed/34889742" } @Article{info:doi/10.2196/34591, author="Tempelaar, Wanda and Barwick, Melanie and Crawford, Allison and Voineskos, Aristotle and Addington, Donald and Addington, Jean and Alexander, Tallan and Baluyut, Crystal and Bromley, Sarah and Durbin, Janet and Foussias, George and Ford, Catherine and de Freitas, Lauren and Jindani, Seharish and Kirvan, Anne and Kurdyak, Paul and Pauly, Kirstin and Polillo, Alexia and Roby, Rachel and Sockalingam, Sanjeev and Sosnowski, Alexandra and Villanueva, Victoria and Wang, Wei and Kozloff, Nicole", title="Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="7", volume="10", number="12", pages="e34591", keywords="virtual care delivery", keywords="early psychosis intervention", keywords="mixed methods implementation", abstract="Background: Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. Objective: This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. Methods: The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. Results: Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. Conclusions: This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. International Registered Report Identifier (IRRID): DERR1-10.2196/34591 ", doi="10.2196/34591", url="https://www.researchprotocols.org/2021/12/e34591", url="http://www.ncbi.nlm.nih.gov/pubmed/34806990" } @Article{info:doi/10.2196/28141, author="Lal, Shalini and Gleeson, F. John and D'Alfonso, Simon and Etienne, Geraldine and Joober, Ridha and Lepage, Martin and Lee, Hajin and Alvarez-Jimenez, Mario", title="A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2)", journal="JMIR Res Protoc", year="2021", month="Dec", day="7", volume="10", number="12", pages="e28141", keywords="psychotic disorders", keywords="mental health", keywords="telemedicine", keywords="young adult", keywords="mental health services", keywords="e--mental health", keywords="virtual care", keywords="schizophrenia", keywords="eHealth", keywords="social support", keywords="therapy", keywords="psychiatry", keywords="psychology", abstract="Background: Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. Objective: In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). Methods: This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. Results: This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre int{\'e}gr{\'e} universitaire de sant{\'e} et de services sociaux de l'Ouest-de-l'{\^I}le-de-Montr{\'e}al on April 11, 2018 (\#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. Conclusions: This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. Trial Registration: ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105 International Registered Report Identifier (IRRID): RR1-10.2196/28141 ", doi="10.2196/28141", url="https://www.researchprotocols.org/2021/12/e28141", url="http://www.ncbi.nlm.nih.gov/pubmed/34879000" } @Article{info:doi/10.2196/27462, author="Schick, Anita and Paetzold, Isabell and Rauschenberg, Christian and Hirjak, Dusan and Banaschewski, Tobias and Meyer-Lindenberg, Andreas and Boehnke, R. Jan and Boecking, Benjamin and Reininghaus, Ulrich", title="Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="3", volume="10", number="12", pages="e27462", keywords="experience sampling methodology (ESM)", keywords="ecological momentary assessment (EMA)", keywords="mobile intervention", keywords="at-risk individuals", keywords="smartphone training", keywords="blended care", keywords="mental health", keywords="stress reactivity", keywords="mobile phone", abstract="Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. Objective: This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth---EMIcompass. Methods: In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. Results: The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. Conclusions: This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial Registration: German Clinical Trials Register DRKS00017265; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00017265 International Registered Report Identifier (IRRID): DERR1-10.2196/27462 ", doi="10.2196/27462", url="https://www.researchprotocols.org/2021/12/e27462", url="http://www.ncbi.nlm.nih.gov/pubmed/34870613" } @Article{info:doi/10.2196/29243, author="Wiebe, E. Deanna and Remers, Shannon and Nippak, Pria and Meyer, Julien", title="Evaluation of an Online System for Routine Outcome Monitoring: Cross-sectional Survey Study", journal="JMIR Ment Health", year="2021", month="Dec", day="1", volume="8", number="12", pages="e29243", keywords="routine outcome monitoring", keywords="progress monitoring and feedback", keywords="outcome measures", keywords="web-based outcome monitoring", keywords="routine outcome monitoring software", keywords="outcome measurement questionnaire", keywords="measurement-based care", abstract="Background: The use of routine outcome monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. Objective: The aim of this study is to identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians' views on their experience using the online system over previous paper-based methods. Methods: Client completion rates of self-reported outcome measures were compared pre- and postimplementation of an online system of ROM. In addition, a survey questionnaire was administered to 324 mental health service providers regarding their perception of the benefits with an online system of ROM. Results: Client completion rates of self-reported measures increased from 15.62\% (427/2734) to 53.98\% (1267/2347) after they were moved online. Furthermore, 57\% (56/98) of service providers found the new system less time-consuming than the previous paper-based ROM, and 64\% (63/98) found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23\% (23/98) found it helped them identify clients at risk for treatment failure, and only 18\% (18/98) found it strengthened the therapeutic alliance. Conclusions: Although the current study suggests mixed results regarding service providers' views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement. ", doi="10.2196/29243", url="https://mental.jmir.org/2021/12/e29243", url="http://www.ncbi.nlm.nih.gov/pubmed/34855615" } @Article{info:doi/10.2196/30053, author="Danieli, Morena and Ciulli, Tommaso and Mousavi, Mahed Seyed and Riccardi, Giuseppe", title="A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design", journal="JMIR Form Res", year="2021", month="Dec", day="1", volume="5", number="12", pages="e30053", keywords="mental health care", keywords="conversational AI", keywords="mHealth", keywords="personal health care agents", keywords="participatory design", keywords="psychotherapy", abstract="Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists' acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants' levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. ", doi="10.2196/30053", url="https://formative.jmir.org/2021/12/e30053", url="http://www.ncbi.nlm.nih.gov/pubmed/34855607" } @Article{info:doi/10.2196/28734, author="Fisher, B. Lauren and Tuchman, Sylvie and Curreri, J. Andrew and Markgraf, Maggie and Nyer, B. Maren and Cassano, Paolo and Iverson, L. Grant and Fava, Maurizio and Zafonte, D. Ross and Pedrelli, Paola", title="Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study", journal="JMIR Form Res", year="2021", month="Dec", day="1", volume="5", number="12", pages="e28734", keywords="COVID-19", keywords="telemental health", keywords="clinical trial", keywords="traumatic brain injury", keywords="depression", keywords="cognitive behavioral therapy", abstract="Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 ", doi="10.2196/28734", url="https://formative.jmir.org/2021/12/e28734", url="http://www.ncbi.nlm.nih.gov/pubmed/34662285" } @Article{info:doi/10.2196/27404, author="Saad, Anthony and Bruno, Deanna and Camara, Bettina and D'Agostino, Josephine and Bolea-Alamanac, Blanca", title="Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review", journal="JMIR Ment Health", year="2021", month="Nov", day="26", volume="8", number="11", pages="e27404", keywords="digital therapeutics", keywords="self-directed", keywords="mental health", keywords="telehealth", keywords="technology", keywords="mobile applications", keywords="telemedicine", keywords="internet", keywords="mobile phone", abstract="Background: Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. Objective: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient's or at the technology's end), so the patients can implement them without any support. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. Results: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80\%, citing potential problems with the acceptability of the suggested technologies. Conclusions: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates. ", doi="10.2196/27404", url="https://mental.jmir.org/2021/11/e27404", url="http://www.ncbi.nlm.nih.gov/pubmed/34842556" } @Article{info:doi/10.2196/27630, author="Xiang, Xiaoling and Kayser, Jay and Sun, Yihang and Himle, Joseph", title="Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants' Experiences", journal="JMIR Aging", year="2021", month="Nov", day="22", volume="4", number="4", pages="e27630", keywords="internet-based cognitive behavioral therapy", keywords="homebound older adults", keywords="home care", keywords="direct care workers", keywords="depression", keywords="qualitative study", abstract="Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants' experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants' perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 ", doi="10.2196/27630", url="https://aging.jmir.org/2021/4/e27630", url="http://www.ncbi.nlm.nih.gov/pubmed/34813491" } @Article{info:doi/10.2196/28196, author="Aylward, Marion Shannon and Farrell, Alison and Walsh, Anna and Godwin, Marshall and Chafe, Roger and Asghari, Shabnam", title="Quality of Primary Care for the Adult Population With Autism Spectrum Disorder: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Nov", day="19", volume="10", number="11", pages="e28196", keywords="autism spectrum disorder", keywords="primary care", keywords="family physician", keywords="quality", keywords="scoping review", keywords="protocol", abstract="Background: A strong primary care system is vital to overall health. Research on the primary care of people with autism spectrum disorder (ASD) has mostly focused on children. A synthesis of the existing literature related to the quality of primary care for the adult population with ASD would elucidate what is known about the topic as well as inform future research and clinical practice. Objective: The purpose of our scoping review is to describe what is known about the quality of primary care for adults with ASD and identify knowledge gaps. Methods: Prior to beginning the literature search, we reviewed literature related to defining both primary care and primary care quality to establish the context and concept of the research question. The search strategy was designed and executed by a research librarian. The MEDLINE, CINAHL, EMBASE, PsycINFO, and ProQuest Dissertations and Theses databases were searched for relevant literature. Grey literature will include relevant reports from government websites and associations with a focus on ASD. Two members of the research team will independently screen the academic and grey literature. Quantitative, qualitative, or mixed methods study designs involving the quality of primary care services or patient-centered care for adults with ASD are eligible for inclusion in our scoping review. Studies that make it past the full-text review will undergo data extraction and quality appraisal by 2 independent reviewers. The data extraction results will be presented in a tabular format to clearly present what is known about the quality of primary care for adults with ASD; this table will be accompanied by a narrative synthesis. Literature selected for extraction will be coded for themes, which will form the basis of a thematic synthesis. The scoping review will follow the guidance proposed by the Joanna Briggs Institute. Results: The search of electronic databases was conducted in October 2020, and it returned 2820 results. This research is still in progress. The results from our scoping review are expected to be available by fall 2021. Conclusions: The results from our scoping review will be useful for guiding future research on the quality of primary care for adults with ASD. International Registered Report Identifier (IRRID): PRR1-10.2196/28196 ", doi="10.2196/28196", url="https://www.researchprotocols.org/2021/11/e28196", url="http://www.ncbi.nlm.nih.gov/pubmed/34806989" } @Article{info:doi/10.2196/30479, author="Martel, Rhiannon and Shepherd, Matthew and Goodyear-Smith, Felicity", title="Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review", journal="JMIR Ment Health", year="2021", month="Nov", day="19", volume="8", number="11", pages="e30479", keywords="adolescent", keywords="mental health", keywords="risk behavior", keywords="screening", keywords="primary care", abstract="Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50\% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases---MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews---were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. ", doi="10.2196/30479", url="https://mental.jmir.org/2021/11/e30479", url="http://www.ncbi.nlm.nih.gov/pubmed/34807833" } @Article{info:doi/10.2196/22369, author="Klein, Arno and Clucas, Jon and Krishnakumar, Anirudh and Ghosh, S. Satrajit and Van Auken, Wilhelm and Thonet, Benjamin and Sabram, Ihor and Acuna, Nino and Keshavan, Anisha and Rossiter, Henry and Xiao, Yao and Semenuta, Sergey and Badioli, Alessandra and Konishcheva, Kseniia and Abraham, Ann Sanu and Alexander, M. Lindsay and Merikangas, R. Kathleen and Swendsen, Joel and Lindner, B. Ariel and Milham, P. Michael", title="Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study", journal="J Med Internet Res", year="2021", month="Nov", day="11", volume="23", number="11", pages="e22369", keywords="mental health", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="eHealth", keywords="digital psychiatry", keywords="digital phenotyping", keywords="teletherapy", keywords="mobile device", keywords="mobile phone", keywords="smartphone", keywords="ecological momentary assessment", keywords="ecological momentary intervention", keywords="EMA", keywords="EMI", keywords="ESM", keywords="experience sampling", keywords="experience sampling methods", abstract="Background: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform's configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users' data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser--based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health--related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population. ", doi="10.2196/22369", url="https://www.jmir.org/2021/11/e22369", url="http://www.ncbi.nlm.nih.gov/pubmed/34762054" } @Article{info:doi/10.2196/29866, author="Przybylko, Geraldine and Morton, Darren and Morton, Jason and Renfrew, Melanie", title="The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study", journal="JMIR Ment Health", year="2021", month="Nov", day="11", volume="8", number="11", pages="e29866", keywords="age", keywords="gender", keywords="adherence", keywords="digital health", keywords="interdisciplinary", keywords="mental health", keywords="promotion", keywords="intervention", keywords="lifestyle medicine", keywords="positive psychology", keywords="multicomponent", keywords="lifestyle", keywords="outcome", keywords="cohort study", abstract="Background: The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective: The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods: This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the ``mental health'' and ``vitality'' subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results: On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5\% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions: Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx ", doi="10.2196/29866", url="https://mental.jmir.org/2021/11/e29866", url="http://www.ncbi.nlm.nih.gov/pubmed/34762058" } @Article{info:doi/10.2196/28191, author="Levati, Sara and Mellacqua, Zefiro and Caiata-Zufferey, Maria and Soldini, Emiliano and Albanese, Emiliano and Alippi, Maddalena and Bolla, Emilio and Colombo, Ada Raffaella and Cordasco, Severino and Kawohl, Wolfram and Larghi, Giuseppina and Lisi, Angela and Lucchini, Mario and Rossa, Simona and Traber, Rafael and Crivelli, Luca", title="Home Treatment for Acute Mental Health Care: Protocol for the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="9", volume="10", number="11", pages="e28191", keywords="acute mental healthcare", keywords="home treatment", keywords="crisis resolution", keywords="home visits", keywords="mental health", keywords="home care", keywords="crisis", keywords="home", keywords="community-based", keywords="mental health services", keywords="economic", keywords="risk", keywords="risks", keywords="efficacy", keywords="public health", keywords="accessibility", abstract="Background: Crisis Resolution and Home Treatment (CRHT) teams represent a community-based mental health service offering a valid alternative to hospitalization. CRHT teams have been widely implemented in various mental health systems worldwide, and their goal is to provide care for people with severe acute mental disorders who would be considered for admission to acute psychiatric wards. The evaluation of several home-treatment experiences shows promising results; however, it remains unclear which specific elements and characteristics of CRHT are more effective and acceptable. Objective: This study aims to assess the acceptability, effectiveness, and cost-effectiveness of a new CRHT intervention in Ticino, Southern Switzerland. Methods: This study includes an interventional, nonrandomized, quasi-experimental study combined with a qualitative study and an economic evaluation to be conducted over a 48-month period. The quasi-experimental evaluation involves two groups: patients in the northern area of the region who were offered the CRHT service (ie, intervention group) and patients in the southern area of the region who received care as usual (ie, control group). Individual interviews will be conducted with patients receiving the home treatment intervention and their family members. CRHT members will also be asked to participate in a focus group. The economic evaluation will include a cost-effectiveness analysis. Results: The project is funded by the Swiss National Science Foundation as part of the National Research Program NRP74 for a period of 48 months starting from January 2017. As of October 2021, data for the nonrandomized, quasi-experimental study and the qualitative study have been collected, and the results are expected to be published by the end of the year. Data are currently being collected for the economic evaluation. Conclusions: Compared to other Swiss CRHT experiences, the CRHT intervention in Ticino represents a unique case, as the introduction of the service is backed by the closing of one of its acute wards. The proposed study will address several areas where there are evidence gaps or contradictory findings relating to the home treatment of acute mental crisis. Findings from this study will allow local services to improve their effectiveness in a challenging domain of public health and contribute to improving access to more effective care for people with severe mental disorders. Trial Registration: ISRCTN registry ISRCTN38472626; https://www.isrctn.com/ISRCTN38472626 International Registered Report Identifier (IRRID): DERR1-10.2196/28191 ", doi="10.2196/28191", url="https://www.researchprotocols.org/2021/11/e28191", url="http://www.ncbi.nlm.nih.gov/pubmed/34751660" } @Article{info:doi/10.2196/33268, author="McIntyre, Heather and Loughhead, Mark and Hayes, Laura and Procter, Gerard Nicholas", title="National Disability Insurance Scheme and Lived Experience of People Presenting to the Emergency Department: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="4", volume="10", number="11", pages="e33268", keywords="lived experience", keywords="National Disability Insurance Scheme", keywords="emergency department", keywords="psychosocial disability", keywords="communication pathways", abstract="Background: Currently, within Australia, 3.6\% of all emergency department (ED) presentations are mental health--related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early support and care continuity that could potentially inform ED practitioners to revise current practices. Objective: The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for improving continuity of care and consumer experience. Methods: This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring concerns that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals' meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). Results: This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. Conclusions: Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for consumers and carers, while also informing health policy. International Registered Report Identifier (IRRID): PRR1-10.2196/33268 ", doi="10.2196/33268", url="https://www.researchprotocols.org/2021/11/e33268", url="http://www.ncbi.nlm.nih.gov/pubmed/34554101" } @Article{info:doi/10.2196/26842, author="Lilja, Lotten Josefine and Rupcic Ljustina, Mirna and Nissling, Linnea and Larsson, Caroline Anna and Weineland, Sandra", title="Youths' and Parents' Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="1", volume="4", number="4", pages="e26842", keywords="internet", keywords="CBT", keywords="cognitive behavioral therapy", keywords="adolescents", keywords="parents", keywords="anxiety", keywords="primary care", keywords="mixed methods", keywords="experiences", keywords="youths", keywords="digital health", abstract="Background: Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people's interest in internet treatment or the attitudes they and their parents have toward it. Objective: This study aims to investigate adolescents' and parents' attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects. Methods: The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment. Results: The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms ($\chi$22=8.333; P=.02) and that adolescents' motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths' need for autonomy while also engaging with them in the treatment work. Conclusions: Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist's role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment. ", doi="10.2196/26842", url="https://pediatrics.jmir.org/2021/4/e26842", url="http://www.ncbi.nlm.nih.gov/pubmed/34723830" } @Article{info:doi/10.2196/27907, author="Mathlin, Georgina and Freestone, Mark and Taylor, Celia and Shaw, Jake", title="Offenders With Personality Disorder Who Fail to Progress: A Case-Control Study Using Partial Least Squares Structural Equation Modeling Path Analysis", journal="JMIRx Med", year="2021", month="Oct", day="29", volume="2", number="4", pages="e27907", keywords="offender", keywords="personality disorder", keywords="progression", keywords="prison", keywords="PLS-SEM", keywords="partial least squares structural equation modeling", keywords="mental health", keywords="OPD", keywords="offender personality disorder", keywords="proactive diagnosis", keywords="psychopathy", keywords="psychosis", keywords="mental health services", keywords="health services", abstract="Background: Offenders with personality disorder can be challenging to engage and retain in treatment. The UK Offender Personality Disorder (OPD) pathway aims to proactively and responsively identify and engage offenders with personality disorder. However, a subpopulation of offenders on the pathway have been found to not be accepted into any OPD service and therefore fail to progress. Objective: This study aims to identify and describe offenders on the OPD pathway who fail to progress and to understand the causal drivers by which individuals fail to progress in the pathway. Methods: A sample of 50 offenders on the OPD pathway who had been refused from at least two OPD services (nonprogression group) were compared to 100 offenders accepted into OPD services (control group). Partial least squares structural equation modeling was used to model the causal factors involved in not being accepted into OPD services. Results: The path coefficients in the structural model showed that the most influential factor in nonprogression was attitude toward treatment ($\beta$=.41; P<.001; f2=0.25) alongside those with psychopathology ($\beta$=.41; P<.001; f2=0.25), specifically, psychopathy, psychosis, and co-occurring personality disorder. Conclusions: The findings of the study provide a basis of how to work with this population in the future to increase the likelihood of acceptance into OPD services. ", doi="10.2196/27907", url="https://med.jmirx.org/2021/4/e27907", url="http://www.ncbi.nlm.nih.gov/pubmed/37725548" } @Article{info:doi/10.2196/31742, author="Bond, Jessica and Robotham, Dan and Kenny, Alexandra and Pinfold, Vanessa and Kabir, Thomas and Andleeb, Humma and Larkin, Michael and Martin, L. Jennifer and Brown, Susan and Bergin, D. Aislinn and Petit, Ariane and Rosebrock, Laina and Lambe, Sin{\'e}ad and Freeman, Daniel and Waite, Felicity", title="Automated Virtual Reality Cognitive Therapy for People With Psychosis: Protocol for a Qualitative Investigation Using Peer Research Methods", journal="JMIR Res Protoc", year="2021", month="Oct", day="25", volume="10", number="10", pages="e31742", keywords="virtual reality", keywords="therapy", keywords="schizophrenia", keywords="agoraphobia", keywords="peer research", keywords="qualitative methods", keywords="implementation", keywords="mental health", keywords="psychosis", keywords="cognitive therapy", abstract="Background: Many people with psychosis experience difficulties in everyday social situations. Anxiety can make life challenging, leading to withdrawal. Cognitive therapy, using active in vivo learning, enables people to overcome fears. These treatments are not readily available to people with psychosis. Automated virtual reality (VR) therapy is a potential route to increase accessibility. The gameChange automated VR cognitive therapy is designed to help people overcome anxious avoidance and build confidence in everyday social situations. A virtual coach guides the person through the treatment. Understanding user experience is key to facilitating future implementation. Peer research methods, in which people with lived experience of the issues being studied are involved in collecting and analyzing data, may be useful in developing this understanding. This encourages researchers to draw on their lived experience to explore participant perspectives and co-create knowledge. Objective: The primary objective is to use a peer research approach to explore the participant experience of a novel automated VR therapy for anxious social avoidance. This includes understanding (1) the experience of anxious social avoidance in people with psychosis, (2) the experience of the gameChange automated VR cognitive therapy, and (3) any potential impact of the therapy in people's lives. This will inform future implementation strategies. The secondary objective is to explore how peer research can be used to co-create knowledge. Methods: Semistructured interviews will be conducted with approximately 25 people with psychosis participating in the gameChange trial (ISRCTN17308399). Participants will be recruited from the five trial centers based in National Health Service mental health trusts across England. Interviews will be conducted by two researchers. One is a peer researcher with similar lived experience to the trial participants. The other has lived experiences of mental health issues that do not directly overlap with those of the trial participants. Interview questions will focus on an individual's experience of anxious social avoidance, experiences of participating in the gameChange VR therapy, and any changes or impact following therapy. The interview schedule was developed in collaboration with the gameChange Lived Experience Advisory Panel (LEAP), comprising 10 project advisors with lived experience of psychosis. Interpretative phenomenological analysis and template analysis will be used to explore individual accounts. The LEAP will contribute to the analysis. Results: Data collection will be conducted from April to September 2021, and analysis will be conducted from June to October 2021. As of September 28, 2021, 20 participants had been interviewed, and coding is underway. Conclusions: The study, employing a peer research approach, may provide a unique insight into the experiences of anxious social avoidance in people with psychosis and its treatment using automated VR therapy. This will inform potential future implementation of VR automated therapies in mental health services. International Registered Report Identifier (IRRID): DERR1-10.2196/31742 ", doi="10.2196/31742", url="https://www.researchprotocols.org/2021/10/e31742", url="http://www.ncbi.nlm.nih.gov/pubmed/34694236" } @Article{info:doi/10.2196/29989, author="Parker, L. Belinda and Anderson, Melissa and Batterham, J. Philip and Gayed, Aimee and Subotic-Kerry, Mirjana and Achilles, R. Melinda and Chakouch, Cassandra and Werner-Seidler, Aliza and Whitton, E. Alexis and O'Dea, Bridianne", title="Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators' Skills in Adolescent Mental Health) Program", journal="JMIR Ment Health", year="2021", month="Oct", day="22", volume="8", number="10", pages="e29989", keywords="mental health", keywords="training", keywords="high school teachers", keywords="youth", keywords="mental health programs", keywords="secondary schools", abstract="Background: Secondary schools are increasingly supporting adolescents' mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators' skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers' knowledge and confidence in caring for students' mental health. Objective: This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers. Methods: A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants' perceptions of program effectiveness. Results: A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness. Conclusions: Findings indicated that a web-based training program may be beneficial for improving secondary school teachers' abilities to care for students' mental health; however, program modifications are required to increase training completions. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529 ", doi="10.2196/29989", url="https://mental.jmir.org/2021/10/e29989", url="http://www.ncbi.nlm.nih.gov/pubmed/34677134" } @Article{info:doi/10.2196/32100, author="Wu, S. Monica and Chen, Shih-Yin and Wickham, E. Robert and O'Neil-Hart, Shane and Chen, Connie and Lungu, Anita", title="Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study", journal="JMIR Ment Health", year="2021", month="Oct", day="21", volume="8", number="10", pages="e32100", keywords="blended care", keywords="coaching", keywords="cognitive", keywords="behavior", keywords="depression", keywords="anxiety", keywords="digital health", keywords="retrospective", keywords="mental health", keywords="CBT", keywords="cognitive behavioral therapy", keywords="outcome", keywords="video conference", abstract="Background: Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. Objective: The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. Methods: This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. Results: Out of the total sample of 1496 clients, 75.9\% (n=1136) demonstrated reliable improvement, and 88.6\% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=--1.04) and depression (b=--0.79) symptoms in the same week, as well as lower anxiety (b=--0.74) and depression (b=--0.91) symptoms the following week (P<.001). Conclusions: The BCC program demonstrated strong outcomes in decreasing symptomology for clients presenting with moderate levels of anxiety and depression. When clients received coaching sessions, significant decreases in symptoms were observed, reflecting the importance of session attendance. Additionally, the steepest declines in symptoms tended to occur during the initial weeks of coaching, emphasizing the importance of client buy-in and early engagement. Collectively, these findings have implications for addressing unmet mental health care needs in a more accessible, cost-effective manner. ", doi="10.2196/32100", url="https://mental.jmir.org/2021/10/e32100", url="http://www.ncbi.nlm.nih.gov/pubmed/34673534" } @Article{info:doi/10.2196/27507, author="Spadaro, Benedetta and Martin-Key, A. Nayra and Bahn, Sabine", title="Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators", journal="J Med Internet Res", year="2021", month="Oct", day="13", volume="23", number="10", pages="e27507", keywords="digital implementation", keywords="digital mental health", keywords="digital psychiatry", keywords="digital technology", keywords="viewpoint", doi="10.2196/27507", url="https://www.jmir.org/2021/10/e27507", url="http://www.ncbi.nlm.nih.gov/pubmed/34643537" } @Article{info:doi/10.2196/25622, author="Hendrikx, Josephine Laura and Murphy, Dominic", title="Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Oct", day="12", volume="8", number="10", pages="e25622", keywords="mental health support", keywords="online group-based support", keywords="military partners", abstract="Background: Despite an increased risk of psychological difficulties, there remains a lack of evidence-based support for the mental health needs of military partners. Objective: This study aims to investigate whether the Together Webinar Programme (TTP-Webinar), a 6-week structured, remote access group intervention would reduce military partners' experience of common mental health difficulties and secondary trauma symptoms. Methods: A pilot randomized controlled trial was used to compare the TTP-Webinar intervention with a waitlist control. The sample was UK treatment-seeking veterans engaged in a mental health charity. A total of 196 military partners (1 male and 195 females; aged mean 42.28, SD 10.82 years) were randomly allocated to the intervention (n=97) or waitlist (n=99) condition. Outcome measures were self-reported measures of common mental health difficulties, secondary trauma symptoms, and overall quality of life rating. Results: Compared with the waitlist, military partners in the TTP-Webinar had reduced common mental health difficulties (P=.02) and secondary trauma symptoms (P=.001). However, there was no difference in quality-of-life ratings (P=.06). Conclusions: The results suggest that TTP-Webinar is an effective intervention to support the mental health difficulties of military partners. This study provides promising evidence that webinars may be an appropriate platform for providing group-based support. Trial Registration: ClinicalTrials.gov NCT05013398; https://clinicaltrials.gov/ct2/show/NCT05013398 ", doi="10.2196/25622", url="https://mental.jmir.org/2021/10/e25622", url="http://www.ncbi.nlm.nih.gov/pubmed/34636734" } @Article{info:doi/10.2196/29681, author="Baghaei, Nilufar and Chitale, Vibhav and Hlasnik, Andrej and Stemmet, Lehan and Liang, Hai-Ning and Porter, Richard", title="Virtual Reality for Supporting the Treatment of Depression and Anxiety: Scoping Review", journal="JMIR Ment Health", year="2021", month="Sep", day="23", volume="8", number="9", pages="e29681", keywords="virtual reality", keywords="mental health", keywords="depression", keywords="anxiety", keywords="CBT", abstract="Background: Mental health conditions pose a major challenge to health care providers and society at large. The World Health Organization predicts that by 2030, mental health conditions will be the leading cause of disease burden worldwide. The current need for mental health care is overwhelming. In New Zealand, 1 in 6 adults has been diagnosed with common mental disorders, such as depression and anxiety disorders, according to a national survey. Cognitive behavioral therapy (CBT) has been shown to effectively help patients overcome a wide variety of mental health conditions. Virtual reality exposure therapy (VRET) might be one of the most exciting technologies emerging in the clinical setting for the treatment of anxiety and depression. Objective: This study aims to investigate the virtual reality (VR) technologies currently being used to help support the treatment of depression and anxiety. We also aim to investigate whether and how CBT is included as part of VRET and look at the VR technologies and interventions that have been used in recent studies on depression and anxiety. Methods: We performed a scoping review. To identify significant studies, we decided to use already aggregated sources from the Google Scholar database. Overall, the goal of our search strategy was to limit the number of initial results related to VR in mental health to only a relevant minimum. Results: Using our defined keywords, Google Scholar identified >17,300 articles. After applying all the inclusion and exclusion criteria, we identified a total of 369 articles for further processing. After manual evaluation, 34 articles were shortlisted; of the 34 articles, 9 (26\%) reported the use of CBT with VR. All of the articles were published between 2017 and 2021. Out of the 9 studies, CBT was conducted within a VR environment in 5 (56\%) studies, whereas in the remaining 4 (44\%) studies, CBT was used as an addition to VRET. All 9 studies reported the use of CBT either in vivo or in a virtual environment to be effective in supporting the treatment of anxiety or depression. Conclusions: Most studies demonstrated the use of VR to be effective for supporting the treatment of anxiety or depression in a range of settings and recommended its potential as a tool for use in a clinical environment. Even though standalone headsets are much easier to work with and more suitable for home use, the shift from tethered VR headsets to standalone headsets in the mental health environment was not observed. All studies that looked at the use of CBT either in vivo or in a virtual environment found it to be effective in supporting the treatment of anxiety or depression. ", doi="10.2196/29681", url="https://mental.jmir.org/2021/9/e29681", url="http://www.ncbi.nlm.nih.gov/pubmed/34554097" } @Article{info:doi/10.2196/28066, author="Rantanen, Teemu and Gluschkoff, Kia and Silvennoinen, Piia and Heponiemi, Tarja", title="The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services: Evidence From a Finnish Population-Based Study", journal="J Med Internet Res", year="2021", month="Sep", day="21", volume="23", number="9", pages="e28066", keywords="digital inclusion", keywords="digital exclusion", keywords="digital divide", keywords="mental health", keywords="attitudes", abstract="Background: The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems. Objective: This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations. Methods: Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services. Results: The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services. Conclusions: Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services. ", doi="10.2196/28066", url="https://www.jmir.org/2021/9/e28066", url="http://www.ncbi.nlm.nih.gov/pubmed/34546184" } @Article{info:doi/10.2196/29454, author="Exner-Cortens, Deinera and Baker, Elizabeth and Gray, Shawna and Fernandez Conde, Cristina and Rivera, Ramirez Rocio and Van Bavel, Marisa and Vezina, Elisabeth and Ambrose, Aleta and Pawluk, Chris and Schwartz, D. Kelly and Arnold, D. Paul", title="School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review", journal="JMIR Ment Health", year="2021", month="Sep", day="21", volume="8", number="9", pages="e29454", keywords="suicide", keywords="risk assessment", keywords="youth", keywords="eHealth", keywords="school mental health", keywords="mobile phone", abstract="Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature---consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former's focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. ", doi="10.2196/29454", url="https://mental.jmir.org/2021/9/e29454", url="http://www.ncbi.nlm.nih.gov/pubmed/34546178" } @Article{info:doi/10.2196/28369, author="Whitton, E. Alexis and Hardy, Rebecca and Cope, Kate and Gieng, Chilin and Gow, Leanne and MacKinnon, Andrew and Gale, Nyree and O'Moore, Kathleen and Anderson, Josephine and Proudfoot, Judith and Cockayne, Nicole and O'Dea, Bridianne and Christensen, Helen and Newby, Maree Jill", title="Mental Health Screening in General Practices as a Means for Enhancing Uptake of Digital Mental Health Interventions: Observational Cohort Study", journal="J Med Internet Res", year="2021", month="Sep", day="16", volume="23", number="9", pages="e28369", keywords="depression", keywords="anxiety", keywords="general practice", keywords="screening", keywords="digital mental health", abstract="Background: Digital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking. Objective: This study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (StepCare) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions. Methods: StepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening. Results: Screening identified depressive or anxious symptoms in 43.09\% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6\%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it. Conclusions: Implementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits. ", doi="10.2196/28369", url="https://www.jmir.org/2021/9/e28369", url="http://www.ncbi.nlm.nih.gov/pubmed/34528896" } @Article{info:doi/10.2196/28044, author="van Agteren, Joep and Ali, Kathina and Fassnacht, B. Daniel and Iasiello, Matthew and Furber, Gareth and Howard, Alexis and Woodyatt, Lydia and Musker, Michael and Kyrios, Mike", title="Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e28044", keywords="COVID-19", keywords="internet-based interventions", keywords="mental health", keywords="well-being", keywords="intervention", keywords="study", keywords="impact", keywords="internet", keywords="online intervention", keywords="distress", keywords="resilience", keywords="depression", keywords="anxiety", keywords="stress", abstract="Background: During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective: This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods: A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results: The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks $\Lambda$=.71; partial $\eta$2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being ($\eta$2=.22 and $\eta$2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92\% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions: The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness. ", doi="10.2196/28044", url="https://mental.jmir.org/2021/9/e28044", url="http://www.ncbi.nlm.nih.gov/pubmed/34357876" } @Article{info:doi/10.2196/30162, author="Kozlov, Elissa and McDarby, Meghan and Prescott, Maximo and Altman, Myra", title="Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="Sep", day="15", volume="5", number="9", pages="e30162", keywords="stepped care", keywords="technology", keywords="mental health care", keywords="patient-centered care", abstract="Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06\%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06\%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03\%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95\% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95\% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95\% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. ", doi="10.2196/30162", url="https://formative.jmir.org/2021/9/e30162", url="http://www.ncbi.nlm.nih.gov/pubmed/34343965" } @Article{info:doi/10.2196/27745, author="Borghouts, Judith and Eikey, V. Elizabeth and Mark, Gloria and De Leon, Cinthia and Schueller, M. Stephen and Schneider, Margaret and Stadnick, Nicole and Zheng, Kai and Mukamel, B. Dana and Sorkin, H. Dara", title="Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study", journal="J Med Internet Res", year="2021", month="Sep", day="14", volume="23", number="9", pages="e27745", keywords="mHealth", keywords="mental health", keywords="community college", keywords="students", keywords="structural equation modeling", keywords="mobile apps", keywords="services", keywords="mental health services", keywords="stress", keywords="privacy", abstract="Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2\%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. ", doi="10.2196/27745", url="https://www.jmir.org/2021/9/e27745", url="http://www.ncbi.nlm.nih.gov/pubmed/34519668" } @Article{info:doi/10.2196/25017, author="Miguel-Cruz, Antonio and Ladurner, Anna-Maria and Kohls-Wiebe, Megan and Rawani, David", title="The Effects of 3D Immersion Technology (3Scape) on Mental Health in Outpatients From a Short-Term Assessment, Rehabilitation, and Treatment Program: Feasibility Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Sep", day="14", volume="10", number="9", pages="e25017", keywords="technology assessment", keywords="mental health", keywords="technology for rehabilitation", keywords="clinical engineering", keywords="biomedical engineering", abstract="Background: Mental health conditions are prevalent among Canadians and are a leading cause of disability. Each year, 1 in 5 Canadians experiences a mental health issue. A total of 5\% of people aged ?65 years perceive their mental health as fair or poor, and 6.3\% of them have mood disorders. Regarding older adults with cognitive impairments such as dementia, up to 40\%-50\% of them experience depression at some point. We believe that older adults can benefit significantly from information and telecommunication technologies as a strategy for improving mental health conditions such as depression and anxiety, while simultaneously improving their quality of life. 3Scape Systems Inc is an Alberta-based private company that has produced a series of specialized 3D videos designed to simulate real-life events and engage individuals living with mental health disorders and cognitive impairments such as dementia. Objective: This study aims to explore the trial design and effects of 3Scape videos on older adults' symptoms of depression and anxiety and the efficacy of this technology in improving the quality of life of patients attending the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital and to provide data to estimate the parameters required to design a definitive randomized controlled trial. Methods: The trial will use a randomized controlled design comprising 15 intervention participants and 15 control group participants. The participants will be adults aged ?65 years who are cognitively intact or have minimal cognitive impairment (ie, Montreal Cognitive Assessment score ?18), and are clients of the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital. This study's primary outcome variables are related to clients' depressive and anxiety symptoms and their quality of life. The control group will receive the standard of care (ie, the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital). The intervention group will receive the same standard of care as the control group and will use 3Scape Systems videos for therapeutic activities. Results: Our study is currently on hold because of the COVID-19 pandemic. The recruitment process is expected to resume by November 2021, and the primary impact analysis is expected to be conducted by February 2022. Conclusions: This study will provide valuable information such as the measurement of comparative intervention effects, perception of older adults and mental health therapists about the 3Scape Systems, the associated costs of treatment, and product costs. This will contribute to the evidence planning process, which will be crucial for the future adoption of 3Scape Systems. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 93685907; https://www.isrctn.com/ISRCTN93685907. International Registered Report Identifier (IRRID): PRR1-10.2196/25017 ", doi="10.2196/25017", url="https://www.researchprotocols.org/2021/9/e25017", url="http://www.ncbi.nlm.nih.gov/pubmed/34519669" } @Article{info:doi/10.2196/31211, author="Fung, Po-Lun Kenneth and Vahabi, Mandana and Moosapoor, Masoomeh and Akbarian, Abdolreza and Jing-Wen Liu, Jenny and Wong, Pui-Hing Josephine", title="Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol", journal="JMIR Res Protoc", year="2021", month="Sep", day="13", volume="10", number="9", pages="e31211", keywords="migrant live-in caregiver", keywords="women", keywords="mental health", keywords="acceptance commitment therapy", keywords="resiliency", keywords="empowerment", abstract="Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective: The Women Empowerment - Caregiver Acceptance \& Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants' satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale -- Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID): DERR1-10.2196/31211 ", doi="10.2196/31211", url="https://www.researchprotocols.org/2021/9/e31211", url="http://www.ncbi.nlm.nih.gov/pubmed/34515642" } @Article{info:doi/10.2196/30564, author="Zurynski, Yvonne and Ellis, A. Louise and Tong, Ly Huong and Laranjo, Liliana and Clay-Williams, Robyn and Testa, Luke and Meulenbroeks, Isabelle and Turton, Charmaine and Sara, Grant", title="Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review", journal="JMIR Ment Health", year="2021", month="Sep", day="7", volume="8", number="9", pages="e30564", keywords="electronic medical records", keywords="health information technology", keywords="implementation", keywords="mental health", abstract="Background: The success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field. Objective: We intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes. Methods: The scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Results: This review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed; the primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs. Conclusions: The body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps. ", doi="10.2196/30564", url="https://mental.jmir.org/2021/9/e30564", url="http://www.ncbi.nlm.nih.gov/pubmed/34491208" } @Article{info:doi/10.2196/21348, author="Kobori, Osamu and Yoshinaga, Naoki", title="Investigation of the Effects of an Online Support Group for Mental Health Problems on Stigma and Help-Seeking Among Japanese Adults: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="Sep", day="7", volume="5", number="9", pages="e21348", keywords="online support group", keywords="mental health", keywords="depression", keywords="stigma", keywords="help-seeking", abstract="Background: Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief--related outcomes. Objective: This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation. Methods: A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire. Results: Regarding the therapy received, 88\% (308/350) of participants had taken medication for mental health problems, and 66.6\% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7\% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions. Conclusions: It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful. ", doi="10.2196/21348", url="https://formative.jmir.org/2021/9/e21348", url="http://www.ncbi.nlm.nih.gov/pubmed/34491206" } @Article{info:doi/10.2196/28849, author="Kr{\"u}ckl, Sophia Jana and Moeller, Julian and Gaupp, Rainer and Meier, E. Christoph and Roth, B{\'e}n{\'e}dict Carl and Lang, Emmi Undine and Huber, G. Christian", title="Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report", journal="JMIR Ment Health", year="2021", month="Sep", day="1", volume="8", number="9", pages="e28849", keywords="home office", keywords="psychiatry", keywords="employees", keywords="mental health", keywords="depression", keywords="anxiety", keywords="stress factors", keywords="Patient Health Questionnaire", keywords="PHQ-2", keywords="General Anxiety Disorder", keywords="GAD-2", keywords="PHQ-D", keywords="COVID-19", keywords="pandemic", abstract="Background: During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. Objective: The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees' mental health in a large psychiatric university hospital in Switzerland. Methods: We obtained and analyzed home office implementation and use data from the psychiatric university hospital's information technology services. We also conducted a cross-sectional web-based survey to assess the employees' attitudes toward the clinic's crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]--2), anxiety (General Anxiety Disorder [GAD]--2), and stress factors (stress module of the PHQ-D); a cut-off score ?3 was used for the PHQ-2 and GAD-2. Results: Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5\%). Home office use differed significantly across professional groups ($\chi$162=72.72, P?.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use ($\chi$42=9.72, P=.04). Conclusions: In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees' work--life balance, to save employers costs and foster other benefits. ", doi="10.2196/28849", url="https://mental.jmir.org/2021/9/e28849", url="http://www.ncbi.nlm.nih.gov/pubmed/34115606" } @Article{info:doi/10.2196/25592, author="Fung, Kenneth and Cheng, Sheng-Li and Ning, Xuan and Li, Tai-Wai Alan and Zhang, Jingxuan and Liu, Jing-Wen Jenny and Hilario, T. Carla and Cheng, Xiaojing and Yu, Miao and Jia, Cun-Xian and Gao, Jianguo and Wong, Pui-Hing Josephine", title="Mental Health Promotion and Stigma Reduction Among University Students Using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) Framework: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="26", volume="10", number="8", pages="e25592", keywords="China", keywords="implementation science", keywords="intervention", keywords="mental health", keywords="stigma reduction", keywords="university students", abstract="Background: Rapid urbanization, academic pressures, and developmental life transition stressors contribute to mental health stress for postsecondary students in China. Effective prevention, early identification, and timely intervention are challenged by stigma, a lack of mental health literacy, and inadequate mental health resources. Objective: Our implementation science (IS) research project is aimed at evaluating the use of an evidence-informed mental health promotion intervention named Acceptance and Commitment to Empowerment -- Linking Youth and `Xin' (hearts) (ACE-LYNX) to promote university student mental health in Jinan, China. Methods: We will engage and collaborate with Shandong Mental Health Center, the provincial mental health center, and six local universities in different regions of Jinan. The ACE-LYNX intervention aims to reduce social stigma against mental illness, enhance mental health literacy, and improve access to quality mental health care by increasing interdisciplinary collaboration and forming a mental health network. It is based on two evidence-based approaches, Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP), and it will be delivered through online learning and in-person group training. The project will train 90 interdisciplinary professionals using the model. They will in turn train 15 professionals and 20 students at each university. The project will adopt the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which provides a structure to examine the process and outcomes of implementation using mixed methods comprising quantitative and qualitative approaches along five dimensions: reach, efficacy, adoption, implementation, and maintenance. Results: Over the course of the project, 720 champions will be directly trained. They will contribute to developing a formal and informal mental health network, strengthened by student-led mental health initiatives and professional-led initiatives to promote collaborative care and facilitated care pathways. We anticipate that our project will reach out to 11,000 to 18,000 students. Conclusions: This IS protocol will outline our unique intervention model and key steps to contextualize, implement, and evaluate community-based mental health intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/25592 ", doi="10.2196/25592", url="https://www.researchprotocols.org/2021/8/e25592", url="http://www.ncbi.nlm.nih.gov/pubmed/34435956" } @Article{info:doi/10.2196/27379, author="Knapp, A. Ashley and Cohen, Katherine and Nicholas, Jennifer and Mohr, C. David and Carlo, D. Andrew and Skerl, J. Joshua and Lattie, G. Emily", title="Integration of Digital Tools Into Community Mental Health Care Settings That Serve Young People: Focus Group Study", journal="JMIR Ment Health", year="2021", month="Aug", day="19", volume="8", number="8", pages="e27379", keywords="digital mental health", keywords="treatment", keywords="young people", keywords="children", keywords="adolescents", keywords="community mental health care", keywords="mobile phone", abstract="Background: Digital mental health tools have substantial potential to be easily integrated into people's lives and fundamentally impact public health. Such tools can extend the reach and maximize the impact of mental health interventions. Before implementing digital tools in new settings, it is critical to understand what is important to organizations and individuals who will implement and use these tools. Given that young people are highly familiar with technology and many mental health concerns emerge in childhood and adolescence, it is especially crucial to understand how digital tools can be integrated into settings that serve young people. Objective: This study aims to learn about considerations and perspectives of community behavioral health care providers on incorporating digital tools into their clinical care for children and adolescents. Methods: Data were analyzed from 5 focus groups conducted with clinicians (n=37) who work with young people at a large community service organization in the United States. This organization provides care to more than 27,000 people annually, most of whom are of low socioeconomic status. The transcripts were coded using thematic analysis. Results: Clinicians first provided insight into the digital tools they were currently using in their treatment sessions with young people, such as web-based videos and mood-tracking apps. They explained that their main goals in using these tools were to help young people build skills, facilitate learning, and monitor symptoms. Benefits were expressed, such as engagement of adolescents in treatment, along with potential challenges (eg, accessibility and limited content) and developmental considerations (eg, digital devices getting taken away as punishment). Clinicians discussed their desire for a centralized digital platform that securely connects the clinician, young person, and caregivers. Finally, they offered several considerations for integrating digital tools into mental health care, such as setting up expectations with clients and the importance of human support. Conclusions: Young people have unique considerations related to complex accessibility patterns and technology expectations that may not be observed when adults are the intended users of mental health technologies. Therefore, these findings provide critical insights to inform the development of future tools, specifically regarding connectivity, conditional restraints (eg, devices taken away as punishment and school restrictions), expectations of users from different generations, and the blended nature in which digital tools can support young people. ", doi="10.2196/27379", url="https://mental.jmir.org/2021/8/e27379", url="http://www.ncbi.nlm.nih.gov/pubmed/34420928" } @Article{info:doi/10.2196/26700, author="Gehri, Beatrice and Bachnick, Stefanie and Schwendimann, Ren{\'e} and Simon, Michael", title="Matching Registered Nurse Services With Changing Care Demands in Psychiatric Hospitals: Protocol for a Multicenter Observational Study (MatchRN Psychiatry Study)", journal="JMIR Res Protoc", year="2021", month="Aug", day="17", volume="10", number="8", pages="e26700", keywords="quality of care", keywords="psychiatric hospitals", keywords="nurses", keywords="patient routine data", keywords="work environment", keywords="Switzerland", abstract="Background: The quality of care is often poorly assessed in mental health settings, and accurate evaluation requires the monitoring and comparison of not only the outcomes but also the structures and processes. The resulting data allow hospital administrators to compare their patient outcome data against those reported nationally. As Swiss psychiatric hospitals are planned and coordinated at the cantonal level, they vary considerably. In addition, nursing care structures and processes, such as nurse staffing, are only reported and aggregated at the national level, whereas nurse outcomes, such as job satisfaction or intention to leave, have yet to be assessed in Swiss psychiatric hospitals. Because they lack these key figures, psychiatric hospitals' quality of care cannot be reasonably described. Objective: This study's purpose is to describe health care quality by exploring hospital structures such as nurse staffing and the work environment; processes such as the rationing of care; nurse outcomes, including job satisfaction and work-life balance; and patients' symptom burden. Methods: MatchRN Psychiatry is a multicenter observational study of Swiss psychiatric hospitals. The sample for this study included approximately 1300 nurses from 113 units of 13 psychiatric hospitals in Switzerland's German-speaking region. In addition, routine patient assessment data from each participating hospital were included. The nurse survey consisted of 164 items covering three dimensions---work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses' education levels. Routine patient data included items such as main diagnosis, the number and duration of freedom-restrictive measures, and symptom burden at admission and discharge. Data were collected between September 2019 and June 2021. The data will be analyzed descriptively by using multilevel regression linear mixed models and generalized linear mixed models to explore associations between variables of interest. Results: The response rate from the nurse survey was 71.49\% (1209/1691). All data are currently being checked for consistency and plausibility. The MatchRN Psychiatry study is funded by the participating psychiatric hospitals and the Swiss Psychiatric Nursing Leaders Association (Vereinigung Pflegekader Psychiatrie Schweiz). Conclusions: For the first time, the MatchRN Psychiatry study will systematically evaluate the quality of care in psychiatric hospitals in Switzerland in terms of organizational structures, processes, and patient and nurse outcomes. The participating psychiatric hospitals will benefit from findings that are relevant to the future planning of nurse staffing. The findings of this study will contribute to improvement strategies for nurses' work environments and patient experiences in Swiss psychiatric hospitals. International Registered Report Identifier (IRRID): DERR1-10.2196/26700 ", doi="10.2196/26700", url="https://www.researchprotocols.org/2021/8/e26700", url="http://www.ncbi.nlm.nih.gov/pubmed/34402796" } @Article{info:doi/10.2196/28555, author="Kozelka, Elizabeth Ellen and Jenkins, H. Janis and Carpenter-Song, Elizabeth", title="Advancing Health Equity in Digital Mental Health: Lessons From Medical Anthropology for Global Mental Health", journal="JMIR Ment Health", year="2021", month="Aug", day="16", volume="8", number="8", pages="e28555", keywords="qualitative methods", keywords="digital health", keywords="mental health", keywords="health equity", doi="10.2196/28555", url="https://mental.jmir.org/2021/8/e28555", url="http://www.ncbi.nlm.nih.gov/pubmed/34398788" } @Article{info:doi/10.2196/26369, author="Smith-MacDonald, Lorraine and Jones, Chelsea and Sevigny, Phillip and White, Allison and Laidlaw, Alexa and Voth, Melissa and Mikolas, Cynthia and Heber, Alexandra and Greenshaw, J. Andrew and Br{\'e}mault-Phillips, Suzette", title="The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis", journal="JMIR Form Res", year="2021", month="Aug", day="12", volume="5", number="8", pages="e26369", keywords="trauma", keywords="mental health", keywords="telemedicine", keywords="therapy", keywords="rehabilitation", keywords="digital health", keywords="psychotherapy", keywords="military", keywords="veteran", keywords="first responder", keywords="public safety personnel", keywords="teletherapy", keywords="telepsychiatry", keywords="mobile phone", abstract="Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants' responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers' perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. ", doi="10.2196/26369", url="https://formative.jmir.org/2021/8/e26369", url="http://www.ncbi.nlm.nih.gov/pubmed/34387549" } @Article{info:doi/10.2196/25650, author="Rauschenberg, Christian and Boecking, Benjamin and Paetzold, Isabell and Schruers, Koen and Schick, Anita and van Amelsvoort, Th{\'e}r{\`e}se and Reininghaus, Ulrich", title="A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study", journal="JMIR Ment Health", year="2021", month="Aug", day="5", volume="8", number="8", pages="e25650", keywords="mental health", keywords="adolescent psychopathology", keywords="digital interventions", keywords="mobile health", keywords="self-compassion", keywords="ecological momentary assessment", keywords="mobile phone", abstract="Background: Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective: This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods: In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results: In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80\%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions: Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. ", doi="10.2196/25650", url="https://mental.jmir.org/2021/8/e25650", url="http://www.ncbi.nlm.nih.gov/pubmed/34383687" } @Article{info:doi/10.2196/17910, author="Simonsson, Olivia and Engberg, Hedvig and Bjureberg, Johan and Lj{\'o}tsson, Brj{\'a}nn and Stensils, Julia and Sahlin, Hanna and Hellner, Clara", title="Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study", journal="JMIR Form Res", year="2021", month="Jul", day="23", volume="5", number="7", pages="e17910", keywords="nonsuicidal self-injury", keywords="self-injurious behavior", keywords="online treatment", keywords="internet", keywords="digital health", keywords="emotion regulation", keywords="emotion regulation individual therapy for adolescents", keywords="adolescent", keywords="qualitative", keywords="experience", abstract="Background: Nonsuicidal self-injury (NSSI) is common in adolescence and is associated with several adverse outcomes. Despite this, few established treatment options exist. Online treatment seems promising for several conditions; however, knowledge on NSSI is scarce. It is important to explore how online treatment for NSSI is experienced to improve such interventions and learn more about factors that are important in the treatment of adolescents with NSSI. Objective: This study aims to explore the experiences of a novel online treatment for adolescents with NSSI and their caregivers. Methods: A qualitative study using thematic analysis was conducted through semistructured interviews with 9 adolescents and 11 caregivers at treatment termination or at the 6-month follow-up of the online emotion regulation individual therapy for adolescents. Results: A total of 3 overarching themes were identified. The theme support can come in different shapes showed how support could be attained through both interaction with the therapist as well as through the format itself (such as through the fictional characters in the material and the mobile app). Caregivers found it helpful to have their own online course, and adolescents accepted their involvement. The theme self-responsibility can be empowering as well as distressing showed that self-responsibility was highly appreciated (such as deciding when and how to engage in treatment) but also challenging; it caused occasional distress for some. The theme acquiring new skills and treatment effects showed the advantages and challenges of learning several different emotion regulation skills and that decreased emotion regulation difficulties were important treatment outcomes for adolescents. In addition, several different skills seemed to facilitate emotion regulation, and having access to such skills could hinder NSSI. Conclusions: Online emotion regulation individual therapy for adolescents seems to offer an accepted way to deliver family interventions for this target group; facilitate skills training with several means of support, including support from both the mobile app and the therapist; contribute to decreasing emotion regulation difficulties and teaching skills that could hinder NSSI; and cause (in some individuals) distress because of the self-responsibility that is inherent to online formats, which needs to be addressed. ", doi="10.2196/17910", url="https://formative.jmir.org/2021/7/e17910", url="http://www.ncbi.nlm.nih.gov/pubmed/34297001" } @Article{info:doi/10.2196/25836, author="Mundt, P. Adrian and Irarr{\'a}zaval, Mat{\'i}as and Mart{\'i}nez, Pablo and Fern{\'a}ndez, Olga and Mart{\'i}nez, Vania and Rojas, Graciela", title="Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study", journal="JMIR Public Health Surveill", year="2021", month="Jul", day="22", volume="7", number="7", pages="e25836", keywords="telemedicine", keywords="psychiatry", keywords="primary health care", keywords="child protective services", abstract="Background: Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities. Objective: The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services. Methods: We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valpara{\'i}so Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program. Results: During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions. Conclusions: The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation. ", doi="10.2196/25836", url="https://publichealth.jmir.org/2021/7/e25836", url="http://www.ncbi.nlm.nih.gov/pubmed/34292164" } @Article{info:doi/10.2196/30334, author="Philipp-Muller, Emile Aaron and Reshetukha, Taras and Vazquez, Gustavo and Milev, Roumen and Armstrong, Dawn and Jagayat, Jasleen and Alavi, Nazanin", title="Combining Ketamine and Internet-Based Cognitive Behavioral Therapy for the Treatment of Posttraumatic Stress Disorder: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="20", volume="10", number="7", pages="e30334", keywords="mental health", keywords="PTSD", keywords="psychotherapy", keywords="cognitive behavioral therapy", keywords="online", keywords="internet", keywords="electronic", keywords="virtual", keywords="mental health care", keywords="ketamine", abstract="Background: Over one third of patients with posttraumatic stress disorder (PTSD) do not respond to current interventions. Ketamine presents a potential treatment option; however, its effects are temporary. Administering ketamine alongside psychotherapy is one potential means of prolonging its effects; however, only a few studies have investigated this treatment method to date, and none have tested ketamine with internet-based or electronically delivered cognitive behavioral therapy (e-CBT). Objective: This open-label randomized controlled trial aims to assess the efficacy of a combined treatment method of subanesthetic intravenous ketamine and e-CBT for treating patients with PTSD. Methods: In total, 20 patients with refractory PTSD recruited from a community clinic will be randomly assigned to either an experimental group (n=10), receiving a combination of ketamine and therapist-administered e-CBT over 14 weeks, or a waitlist control group (n=10), receiving the experimental treatment after 14 weeks. Both groups will be assessed for the symptoms of PTSD and comorbid disorders before treatment, at two midway points, and at the end of the experiment. Results: PTSD symptoms of participants in the experimental group are expected to improve significantly more than those of participants in the waitlist control group (P=.05) with a large effect size ($\eta$2=0.14). Conclusions: This is the first study to assess the relationship between e-CBT and ketamine and their combined ability to treat refractory PTSD. If successful, this study will open web-based, asynchronous therapeutic options for patients with PTSD and will provide new insights into the functional role of glutamate in trauma-related disorders as well as in learning, memory, and fear extinction. Trial Registration: ClinicalTrials.gov NCT04771767; https://clinicaltrials.gov/ct2/show/NCT04771767. International Registered Report Identifier (IRRID): PRR1-10.2196/30334 ", doi="10.2196/30334", url="https://www.researchprotocols.org/2021/7/e30334", url="http://www.ncbi.nlm.nih.gov/pubmed/34092549" } @Article{info:doi/10.2196/16949, author="Eccles, Heidi and Nannarone, Molly and Lashewicz, Bonnie and Attridge, Mark and Marchand, Alain and Aiken, Alice and Ho, Kendall and Wang, JianLi", title="Barriers to the Use of Web-Based Mental Health Programs for Preventing Depression: Qualitative Study", journal="JMIR Form Res", year="2021", month="Jul", day="15", volume="5", number="7", pages="e16949", keywords="prevention", keywords="mental health", keywords="depression", keywords="problem solving therapy", keywords="barriers", keywords="web-based program", keywords="qualitative study", abstract="Background: Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. Objective: The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. Methods: BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e--mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth---the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2\%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7\%). Semistructured interviews were performed with the participants (70/847, 8.3\%) and analyzed using content analysis. Results: There were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants' engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms. Conclusions: There are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention. ", doi="10.2196/16949", url="https://formative.jmir.org/2021/7/e16949", url="http://www.ncbi.nlm.nih.gov/pubmed/34264195" } @Article{info:doi/10.2196/23091, author="Treanor, J. Charlene and Kouvonen, Anne and Lallukka, Tea and Donnelly, Michael", title="Acceptability of Computerized Cognitive Behavioral Therapy for Adults: Umbrella Review", journal="JMIR Ment Health", year="2021", month="Jul", day="6", volume="8", number="7", pages="e23091", keywords="computerized/internet cognitive behavioral therapy", keywords="cCBT", keywords="iCBT", keywords="acceptability", keywords="mental health", keywords="umbrella review", abstract="Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34\% of guided and 36\% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8\%-74\% of the participants, while 94\% completed one module and 67\%-84\% completed some modules. Unguided cCBT was completed in full by 16\%-66\% of participants, while 95\% completed one module and 54\%-93\% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one's own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users' preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that ``one size did not fit all'' regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health. ", doi="10.2196/23091", url="https://mental.jmir.org/2021/7/e23091", url="http://www.ncbi.nlm.nih.gov/pubmed/34255714" } @Article{info:doi/10.2196/29538, author="Sung, Y. Jenna and Mumper, Emma and Schleider, Lee Jessica", title="Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation", journal="JMIR Ment Health", year="2021", month="Jul", day="6", volume="8", number="7", pages="e29538", keywords="acceptability", keywords="adolescent mental health", keywords="adolescent", keywords="anxiety", keywords="avoidance", keywords="behavior", keywords="child mental health", keywords="children", keywords="digital mental health", keywords="intervention", keywords="mental health", keywords="parent", keywords="prevention", keywords="young adult", abstract="Background: A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions---particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children---for instance, by mitigating known anxiety risk factors---remains unexplored. Objective: This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods: In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results: Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions: Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration: ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9 ", doi="10.2196/29538", url="https://mental.jmir.org/2021/7/e29538", url="http://www.ncbi.nlm.nih.gov/pubmed/34255718" } @Article{info:doi/10.2196/25331, author="Iorfino, Frank and Occhipinti, Jo-An and Skinner, Adam and Davenport, Tracey and Rowe, Shelley and Prodan, Ante and Sturgess, Julie and Hickie, B. Ian", title="The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model", journal="J Med Internet Res", year="2021", month="Jun", day="30", volume="23", number="6", pages="e25331", keywords="medical informatics", keywords="internet", keywords="care coordination", keywords="complex systems", keywords="simulation", keywords="health systems", keywords="policy", keywords="mental health", abstract="Background: Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. Objective: This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. Methods: A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health--related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20\%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre-- and post--COVID-19 social and economic conditions. Results: Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71\% (95\% interval 5.63\%-7.87\%), mental health--related ED presentations by 10.33\% (95\% interval 8.58\%-12.19\%), and the prevalence of high psychological distress by 1.76 percentage points (95\% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20\% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post--COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. Conclusions: The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20\% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed. ", doi="10.2196/25331", url="https://www.jmir.org/2021/6/e25331", url="http://www.ncbi.nlm.nih.gov/pubmed/34077384" } @Article{info:doi/10.2196/25998, author="Williams, Anne and Fossey, Ellie and Farhall, John and Foley, Fiona and Thomas, Neil", title="Impact of Jointly Using an e--Mental Health Resource (Self-Management And Recovery Technology) on Interactions Between Service Users Experiencing Severe Mental Illness and Community Mental Health Workers: Grounded Theory Study", journal="JMIR Ment Health", year="2021", month="Jun", day="16", volume="8", number="6", pages="e25998", keywords="digital mental health", keywords="tablet computers", keywords="therapeutic relationship", keywords="recovery narratives", keywords="lived experience video", keywords="personal recovery", keywords="schizophrenia", keywords="mobile phone", abstract="Background: e--Mental health resources are increasingly available for people who experience severe mental illness, including those who are users of community mental health services. However, the potential for service users (SUs) living with severe mental illness to use e--mental health resources together with their community mental health workers (MHWs) has received little attention. Objective: This study aims to identify how jointly using an interactive website called Self-Management And Recovery Technology (SMART) in a community mental health context influenced therapeutic processes and interactions between SUs and MHWs from their perspective. Methods: We conducted a qualitative study using a constructivist grounded theory methodology. Data were collected through individual semistructured interviews with 37 SUs and 15 MHWs who used the SMART website together for 2 to 6 months. Data analysis involved iterative phases of coding, constant comparison, memo writing, theoretical sampling, and consultation with stakeholders to support the study's credibility. Results: A substantive grounded theory, discovering ways to keep life on track, was developed, which portrays a shared discovery process arising from the SU-worker-SMART website interactions. The discovery process included choosing to use the website, revealing SUs' experiences, exploring these experiences, and gaining new perspectives on how SUs did and could keep their lives on track. SUs and MHWs perceived that their three-way interactions were enjoyable, beneficial, and recovery focused when using the website together. They experienced the shared discovery process as relationship building---their interactions when using the website together were more engaging and equal. Conclusions: Jointly using an e--mental health resource elicited recovery-oriented interactions and processes between SUs and MHWs that strengthened their therapeutic relationship in real-world community mental health services. Further work to develop and integrate this novel use of e--mental health in community mental health practice is warranted. ", doi="10.2196/25998", url="https://mental.jmir.org/2021/6/e25998", url="http://www.ncbi.nlm.nih.gov/pubmed/34132647" } @Article{info:doi/10.2196/15527, author="G{\'o}ngora Alonso, Susel and de Bustos Molina, Andr{\'e}s and Sainz-De-Abajo, Beatriz and Franco-Mart{\'i}n, Manuel and De la Torre D{\'i}ez, Isabel", title="Analysis of Mental Health Disease Trends Using BeGraph Software in Spanish Health Care Centers: Case Study", journal="JMIR Med Inform", year="2021", month="Jun", day="16", volume="9", number="6", pages="e15527", keywords="BeGraph software", keywords="diseases", keywords="health care complexes", keywords="mental health", keywords="visualization", abstract="Background: In the era of big data, networks are becoming a popular factor in the field of data analysis. Networks are part of the main structure of BeGraph software, which is a 3D visualization application dedicated to the analysis of complex networks. Objective: The main objective of this research was to visually analyze tendencies of mental health diseases in a region of Spain, using the BeGraph software, in order to make the most appropriate health-related decisions in each case. Methods: For the study, a database was used with 13,531 records of patients with mental health disorders in three acute medical units from different health care complexes in a region of Spain. For the analysis, BeGraph software was applied. It is a web-based 3D visualization tool that allows the exploration and analysis of data through complex networks. Results: The results obtained with the BeGraph software allowed us to determine the main disease in each of the health care complexes evaluated. We noted 6.50\% (463/7118) of admissions involving unspecified paranoid schizophrenia at the University Clinic of Valladolid, 9.62\% (397/4128) of admissions involving chronic paranoid schizophrenia with acute exacerbation at the Zamora Hospital, and 8.84\% (202/2285) of admissions involving dysthymic disorder at the Rio Hortega Hospital in Valladolid. Conclusions: The data analysis allowed us to focus on the main diseases detected in the health care complexes evaluated in order to analyze the behavior of disorders and help in diagnosis and treatment. ", doi="10.2196/15527", url="https://medinform.jmir.org/2021/6/e15527", url="http://www.ncbi.nlm.nih.gov/pubmed/34132650" } @Article{info:doi/10.2196/27489, author="Alavi, Nazanin and Stephenson, Callum and Yang, Megan and Kumar, Anchan and Shao, Yijia and Miller, Shad{\'e} and Yee, S. Caitlin and Stefatos, Anthi and Gholamzadehmir, Maedeh and Abbaspour, Zara and Jagayat, Jasleen and Shirazi, Amirhossein and Omrani, Mohsen and Patel, Archana and Patel, Charmy and Groll, Dianne", title="Feasibility and Efficacy of Delivering Cognitive Behavioral Therapy Through an Online Psychotherapy Tool for Depression: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jun", day="16", volume="10", number="6", pages="e27489", keywords="mental health", keywords="depression", keywords="psychotherapy", keywords="cognitive behavioral therapy", keywords="online", keywords="internet", keywords="electronic", keywords="virtual", keywords="mental health care", abstract="Background: Major depressive disorder (MDD) is a prevalent and debilitating mental health disorder. Among different therapeutic approaches (eg, medication and psychotherapy), psychotherapy in the form of cognitive behavioral therapy (CBT) is considered the gold standard treatment for MDD. However, although efficacious, CBT is not readily accessible to many patients in need because of hurdles such as stigma, long wait times, high cost, the large time commitment for health care providers, and cultural or geographic barriers. Electronically delivered cognitive behavioral therapy (e-CBT) can effectively address many of these accessibility barriers. Objective: This study aims to investigate the efficacy and feasibility of implementing an e-CBT program compared with in-person treatment for MDD. It is hypothesized that the e-CBT program will offer results comparable with those of the in-person treatment program, regarding symptom reduction and quality of life improvement. Methods: This nonrandomized controlled trial intervention will provide e-CBT for MDD through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants (aged 18-65 years) will be offered 12 weekly sessions of an e-CBT program tailored to MDD to address their depressive symptoms. Participants (n=55) will complete predesigned modules and homework assignments while receiving personalized feedback and interacting with a therapist through the platform. Using clinically validated symptomology questionnaires, the efficacy of the e-CBT program will be compared with that of a group (n=55) receiving in-person CBT. Questionnaires will be completed at baseline, at week 6 and week 12, and at a 6-month follow-up. Focus groups will be conducted to investigate personal, cultural, and social factors impacting the accessibility and feasibility of implementing a web-based psychotherapy tool from a patient and care provider perspective. Inclusion criteria include diagnosis of MDD, competence to consent to participate, ability to speak and read English, and consistent and reliable access to the internet. Exclusion criteria include active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. Results: Ethics approval was obtained in January 2019, and recruitment of participants began in June 2019. Recruitment has been conducted via social media, web-based communities, and physician referrals. To date, 52 participants have been recruited to the e-CBT group, and 48 patients have been recruited to the in-person CBT group. Data collection is expected to be completed by March 2021, and analyses are expected to be completed by June 2021, as linear regression (for continuous outcomes) and binomial regression analysis (for categorical outcomes) are still being conducted. Conclusions: The results of this study can provide valuable information for the development of more accessible and scalable mental health interventions with increased care capacity for MDD, without sacrificing the quality of care. Trial Registration: ClinicalTrials.gov NCT04478058; http://clinicaltrials.gov/ct2/show/NCT04478058 International Registered Report Identifier (IRRID): DERR1-10.2196/27489 ", doi="10.2196/27489", url="https://www.researchprotocols.org/2021/6/e27489", url="http://www.ncbi.nlm.nih.gov/pubmed/33990076" } @Article{info:doi/10.2196/24115, author="Taylor Salisbury, Tatiana and Kohrt, A. Brandon and Bakolis, Ioannis and Jordans, JD Mark and Hull, Louise and Luitel, P. Nagendra and McCrone, Paul and Sevdalis, Nick and Pokhrel, Pooja and Carswell, Kenneth and Ojagbemi, Akin and Green, P. Eric and Chowdhary, Neerja and Kola, Lola and Lempp, Heidi and Dua, Tarun and Milenova, Maria and Gureje, Oye and Thornicroft, Graham", title="Adaptation of the World Health Organization Electronic Mental Health Gap Action Programme Intervention Guide App for Mobile Devices in Nepal and Nigeria: Protocol for a Feasibility Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jun", day="15", volume="10", number="6", pages="e24115", keywords="mental health", keywords="community mental health", keywords="digital technology", keywords="primary health care", keywords="intervention", keywords="eHealth", keywords="mHealth", keywords="LMIC", keywords="remote supervision", keywords="training", keywords="mobile phone", abstract="Background: There is a growing global need for scalable approaches to training and supervising primary care workers (PCWs) to deliver mental health services. Over the past decade, the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) and associated training and implementation guidance have been disseminated to more than 100 countries. On the basis of the opportunities provided by mobile technology, an updated electronic Mental Health Gap Action Programme Intervention Guide (e-mhGAP-IG) is now being developed along with a clinical dashboard and guidance for the use of mobile technology in supervision. Objective: This study aims to assess the feasibility, acceptability, adoption, and other implementation parameters of the e-mhGAP-IG for diagnosis and management of depression in 2 lower-middle-income countries (Nepal and Nigeria) and to conduct a feasibility cluster randomized controlled trial (cRCT) to evaluate trial procedures for a subsequent fully powered trial comparing the clinical effectiveness and cost-effectiveness of the e-mhGAP-IG and remote supervision with standard mhGAP-IG implementation. Methods: A feasibility cRCT will be conducted in Nepal and Nigeria to evaluate the feasibility of the e-mhGAP-IG for use in depression diagnosis and treatment. In each country, an estimated 20 primary health clinics (PHCs) in Nepal and 6 PHCs in Nigeria will be randomized to have their staff trained in e-mhGAP-IG or the paper version of mhGAP-IG v2.0. The PHC will be the unit of clustering. All PCWs within a facility will receive the same training (e-mhGAP-IG vs paper mhGAP-IG). Approximately 2-5 PCWs, depending on staffing, will be recruited per clinic (estimated 20 health workers per arm in Nepal and 15 per arm in Nigeria). The primary outcomes of interest will be the feasibility and acceptability of training, supervision, and care delivery using the e-mhGAP-IG. Secondary implementation outcomes include the adoption of the e-mhGAP-IG and feasibility of trial procedures. The secondary intervention outcome---and the primary outcome for a subsequent fully powered trial---will be the accurate identification of depression by PCWs. Detection rates before and after training will be compared in each arm. Results: To date, qualitative formative work has been conducted at both sites to prepare for the pilot feasibility cRCT, and the e-mhGAP-IG and remote supervision guidelines have been developed. Conclusions: The incorporation of mobile digital technology has the potential to improve the scalability of mental health services in primary care and enhance the quality and accuracy of care. Trial Registration: ClinicalTrials.gov NCT04522453; https://clinicaltrials.gov/ct2/show/NCT04522453. International Registered Report Identifier (IRRID): PRR1-10.2196/24115 ", doi="10.2196/24115", url="https://www.researchprotocols.org/2021/6/e24115", url="http://www.ncbi.nlm.nih.gov/pubmed/34128819" } @Article{info:doi/10.2196/24697, author="Dohnt, C. Henriette and Dowling, J. Mitchell and Davenport, A. Tracey and Lee, Grace and Cross, P. Shane and Scott, M. Elizabeth and Song, C. Yun Ju and Hamilton, Blake and Hockey, J. Samuel and Rohleder, Cathrin and LaMonica, M. Haley and Hickie, B. Ian", title="Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study", journal="JMIR Res Protoc", year="2021", month="Jun", day="14", volume="10", number="6", pages="e24697", keywords="mental health service delivery", keywords="youth mental health", keywords="model of care coordination", keywords="transdiagnostic", keywords="health information technology", keywords="education", keywords="training", keywords="adoption into clinical practice", keywords="Kirkpatrick evaluation", abstract="Background: Australia's mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney's Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC's Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. Objective: This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. Methods: The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. Results: This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District's Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. Conclusions: The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. International Registered Report Identifier (IRRID): PRR1-10.2196/24697 ", doi="10.2196/24697", url="https://www.researchprotocols.org/2021/6/e24697", url="http://www.ncbi.nlm.nih.gov/pubmed/34125074" } @Article{info:doi/10.2196/27022, author="Stafford, Elizabeth and Brister, Teri and Duckworth, Ken and Rauseo-Ricupero, Natali and Lagan, Sarah", title="Needs and Experiences of Users of Digital Navigation Tools for Mental Health Treatment and Supportive Services: Survey Study", journal="JMIR Ment Health", year="2021", month="Jun", day="9", volume="8", number="6", pages="e27022", keywords="mental health", keywords="supportive services", keywords="perception", keywords="quality", keywords="satisfaction", keywords="needs", keywords="digital tools", keywords="directories", keywords="navigation", abstract="Background: Despite a recent proliferation in web-based and digital resources that are designed to assist users in finding appropriate mental health treatment and supportive services, it can be overwhelming, confusing, and difficult for an individual or family member to access and use an appropriate navigation tool. As digital resources are increasingly sought after, there is an urgent need for a clearer understanding of digital navigation tools in order to help link individuals with the tool that is best suited to their needs. Objective: The objective of this study was to determine the needs of individuals seeking mental health treatment and supportive services and to quantify their experiences and satisfaction with available digital navigation tools. Methods: A survey was offered via an email newsletter and social media posting throughout the extended membership of the National Alliance on Mental Illness, which includes both individuals with a mental health condition and their family members and support networks. A 13-item anonymous survey, which consisted of multiple-choice and open response options, was developed to measure participants' past use of and experiences with web-based, mobile, and phone-based navigation tools. The survey was available from April 9 through May 21, 2020. Results: A total of 478 respondents completed the survey; the majority of respondents were female (397/478, 83.1\%) and aged ?35 years (411/478, 86\%). Younger respondents were more likely to report seeking mental health services for themselves, while older respondents were more likely to be searching for such services on behalf of a family member. The majority of respondents seeking such services on behalf of a family member (113/194, 58.2\%) required a combination of mental health treatment and supportive services. Furthermore, two-thirds of respondents (322/478, 67.4\%) used a navigation tool to find treatment or services. The majority of respondents who provided feedback about their experiences with navigation tools (224/280, 80\%) reported difficulties, with data availability and accuracy being the most commonly reported issues. Conclusions: The survey results suggest that issues with data availability and accuracy in available navigation tools remain a major barrier for locating timely and appropriate mental health treatment and supportive services within the population of individuals seeking such services. Particularly for individuals seeking care on behalf of a family member, improving the accuracy of and users' experiences with navigation tools could have a major impact on effectively connecting people to treatment and support services. ", doi="10.2196/27022", url="https://mental.jmir.org/2021/6/e27022", url="http://www.ncbi.nlm.nih.gov/pubmed/34106079" } @Article{info:doi/10.2196/26681, author="Blitz, Rog{\'e}rio and Storck, Michael and Baune, T. Bernhard and Dugas, Martin and Opel, Nils", title="Design and Implementation of an Informatics Infrastructure for Standardized Data Acquisition, Transfer, Storage, and Export in Psychiatric Clinical Routine: Feasibility Study", journal="JMIR Ment Health", year="2021", month="Jun", day="9", volume="8", number="6", pages="e26681", keywords="medical informatics", keywords="digital mental health", keywords="digital data collection", keywords="psychiatry", keywords="single-source metadata architecture transformation", keywords="mental health", keywords="design", keywords="implementation", keywords="feasibility", keywords="informatics", keywords="infrastructure", keywords="data", abstract="Background: Empirically driven personalized diagnostic applications and treatment stratification is widely perceived as a major hallmark in psychiatry. However, databased personalized decision making requires standardized data acquisition and data access, which are currently absent in psychiatric clinical routine. Objective: Here, we describe the informatics infrastructure implemented at the psychiatric M{\"u}nster University Hospital, which allows standardized acquisition, transfer, storage, and export of clinical data for future real-time predictive modelling in psychiatric routine. Methods: We designed and implemented a technical architecture that includes an extension of the electronic health record (EHR) via scalable standardized data collection and data transfer between EHRs and research databases, thus allowing the pooling of EHRs and research data in a unified database and technical solutions for the visual presentation of collected data and analyses results in the EHR. The Single-source Metadata ARchitecture Transformation (SMA:T) was used as the software architecture. SMA:T is an extension of the EHR system and uses module-driven engineering to generate standardized applications and interfaces. The operational data model was used as the standard. Standardized data were entered on iPads via the Mobile Patient Survey (MoPat) and the web application Mopat@home, and the standardized transmission, processing, display, and export of data were realized via SMA:T. Results: The technical feasibility of the informatics infrastructure was demonstrated in the course of this study. We created 19 standardized documentation forms with 241 items. For 317 patients, 6451 instances were automatically transferred to the EHR system without errors. Moreover, 96,323 instances were automatically transferred from the EHR system to the research database for further analyses. Conclusions: In this study, we present the successful implementation of the informatics infrastructure enabling standardized data acquisition and data access for future real-time predictive modelling in clinical routine in psychiatry. The technical solution presented here might guide similar initiatives at other sites and thus help to pave the way toward future application of predictive models in psychiatric clinical routine. ", doi="10.2196/26681", url="https://mental.jmir.org/2021/6/e26681", url="http://www.ncbi.nlm.nih.gov/pubmed/34106072" } @Article{info:doi/10.2196/24567, author="Polillo, Alexia and Voineskos, N. Aristotle and Foussias, George and Kidd, A. Sean and Sav, Andreea and Hawley, Steve and Soklaridis, Sophie and Stergiopoulos, Vicky and Kozloff, Nicole", title="Using Digital Tools to Engage Patients With Psychosis and Their Families in Research: Survey Recruitment and Completion in an Early Psychosis Intervention Program", journal="JMIR Ment Health", year="2021", month="May", day="31", volume="8", number="5", pages="e24567", keywords="digital", keywords="online", keywords="psychosis", keywords="schizophrenia", keywords="early psychosis intervention", keywords="surveys", abstract="Background: Barriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. Objective: The objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. Methods: This study used Research Electronic Data Capture (REDCap)---a secure web-based platform with built-in tools for data collection and storage---to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. Results: A total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3\%) and family members (109/187, 58.3\%) consented to participate in the survey. Most patients (182/229, 79.5\%) and family members (75/116, 64.7\%) who completed the consent form did so remotely, with more family members (41/116, 35.3\%) than patients (47/229, 20.5\%) completing it in person. Of those who consented, 77.3\% (167/216) of patients and 72.5\% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5\%) and family members (174/190, 91.6\%) requested to receive the consent form and survey by email, and only 4.1\% (19/462) and 3.2\% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5\%) and family members (42/79, 53.2\%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. Conclusions: When offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic. ", doi="10.2196/24567", url="https://mental.jmir.org/2021/5/e24567", url="http://www.ncbi.nlm.nih.gov/pubmed/34057421" } @Article{info:doi/10.2196/25708, author="Morgi{\`e}ve, Margot and Mesdjian, Pierre and Las Vergnas, Olivier and Bury, Patrick and Demassiet, Vincent and Roelandt, Jean-Luc and Sebbane, D{\'e}borah", title="Social Representations of e-Mental Health Among the Actors of the Health Care System: Free-Association Study", journal="JMIR Ment Health", year="2021", month="May", day="27", volume="8", number="5", pages="e25708", keywords="e-mental health", keywords="social representations", keywords="free association task", keywords="psychiatry", keywords="mental health", keywords="mental health service users", keywords="technology", keywords="digital health", abstract="Background: Electronic mental (e-mental) health offers an opportunity to overcome many challenges such as cost, accessibility, and the stigma associated with mental health, and most people with lived experiences of mental problems are in favor of using applications and websites to manage their mental health problems. However, the use of these new technologies remains weak in the area of mental health and psychiatry. Objective: This study aimed to characterize the social representations associated with e-mental health by all actors to implement new technologies in the best possible way in the health system. Methods: A free-association task method was used. The data were subjected to a lexicometric analysis to qualify and quantify words by analyzing their statistical distribution, using the ALCESTE method with the IRaMuTeQ software. Results: In order of frequency, the terms most frequently used to describe e-mental health in the whole corpus are: ``care'' (n=21), ``internet'' (n=21), ``computing'' (n=15), ``health'' (n=14), ``information'' (n=13), ``patient'' (n=12), and ``tool'' (n=12). The corpus of text is divided into 2 themes, with technological and computing terms on one side and medical and public health terms on the other. The largest family is focused on ``care,'' ``advances,'' ``research,'' ``life,'' ``quality,'' and ``well-being,'' which was significantly associated with users. The nursing group used very medical terms such as ``treatment,'' ``diagnosis,'' ``psychiatry'','' and ``patient'' to define e-mental health. Conclusions: This study shows that there is a gap between the representations of users on e-mental health as a tool for improving their quality of life and those of health professionals (except nurses) that are more focused on the technological potential of these digital care tools. Developers, designers, clinicians, and users must be aware of the social representation of e-mental health conditions uses and intention of use. This understanding of everyone's stakes will make it possible to redirect the development of tools to adapt them as much as possible to the needs and expectations of the actors of the mental health system. ", doi="10.2196/25708", url="https://mental.jmir.org/2021/5/e25708", url="http://www.ncbi.nlm.nih.gov/pubmed/34042591" } @Article{info:doi/10.2196/27400, author="Bantjes, Jason and Kazdin, E. Alan and Cuijpers, Pim and Breet, Elsie and Dunn-Coetzee, Munita and Davids, Charl and Stein, J. Dan and Kessler, C. Ronald", title="A Web-Based Group Cognitive Behavioral Therapy Intervention for Symptoms of Anxiety and Depression Among University Students: Open-Label, Pragmatic Trial", journal="JMIR Ment Health", year="2021", month="May", day="27", volume="8", number="5", pages="e27400", keywords="anxiety", keywords="cognitive behavioral therapy", keywords="depression", keywords="e-intervention", keywords="group therapy", keywords="web-based", keywords="university students", keywords="South Africa", abstract="Background: Anxiety and depression are common among university students, and university counseling centers are under pressure to develop effective, novel, and sustainable interventions that engage and retain students. Group interventions delivered via the internet could be a novel and effective way to promote student mental health. Objective: We conducted a pragmatic open trial to investigate the uptake, retention, treatment response, and level of satisfaction with a remote group cognitive behavioral therapy intervention designed to reduce symptoms of anxiety and depression delivered on the web to university students during the COVID-19 pandemic. Methods: Preintervention and postintervention self-reported data on anxiety and depression were collected using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Satisfaction was assessed postintervention using the Client Satisfaction with Treatment Questionnaire. Results: A total of 175 students were enrolled, 158 (90.3\%) of whom initiated treatment. Among those initiating treatment, 86.1\% (135/158) identified as female, and the mean age was 22.4 (SD 4.9) years. The mean number of sessions attended was 6.4 (SD 2.8) out of 10. Among participants with clinically significant symptoms at baseline, mean symptom scores decreased significantly for anxiety (t56=11.6; P<.001), depression (t61=7.8; P<.001), and composite anxiety and depression (t60=10.7; P<.001), with large effect sizes (d=1-1.5). Remission rates among participants with clinically significant baseline symptoms were 67.7\%-78.9\% and were not associated with baseline symptom severity. High overall levels of satisfaction with treatment were reported. Conclusions: The results of this study serve as a proof of concept for the use of web-based group cognitive behavioral therapy to promote the mental health of university students. ", doi="10.2196/27400", url="https://mental.jmir.org/2021/5/e27400", url="http://www.ncbi.nlm.nih.gov/pubmed/34042598" } @Article{info:doi/10.2196/25528, author="Charles, Ashleigh and Nixdorf, Rebecca and Ibrahim, Nashwa and Meir, Gai Lion and Mpango, S. Richard and Ngakongwa, Fileuka and Nudds, Hannah and Pathare, Soumitra and Ryan, Grace and Repper, Julie and Wharrad, Heather and Wolf, Philip and Slade, Mike and Mahlke, Candelaria", title="Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation", journal="JMIR Ment Health", year="2021", month="May", day="27", volume="8", number="5", pages="e25528", keywords="peer support work", keywords="peer support worker training", keywords="Delphi consultation", keywords="mental health", keywords="mobile phone", abstract="Background: Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. Objective: The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. Methods: A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. Results: The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). Conclusions: The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support. ", doi="10.2196/25528", url="https://mental.jmir.org/2021/5/e25528", url="http://www.ncbi.nlm.nih.gov/pubmed/34042603" } @Article{info:doi/10.2196/24044, author="Dunham, Michael C. and Burger, J. Amanda and Hileman, M. Barbara and Chance, A. Elisha and Hutchinson, E. Amy", title="Bispectral Index Alterations and Associations With Autonomic Changes During Hypnosis in Trauma Center Researchers: Formative Evaluation Study", journal="JMIR Form Res", year="2021", month="May", day="26", volume="5", number="5", pages="e24044", keywords="bispectral index", keywords="hypnosis", keywords="heart rate variability", keywords="electromyography", keywords="skin conductance", keywords="skin temperature", keywords="respiratory rate", keywords="expired carbon dioxide", keywords="neurofeedback", abstract="Background: Previous work performed by our group demonstrated that intermittent reductions in bispectral index (BIS) values were found during neurofeedback following mindfulness instructions. Hypnosis was induced to enhance reductions in BIS values. Objective: This study aims to assess physiologic relaxation and explore its associations with BIS values using autonomic monitoring. Methods: Each session consisted of reading a 4-minute baseline neutral script and playing an 18-minute hypnosis tape to 3 researchers involved in the BIS neurofeedback study. In addition to BIS monitoring, autonomic monitoring was performed, and this included measures of electromyography (EMG), skin temperature, skin conductance, respiratory rate, expired carbon dioxide, and heart rate variability. The resulting data were analyzed using two-tailed t tests, correlation analyses, and multivariate linear regression analyses. Results: We found that hypnosis was associated with reductions in BIS (P<.001), EMG (P<.001), respiratory rate (P<.001), skin conductance (P=.006), and very low frequency power (P=.04); it was also associated with increases in expired carbon dioxide (P<.001), skin temperature (P=.04), high frequency power (P<.001), and successive heart interbeat interval difference (P=.04) values. Decreased BIS values were associated with reduced EMG measures (R=0.76; P<.001), respiratory rate (R=0.35; P=.004), skin conductance (R=0.57; P<.001), and low frequency power (R=0.32; P=.01) and with increased high frequency power (R=?0.53; P<.001), successive heart interbeat interval difference (R=?0.32; P=.009), and heart interbeat interval SD (R=?0.26; P=.04) values. Conclusions: Hypnosis appeared to induce mental and physical relaxation, enhance parasympathetic neural activation, and attenuate sympathetic nervous system activity, changes that were associated with BIS values. Findings from this preliminary formative evaluation suggest that the current hypnosis model may be useful for assessing autonomic physiological associations with changes in BIS values, thus motivating us to proceed with a larger investigation in trauma center nurses and physicians. ", doi="10.2196/24044", url="https://formative.jmir.org/2021/5/e24044", url="http://www.ncbi.nlm.nih.gov/pubmed/34037529" } @Article{info:doi/10.2196/25656, author="Hawley, Steve and Yu, Joanna and Bogetic, Nikola and Potapova, Natalia and Wakefield, Chris and Thompson, Mike and Kloiber, Stefan and Hill, Sean and Jankowicz, Damian and Rotenberg, David", title="Digitization of Measurement-Based Care Pathways in Mental Health Through REDCap and Electronic Health Record Integration: Development and Usability Study", journal="J Med Internet Res", year="2021", month="May", day="20", volume="23", number="5", pages="e25656", keywords="REDCap", keywords="electronic health record", keywords="systems integration", keywords="measurement-based care", keywords="hospital information systems", abstract="Background: The delivery of standardized self-report assessments is essential for measurement-based care in mental health. Paper-based methods of measurement-based care data collection may result in transcription errors, missing data, and other data quality issues when entered into patient electronic health records (EHRs). Objective: This study aims to help address these issues by using a dedicated instance of REDCap (Research Electronic Data Capture; Vanderbilt University)---a free, widely used electronic data capture platform---that was established to enable the deployment of digitized self-assessments in clinical care pathways to inform clinical decision making. Methods: REDCap was integrated with the primary clinical information system to facilitate the real-time transfer of discrete data and PDF reports from REDCap into the EHR. Both technical and administrative components were required for complete implementation. A technology acceptance survey was also administered to capture physicians' and clinicians' attitudes toward the new system. Results: The integration of REDCap with the EHR transitioned clinical workflows from paper-based methods of data collection to electronic data collection. This resulted in significant time savings, improved data quality, and valuable real-time information delivery. The digitization of self-report assessments at each appointment contributed to the clinic-wide implementation of the major depressive disorder integrated care pathway. This digital transformation facilitated a 4-fold increase in the physician adoption of this integrated care pathway workflow and a 3-fold increase in patient enrollment, resulting in an overall significant increase in major depressive disorder integrated care pathway capacity. Physicians' and clinicians' attitudes were overall positive, with almost all respondents agreeing that the system was useful to their work. Conclusions: REDCap provided an intuitive patient interface for collecting self-report measures and accessing results in real time to inform clinical decisions and an extensible backend for system integration. The approach scaled effectively and expanded to high-impact clinics throughout the hospital, allowing for the broad deployment of complex workflows and standardized assessments, which led to the accumulation of harmonized data across clinics and care pathways. REDCap is a flexible tool that can be effectively leveraged to facilitate the automatic transfer of self-report data to the EHR; however, thoughtful governance is required to complement the technical implementation to ensure that data standardization, data quality, patient safety, and privacy are maintained. ", doi="10.2196/25656", url="https://www.jmir.org/2021/5/e25656", url="http://www.ncbi.nlm.nih.gov/pubmed/34014169" } @Article{info:doi/10.2196/27868, author="Darcy, Alison and Daniels, Jade and Salinger, David and Wicks, Paul and Robinson, Athena", title="Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study", journal="JMIR Form Res", year="2021", month="May", day="11", volume="5", number="5", pages="e27868", keywords="conversational agents", keywords="mobile mental health", keywords="chatbots", keywords="depression", keywords="anxiety", keywords="digital health", abstract="Background: There are far more patients in mental distress than there is time available for mental health professionals to support them. Although digital tools may help mitigate this issue, critics have suggested that technological solutions that lack human empathy will prevent a bond or therapeutic alliance from being formed, thereby narrowing these solutions' efficacy. Objective: We aimed to investigate whether users of a cognitive behavioral therapy (CBT)--based conversational agent would report therapeutic bond levels that are similar to those in literature about other CBT modalities, including face-to-face therapy, group CBT, and other digital interventions that do not use a conversational agent. Methods: A cross-sectional, retrospective study design was used to analyze aggregate, deidentified data from adult users who self-referred to a CBT-based, fully automated conversational agent (Woebot) between November 2019 and August 2020. Working alliance was measured with the Working Alliance Inventory-Short Revised (WAI-SR), and depression symptom status was assessed by using the 2-item Patient Health Questionnaire (PHQ-2). All measures were administered by the conversational agent in the mobile app. WAI-SR scores were compared to those in scientific literature abstracted from recent reviews. Results: Data from 36,070 Woebot users were included in the analysis. Participants ranged in age from 18 to 78 years, and 57.48\% (20,734/36,070) of participants reported that they were female. The mean PHQ-2 score was 3.03 (SD 1.79), and 54.67\% (19,719/36,070) of users scored over the cutoff score of 3 for depression screening. Within 5 days of initial app use, the mean WAI-SR score was 3.36 (SD 0.8) and the mean bond subscale score was 3.8 (SD 1.0), which was comparable to those in recent studies from the literature on traditional, outpatient, individual CBT and group CBT (mean bond subscale scores of 4 and 3.8, respectively). PHQ-2 scores at baseline weakly correlated with bond scores (r=?0.04; P<.001); however, users with depression and those without depression had high bond scores of 3.45. Conclusions: Although bonds are often presumed to be the exclusive domain of human therapeutic relationships, our findings challenge the notion that digital therapeutics are incapable of establishing a therapeutic bond with users. Future research might investigate the role of bonds as mediators of clinical outcomes, since boosting the engagement and efficacy of digital therapeutics could have major public health benefits. ", doi="10.2196/27868", url="https://formative.jmir.org/2021/5/e27868", url="http://www.ncbi.nlm.nih.gov/pubmed/33973854" } @Article{info:doi/10.2196/25009, author="Wong, Pui-Hing Josephine and Jia, Cun-Xian and Vahabi, Mandana and Liu, Wen Jenny Jing and Li, Tai-Wai Alan and Cong, Xiaofeng and Poon, Kwong-Lai Maurice and Yamada, Janet and Ning, Xuan and Gao, Jianguo and Cheng, Shengli and Sun, Guoxiao and Wang, Xinting and Fung, Po-Lun Kenneth", title="Promoting the Mental Health of University Students in China: Protocol for Contextual Assessment to Inform Intervention Design and Adaptation", journal="JMIR Res Protoc", year="2021", month="May", day="11", volume="10", number="5", pages="e25009", keywords="mental health", keywords="mental illness", keywords="stigma", keywords="protocol", keywords="acceptance and commitment therapy", keywords="implementation science", keywords="student mental health", abstract="Background: Chinese students are extremely vulnerable to developing mental illness. The stigma associated with mental illness presents a barrier to seeking help for their mental health. Objective: The Linking Hearts---Linking Youth and `Xin' (hearts) project is an implementation science project that seeks to reduce mental illness stigma and promote the mental health of university students in Jinan, China. The Linking Hearts project consists of 3 components. In this paper, we outline the protocol for the first component, that is, the contextual assessment and analysis of the mental health needs of university students as the first step to inform the adaptation of an evidence-based intervention to be implemented in Jinan, China. Methods: Six local universities will participate in the Linking Hearts project. A total of 100 students from each university (n=600) will engage in the contextual assessment through self-report surveys on depression, anxiety, stress, mental health knowledge, and mental health stigma. Quantitative data will be analyzed using several descriptive and inferential analyses via SPSS. A small number of participants (144 students and 144 service providers) will also be engaged in focus groups to assess the socio-environmental contexts of university students' health and availability of mental health resources. Qualitative data will be transcribed verbatim and NVivo will be used for data management. Social network analysis will also be performed using EgoNet. Results: Linking Hearts was funded in January 2018 for 5 years. The protocol of Linking Hearts and its 3 components was approved by the research ethics boards of all participating institutions in China in November 2018. Canadian institutions that gave approval were Ryerson University (REB2018-455) in January 2019, University of Alberta (Pro00089364), York University (e2019-162) in May 2019, and University of Toronto (RIS37724) in August 2019. Data collection took place upon ethics approval and was completed in January 2020. A total of 600 students were surveyed. An additional 147 students and 138 service providers took part in focus groups. Data analysis is ongoing. Results will be published in 2021. Conclusions: Findings from this contextual assessment and analysis will generate new knowledge on university students' mental health status, mental health knowledge, and resources available for them. These findings will be used to adapt and refine the Acceptance and Commitment to Empowerment-Linking Youth N' Xin intervention model. The results of this contextual assessment will be used to inform the adaptation and refinement of the mental health intervention to promote the mental health of Chinese university students in Jinan. International Registered Report Identifier (IRRID): RR1-10.2196/25009 ", doi="10.2196/25009", url="https://www.researchprotocols.org/2021/5/e25009", url="http://www.ncbi.nlm.nih.gov/pubmed/33973869" } @Article{info:doi/10.2196/25547, author="Lal, Shalini and Siafa, Lyna and Lee, Hajin and Adair, E. Carol", title="Priority Given to Technology in Government-Based Mental Health and Addictions Vision and Strategy Documents: Systematic Policy Review", journal="J Med Internet Res", year="2021", month="May", day="5", volume="23", number="5", pages="e25547", keywords="e-mental health", keywords="digital mental health", keywords="virtual care", keywords="technology", keywords="mental health", keywords="addictions", keywords="review", keywords="policy", keywords="e-health", keywords="mHealth", keywords="digital health", keywords="tele", abstract="Background: The use of information and communication technologies (ICTs) to deliver mental health and addictions (MHA) services is a global priority, especially considering the urgent shift towards virtual delivery of care in response to the COVID-19 pandemic. It is important to monitor the evolving role of technology in MHA services. Given that MHA policy documents represent the highest level of priorities for a government's vision and strategy for mental health care, one starting point is to measure the frequency with which technology is mentioned and the terms used to describe its use in MHA policy documents (before, during, and after COVID-19). Yet, to our knowledge, no such review of the extent to which ICTs are referred to in Canadian MHA policy documents exists to date. Objective: The objective of this systematic policy review was to examine the extent to which technology is addressed in Canadian government--based MHA policy documents prior to the COVID-19 pandemic to establish a baseline for documenting change. Methods: We reviewed 22 government-based MHA policy documents, published between 2011 and 2019 by 13 Canadian provinces and territories. We conducted content analysis to synthesize the policy priorities addressed in these documents into key themes, and then systematically searched for and tabulated the use of 39 technology-related keywords (in English and French) to describe and compare jurisdictions. Results: Technology was addressed in every document, however, to a varying degree. Of the 39 searched keywords, we identified 22 categories of keywords pertaining to the use of technology to deliver MHA services and information. The 6 most common categories were tele (n=16/22), phone (n=12/22), tech (n=11/22), online (n=10/22), line (n=10/22), and web (n=10/22), with n being the number of policy documents in which the category was mentioned out of 22 documents. The use of terms referring to advanced technologies, such as virtual (n=6/22) and app (n= 4/22), were less frequent. Additionally, policy documents from some provinces and territories (eg, Alberta and Newfoundland and Labrador) mentioned a diverse range of ICTs, whereas others described only 1 form of ICT. Conclusions: This review indicates that technology has been given limited strategic attention in Canadian MHA policy. Policy makers may have limited knowledge on the evidence and potential of using technology in this field, highlighting the value for knowledge translation and collaborative initiatives among policy makers and researchers. The development of a pan-Canadian framework for action addressing the integration and coordination of technology in mental health services can also guide initiatives in this field. Our findings provide a prepandemic baseline and replicable methods to monitor how the use of technology-supported services and innovations emerge relative to other priorities in MHA policy during and after the COVID-19 pandemic. ", doi="10.2196/25547", url="https://www.jmir.org/2021/5/e25547", url="http://www.ncbi.nlm.nih.gov/pubmed/33949955" } @Article{info:doi/10.2196/26294, author="AlHadi, N. Ahmad and Alammari, A. Khawla and Alsiwat, J. Lojain and Alhaidri, E. Nojood and Alabdulkarim, H. Nouf and Altwaijri, A. Nouf and AlSohaili, A. Shamma", title="Perception of Mental Health Care Professionals in Saudi Arabia on Computerized Cognitive Behavioral Therapy: Observational Cross-sectional Study", journal="JMIR Form Res", year="2021", month="May", day="3", volume="5", number="5", pages="e26294", keywords="CBT", keywords="iCBT", keywords="cCBT", keywords="knowledge", keywords="attitude", keywords="mental health care professionals", keywords="computer usage", keywords="psychotherapy", keywords="therapy", keywords="cognitive behavioral therapy", keywords="health care worker", keywords="perception", keywords="Saudi Arabia", keywords="preference", keywords="mental health", abstract="Background: Mental health disorders are common in Saudi Arabia with a 34\% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3\% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population. ", doi="10.2196/26294", url="https://formative.jmir.org/2021/5/e26294", url="http://www.ncbi.nlm.nih.gov/pubmed/33938810" } @Article{info:doi/10.2196/25773, author="Strudwick, Gillian and McLay, David and Lo, Brian and Shin, Danielle Hwayeon and Currie, Leanne and Thomson, Nicole and Maillet, {\'E}ric and Strong, Vanessa and Miller, Alanna and Shen, Nelson and Campbell, Janis", title="Development of a Resource Guide to Support the Engagement of Mental Health Providers and Patients With Digital Health Tools: Multimethod Study", journal="J Med Internet Res", year="2021", month="Apr", day="22", volume="23", number="4", pages="e25773", keywords="digital health", keywords="mental health", keywords="psychiatry", keywords="COVID-19", keywords="nursing informatics", keywords="health informatics", abstract="Background: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. Objective: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. Methods: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. Results: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). Conclusions: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways. ", doi="10.2196/25773", url="https://www.jmir.org/2021/4/e25773", url="http://www.ncbi.nlm.nih.gov/pubmed/33885374" } @Article{info:doi/10.2196/26994, author="Sorkin, H. Dara and Janio, A. Emily and Eikey, V. Elizabeth and Schneider, Margaret and Davis, Katelyn and Schueller, M. Stephen and Stadnick, A. Nicole and Zheng, Kai and Neary, Martha and Safani, David and Mukamel, B. Dana", title="Rise in Use of Digital Mental Health Tools and Technologies in the United States During the COVID-19 Pandemic: Survey Study", journal="J Med Internet Res", year="2021", month="Apr", day="16", volume="23", number="4", pages="e26994", keywords="COVID-19", keywords="digital technologies", keywords="mHealth", keywords="mental health", keywords="anxiety", keywords="depression", keywords="MTurk", keywords="e-mental health", keywords="digital health", keywords="distress", keywords="self-management", abstract="Background: Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. Objective: The objective of this study was to systematically examine whether there was a COVID-19 pandemic--related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. Methods: We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. Results: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95\% CI 1.27-3.35), but not anxiety (OR 1.21, 95\% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95\% CI 1.12-1.27 and OR 1.12, 95\% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95\% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95\% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95\% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95\% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95\% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. Conclusions: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy. ", doi="10.2196/26994", url="https://www.jmir.org/2021/4/e26994", url="http://www.ncbi.nlm.nih.gov/pubmed/33822737" } @Article{info:doi/10.2196/27397, author="Blease, Charlotte and Torous, John and Kharko, Anna and DesRoches, M. Catherine and Harcourt, Kendall and O'Neill, Stephen and Salmi, Liz and Wachenheim, Deborah and H{\"a}gglund, Maria", title="Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts", journal="JMIR Ment Health", year="2021", month="Apr", day="16", volume="8", number="4", pages="e27397", keywords="open notes", keywords="electronic health records", keywords="attitudes", keywords="survey", keywords="mental health", keywords="psychiatry", keywords="psychotherapy", keywords="qualitative research", keywords="mobile phone", abstract="Background: In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients. Objective: The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care. Methods: In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts' written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations. Results: A total of 70 of 92 (76\%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes. Conclusions: This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design. ", doi="10.2196/27397", url="https://mental.jmir.org/2021/4/e27397", url="http://www.ncbi.nlm.nih.gov/pubmed/33861202" } @Article{info:doi/10.2196/18764, author="Jung, Young Se and Hwang, Hee and Lee, Keehyuck and Lee, Donghyun and Yoo, Sooyoung and Lim, Kahyun and Lee, Ho-Young and Kim, Eric", title="User Perspectives on Barriers and Facilitators to the Implementation of Electronic Health Records in Behavioral Hospitals: Qualitative Study", journal="JMIR Form Res", year="2021", month="Apr", day="8", volume="5", number="4", pages="e18764", keywords="electronic health records", keywords="mental health care", keywords="qualitative study", keywords="mobile phone", abstract="Background: Despite the rapid adoption of electronic health records (EHRs) resulting from the reimbursement program of the US government, EHR adoption in behavioral hospitals is still slow, and there remains a lack of evidence regarding barriers and facilitators to the implementation of mental health care EHRs. Objective: The aim of this study is to analyze the experience of mental health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of a mental health care EHR. Methods: In this phenomenological qualitative study, we interviewed physicians, nurses, pharmacists, mental health clinicians, and administrative professionals separately at 4 behavioral hospitals in the United States. We conducted semistructured interviews (N=43) from behavioral hospitals involved in the adoption of the mental health care EHR. Purposeful sampling was used to maximize the diversity. Transcripts were coded and analyzed for emergent domains. An exploratory data analysis was conducted. Results: Content analyses revealed 7 barriers and 4 facilitators. The most important barriers to implementing the mental health care EHR were the low levels of computer proficiency among nurses, complexity of the system, alert fatigue, and resistance because of legacy systems. This led to poor usability, low acceptability, and distrust toward the system. The major facilitators to implementing the mental health care EHR were well-executed training programs, improved productivity, better quality of care, and the good usability of the mental health care EHR. Conclusions: Health care professionals expected to enhance their work productivity and interprofessional collaboration by introducing the mental health care EHR. Routine education for end users is an essential starting point for the successful implementation of mental health care EHR electronic decision support. When adopting the mental health care EHR, managers need to focus on common practices in behavioral hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of mental health care into the system. ", doi="10.2196/18764", url="https://formative.jmir.org/2021/4/e18764", url="http://www.ncbi.nlm.nih.gov/pubmed/33830061" } @Article{info:doi/10.2196/25933, author="B{\'e}rub{\'e}, Caterina and Schachner, Theresa and Keller, Roman and Fleisch, Elgar and v Wangenheim, Florian and Barata, Filipe and Kowatsch, Tobias", title="Voice-Based Conversational Agents for the Prevention and Management of Chronic and Mental Health Conditions: Systematic Literature Review", journal="J Med Internet Res", year="2021", month="Mar", day="29", volume="23", number="3", pages="e25933", keywords="voice", keywords="speech", keywords="delivery of health care", keywords="noncommunicable diseases", keywords="conversational agents", keywords="mobile phone", keywords="smart speaker", keywords="monitoring", keywords="support", keywords="chronic disease", keywords="mental health", keywords="systematic literature review", abstract="Background: Chronic and mental health conditions are increasingly prevalent worldwide. As devices in our everyday lives offer more and more voice-based self-service, voice-based conversational agents (VCAs) have the potential to support the prevention and management of these conditions in a scalable manner. However, evidence on VCAs dedicated to the prevention and management of chronic and mental health conditions is unclear. Objective: This study provides a better understanding of the current methods used in the evaluation of health interventions for the prevention and management of chronic and mental health conditions delivered through VCAs. Methods: We conducted a systematic literature review using PubMed MEDLINE, Embase, PsycINFO, Scopus, and Web of Science databases. We included primary research involving the prevention or management of chronic or mental health conditions through a VCA and reporting an empirical evaluation of the system either in terms of system accuracy, technology acceptance, or both. A total of 2 independent reviewers conducted the screening and data extraction, and agreement between them was measured using Cohen kappa. A narrative approach was used to synthesize the selected records. Results: Of 7170 prescreened papers, 12 met the inclusion criteria. All studies were nonexperimental. The VCAs provided behavioral support (n=5), health monitoring services (n=3), or both (n=4). The interventions were delivered via smartphones (n=5), tablets (n=2), or smart speakers (n=3). In 2 cases, no device was specified. A total of 3 VCAs targeted cancer, whereas 2 VCAs targeted diabetes and heart failure. The other VCAs targeted hearing impairment, asthma, Parkinson disease, dementia, autism, intellectual disability, and depression. The majority of the studies (n=7) assessed technology acceptance, but only few studies (n=3) used validated instruments. Half of the studies (n=6) reported either performance measures on speech recognition or on the ability of VCAs to respond to health-related queries. Only a minority of the studies (n=2) reported behavioral measures or a measure of attitudes toward intervention-targeted health behavior. Moreover, only a minority of studies (n=4) reported controlling for participants' previous experience with technology. Finally, risk bias varied markedly. Conclusions: The heterogeneity in the methods, the limited number of studies identified, and the high risk of bias show that research on VCAs for chronic and mental health conditions is still in its infancy. Although the results of system accuracy and technology acceptance are encouraging, there is still a need to establish more conclusive evidence on the efficacy of VCAs for the prevention and management of chronic and mental health conditions, both in absolute terms and in comparison with standard health care. ", doi="10.2196/25933", url="https://www.jmir.org/2021/3/e25933", url="http://www.ncbi.nlm.nih.gov/pubmed/33658174" } @Article{info:doi/10.2196/26811, author="Balcombe, Luke and De Leo, Diego", title="Digital Mental Health Challenges and the Horizon Ahead for Solutions", journal="JMIR Ment Health", year="2021", month="Mar", day="29", volume="8", number="3", pages="e26811", keywords="challenges", keywords="COVID-19", keywords="digital mental health implementation", keywords="explainable artificial intelligence", keywords="hybrid model of care", keywords="human-computer interaction", keywords="resilience", keywords="technology", doi="10.2196/26811", url="https://mental.jmir.org/2021/3/e26811", url="http://www.ncbi.nlm.nih.gov/pubmed/33779570" } @Article{info:doi/10.2196/25542, author="Puspitasari, J. Ajeng and Heredia, Dagoberto and Coombes, J. Brandon and Geske, R. Jennifer and Gentry, T. Melanie and Moore, R. Wendy and Sawchuk, N. Craig and Schak, M. Kathryn", title="Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19", journal="JMIR Ment Health", year="2021", month="Mar", day="11", volume="8", number="3", pages="e25542", keywords="COVID-19", keywords="teletherapy", keywords="intensive outpatient", keywords="serious mental illness", keywords="mental health", keywords="therapy", keywords="telemedicine", keywords="telehealth", keywords="feasibility", keywords="outcome", keywords="behavioral science", keywords="pilot", keywords="implementation", keywords="effective", abstract="Background: In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. Objective: This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. Methods: Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. Results: Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92\%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95\%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95\% CI --3.6 to --6.2; Cohen d=0.77; P<.001), anxiety (95\% CI --3.0 to --4.9; Cohen d=0.74; P<.001), overall suicide risk (95\% CI --0.5 to --0.1; Cohen d=0.41; P=.02), wish to live (95\% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95\% CI --0.2 to --1.4; Cohen d=0.52; P=.01), and overall mental health (95\% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. Conclusions: Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials. ", doi="10.2196/25542", url="https://mental.jmir.org/2021/3/e25542", url="http://www.ncbi.nlm.nih.gov/pubmed/33651706" } @Article{info:doi/10.2196/17438, author="Patel, Shivani and Craigen, Gerry and Pinto da Costa, Mariana and Inkster, Becky", title="Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study", journal="J Med Internet Res", year="2021", month="Mar", day="9", volume="23", number="3", pages="e17438", keywords="mental health", keywords="technology", keywords="psychiatry", keywords="mobile phone", abstract="Background: The concept of digital social prescription usually refers to social prescriptions that are facilitated by using technology. Tools that enable such digital social prescriptions may be beneficial in recommending nonmedical activities to people with mental illness. As these tools are still somewhat novel and emerging, little is known about their potential advantages and disadvantages. Objective: The objective of this study is to identify the potential opportunities and challenges that may arise from digital social prescriptions. Methods: We developed a qualitative questionnaire that was disseminated through social media (Facebook and Twitter). A purposive sample targeting digital mental health experts and nonexperts was approached. The questionnaire asked participants' views about digital social prescription; the core elements linked with a definition of digital social prescription; and the strengths, weaknesses, opportunities, and threats associated with digital social prescription. Results: Four core elements were recommended to define the concept of digital social prescription: digital, facilitate, user, and social. The main strength identified was the possibility to rapidly start using digital social prescription tools, which were perceived as cost-effective. The main weaknesses were their poor adherence and difficulties with using such tools. The main opportunities were an increased access to social prescription services and the prevention of serious mental illness. The main threats were certain groups being disadvantaged, patients being subject to unintended negative consequences, and issues relating to confidentiality and data protection. Conclusions: Although digital social prescriptions may be able to effectively augment the social prescriptions, a careful consideration of practical challenges and data ethics is imperative in the design and implementation of such technologies. ", doi="10.2196/17438", url="https://www.jmir.org/2021/3/e17438", url="http://www.ncbi.nlm.nih.gov/pubmed/33687338" } @Article{info:doi/10.2196/25867, author="Myers, L. Amanda and Collins-Pisano, Caroline and Ferron, C. Joelle and Fortuna, L. Karen", title="Feasibility and Preliminary Effectiveness of a Peer-Developed and Virtually Delivered Community Mental Health Training Program (Emotional CPR): Pre-Post Study", journal="J Particip Med", year="2021", month="Mar", day="4", volume="13", number="1", pages="e25867", keywords="Emotional CPR (eCPR)", keywords="peer support", keywords="peer-delivered training", keywords="mental health", keywords="community mental health", abstract="Background: The COVID-19 pandemic has led to a global mental health crisis, highlighting the need for a focus on community-wide mental health. Emotional CPR (eCPR) is a program and practice developed by persons with a lived experience of recovery from trauma or mental health challenges to train community members from diverse backgrounds to support others through mental health crises. eCPR trainers have found that eCPR may promote feelings of belonging by increasing supportive behaviors toward individuals with mental health problems. Thus, clinical outcomes related to positive and negative affect would improve along with feelings of loneliness. Objective: This study examined the feasibility and preliminary effectiveness of eCPR. Methods: We employed a pre-post design with 151 individuals, including peer support specialists, service users, clinicians, family members, and nonprofit leaders, who participated in virtual eCPR trainings between April 20, 2020, and July 31, 2020. Instruments were administered before and after training and included the Herth Hope Scale; Empowerment Scale; Flourishing Scale (perceived capacity to support individuals); Mindful Attention Awareness Scale; Active-Empathic Listening Scale (supportive behaviors toward individuals with mental health challenges); Social Connectedness Scale (feelings of belonging and connection with others); Positive and Negative Affect Schedule; and University of California, Los Angeles 3-item Loneliness Scale (symptoms and emotions). The eCPR fidelity scale was used to determine the feasibility of delivering eCPR with fidelity. We conducted 2-tailed paired t tests to examine posttraining improvements related to each scale. Additionally, data were stratified to identify pre-post differences by role. Results: Findings indicate that it is feasible for people with a lived experience of a mental health condition to develop a program and train people to deliver eCPR with fidelity. Statistically significant pre-post changes were found related to one's ability to identify emotions, support others in distress, communicate nonverbally, share emotions, and take care of oneself, as well as to one's feelings of social connectedness, self-perceived flourishing, and positive affect (P?.05). Findings indicated promising evidence of pre-post improvements (not statistically significant) related to loneliness, empowerment, active-empathetic listening, mindfulness awareness, and hope. Nonprofit leaders and workers demonstrated the greatest improvements related to loneliness, social connectedness, empathic listening, and flourishing. Peer support specialists demonstrated the greatest improvements related to positive affect, and clinicians demonstrated the greatest improvements related to mindfulness awareness. Conclusions: Promising evidence indicates that eCPR, a peer-developed and peer-delivered program, may increase feelings of belonging while increasing supportive behaviors toward individuals with mental health problems and improving clinical outcomes related to positive and negative affect and feelings of loneliness. ", doi="10.2196/25867", url="https://jopm.jmir.org/2021/1/e25867", url="http://www.ncbi.nlm.nih.gov/pubmed/33661129" } @Article{info:doi/10.2196/26550, author="Strudwick, Gillian and Sockalingam, Sanjeev and Kassam, Iman and Sequeira, Lydia and Bonato, Sarah and Youssef, Alaa and Mehta, Rohan and Green, Nadia and Agic, Branka and Soklaridis, Sophie and Impey, Danielle and Wiljer, David and Crawford, Allison", title="Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review", journal="JMIR Ment Health", year="2021", month="Mar", day="2", volume="8", number="3", pages="e26550", keywords="digital health", keywords="psychiatry", keywords="mental health", keywords="informatics", keywords="pandemic", keywords="COVID-19", keywords="telemedicine", keywords="eHealth", keywords="public health", keywords="virtual care", keywords="mobile apps", keywords="population health", abstract="Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22\% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. ", doi="10.2196/26550", url="https://mental.jmir.org/2021/3/e26550", url="http://www.ncbi.nlm.nih.gov/pubmed/33650985" } @Article{info:doi/10.2196/17993, author="Heidary, Zahra and Cochran, M. Jeffrey and Peters-Strickland, Timothy and Knights, Jonathan", title="A Rest Quality Metric Using a Cluster-Based Analysis of Accelerometer Data and Correlation With Digital Medicine Ingestion Data: Algorithm Development", journal="JMIR Form Res", year="2021", month="Mar", day="2", volume="5", number="3", pages="e17993", keywords="serious mental illness", keywords="rest quality", keywords="actimetry", keywords="behavioral health", keywords="digital medicine", keywords="accelerometer", keywords="medication adherence", abstract="Background: Adherence to medication regimens and patient rest are two important factors in the well-being of patients with serious mental illness. Both of these behaviors are traditionally difficult to record objectively in unsupervised populations. Objective: A digital medicine system that provides objective time-stamped medication ingestion records was used by patients with serious mental illness. Accelerometer data from the digital medicine system was used to assess rest quality and thus allow for investigation into correlations between rest and medication ingestion. Methods: Longest daily rest periods were identified and then evaluated using a k-means clustering algorithm and distance metric to quantify the relative quality of patient rest during these periods. This accelerometer-derived quality-of-rest metric, along with other accepted metrics of rest quality, such as duration and start time of the longest rest periods, was compared to the objective medication ingestion records. Overall medication adherence classification based on rest features was not performed due to a lack of patients with poor adherence in the sample population. Results: Explorations of the relationship between these rest metrics and ingestion did seem to indicate that patients with poor adherence experienced relatively low quality of rest; however, patients with better adherence did not necessarily exhibit consistent rest quality. This sample did not contain sufficient patients with poor adherence to draw more robust correlations between rest quality and ingestion behavior. The correlation of temporal outliers in these rest metrics with daily outliers in ingestion time was also explored. Conclusions: This result demonstrates the ability of digital medicine systems to quantify patient rest quality, providing a framework for further work to expand the participant population, compare these rest metrics to gold-standard sleep measurements, and correlate these digital medicine biomarkers with objective medication ingestion data. ", doi="10.2196/17993", url="https://formative.jmir.org/2021/3/e17993", url="http://www.ncbi.nlm.nih.gov/pubmed/33650981" } @Article{info:doi/10.2196/19004, author="Cataldo, Francesco and Chang, Shanton and Mendoza, Antonette and Buchanan, George", title="A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review", journal="JMIR Ment Health", year="2021", month="Feb", day="19", volume="8", number="2", pages="e19004", keywords="videoconference", keywords="psychotherapy", keywords="professional-patient relations", keywords="client-psychologist relationships", keywords="therapeutic alliance", keywords="telehealth", keywords="mobile phone", abstract="Background: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. Objective: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. Methods: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. Results: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. Conclusions: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients. ", doi="10.2196/19004", url="http://mental.jmir.org/2021/2/e19004/", url="http://www.ncbi.nlm.nih.gov/pubmed/33605891" } @Article{info:doi/10.2196/19532, author="Milton, Clare Alyssa and Hambleton, Ashlea and Dowling, Mitchell and Roberts, Elizabeth Anna and Davenport, Tracey and Hickie, Ian", title="Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study", journal="J Med Internet Res", year="2021", month="Feb", day="16", volume="23", number="2", pages="e19532", keywords="eating disorders", keywords="body image", keywords="mental health", keywords="technology", keywords="co-design", keywords="participatory design", keywords="service reform", keywords="consumer engagement", abstract="Background: The recent Australian National Agenda for Eating Disorders highlights the role technology can play in improving accessibility and service development through web-based prevention, early access pathways, self-help, and recovery assistance. However, engagement with the eating disorders community to co-design, build, and evaluate these much-needed technology solutions through participatory design processes has been lacking and, until recently, underresourced. Objective: This study aims to customize and configure a technology solution for a nontraditional (web-based, phone, email) mental health service that provides support for eating disorders and body image issues through the use of participatory design processes. Methods: Participants were recruited chiefly through the Butterfly National Helpline 1800 ED HOPE (Butterfly's National Helpline), an Australian-wide helpline supporting anyone concerned by an eating disorder or body image issue. Participants included individuals with lived experience of eating disorders and body image issues, their supportive others (such as family, health professionals, support workers), and staff of the Butterfly Foundation. Participants took part in participatory design workshops, running up to four hours, which were held nationally in urban and regional locations. The workshop agenda followed an established process of discovery, evaluation, and prototyping. Workshop activities included open and prompted discussion, reviewing working prototypes, creating descriptive artifacts, and developing user journeys. Workshop artifacts were used in a knowledge translation process, which identified key learnings to inform user journeys, user personas, and the customization and configuration of the InnoWell Platform for Butterfly's National Helpline. Further, key themes were identified using thematic techniques and coded in NVivo 12 software. Results: Six participatory design workshops were held, of which 45 participants took part. Participants highlighted that there is a critical need to address some of the barriers to care, particularly in regional and rural areas. The workshops highlighted seven overarching qualitative themes: identified barriers to care within the current system; need for people to be able to access the right care anywhere, anytime; recommendations for the technological solution (ie, InnoWell Platform features and functionality); need for communication, coordination, and integration of a technological solution embedded in Butterfly's National Helpline; need to consider engagement and tone within the technological solution; identified challenges and areas to consider when implementing a technological solution in the Helpline; and potential outcomes of the technological solution embedded in the Helpline relating to system and service reform. Ultimately, this technology solution should ensure that the right care is provided to individuals the first time. Conclusions: Our findings highlight the value of actively engaging stakeholders in participatory design processes for the customization and configuration of new technologies. End users can highlight the critical areas of need, which can be used as a catalyst for reform through the implementation of these technologies in nontraditional services. ", doi="10.2196/19532", url="http://www.jmir.org/2021/2/e19532/", url="http://www.ncbi.nlm.nih.gov/pubmed/33591283" } @Article{info:doi/10.2196/21872, author="Rickwood, Debra and Kennedy, Vanessa and Miyazaki, Koki and Telford, Nic and Carbone, Stephen and Hewitt, Ella and Watts, Carolyn", title="An Online Platform to Provide Work and Study Support for Young People With Mental Health Challenges: Observational and Survey Study", journal="JMIR Ment Health", year="2021", month="Feb", day="9", volume="8", number="2", pages="e21872", keywords="youth", keywords="mental health", keywords="unemployment", keywords="work", keywords="study", keywords="online support", abstract="Background: Young people, aged 15-25 years, are at a critical stage of life when they need to navigate vocational pathways and achieve work and study outcomes. Those with mental health problems are particularly at risk of disengagement with work and study and need effective support. The headspace Work and Study (hWS) service is an innovative online platform implemented in Australia to support young people aged 15-25 years with mental health problems to achieve work and study goals. Objective: This study aims to determine whether the hWS service has been implemented as planned, provides appropriate support for young people, and achieves its main goals. Methods: Data were collected via 2 methodologies: (1) the hWS Minimum Data Set, which includes data on all clients in the service (n=1139), services delivered, and service impact; and (2) a survey of hWS clients who volunteered to participate in an evaluation of the hWS service (n=137). Results: The service was accessed by its defined target group, young people aged 15-25 years with mental health and work and study difficulties. Young people found the online platform to be acceptable, and the assistance provided and clinical integration useful; many young people achieved positive work and study outcomes, particularly those who engaged more times with the service. More assistance was sought for work than study goals, suggesting that the transition to work may be particularly challenging for young people. One-third (298/881, 33.8\%) of the sample for the service impact analyses achieved at least 1 primary work or study outcome, and this increased to 44.5\% (225/506) for those who engaged with 5 or more sessions, demonstrating that greater engagement with the service produced better outcomes. Conclusions: Critical work and study support can be effectively delivered via an online modality to young people with common mental health problems. Digital services are scaleable to reach many young people and are of particular value for those with difficulty accessing in-person services. ", doi="10.2196/21872", url="https://mental.jmir.org/2021/2/e21872", url="http://www.ncbi.nlm.nih.gov/pubmed/33560238" } @Article{info:doi/10.2196/23771, author="Rauseo-Ricupero, Natali and Torous, John", title="Technology Enabled Clinical Care (TECC): Protocol for a Prospective Longitudinal Cohort Study of Smartphone-Augmented Mental Health Treatment", journal="JMIR Res Protoc", year="2021", month="Jan", day="14", volume="10", number="1", pages="e23771", keywords="mental health care", keywords="access", keywords="multi-language", keywords="smartphone", keywords="app", keywords="quality improvement", keywords="protocol", keywords="mental health", keywords="treatment", keywords="acceptability", keywords="efficacy", keywords="COVID-19", abstract="Background: Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision---Technology Enabled Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP. Objective: TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design. Methods: The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations. Results: The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction. Conclusions: TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations. International Registered Report Identifier (IRRID): PRR1-10.2196/23771 ", doi="10.2196/23771", url="https://www.researchprotocols.org/2021/1/e23771", url="http://www.ncbi.nlm.nih.gov/pubmed/33296869" } @Article{info:doi/10.2196/21819, author="Andalibi, Nazanin and Flood, K. Madison", title="Considerations in Designing Digital Peer Support for Mental Health: Interview Study Among Users of a Digital Support System (Buddy Project)", journal="JMIR Ment Health", year="2021", month="Jan", day="4", volume="8", number="1", pages="e21819", keywords="mental health", keywords="peer support", keywords="technology", keywords="design", keywords="digital peer support", keywords="mHealth", keywords="digital health", keywords="internet", abstract="Background: Peer support is an approach to cope with mental illness, and technology provides a way to facilitate peer support. However, there are barriers to seeking support in offline and technology-mediated contexts. Objective: This study aims to uncover potential ways to design digital mental health peer support systems and to outline a set of principles for future designers to consider as they embark on designing these systems. By learning how existing systems are used by people in daily life and by centering their experiences, we can better understand how to design mental health peer support technologies that foreground people's needs. One existing digital peer support system is Buddy Project, the case study in this paper. Methods: This paper reports on an interview study with Buddy Project users (N=13). Data were analyzed using the constant comparative approach. Results: Individuals matched through Buddy Project developed supportive friendships with one another, leading them to become each other's peer supporters in their respective journeys. It was not only the mental health peer support that was important to participants but also being able to connect over other parts of their lives and identities. The design of Buddy Project provided a sense of anonymity and separation from pre-existing ties, making it easier for participants to disclose struggles; moreover, the pairs appreciated being able to browse each other's social media pages before connecting. Buddy Project has an explicit mission to prevent suicide and demonstrates this mission across its online platforms, which helps reduce the stigma around mental health within the peer support space. Pairs were matched based on shared interests and identities. This choice aided the pairs in developing meaningful, compatible, and supportive relationships with each other, where they felt seen and understood. However, the pairs were concerned that matching based on a shared mental health diagnosis may lead to sharing unhealthy coping mechanisms or comparing themselves and the severity of their experiences with their peers. Conclusions: The results of this study shed light on desirable features of a digital mental health peer support system: matching peers based on interests and identities that they self-identify with; having an explicit mental health--related mission coupled with social media and other web-based presences to signal that discussing mental health is safe within the peer support ecosystem; and not matching peers based on a broad mental health diagnosis. However, if the diagnosis is important, this matching should account for illness severity and educate peers on how to provide support while avoiding suggesting unhelpful coping mechanisms; allowing for some degree of anonymity and control over how peers present themselves to each other; and providing relevant information and tools to potential peers to help them decide if they would like to embark on a relationship with their matched peer before connecting with them. ", doi="10.2196/21819", url="https://mental.jmir.org/2021/1/e21819", url="http://www.ncbi.nlm.nih.gov/pubmed/33393909" } @Article{info:doi/10.2196/15776, author="G{\'o}ngora Alonso, Susel and Sainz-De-Abajo, Beatriz and De la Torre-D{\'i}ez, Isabel and Franco-Martin, Manuel", title="Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study", journal="JMIR Ment Health", year="2020", month="Nov", day="30", volume="7", number="11", pages="e15776", keywords="acute inpatient psychiatry unit", keywords="database", keywords="hospitalizations", keywords="mental health", keywords="readmission", keywords="SPSS", abstract="Background: Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. Objective: The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model. Methods: For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015. Results: After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69\%. This trend is due to the implementation of a new hospital management model in this health complex. Conclusions: With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced. ", doi="10.2196/15776", url="http://mental.jmir.org/2020/11/e15776/", url="http://www.ncbi.nlm.nih.gov/pubmed/33252351" } @Article{info:doi/10.2196/18759, author="LaMonica, M. Haley and Milton, Alyssa and Braunstein, Katharine and Rowe, C. Shelley and Ottavio, Antonia and Jackson, Tanya and Easton, A. Michael and Hambleton, Ashlea and Hickie, B. Ian and Davenport, A. Tracey", title="Technology-Enabled Solutions for Australian Mental Health Services Reform: Impact Evaluation", journal="JMIR Form Res", year="2020", month="Nov", day="19", volume="4", number="11", pages="e18759", keywords="evaluation methodology", keywords="mental health", keywords="health care reform", keywords="technology", keywords="mobile phone", keywords="community-based participatory research", abstract="Background: Health information technologies (HITs) are becoming increasingly recognized for their potential to provide innovative solutions to improve the delivery of mental health services and drive system reforms for better outcomes. Objective: This paper describes the baseline results of a study designed to systematically monitor and evaluate the impact of implementing an HIT, namely the InnoWell Platform, into Australian mental health services to facilitate the iterative refinement of the HIT and the service model in which it is embedded to meet the needs of consumers and their supportive others as well as health professionals and service providers. Methods: Data were collected via web-based surveys, semistructured interviews, and a workshop with staff from the mental health services implementing the InnoWell Platform to systematically monitor and evaluate its impact. Descriptive statistics, Fisher exact tests, and a reliability analysis were used to characterize the findings from the web-based surveys, including variability in the results between the services. Semistructured interviews were coded using a thematic analysis, and workshop data were coded using a basic content analysis. Results: Baseline data were collected from the staff of 3 primary youth mental health services (n=18), a counseling service for veterans and their families (n=23), and a helpline for consumers affected by eating disorders and negative body image issues (n=6). As reported via web-based surveys, staff members across the services consistently agreed or strongly agreed that there was benefit associated with using technology as part of their work (38/47, 81\%) and that the InnoWell Platform had the potential to improve outcomes for consumers (27/45, 60\%); however, there was less certainty as to whether their consumers' capability to use technology aligned with how the InnoWell Platform would be used as part of their mental health care (11/45, 24\% of the participants strongly disagreed or disagreed; 15/45, 33\% were neutral; and 19/45, 42\% strongly agreed or agreed). During the semistructured interviews (n=3) and workshop, participants consistently indicated that the InnoWell Platform was appropriate for their respective services; however, they questioned whether the services' respective consumers had the digital literacy required to use the technology. Additional potential barriers to implementation included health professionals' digital literacy and service readiness for change. Conclusions: Despite agreement among participants that HITs have the potential to result in improved outcomes for consumers and services, service readiness for change (eg, existing technology infrastructure and the digital literacy of staff and consumers) was noted to potentially impact the success of implementation, with less than half (20/45, 44\%) of the participants indicating that their service was ready to implement new technologies to enhance mental health care. Furthermore, participants reported mixed opinions as to whether it was their responsibility to recommend technology as part of standard care. ", doi="10.2196/18759", url="https://formative.jmir.org/2020/11/e18759", url="http://www.ncbi.nlm.nih.gov/pubmed/33211024" } @Article{info:doi/10.2196/15149, author="St{\o}rksen, Therese Hege and Haga, Marie Silje and Slinning, Kari and Drozd, Filip", title="Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study", journal="JMIR Ment Health", year="2020", month="Nov", day="18", volume="7", number="11", pages="e15149", keywords="internet", keywords="parent support", keywords="children", keywords="mental health", keywords="acceptability", keywords="health care services", abstract="Background: Approximately 10\%-15\% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel's attitudes to perceived usefulness of internet-based interventions. Objective: The purpose of this study was to examine health professionals' perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. Methods: Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: ``How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?'' The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). Results: The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). Conclusions: Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support. ", doi="10.2196/15149", url="http://mental.jmir.org/2020/11/e15149/", url="http://www.ncbi.nlm.nih.gov/pubmed/33206058" } @Article{info:doi/10.2196/20790, author="Wiljer, David and Shi, Jenny and Lo, Brian and Sanches, Marcos and Hollenberg, Elisa and Johnson, Andrew and Abi-Jaoud{\'e}, Alexxa and Chaim, Gloria and Cleverley, Kristin and Henderson, Joanna and Isaranuwatchai, Wanrudee and Levinson, Andrea and Robb, Janine and Wong, W. Howard and Voineskos, Aristotle", title="Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Oct", day="30", volume="22", number="10", pages="e20790", keywords="crowdsourcing", keywords="help-seeking behavior", keywords="mental health", keywords="mobile applications", keywords="randomized controlled trial", keywords="school mental health services", keywords="social support", keywords="young adult", abstract="Background: Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research. Objective: The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada. Methods: A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy. Results: A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95\% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95\% CI 0.22 to 0.73, P<.001). Conclusions: Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 ", doi="10.2196/20790", url="http://www.jmir.org/2020/10/e20790/", url="http://www.ncbi.nlm.nih.gov/pubmed/33124984" } @Article{info:doi/10.2196/23660, author="Haun, W. Markus and Stephan, Isabella and Wensing, Michel and Hartmann, Mechthild and Hoffmann, Mariell and Friederich, Hans-Christoph", title="Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory", journal="JMIR Ment Health", year="2020", month="Oct", day="15", volume="7", number="10", pages="e23660", keywords="video consultations", keywords="videoconferencing", keywords="telehealth", keywords="integrated care", keywords="mental health", keywords="preimplementation", keywords="diffusion of innovations", keywords="early adopters", keywords="mixed methods", keywords="cumulative logit model", keywords="content analysis", abstract="Background: Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. Objective: This mixed method preimplementation study aims to assess GPs' intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). Methods: Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. Results: This study found that about one in two GPs (87/176, 49.4\%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2\%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs ($\beta$=2.03, SE 0.345, P<.001), supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC, and characteristics of supporting and nonsupporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. Conclusions: A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs. ", doi="10.2196/23660", url="http://mental.jmir.org/2020/10/e23660/", url="http://www.ncbi.nlm.nih.gov/pubmed/33055058" } @Article{info:doi/10.2196/21344, author="Bierbooms, A. Joyce J. P. and van Haaren, Monique and IJsselsteijn, A. Wijnand and de Kort, W. Yvonne A. and Feijt, Milou and Bongers, B. Inge M.", title="Integration of Online Treatment Into the ``New Normal'' in Mental Health Care in Post--COVID-19 Times: Exploratory Qualitative Study", journal="JMIR Form Res", year="2020", month="Oct", day="8", volume="4", number="10", pages="e21344", keywords="online treatment", keywords="sustainability", keywords="mental health care", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the ``new normal'' in mental health care will be like in post--COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? Objective: In this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. Methods: In an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. Results: From the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. Conclusions: Sustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care. ", doi="10.2196/21344", url="http://formative.jmir.org/2020/10/e21344/", url="http://www.ncbi.nlm.nih.gov/pubmed/33001835" } @Article{info:doi/10.2196/21155, author="Katapally, Reddy Tarun", title="Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health", journal="JMIR Pediatr Parent", year="2020", month="Sep", day="25", volume="3", number="2", pages="e21155", keywords="Indigenous youth", keywords="mental health", keywords="school policies", keywords="health policy", keywords="digital health interventions", keywords="mHealth", keywords="systems integration", keywords="land-based learning", keywords="physical activity", doi="10.2196/21155", url="http://pediatrics.jmir.org/2020/2/e21155/", url="http://www.ncbi.nlm.nih.gov/pubmed/32975527" } @Article{info:doi/10.2196/17424, author="Norman, P. Kim and Govindjee, Anita and Norman, R. Seth and Godoy, Michael and Cerrone, L. Kimberlie and Kieschnick, W. Dustin and Kassler, William", title="Natural Language Processing Tools for Assessing Progress and Outcome of Two Veteran Populations: Cohort Study From a Novel Online Intervention for Posttraumatic Growth", journal="JMIR Form Res", year="2020", month="Sep", day="23", volume="4", number="9", pages="e17424", keywords="natural language analysis", keywords="emotional tone", keywords="personality", keywords="values", keywords="PTSD", keywords="military sexual trauma", keywords="online interventions", keywords="internet-based cognitive behavioral therapy", keywords="narrative therapy", keywords="mindfulness", abstract="Background: Over 100 million Americans lack affordable access to behavioral health care. Among these, military veterans are an especially vulnerable population. Military veterans require unique behavioral health services that can address military experiences and challenges transitioning to the civilian sector. Real-world programs to help veterans successfully transition to civilian life must build a sense of community, have the ability to scale, and be able to reach the many veterans who cannot or will not access care. Digitally based behavioral health initiatives have emerged within the past few years to improve this access to care. Our novel behavioral health intervention teaches mindfulness-based cognitive behavioral therapy and narrative therapy using peer support groups as guides, with human-facilitated asynchronous online discussions. Our study applies natural language processing (NLP) analytics to assess effectiveness of our online intervention in order to test whether NLP may provide insights and detect nuances of personal change and growth that are not currently captured by subjective symptom measures. Objective: This paper aims to study the value of NLP analytics in assessing progress and outcomes among combat veterans and military sexual assault survivors participating in novel online interventions for posttraumatic growth. Methods: IBM Watson and Linguistic Inquiry and Word Count tools were applied to the narrative writings of combat veterans and survivors of military sexual trauma who participated in novel online peer-supported group therapies for posttraumatic growth. Participants watched videos, practiced skills such as mindfulness meditation, told their stories through narrative writing, and participated in asynchronous, facilitated online discussions with peers. The writings, including online postings, by the 16 participants who completed the program were analyzed after completion of the program. Results: Our results suggest that NLP can provide valuable insights on shifts in personality traits, personal values, needs, and emotional tone in an evaluation of our novel online behavioral health interventions. Emotional tone analysis demonstrated significant decreases in fear and anxiety, sadness, and disgust, as well as increases in joy. Significant effects were found for personal values and needs, such as needing or desiring closeness and helping others, and for personality traits of openness, conscientiousness, extroversion, agreeableness, and neuroticism (ie, emotional range). Participants also demonstrated increases in authenticity and clout (confidence) of expression. NLP results were generally supported by qualitative observations and analysis, structured data, and course feedback. Conclusions: The aggregate of results in our study suggest that our behavioral health intervention was effective and that NLP can provide valuable insights on shifts in personality traits, personal values, and needs, as well as measure changes in emotional tone. NLP's sensitivity to changes in emotional tone, values, and personality strengths suggests the efficacy of NLP as a leading indicator of treatment progress. ", doi="10.2196/17424", url="https://formative.jmir.org/2020/9/e17424", url="http://www.ncbi.nlm.nih.gov/pubmed/32769074" } @Article{info:doi/10.2196/17164, author="Bernecker, L. Samantha and Williams, Jay Joseph and Caporale-Berkowitz, A. Norian and Wasil, R. Akash and Constantino, J. Michael", title="Nonprofessional Peer Support to Improve Mental Health: Randomized Trial of a Scalable Web-Based Peer Counseling Course", journal="J Med Internet Res", year="2020", month="Sep", day="21", volume="22", number="9", pages="e17164", keywords="online learning", keywords="nonprofessional education", keywords="educational technology", keywords="computer-assisted instruction", keywords="social support", keywords="mental health", keywords="psychological stress", keywords="eHealth", keywords="internet", abstract="Background: Millions of people worldwide are underserved by the mental health care system. Indeed, most mental health problems go untreated, often because of resource constraints (eg, limited provider availability and cost) or lack of interest or faith in professional help. Furthermore, subclinical symptoms and chronic stress in the absence of a mental illness diagnosis often go unaddressed, despite their substantial health impact. Innovative and scalable treatment delivery methods are needed to supplement traditional therapies to fill these gaps in the mental health care system. Objective: This study aims to investigate whether a self-guided web-based course can teach pairs of nonprofessional peers to deliver psychological support to each other. Methods: In this experimental study, a community sample of 30 dyads (60 participants, mostly friends), many of whom presented with mild to moderate psychological distress, were recruited to complete a web-based counseling skills course. Dyads were randomized to either immediate or delayed access to training. Before and after training, dyads were recorded taking turns discussing stressors. Participants' skills in the helper role were assessed before and after taking the course: the first author and a team of trained research assistants coded recordings for the presence of specific counseling behaviors. When in the client role, participants rated the session on helpfulness in resolving their stressors and supportiveness of their peers. We hypothesized that participants would increase the use of skills taught by the course and decrease the use of skills discouraged by the course, would increase their overall adherence to the guidelines taught in the course, and would perceive posttraining counseling sessions as more helpful and their peers as more supportive. Results: The course had large effects on most helper-role speech behaviors: helpers decreased total speaking time, used more restatements, made fewer efforts to influence the speaker, and decreased self-focused and off-topic utterances (ds=0.8-1.6). When rating the portion of the session in which they served as clients, participants indicated that they made more progress in addressing their stressors during posttraining counseling sessions compared with pretraining sessions (d=1.1), but they did not report substantive changes in feelings of closeness and supportiveness of their peers (d=0.3). Conclusions: The results provide proof of concept that nonprofessionals can learn basic counseling skills from a scalable web-based course. The course serves as a promising model for the development of web-based counseling skills training, which could provide accessible mental health support to some of those underserved by traditional psychotherapy. ", doi="10.2196/17164", url="http://www.jmir.org/2020/9/e17164/", url="http://www.ncbi.nlm.nih.gov/pubmed/32955451" } @Article{info:doi/10.2196/15625, author="Engdahl, Patrik and Svedberg, Petra and Lex{\'e}n, Annika and Bejerholm, Ulrika", title="Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups", journal="JMIR Form Res", year="2020", month="Sep", day="16", volume="4", number="9", pages="e15625", keywords="qualitative method", keywords="mental health", keywords="mHealth", keywords="quality improvement", keywords="vocational rehabilitation", abstract="Background: Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. Objective: The aim of this study was to examine stakeholder groups' perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. Methods: A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. Results: The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers' concern of legislation incompatibility with innovative technology, and RTW professionals' concern of the possibility that digital solutions may replace them to a certain extent. Conclusions: This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context. ", doi="10.2196/15625", url="http://formative.jmir.org/2020/9/e15625/", url="http://www.ncbi.nlm.nih.gov/pubmed/32936089" } @Article{info:doi/10.2196/19950, author="Drissi, Nidal and Ouhbi, Sofia and Janati Idrissi, Abdou Mohammed and Fernandez-Luque, Luis and Ghogho, Mounir", title="Connected Mental Health: Systematic Mapping Study", journal="J Med Internet Res", year="2020", month="Aug", day="28", volume="22", number="8", pages="e19950", keywords="mental health", keywords="connected health", keywords="eHealth", keywords="mobile health", keywords="telehealth", keywords="mHealth", keywords="mobile phone", keywords="health informatics", keywords="review", keywords="interdisciplinary research", keywords="information technology", keywords="information systems", abstract="Background: Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. Objective: The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. Methods: A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. Results: The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. Conclusions: CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues. ", doi="10.2196/19950", url="http://www.jmir.org/2020/8/e19950/", url="http://www.ncbi.nlm.nih.gov/pubmed/32857055" } @Article{info:doi/10.2196/19271, author="Singla, Radha Daisy and Lemberg-Pelly, Sasha and Lawson, Andrea and Zahedi, Nika and Thomas-Jacques, Tyla and Dennis, Cindy-Lee", title="Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective", journal="JMIR Ment Health", year="2020", month="Aug", day="27", volume="7", number="8", pages="e19271", keywords="nonspecialist providers", keywords="task sharing", keywords="perinatal mental health", keywords="perinatal depression", keywords="telemedicine", keywords="psychological treatments", abstract="Background: Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers---individuals with no formal training in mental health---have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery. Objective: The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider--delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective. Methods: This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups. Results: Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90\%). Across all stakeholder groups, nurses (20/33, 61\%) and midwives (14/33, 42\%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97\%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82\%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48\%). Empathy was the most desired characteristic of a nonspecialist provider (61\%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58\%), compared to clinicians (2/9, 22\%) and spouses (1/5, 20\%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33\%), compared to other stakeholder groups. Conclusions: These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts. ", doi="10.2196/19271", url="http://mental.jmir.org/2020/8/e19271/", url="http://www.ncbi.nlm.nih.gov/pubmed/32852281" } @Article{info:doi/10.2196/14885, author="Friesen, Laura and Gaine, Graham and Klaver, Ellen and Klingle, Kirsten and Parmar, Devashree and Hrabok, Marianne and Kelland, Jill and Surood, Shireen and Agyapong, Vincent", title="Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation", journal="JMIR Res Protoc", year="2020", month="Aug", day="20", volume="9", number="8", pages="e14885", keywords="borderline personality disorder", keywords="mental health services", keywords="health care quality", keywords="access", keywords="evaluation", keywords="care pathways", abstract="Background: Borderline personality disorder (BPD) is characterized by severe emotion dysregulation that is often complicated by comorbid diagnoses, deliberate self-harm, and chronic suicidal ideation. Unfortunately, current care pathways for individuals with BPD are strained by limited resources, inadequate training, and an overuse of emergency departments and crisis teams. Such barriers result in delayed access to effective treatment, which increases risk of deterioration, disability, and morbidity. A first step toward addressing these limitations of the current care pathway is to understand key stakeholders' lived experiences in this pathway and their perspectives on potential solutions. Objective: The purpose of this paper is to present a protocol for a study that explores the lived experiences of the current care pathway from the perspectives of patients with BPD, as well as their caregivers and clinicians. Methods: A qualitative approach is most appropriate for the exploratory nature of the research objective. Accordingly, 3 to 6 patients with a diagnosis of BPD, 3 caregivers of individuals with BPD, and 3 clinicians of patients diagnosed with BPD will be invited to participate in individual, semistructured interviews that focus on service experiences. Results: It is anticipated that results will yield insight into the lived experiences of patients with BPD, caregivers, and clinicians and provide a better understanding of the perceived gaps in services and potential solutions. Results are expected to be available in 12 months. Conclusions: This paper describes a protocol for a qualitative study that seeks to understand the lived experiences and perspectives of key stakeholders (patients, caregivers, and clinicians) on the current care pathway for BPD. Results will provide a basis for future research in this area and will have the potential to inform training, practice, and policy. International Registered Report Identifier (IRRID): DERR1-10.2196/14885 ", doi="10.2196/14885", url="https://www.researchprotocols.org/2020/8/e14885", url="http://www.ncbi.nlm.nih.gov/pubmed/32815818" } @Article{info:doi/10.2196/18642, author="Titzler, Ingrid and Berking, Matthias and Schlicker, Sandra and Riper, Heleen and Ebert, Daniel David", title="Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners' Views", journal="JMIR Ment Health", year="2020", month="Aug", day="18", volume="7", number="8", pages="e18642", keywords="barriers and facilitators", keywords="general practitioners", keywords="depression", keywords="referral", keywords="blended therapy", keywords="internet-based intervention", keywords="mobile phone", keywords="psychotherapy", keywords="qualitative research", abstract="Background: Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users' perspectives and behavior. Objective: This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. Methods: Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. Results: GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs' referrals and their self-rated pharmacotherapeutic competence, r(73)=?0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included ``little knowledge about internet-based interventions'' and ``patients' lack of familiarity with technology/internet/media'' (number of statements, each k=22). Key facilitators were ``perceived patient suitability, e.g. well-educated, young'' (k=22) and ``no conflict with GP's role'' (k=16). The follow-up survey showed a very high agreement rate of at least 75\% for 71\% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. Conclusions: This study provides insights into factors influencing GPs' referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates. ", doi="10.2196/18642", url="http://mental.jmir.org/2020/8/e18642/", url="http://www.ncbi.nlm.nih.gov/pubmed/32673213" } @Article{info:doi/10.2196/17155, author="Alvarez-Jimenez, Mario and Rice, Simon and D'Alfonso, Simon and Leicester, Steven and Bendall, Sarah and Pryor, Ingrid and Russon, Penni and McEnery, Carla and Santesteban-Echarri, Olga and Da Costa, Gustavo and Gilbertson, Tamsyn and Valentine, Lee and Solves, Laia and Ratheesh, Aswin and McGorry, D. Patrick and Gleeson, John", title="A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service", journal="J Med Internet Res", year="2020", month="Aug", day="13", volume="22", number="8", pages="e17155", keywords="mHealth", keywords="youth", keywords="social media", keywords="social networking", keywords="mobile phone", keywords="internet-based intervention", abstract="Background: Mental ill-health is the leading cause of disability worldwide. Moreover, 75\% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. Objective: The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. Methods: Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5\%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. Results: Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33\%) to severe (96/157, 61\%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ?3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98\% (91/93) of participants reported a positive experience using MOST+, 82\% (70/93) reported that using MOST+ helped them feel better, 86\% (76/93) felt more socially connected using it, and 92\% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97\% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=?0.39; P<.001), perceived stress (d=?0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=?0.29; P<.001), loneliness (d=?0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. Conclusions: MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services. ", doi="10.2196/17155", url="https://www.jmir.org/2020/8/e17155", url="http://www.ncbi.nlm.nih.gov/pubmed/32788151" } @Article{info:doi/10.2196/19591, author="Kamel, Mamdouh Mostafa and Westenberg, Nicolas Jean and Choi, Fiona and Tabi, Katarina and Badawy, Adel and Ramy, Hisham and Elsawi, Hossam and Krausz, Michael", title="Electronic Mental Health as an Option for Egyptian Psychiatry: Cross-Sectional Study", journal="JMIR Ment Health", year="2020", month="Aug", day="13", volume="7", number="8", pages="e19591", keywords="psychiatry", keywords="e-mental health", keywords="Arab countries", keywords="mental health care", keywords="psychiatrists", keywords="health care providers", abstract="Background: Egypt is a country of nearly 100 million citizens, and there are less than 1000 registered psychiatrists. The mental health care system is under resourced and nearly inaccessible for the majority of the population. In addition, youth under the age of 25 years represent 50\% of Egyptian citizens; however, there are no specific services addressing their unique needs. How can the needs of the largest population in the Middle East be effectively addressed? Is a web-based framework an option for Egyptian psychiatrists to serve the population? Objective: The aims of this study were to better understand the opinions of psychiatrists on the current state of mental health care services in Egypt and their current knowledge on electronic mental health (EMH); assess the attitudes of Egyptian psychiatrists toward web-based interventions and telemedicine for mental health; and identify perceived advantages and barriers of EMH development in Egypt. Methods: A cross-sectional survey was conducted online among 640 Egyptian psychiatrists. It included a total of 36 items within a set of 16 questions asking about EMH literacy, integrating EMH into the mental health care system, and the perceived priorities and barriers of EMH. The sampling was supported by Tanta University, a large academic institution close to Cairo. Statistical analysis was performed using SPSS 25 (IBM Corp). Descriptive statistics, the chi-square test, the independent sample t test, and analysis of variance were applied. Results: A total of 188 participants responded (response rate of 29.4\%), of which 54.2\% (102/188) were female and 54.3\% (102/188) were between 30 and 45 years old. Less than half of the participants thought that the current health care system was efficient for adults (69/155, 44.4\%), and even less thought it was efficient for youth (44/155, 28.3\%). Almost all participants agreed that EMH would be beneficial for patient care (147/155, 94.8\%) and that integrating EMH into the current health care system would be a good idea (118/155, 76.2\%). The highest rated utility of web-based solutions was documentation, followed by psychoeducation and communication with professionals. The main advantages were to improve access to care in rural areas of the country and its convenience. Conclusions: There is scarcity of mental health resources in Egypt. Egyptian psychiatrists are interested in EMH and believe web-based platforms can become part of the solution for the Egyptian mental health care system. ", doi="10.2196/19591", url="http://mental.jmir.org/2020/8/e19591/", url="http://www.ncbi.nlm.nih.gov/pubmed/32788155" } @Article{info:doi/10.2196/18114, author="Roystonn, Kumarasan and Vaingankar, Ajit Janhavi and Chua, Yiang Boon and Sambasivam, Rajeswari and Shafie, Saleha and Jeyagurunathan, Anitha and Verma, Swapna and Abdin, Edimansyah and Chong, Ann Siow and Subramaniam, Mythily", title="The Public Health Impact and Policy Implications of Online Support Group Use for Mental Health in Singapore: Cross-Sectional Survey", journal="JMIR Ment Health", year="2020", month="Aug", day="4", volume="7", number="8", pages="e18114", keywords="online support group", keywords="internet", keywords="self-help", keywords="mental health treatment", keywords="mental illness", keywords="public health", abstract="Background: The wide mental health treatment gap continues to pose a global and local public health challenge. Online support groups are on the rise and could be used to complement formal treatment services for mental health. Objective: This study aimed to examine the prevalence of online support group use and explore factors associated with the use in the general population using data from a national cross-sectional mental health survey in Singapore. Methods: Singapore residents aged 18 years and above participated in a nationally representative household survey in which the World Health Organization Composite International Diagnostic Interview 3.0 was administered by trained interviewers to examine the use of online support groups for mental health. Multiple logistic regressions were used to analyze the association of online support group use with various sociodemographic and health factors. Results: A total of 6110 respondents with complete data were included in this study. Overall, 10 individuals per 1000 adults (1\%) reported seeking help from online support groups for their mental health problems. Compared to younger adults (those aged 18 to 34 years) and those with university education, individuals aged 50 to 64 years (P<.001; OR 0.1, 95\% CI 0.0-0.3) and those with preuniversity qualifications (P=.02; OR 0.1, 95\% CI 0.0-0.8) were less likely to use online support groups for mental health, respectively. Participants with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorder were 6.8 times more likely (P<.001; 95\% CI 3.0-15.4) to use an online support group; in particular, individuals with major depressive disorder (P<.001; OR 5.4, 95\% CI 2.1-13.8) and obsessive compulsive disorder (P=.01; OR 3.5, 95\% CI 1.3-9.7) were more likely to use an online support group for their mental health. Conclusions: Online support groups could be used to complement formal treatment services, especially for mood and anxiety-related disorders. As online support group use for mental health issues may be more prevalent among younger people, early detection and accurate information in online support groups may guide individuals toward seeking professional help for their mental health problems. ", doi="10.2196/18114", url="https://mental.jmir.org/2020/8/e18114", url="http://www.ncbi.nlm.nih.gov/pubmed/32749231" } @Article{info:doi/10.2196/19778, author="Vaidyam, Aditya and Roux, Spencer and Torous, John", title="Patient Innovation in Investigating the Effects of Environmental Pollution in Schizophrenia: Case Report of Digital Phenotyping Beyond Apps", journal="JMIR Ment Health", year="2020", month="Aug", day="3", volume="7", number="8", pages="e19778", keywords="digital mental health", keywords="mHealth", keywords="apps", keywords="serious mental illness", keywords="schizophrenia", keywords="psychiatry", keywords="digital phenotyping", doi="10.2196/19778", url="https://mental.jmir.org/2020/8/e19778", url="http://www.ncbi.nlm.nih.gov/pubmed/32559173" } @Article{info:doi/10.2196/19497, author="Romm, Lie Kristin and Nilsen, Liv and Gjermundsen, Kristine and Holter, Marit and Fjell, Anne and Melle, Ingrid and Rep{\aa}l, Arne and Lobban, Fiona", title="Remote Care for Caregivers of People With Psychosis: Mixed Methods Pilot Study", journal="JMIR Ment Health", year="2020", month="Jul", day="28", volume="7", number="7", pages="e19497", keywords="REACT", keywords="psychosis", keywords="family work", keywords="early intervention", keywords="psychoeducation", keywords="mental health service", keywords="innovation", keywords="eHealth", abstract="Background: A reduced availability of resources has hampered the implementation of family work in psychosis. Web-based support programs have the potential to increase access to high-quality, standardized resources. This pilot study tested the Norwegian version of the Relatives Education and Coping Toolkit (REACT), a web-based United Kingdom National Health Service program in combination with phone-based support by trained family therapists. Objective: We investigated how the program was perceived by its users and identified the facilitators and barriers to its clinical implementation. Methods: Relatives of people with psychosis were offered access to REACT and to weekly family therapist support (with 1 of 2 trained family therapists) for 26 weeks. Level of distress and level of expressed emotion data were collected at baseline and after 26 weeks using the Family Questionnaire and the Relatives Stress Scale. Both family therapists and a subset of the relatives were interviewed about their experiences after completing the program. Results: During the program, relatives (n=19) had a median of 8 (range 4-11) consultations with the family therapists. Postintervention, there was a significant reduction in stress and in expressed emotions in the relatives of people with psychosis. Interviews with the relatives (n=7) and the family therapists (n=2) indicated the following themes as important---the intervention turned knowledge into action; the intervention strengthened the feeling of being involved and taken seriously by the health services; and management support and the ability for self-referral were important, while lack of reimbursement and clinician resistance to technology were barriers to implementation. Conclusions: The service was found to offer a valued clinical benefit; however, strategies that aim to engage clinicians and increase organizational support toward new technology need to be developed. ", doi="10.2196/19497", url="http://mental.jmir.org/2020/7/e19497/", url="http://www.ncbi.nlm.nih.gov/pubmed/32720905" } @Article{info:doi/10.2196/17362, author="Davies, Fiona and Shepherd, L. Heather and Beatty, Lisa and Clark, Brodie and Butow, Phyllis and Shaw, Joanne", title="Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives", journal="J Med Internet Res", year="2020", month="Jul", day="23", volume="22", number="7", pages="e17362", keywords="health professional views", keywords="implementation", keywords="online psychological therapy", keywords="online CBT", keywords="barriers", keywords="facilitators", keywords="models of care", keywords="cognitive behavioral therapy", keywords="internet-based intervention", abstract="Background: Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. Objective: Our objective in this review was to summarize what is known about health care professionals' perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. Methods: We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals' views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. Results: We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. Conclusions: Without health professionals' support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. Trial Registration: PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk ", doi="10.2196/17362", url="http://www.jmir.org/2020/7/e17362/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706713" } @Article{info:doi/10.2196/16455, author="Higuchi, Masakazu and Nakamura, Mitsuteru and Shinohara, Shuji and Omiya, Yasuhiro and Takano, Takeshi and Mitsuyoshi, Shunji and Tokuno, Shinichi", title="Effectiveness of a Voice-Based Mental Health Evaluation System for Mobile Devices: Prospective Study", journal="JMIR Form Res", year="2020", month="Jul", day="20", volume="4", number="7", pages="e16455", keywords="mental health", keywords="monitoring system", keywords="stress evaluation", keywords="voice analysis", abstract="Background: We developed a system for monitoring mental health using voice data from daily phone calls, termed Mind Monitoring System (MIMOSYS), by implementing a method for estimating mental health status from voice data. Objective: The objective of this study was to evaluate the potential of this system for detecting depressive states and monitoring stress-induced mental changes. Methods: We opened our system to the public in the form of a prospective study in which data were collected over 2 years from a large, unspecified sample of users.We used these data to analyze the relationships between the rate of continued use, the men-to-women ratio, and existing psychological tests for this system over the study duration. Moreover, we analyzed changes in mental data over time under stress from particular life events. Results: The system had a high rate of continued use. Voice indicators showed that women have more depressive tendencies than men, matching the rate of depression in Japan. The system's voice indicators and the scores on classical psychological tests were correlated. We confirmed deteriorating mental health for users in areas affected by major earthquakes in Japan around the time of the earthquakes. Conclusions: The results suggest that although this system is insufficient for detecting depression, it may be effective for monitoring changes in mental health due to stress. The greatest feature of our system is mental health monitoring, which is most effectively accomplished by performing long-term time-series analysis of the acquired data considering the user's life events. Such a system can improve the implementation of patient interventions by evaluating objective data along with life events. ", doi="10.2196/16455", url="http://formative.jmir.org/2020/7/e16455/", url="http://www.ncbi.nlm.nih.gov/pubmed/32554367" } @Article{info:doi/10.2196/20513, author="Schleider, Lee Jessica and Dobias, Mallory and Sung, Jenna and Mumper, Emma and Mullarkey, C. Michael", title="Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health", journal="JMIR Ment Health", year="2020", month="Jun", day="30", volume="7", number="6", pages="e20513", keywords="internet intervention", keywords="online interventions", keywords="youth", keywords="mental health", keywords="adolescent", keywords="depression", keywords="single-session intervention", keywords="intervention", abstract="Background: Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood. Objective: We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment \& Support), an open-access platform offering three online SSIs for youth internalizing distress. Methods: After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES. Results: From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75\% non-white; 78.10\% female; 43.23\% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers). Conclusions: Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress. Trial Registration: Open Science Framework; osf.io/e52p3 ", doi="10.2196/20513", url="http://mental.jmir.org/2020/6/e20513/", url="http://www.ncbi.nlm.nih.gov/pubmed/32602846" } @Article{info:doi/10.2196/17569, author="Hoffmann, Mariell and Wensing, Michel and Peters-Klimm, Frank and Szecsenyi, Joachim and Hartmann, Mechthild and Friederich, Hans-Christoph and Haun, W. Markus", title="Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study", journal="J Med Internet Res", year="2020", month="Jun", day="18", volume="22", number="6", pages="e17569", keywords="video consultations", keywords="videoconferencing", keywords="telehealth", keywords="integrated care", keywords="mental health", keywords="health services research", keywords="qualitative study", keywords="preimplementation", abstract="Background: Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists' acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective: The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods: We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results: Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100\%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55\%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64\%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55\%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82\%), and reimbursement conditions (7/11, 67\%), as key drivers for the acceptance and adoption of the model. Conclusions: While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients' and therapists' engagement. Trial Registration: German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one ", doi="10.2196/17569", url="http://www.jmir.org/2020/6/e17569/", url="http://www.ncbi.nlm.nih.gov/pubmed/32554369" } @Article{info:doi/10.2196/17454, author="Wijnen, M. Ben F. and Smit, Filip and Uhernik, Ivi{\v c}evi{\'c} Ana and Istvanovic, Ana and Dedovic, Jovo and Dinolova, Roumyana and Nica, Raluca and Velickovski, Robert and Wensing, Michel and Petrea, Ionela and Shields-Zeeman, Laura", title="Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial--Based Health-Economic Evaluations Embedded in the RECOVER-E Program", journal="JMIR Res Protoc", year="2020", month="Jun", day="1", volume="9", number="6", pages="e17454", keywords="community-based mental health care", keywords="cost-effectiveness analysis", keywords="cost-utility analysis", keywords="economic evaluation", keywords="mental health", abstract="Background: Community-based recovery-oriented mental health services for people with severe mental disorders have not been fully implemented in Bulgaria, Croatia, Macedonia, Montenegro, and Romania. The RECOVER-E project facilitates the implementation of specialized mental health care delivered by setting up services, implementing the services, and evaluating multidisciplinary community mental health teams. The outcomes of the RECOVER-E project are assessed in a trial-based outcome evaluation in each of the participating countries with a health-economic evaluation linked to these trials. Objective: The aim of this protocol paper is to describe the methodology that will be used for the health-economic evaluation alongside the trials. Methods: Implementation sites have been selected in each of the five countries where hospital-based mental health services are available (care as usual [CAU]) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia, and other psychotic disorders). The newly implemented health care system will involve community-based recovery-oriented mental health care (CMHC). At each site, 180 consenting patients will be randomized to either CAU or CMHC. Patient-level outcomes are personal and social functioning and quality-adjusted life years (QALYs). Data on participants' health care use will be collected and corresponding health care costs will be computed. This enables evaluation of health care costs of CMHC as compared with CAU, and these costs can be related to patient-level outcomes (functioning and QALY gains) in health-economic evaluation. Results: Data collection was started in December 2018 (Croatia), February 2019 (Montenegro), April 2019 (Romania), June 2019 (North Macedonia), and October 2019 (Bulgaria). The findings of the outcome evaluations will be reported for each of the five countries separately, and the five trials will be pooled for multilevel analysis on a combined dataset. Conclusions: The results of the health-economic evaluation of the RECOVER-E project will contribute to the growing evidence base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. Trial Registration: (1) ClinicalTrials.gov NCT03922425 (Bulgaria); https://clinicaltrials.gov/ct2/show/NCT03922425 (2) ClinicalTrials.gov NCT03862209 (Croatia); https://clinicaltrials.gov/ct2/show/NCT03862209 (3) ClinicalTrials.gov NCT03892473 (Macedonia); https://clinicaltrials.gov/ct2/show/NCT03892473 (4) ClinicalTrials.gov NCT03837340 (Montenegro); https://clinicaltrials.gov/ct2/show/NCT03837340 (5) ClinicalTrials.gov NCT03884933 (Romania); https://clinicaltrials.gov/ct2/show/NCT03884933 International Registered Report Identifier (IRRID): DERR1-10.2196/17454 ", doi="10.2196/17454", url="https://www.researchprotocols.org/2020/6/e17454", url="http://www.ncbi.nlm.nih.gov/pubmed/32476658" } @Article{info:doi/10.2196/14835, author="Raphiphatthana, Buaphrao and Sweet, Michelle and Puszka, Stefanie and Whitty, Megan and Dingwall, Kylie and Nagel, Tricia", title="Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated ``Promoting Action on Research Implementation in Health Services'' Framework: Qualitative Study", journal="JMIR Ment Health", year="2020", month="May", day="26", volume="7", number="5", pages="e14835", keywords="eHealth", keywords="implementation science", keywords="health care delivery", abstract="Background: Electronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches. Objective: This study aimed to understand service providers' perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people. Methods: Qualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who hadundergone electronic mental health training workshops. Results: Several factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training. Conclusions: The i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support. ", doi="10.2196/14835", url="http://mental.jmir.org/2020/5/e14835/", url="http://www.ncbi.nlm.nih.gov/pubmed/32452812" } @Article{info:doi/10.2196/14825, author="Too, San Lay and Leach, Liana and Butterworth, Peter", title="Mental Health Problems and Internet Access: Results From an Australian National Household Survey", journal="JMIR Ment Health", year="2020", month="May", day="15", volume="7", number="5", pages="e14825", keywords="internet access", keywords="mental health", keywords="affordability, mobile phone", abstract="Background: Mental health support and interventions are increasingly delivered on the web, and stepped care systems of mental health services are embracing the notion of a digital gateway through which individuals can have access to information, assessment, and services and can be connected with more intensive services if needed. Although concerns have been raised over whether people with mental health problems are disadvantaged in terms of their access to the internet, there is a lack of representative data on this topic. Objective: This study aimed to examine the relationship between mental health and internet access, particularly lack of access because of affordability issues. Methods: Data from wave 14 of the Household, Income, and Labour Dynamics in Australia survey were used (n=15,596) in the analyses. Sample weights available in the survey were used to calculate the proportion of those with or without internet access for those with and without mental health problems and more severe long-term mental health conditions. These proportions were also calculated for those with and without internet access due, specifically, to affordability issues. Multinomial logistic regression analyses assessed the relationship between mental health status and internet access/affordability issues, adjusting for a range of covariates. Results: Access to the internet was poorer for those with mental health problems (87.8\%) than those without mental health problems (92.2\%), and the difference was greater when a measure of more severe mental health conditions was used (81.3\% vs 92.2\%). The regression models showed that even after adjusting for a broad range of covariates, people with mental ill health were significantly more likely to have no internet access because of unaffordability than those without mental ill health (mental health problems: relative risk ratio [RRR] 1.68; 95\% CI 1.11-2.53 and severe mental health conditions: RRR 1.92; 95\% CI 1.16-3.19). Conclusions: As Australia and other nations increasingly deliver mental health services on the web, issues of equity and affordability need to be considered to ensure that those who most need support and assistance are not further disadvantaged. ", doi="10.2196/14825", url="http://mental.jmir.org/2020/5/e14825/", url="http://www.ncbi.nlm.nih.gov/pubmed/32410731" } @Article{info:doi/10.2196/15521, author="Gremyr, Andreas and Andersson G{\"a}re, Boel and Greenhalgh, Trisha and Malm, Ulf and Thor, Johan and Andersson, Ann-Christine", title="Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study", journal="J Med Internet Res", year="2020", month="Apr", day="23", volume="22", number="4", pages="e15521", keywords="health care", keywords="complexity", keywords="schizophrenia", keywords="coproduction", keywords="learning health systems", abstract="Background: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders' experiences with using NASSS-CAT, and practical implications. Methods: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general. ", doi="10.2196/15521", url="http://www.jmir.org/2020/4/e15521/", url="http://www.ncbi.nlm.nih.gov/pubmed/32324143" } @Article{info:doi/10.2196/17330, author="Bleyel, Caroline and Hoffmann, Mariell and Wensing, Michel and Hartmann, Mechthild and Friederich, Hans-Christoph and Haun, W. Markus", title="Patients' Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers", journal="J Med Internet Res", year="2020", month="Apr", day="20", volume="22", number="4", pages="e17330", keywords="telemedicine", keywords="remote consultation", keywords="implementation", keywords="primary health care", keywords="mental health services", keywords="thematic analysis", keywords="integrated behavioral health", keywords="health services research", abstract="Background: Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective: From the patients' perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods: Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results: Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85\%; lower threshold for seeking specialist mental health care: 6/13, 46\%; shorter travel distances: 3/13, 23\%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38\%). The main barriers to the implementation of mental health video consultations from the patients' perspective were the lack of face-to-face contact (13/13, 100\%) and technical challenges (12/13, 92\%). Notably, participants' prerequisites for interacting with therapists (12/13, 92\%) did not seem to differ much from those concerning face-to-face contacts. Conclusions: Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration: German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one ", doi="10.2196/17330", url="http://www.jmir.org/2020/4/e17330/", url="http://www.ncbi.nlm.nih.gov/pubmed/32310139" } @Article{info:doi/10.2196/16945, author="Lal, Shalini and Starcevic, Joanna Danielle and Fuhrer, Rebecca", title="Youth Experiences With Referrals to Mental Health Services in Canada: Protocol for a Web-Based Cross-Sectional Survey Study", journal="JMIR Res Protoc", year="2020", month="Mar", day="24", volume="9", number="3", pages="e16945", keywords="mental disorders", keywords="health care quality, access, and evaluation", keywords="mental health", keywords="psychology", keywords="telemedicine", keywords="young adult", keywords="health services accessibility", keywords="technology", keywords="referral and consultation", abstract="Background: Youth mental health is an important public health concern affecting low-, middle-, and high-income countries, and many young people in need of mental health services do not receive the care they need when they need it. An early step in accessing mental health care is the referral process, yet most of the research done on pathways to care has focused on clinical populations (eg, first-episode psychosis) recruited from mental health care settings. There has been limited research attention on the experiences of referral to mental health services from the perspectives of youth recruited from the general population who may or may not have received the services they need. Objective: This study aims to investigate the experiences that youth between the ages of 17 and 30 years have with referrals to mental health services and to better understand their perspectives on the use of technology to facilitate referrals. Methods: This study will use a cross-sectional, Web-based survey design. A convenience sample of 400 participants from 3 Canadian provinces (Quebec, Ontario, and British Columbia), between the ages of 17 and 30 years, will be recruited via Facebook and will be invited to complete a Web-based survey anonymously. A questionnaire including a series of quantitative and qualitative questions will ask participants about their sociodemographic characteristics, past experiences with referral and access to mental health services, and opinions about using technology to facilitate the referral process. Results: Participant recruitment is planned to be initiated by early January 2020 and is estimated to be completed by May 2020. Data will be analyzed using descriptive statistics and logistic regression or chi-square tests for quantitative data, and descriptive content analysis will be used for the qualitative data. Conclusions: The results of this study can help inform the improvement of referral policies and procedures in youth mental health service delivery. A better understanding of young people's perspectives on referral processes and their opinions on how these processes can be improved are essential to providing appropriate and timely access to mental health care. International Registered Report Identifier (IRRID): PRR1-10.2196/16945 ", doi="10.2196/16945", url="http://www.researchprotocols.org/2020/3/e16945/", url="http://www.ncbi.nlm.nih.gov/pubmed/32207698" } @Article{info:doi/10.2196/14868, author="Pithara, Christalla and Farr, Michelle and Sullivan, A. Sarah and Edwards, B. Hannah and Hall, William and Gadd, Caroline and Walker, Julian and Hebden, Nick and Horwood, Jeremy", title="Implementing a Digital Tool to Support Shared Care Planning in Community-Based Mental Health Services: Qualitative Evaluation", journal="J Med Internet Res", year="2020", month="Mar", day="19", volume="22", number="3", pages="e14868", keywords="health care technology", keywords="mental health", keywords="community health care", keywords="patient-centered care", keywords="patient care planning", keywords="implementation science", abstract="Background: Mental health services aim to provide recovery-focused care and facilitate coproduced care planning. In practice, mental health providers can find supporting individualized coproduced care with service users difficult while balancing administrative and performance demands. To help meet this aim and using principles of coproduction, an innovative mobile digital care pathway tool (CPT) was developed to be used on a tablet computer and piloted in the West of England. Objective: The aim of this study was to examine mental health care providers' views of and experiences with the CPT during the pilot implementation phase and identify factors influencing its implementation. Methods: A total of 20 in-depth telephone interviews were conducted with providers participating in the pilot and managers in the host organization. Interviews were audio recorded, transcribed, anonymized, and thematically analyzed guided by the Consolidated Framework for Implementation Research. Results: The tool was thought to facilitate coproduced recovery-focused care planning, a policy and organizational as well as professional priority. Internet connectivity issues, system interoperability, and access to service users' health records affected use of the tool during mobile working. The organization's resources, such as information technology (IT) infrastructure and staff time and IT culture, influenced implementation. Participants' levels of use of the tool were dependent on knowledge of the tool and self-efficacy; perceived service-user needs and characteristics; and perceptions of impact on the therapeutic relationship. Training and preparation time influenced participants' confidence in using the tool. Conclusions: Findings highlight the importance of congruence between staff, organization, and external policy priorities and digital technologies in aiding intervention engagement, and the need for ongoing training and support of those intended to use the technology during and after the end of implementation interventions. ", doi="10.2196/14868", url="https://www.jmir.org/2020/3/e14868", url="http://www.ncbi.nlm.nih.gov/pubmed/32191210" } @Article{info:doi/10.2196/16263, author="Kemp, Jessica and Zhang, Timothy and Inglis, Fiona and Wiljer, David and Sockalingam, Sanjeev and Crawford, Allison and Lo, Brian and Charow, Rebecca and Munnery, Mikayla and Singh Takhar, Shuranjeet and Strudwick, Gillian", title="Delivery of Compassionate Mental Health Care in a Digital Technology--Driven Age: Scoping Review", journal="J Med Internet Res", year="2020", month="Mar", day="6", volume="22", number="3", pages="e16263", keywords="compassion", keywords="mental health", keywords="medical informatics", keywords="psychiatry", keywords="health information technology", keywords="nursing informatics", abstract="Background: Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. Objective: This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. Methods: We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. Results: Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. Conclusions: Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care. ", doi="10.2196/16263", url="https://www.jmir.org/2020/3/e16263", url="http://www.ncbi.nlm.nih.gov/pubmed/32141833" } @Article{info:doi/10.2196/15553, author="Maulik, K. Pallab and Devarapalli, Siddhardha and Kallakuri, Sudha and Bhattacharya, Amritendu and Peiris, David and Patel, Anushka", title="The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India", journal="J Med Internet Res", year="2020", month="Feb", day="27", volume="22", number="2", pages="e15553", keywords="mental health services", keywords="mHealth", keywords="rural", keywords="India", keywords="mental disorders", keywords="primary health care", abstract="Background: Although around 10\% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective: This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods: A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results: In total, 900 of 22,046 (4.08\%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2\%) reported visiting the doctor for their mental health symptoms, compared with 3.3\% (30/900) at baseline (odds ratio 133.3, 95\% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions: The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial. ", doi="10.2196/15553", url="http://www.jmir.org/2020/2/e15553/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130125" } @Article{info:doi/10.2196/16005, author="Hadjistavropoulos, D. Heather and Peynenburg, Vanessa and Mehta, Swati and Adlam, Kelly and Nugent, Marcie and Gullickson, M. Kirsten and Titov, Nickolai and Dear, Blake", title="An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study", journal="JMIR Ment Health", year="2020", month="Feb", day="4", volume="7", number="2", pages="e16005", keywords="internet", keywords="disability", keywords="depression", keywords="anxiety", keywords="insurance", keywords="cognitive behavior therapy", abstract="Background: Anxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations. Objective: The aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among individuals involved with 2 insurance companies. The 2 samples were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic. Methods: Individuals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months. Results: All samples showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77; anxiety d=1.13; and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other samples, experienced significant moderate effects at posttreatment (depression d=0.58; anxiety d=0.54; and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC samples were significantly smaller than in the PF sample who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF sample who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF samples on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF sample with no disability benefits d=0.90) and those on short-term disability benefits d=0.94). Conclusions: Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small sample sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described. ", doi="10.2196/16005", url="https://mental.jmir.org/2020/2/e16005", url="http://www.ncbi.nlm.nih.gov/pubmed/32014840" } @Article{info:doi/10.2196/14949, author="Kerr, Bradley and Stephens, David and Pham, Daniel and Ghost Dog, Thomas and McCray, Celena and Caughlan, Colbie and Gaston, Amanda and Gritton, Jesse and Jenkins, Marina and Craig Rushing, Stephanie and Moreno, A. Megan", title="Assessing the Usability, Appeal, and Impact of a Web-Based Training for Adults Responding to Concerning Posts on Social Media: Pilot Suicide Prevention Study", journal="JMIR Ment Health", year="2020", month="Jan", day="20", volume="7", number="1", pages="e14949", keywords="community health education", keywords="mental health", keywords="social networking", abstract="Background: Suicide prevention remains challenging among youth, as many do not disclose suicidal ideation. Nearly one-third of American Indian and Alaska Native (AI and AN, tribal, or native) youth see concerning messages on social media at least weekly. Objective: To prepare adults to support AI and AN youth who post or view concerning messages, our team designed an hour-long training: Responding to Concerning Posts on Social Media. This study tested the usability, appeal, and impact of the training. Methods: A purposive sample of 70 adults was recruited to participate in the pilot, which included 2 study arms. Arm 1 participants completed a 30-min training video and reviewed accompanying handouts, including the Viewer Care Plan (VCP). The VCP provided a 3-step planning and response tool: (1) Start the Conversation, (2) Listen, Gather Information, and Assess Viewer Experience, and (3) Plan and Act. The intent of the VCP was to support and connect AI and AN youth who either view or post concerning messages on social media to life-saving resources. Those enrolled in arm 2 participated in an additional interactive role-play scenario with a coach that took place after the training, via text message. Participants provided qualitative and quantitative feedback on the training's relevance, appeal, and utility. Paired t tests were used to assess confidence in addressing concerning posts between pre- and postsurveys. Content analysis of the role-play transcripts was used to assess the quality and completion of the coached role-plays, in relation to the recommended VCP. Results: Altogether, 35 participants finished the training and completed pre- and postsurveys; 22 participants completed the 6-month follow-up survey. Pre-post analyses of differences in means found significant improvement across several efficacy measures, including confidence starting a conversation about social media (P=.003), confidence contacting the person who posted something concerning (P<.001), and confidence recommending support services to youth who view (P=.001) or youth who post concerning messages (P<.001). Similarly, pre- to 6-month analyses found significant positive improvement across multiple measures, including confidence contacting the youth who posted (P<.001), confidence starting a conversation about social media with youth (P=.003), and an increase in the number of experiences recommending resources for youth who viewed concerning social media posts (P=.02). Of the 3 steps of the VCP, the least followed step in coached role-plays was sharing tools and resources, which is a part of the third Plan and Act step. Conclusions: Findings indicate that the Responding to Concerning Posts on Social Media training is a promising tool to prepare adults to intervene and complete the VCP. Additional evaluation with a larger cohort of participants is needed to determine the unique impact of the role-play scenario and changes in mental health referral rates, behaviors, and skills. ", doi="10.2196/14949", url="https://mental.jmir.org/2020/1/e14949", url="http://www.ncbi.nlm.nih.gov/pubmed/31958066" } @Article{info:doi/10.2196/13306, author="Shen, Nelson and Sequeira, Lydia and Silver, Pannor Michelle and Carter-Langford, Abigail and Strauss, John and Wiljer, David", title="Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: Qualitative Study", journal="JMIR Ment Health", year="2019", month="Nov", day="13", volume="6", number="11", pages="e13306", keywords="privacy", keywords="health information exchange", keywords="health information technology", keywords="attitude to health", keywords="trust", abstract="Background: The privacy of patients with mental health conditions is prominent in health information exchange (HIE) discussions, given that their potentially sensitive personal health information (PHI) may be electronically shared for various health care purposes. Currently, the patient privacy perspective in the mental health context is not well understood because of the paucity of in-depth patient privacy research; however, the evidence suggests that patient privacy perspectives are more nuanced than what has been assumed in the academic and health care community. Objective: This study aimed to generate an understanding on how patients with mental health conditions feel about privacy in the context of HIE in Canada. This study also sought to identify the factors underpinning their privacy perspectives and explored how their perspectives influenced their attitudes toward HIE. Methods: Semistructured interviews were conducted with patients at a Canadian academic hospital for addictions and mental health. Guided by the Antecedent-Privacy Concern-Outcome macro-model, interview transcripts underwent deductive and inductive thematic analyses. Results: We interviewed 14 participants. Their privacy concerns varied, depending on the participant's privacy experiences and health care perceptions. Media reports of privacy breaches and hackers had little impact on participants' privacy concerns because of a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in health care settings caused concern. Decisions to trust others with PHI depended on past experiences with the individual (or institution) and health care needs. Participants had little knowledge of patient privacy rights and legislation but were willing to participate in HIE because of perceived individual and societal benefits. Conclusions: This study introduces evidence that patients with mental health conditions would support HIE. Participants were pragmatic, supporting HIE because they wanted the best care possible. They also understood that their PHI was critical in supporting the single-payer Canadian health care system. Participant health care experiences informed their privacy perspectives, trust, and PHI sharing attitudes---all accentuating the importance of the patient experience in building trust in HIE. Their lack of knowledge about patient rights and PHI uses highlights the degree of trust they have in the health care system to protect their privacy. These findings suggest that the patient privacy discourse should extend beyond the oft-cited barrier of patient privacy concerns to include discussions about building trust, communicating the benefits of HIE, and improving patient experiences. Although our findings are in the Canadian context, this study highlights the importance of engaging patients in privacy policy discussions, regardless of jurisdiction, to ensure their nuanced perspectives are reflected in policy decisions on their PHI. ", doi="10.2196/13306", url="https://mental.jmir.org/2019/11/e13306", url="http://www.ncbi.nlm.nih.gov/pubmed/31719029" } @Article{info:doi/10.2196/14366, author="Allan, Stephanie and Bradstreet, Simon and Mcleod, Hamish and Farhall, John and Lambrou, Maria and Gleeson, John and Clark, Andrea and and Gumley, Andrew", title="Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study", journal="J Med Internet Res", year="2019", month="Oct", day="24", volume="21", number="10", pages="e14366", keywords="psychosis", keywords="self-management", keywords="implementation science", abstract="Background: Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker--supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation---both within trials and beyond. Objective: Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods: To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders' expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders' previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration: ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 ", doi="10.2196/14366", url="https://www.jmir.org/2019/10/e14366", url="http://www.ncbi.nlm.nih.gov/pubmed/31651400" } @Article{info:doi/10.2196/13189, author="Sanci, Lena and Kauer, Sylvia and Thuraisingam, Sharmala and Davidson, Sandra and Duncan, Ann-Maree and Chondros, Patty and Mihalopoulos, Cathrine and Buhagiar, Kerrie", title="Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial", journal="JMIR Ment Health", year="2019", month="Oct", day="17", volume="6", number="10", pages="e13189", keywords="adolescent", keywords="young adult", keywords="internet", keywords="web archives as topic", keywords="mental health", keywords="mental disorders", keywords="help-seeking behavior", keywords="mental health services", keywords="affect", abstract="Background: Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. Objective: The study aimed to investigate the effect of Link on young people's positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. Methods: Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). Results: In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78\% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30\% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95\% CI 0.2-2.5) points immediately after the intervention and 2.6 (95\% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. Conclusions: The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731 ", doi="10.2196/13189", url="https://mental.jmir.org/2019/10/e13189", url="http://www.ncbi.nlm.nih.gov/pubmed/31625945" } @Article{info:doi/10.2196/11665, author="Morgi{\`e}ve, Margot and Sebbane, D{\'e}borah and De Rosario, Bianca and Demassiet, Vincent and Kabbaj, Soraya and Briffault, Xavier and Roelandt, Jean-Luc", title="Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study", journal="JMIR Ment Health", year="2019", month="Oct", day="9", volume="6", number="10", pages="e11665", keywords="ehealth", keywords="mental health", keywords="psychiatry", keywords="social representations", keywords="focus group", keywords="users", keywords="caregivers", keywords="qualitative analysis", keywords="digital tools.", abstract="Background: For the World Health Organization, electronic health (eHealth) is seen as an effective way to improve therapeutic practices and disease prevention in health. Digital tools lead to major changes in the field of mental medicine, but specific analyses are required to understand and accompany these changes. Objective: Our objective was to highlight the positions of the different stakeholders of the mental health care system on eHealth services and tools, as well as to establish professional and user group profiles of these positions and the uses of these services. Methods: In order to acquire the opinions and expectations of different categories of people, we carried out a qualitative study based on 10 focus groups (n=70, from 3-12 people per group) composed of: general practitioners, psychiatrists, psychologists, social workers, occupational therapists, nurses, caregivers, mental health services users, user representatives, and the general public. The analyses of focus group discussions were performed independently by four investigators through a common analysis grid. The constant comparative method was adopted within this framework. Results: The interviewees expressed different problems that new technologies engender in the field of mental health. What was previously strictly under the jurisdiction of physicians now tends to be fragmented and distributed over different groups and locations. New technologies reposition care in the field of domestic, rather than therapeutic, activities, and thus the conception of care as an autonomous activity in the subject's life is questioned. The ideal of social autonomy through technology is part of the new logic of health democracy and empowerment, which is linked to a strong, contemporary aspiration to perform. Participants emphasized that there was the potential risk of a decrease in autonomy for the digitally engaged patient, while personal empowerment could become a set of obligations. Conclusions: This qualitative research highlights the heterogeneity of opinions among the groups and within each group. It suggests that opinions on electronic mental health devices are still far from being stabilized, and that a change management process should be set up to both regulate the development and facilitate the use of these tools. ", doi="10.2196/11665", url="https://mental.jmir.org/2019/10/e11665", url="http://www.ncbi.nlm.nih.gov/pubmed/31356151" } @Article{info:doi/10.2196/14233, author="McGranahan, Rose and Rennick-Egglestone, Stefan and Ramsay, Amy and Llewellyn-Beardsley, Joy and Bradstreet, Simon and Callard, Felicity and Priebe, Stefan and Slade, Mike", title="Curation of Mental Health Recovery Narrative Collections: Systematic Review and Qualitative Synthesis", journal="JMIR Ment Health", year="2019", month="Oct", day="4", volume="6", number="10", pages="e14233", keywords="mental health recovery", keywords="narrative medicine", keywords="culturally appropriate technology", abstract="Background: Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, which refer to events or actions over a period. They are readily available either individually or in collections of recovery narratives published in books, health service booklets, or on the Web. Collections of recovery narratives have been used in a range of mental health interventions, and organizations or individuals who curate collections can therefore influence how mental health problems are seen and understood. No systematic review has been conducted of research into curatorial decision making. Objective: This study aimed to produce a conceptual framework identifying and categorizing decisions made in the curation of mental health recovery narrative collections. Methods: A conceptual framework was produced through a systematic review and qualitative evidence synthesis. Research articles were identified through searching bibliographic databases (n=13), indexes of specific journals (n=3), and gray literature repositories (n=4). Informal documents presenting knowledge about curation were identified from editorial chapters of electronically available books (n=50), public documents provided by Web-based collections (n=50), and prefaces of health service booklets identified through expert consultation (n=3). Narrative summaries of included research articles were produced. A qualitative evidence synthesis was conducted on all included documents through an inductive thematic analysis. Subgroup analyses were conducted to identify differences in curatorial concerns between Web-based and printed collections. Results: A total of 5410 documents were screened, and 23 documents were included. These comprised 1 research publication and 22 informal documents. Moreover, 9 higher level themes were identified, which considered: the intended purpose and audience of the collection; how to support safety of narrators, recipients, and third parties; the processes of collecting, selecting, organizing, and presenting recovery narratives; ethical and legal issues around collections; and the societal positioning of the collection. Web-based collections placed more emphasis on providing benefits for narrators and providing safety for recipients. Printed collections placed more emphasis on the ordering of narrative within printed material and the political context. Conclusions: Only 1 research article was identified despite extensive searches, and hence this review has revealed a lack of peer-reviewed empirical research regarding the curation of recovery narrative collections. The conceptual framework can be used as a preliminary version of reporting guidelines for use when reporting on health care interventions that make use of narrative collections. It provides a theory base to inform the development of new narrative collections for use in complex mental health interventions. Collections can serve as a mechanism for supporting collective rather than individual discourses around mental health. ", doi="10.2196/14233", url="https://mental.jmir.org/2019/10/e14233", url="http://www.ncbi.nlm.nih.gov/pubmed/31588912" } @Article{info:doi/10.2196/13639, author="Jeong, Dahn and Cheng, Michael and St-Jean, Mireille and Jalali, Alireza", title="Evaluation of eMentalHealth.ca, a Canadian Mental Health Website Portal: Mixed Methods Assessment", journal="JMIR Ment Health", year="2019", month="Sep", day="06", volume="6", number="9", pages="e13639", keywords="e-mental health", keywords="Canada", keywords="online surveys", keywords="website assessment", abstract="Background: Many Canadians have mental health needs, and it can be challenging not knowing where to go for mental health information, services, and support. The website eMentalHealth.ca was created to facilitate and assist Canadians to (1) learn about mental health, (2) screen for common mental health issues, and (3) find mental health services and support. Objective: The aim of this study was to use multiple methods to learn about visitors of eMentalHealth.ca, their perceptions, and their satisfaction with the website. Methods: Website analytics (Google Analytics) provided information about the number of unique visits to the website and how the site was used. Web-based self-administered surveys were used to gather additional information on users' characteristics and to assess their perception of the website and satisfaction with the website. Results: Web analytic results showed that from January 1 to December 31, 2017, there were 651,107 users, with 1.97 million page views. Users were more often female than male, and the majority of users were aged 35 years and older. Most users were located in Canada (612,806/651,107, 94.12\%), and the most common city of origin of users was Toronto (101,473/651,107, 15.58\%), followed by Ottawa (76,692/651,107, 11.78\%), and Montreal (26,621/651,107, 4.09\%). Web-based surveys were completed by a total of 370 respondents from June to December 2017. Overall, the majority of users were satisfied with the website (93.0\%, 320 out of 344 responses). Positive feedback was related to the content of the website as a helpful resource, and negative feedback was related to technical difficulties as well as the design of the main page. This analysis will be used to help the team with ongoing improvements to the website, for example, improving technical issues and homepage usability. Conclusions: Most visitors reported satisfaction with their use of eMentalHealth.ca to learn about mental health as well as where to find help. Mental health websites such as eMentalHealth.ca are a low-cost way to increase public awareness about mental health. ", doi="10.2196/13639", url="https://mental.jmir.org/2019/9/e13639/", url="http://www.ncbi.nlm.nih.gov/pubmed/31493328" } @Article{info:doi/10.2196/13382, author="Hoffmann, Mariell and Hartmann, Mechthild and Wensing, Michel and Friederich, Hans-Christoph and Haun, W. Markus", title="Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians", journal="J Med Internet Res", year="2019", month="Aug", day="19", volume="21", number="8", pages="e13382", keywords="video consultations", keywords="videoconferencing", keywords="integrated behavioral health", keywords="primary care", keywords="health services research", keywords="mental health", abstract="Background: Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective: This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods: In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results: Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84\%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100\%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58\%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions: By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks\_web/navigate.do? navigationId=trial.HTML\&TRIAL\_ID=DRKS00012487 ", doi="10.2196/13382", url="http://www.jmir.org/2019/8/e13382/", url="http://www.ncbi.nlm.nih.gov/pubmed/31429419" } @Article{info:doi/10.2196/14318, author="Broglia, Emma and Millings, Abigail and Barkham, Michael", title="Counseling With Guided Use of a Mobile Well-Being App for Students Experiencing Anxiety or Depression: Clinical Outcomes of a Feasibility Trial Embedded in a Student Counseling Service", journal="JMIR Mhealth Uhealth", year="2019", month="Aug", day="15", volume="7", number="8", pages="e14318", keywords="counseling", keywords="students", keywords="mental health", keywords="mobile app", keywords="feasibility studies", keywords="outcome measures", keywords="depressive symptoms", keywords="generalized anxiety", keywords="universities", abstract="Background: Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support with fewer resources to a growing student population. The convenience and availability of mobile phone apps offer innovative solutions to address therapeutic challenges and expand the reach of traditional support. Objective: The primary aim of this study was to establish the feasibility of a trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling. Methods: The feasibility trial used a two-arm, parallel nonrandomized design comparing counseling alone (treatment as usual, or TAU) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors evaluated include recruitment duration, treatment preference, randomization acceptability, and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3 and 6 months after recruitment. Results: Both groups demonstrated reduced clinical severity by the end of counseling. This was particularly noticeable for depression, social anxiety, and hostility, whereby clients moved from elevated clinical to low clinical or from low clinical to nonclinical by the end of the intervention. By the 6-month follow-up, TAU clients' (n=18) anxiety had increased whereas intervention clients' (n=20) anxiety continued to decrease, and this group difference was significant (Generalized Anxiety Disorder--7: t22=3.46, P=.002). This group difference was not replicated for levels of depression: students in both groups continued to decrease their levels of depression by a similar amount at the 6-month follow-up (Physical Health Questionnaire--9: t22=1.30, P=.21). Conclusion: Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. Trial registration: ISRCTN registry ISRCTN55102899; http://www.isrctn.com/ISRCTN55102899 ", doi="10.2196/14318", url="http://mhealth.jmir.org/2019/8/e14318/", url="http://www.ncbi.nlm.nih.gov/pubmed/31418424" } @Article{info:doi/10.2196/14127, author="Ospina-Pinillos, Laura and Davenport, Tracey and Mendoza Diaz, Antonio and Navarro-Mancilla, Alvaro and Scott, M. Elizabeth and Hickie, B. Ian", title="Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study", journal="J Med Internet Res", year="2019", month="Aug", day="02", volume="21", number="8", pages="e14127", keywords="telemedicine", keywords="medical informatics", keywords="eHealth", keywords="mental health", keywords="cultural characteristics", keywords="cultural competency", keywords="ethnic groups", keywords="transients and migrants", keywords="quality of health care", keywords="international students", keywords="Hispanics", keywords="Latinos", keywords="community-based participatory research", keywords="primary health care", keywords="patient participation", keywords="patient preference", keywords="patient satisfaction", keywords="consumer health information", abstract="Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype's 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries. ", doi="10.2196/14127", url="https://www.jmir.org/2019/8/e14127/", url="http://www.ncbi.nlm.nih.gov/pubmed/31376271" } @Article{info:doi/10.2196/13065, author="Le, Khanh-Dao Long and Sanci, Lena and Chatterton, Lou Mary and Kauer, Sylvia and Buhagiar, Kerrie and Mihalopoulos, Cathrine", title="The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial", journal="J Med Internet Res", year="2019", month="Jul", day="22", volume="21", number="7", pages="e13065", keywords="economic evaluation", keywords="cost effectiveness", keywords="mental health", keywords="help-seeking", keywords="internet intervention", abstract="Background: Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. Objective: The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. Methods: A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life--4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. Results: Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus \$98 vs Aus \$162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus \$47 vs Aus \$101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus ?\$81 (Aus ?\$348 to Aus \$186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100\% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus \$28,033 per QALY. Results were robust in the sensitivity analysis. Conclusions: Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731 ", doi="10.2196/13065", url="http://www.jmir.org/2019/7/e13065/", url="http://www.ncbi.nlm.nih.gov/pubmed/31333199" } @Article{info:doi/10.2196/10838, author="Hensel, M. Jennifer and Shaw, James and Ivers, M. Noah and Desveaux, Laura and Vigod, N. Simone and Cohen, Ashley and Onabajo, Nike and Agarwal, Payal and Mukerji, Geetha and Yang, Rebecca and Nguyen, Megan and Bouck, Zachary and Wong, Ivy and Jeffs, Lianne and Jamieson, Trevor and Bhatia, Sacha R.", title="A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2019", month="Jun", day="04", volume="21", number="6", pages="e10838", keywords="internet", keywords="mental health", keywords="anxiety", keywords="depression", abstract="Background: Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support. Objective: The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care. Methods: A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers. Results: Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95\% CI 2.90 to 7.05), and decreases in PHQ-9 score (?1.83 points, 95\% CI ?2.85 to ?0.82) and GAD-7 score (?1.55 points, 95\% CI ?2.42 to ?0.70). Follow-up was achieved for 55\% (446/812) at 3 months, 48\% (260/542) of ITG participants and 69\% (186/270) of DTG participants. Only 58\% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group. Conclusions: The Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions. Trial Registration: ClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO) ", doi="10.2196/10838", url="https://www.jmir.org/2019/6/e10838/", url="http://www.ncbi.nlm.nih.gov/pubmed/31165710" } @Article{info:doi/10.2196/13955, author="Davenport, A. Tracey and LaMonica, M. Haley and Whittle, Lisa and English, Amelia and Iorfino, Frank and Cross, Shane and Hickie, B. Ian", title="Validation of the InnoWell Platform: Protocol for a Clinical Trial", journal="JMIR Res Protoc", year="2019", month="May", day="31", volume="8", number="5", pages="e13955", keywords="clinical trial protocol", keywords="mental health", keywords="medical informatics", keywords="suicide", abstract="Background: New electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers and better support self-management of care. We developed a Web-based platform (the InnoWell Platform) that supports the prevention, earlyintervention, treatment, and continuous monitoring of mental health and maintenance of well-being in people aged 2 years and older. The platform is a customizable digital tool kitthat operates through existing service providers who utilize thesystem to provide their consumers with access to evidence-basedassessments and feedback, intervention options, and outcomemonitoring. It does this by collecting, storing, and reportingpersonal and health information back to consumers and theirhealth professionals to promote collaborative care partnershipsthat aim to improve the management of mental ill health andmaintenance of well-being Objective: The aim of this study was to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or Web-based mental health service in which the InnoWell Platform is being offered as part of standard clinical care will be given the opportunity to use the platform. Methods: The Web-based platform is a configurable and customizable digital tool that assists in the assessment, monitoring and management of mental ill health, and maintenance of well-being. It does this by collecting, storing, and reporting health information back to the person and his or her clinician to enable transformation to person-centered care. The clinical trial will be conducted with individuals aged 2 years and older presenting to participating services for care, including persons from the veteran community, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, the lesbian, gay, bisexual, transgender, and intersex community, and those from broader education and workforce sectors, as well as people with disabilities, lived experience of comorbidity, complex disorders, and suicidality. Results: Project Synergy was funded in June 2017, and data collection began in November 2018 at a youth mental health service. At the time of this publication, 5 additional services have also begun recruitment, including 4 youth mental health services and a veteran's service. The first results are expected to be submitted in 2020 for publication. Conclusions: This clinical trial will promote access to comprehensive, high-quality mental health care to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and reduce the rate of suicidal thoughts and/or behaviors and suicide by suggesting pathways to care that are appropriate for the identified level of need, while simultaneously enabling a timely service response. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12618001676202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374632 (Archived by WebCite at http://www.webcitation.org/78TOi5jwl) International Registered Report Identifier (IRRID): DERR1-10.2196/13955 ", doi="10.2196/13955", url="http://www.researchprotocols.org/2019/5/e13955/", url="http://www.ncbi.nlm.nih.gov/pubmed/31152524" } @Article{info:doi/10.2196/12892, author="O'Dea, Bridianne and King, Catherine and Subotic-Kerry, Mirjana and Anderson, Melissa and Achilles, Rose Melinda and Parker, Belinda and Mackinnon, Andrew and Anderson, Josey and Cockayne, Nicole and Christensen, Helen", title="Evaluating a Web-Based Mental Health Service for Secondary School Students in Australia: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2019", month="May", day="17", volume="8", number="5", pages="e12892", keywords="schools", keywords="adolescent", keywords="mental health", keywords="depression", keywords="anxiety", keywords="mental health services", keywords="internet", abstract="Background: Mental health problems are prevalent among Australian secondary school youth; however, help-seeking is low. Schools offer an ideal setting to address these concerns. The Black Dog Institute has developed a Web-based mental health service for secondary schools that is modeled on the principles of stepped care. The Smooth Sailing service aims to improve help-seeking and reduce anxiety and depressive symptoms in secondary school students. The acceptability of this service has been demonstrated in a pilot study. A full trial is now warranted. Objective: This study protocol for a cluster randomized controlled trial (RCT) aims to evaluate the effectiveness of the Smooth Sailing Web-based service for improving help-seeking intentions and behavior, and reducing depressive and anxiety symptoms, alongside other mental health outcomes, when compared with a school-as-usual control condition in secondary school youth. Methods: This RCT aims to recruit 1600 students from 16 secondary schools in regional and urban locations throughout New South Wales, Australia. Schools are randomly assigned to the intervention or school-as-usual control condition at the school level. Approximately 100 students from 1 or multiple grades are recruited from each participating school. Participants complete measures at 3 timepoints: baseline, 6 weeks post, and 12 weeks post, with the primary outcome assessed at 12 weeks posttest. Participants assigned to the intervention condition register to the Web-based service at baseline and receive care in accordance with the service model. Participants in the control condition receive school-as-usual. Results: The first baseline assessment occurred on February 22, 2018, with the12-week endpoint assessments completed on Friday, June 29, 2018. Control schools are currently receiving the service, due for completion by June 30, 2019. The trial results are expected to demonstrate improved help-seeking intentions and behavior among students assigned to the intervention condition, alongside improvements in symptoms of depression, anxiety, distress, and other mental health outcomes when compared with students assigned to the control condition. Conclusions: To our knowledge, this is the first time that a Web-based mental health service based on the principles of stepped care will have been integrated into, and evaluated in, the Australian school context. The findings of this trial will have implications for the suitability of this type of service model in Australian schools and for the delivery of school-based mental health services more broadly. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001539224 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821\&isReview=true (Archived by WebCite at http://www.webcitation.org/77N3MDGS6) International Registered Report Identifier (IRRID): DERR1-10.2196/12892 ", doi="10.2196/12892", url="https://www.researchprotocols.org/2019/5/e12892/", url="http://www.ncbi.nlm.nih.gov/pubmed/31102370" } @Article{info:doi/10.2196/12358, author="McCreary, Michael and Arevian, C. Armen and Brady, Madeline and Mosqueda Chichits, E. Ana and Zhang, Lily and Tang, Lingqi and Zima, Bonnie", title="A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study", journal="JMIR Ment Health", year="2019", month="Apr", day="23", volume="6", number="4", pages="e12358", keywords="integrated health care systems", keywords="data collection methods", keywords="community-based participatory research", keywords="community mental health services", abstract="Background: National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. Objective: The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. Methods: Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. Results: A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. Conclusions: Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. Trial Registration: ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW) ", doi="10.2196/12358", url="http://mental.jmir.org/2019/4/e12358/", url="http://www.ncbi.nlm.nih.gov/pubmed/31012861" } @Article{info:doi/10.2196/11224, author="Smail-Crevier, Rachel and Powers, Gabrielle and Noel, Chelsea and Wang, JianLi", title="Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women", journal="J Med Internet Res", year="2019", month="Mar", day="18", volume="21", number="3", pages="e11224", keywords="occupational health", keywords="workplace", keywords="mental health", keywords="preventive health program", keywords="depression", keywords="internet", abstract="Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers' health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4\%) and women (211/500, 42.2\%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8\%), women (408/479, 85.2\%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7\%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8\%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9\%), and to receive printed materials by mail (215/500, 43.4\%). Men preferred to receive information in a video game format (156/511, 30.7\%). Younger men (46/73, 63\%) and younger women (49/60, 81\%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. ", doi="10.2196/11224", url="http://www.jmir.org/2019/3/e11224/", url="http://www.ncbi.nlm.nih.gov/pubmed/30882361" } @Article{info:doi/10.2196/11198, author="Laine, Anna and V{\"a}lim{\"a}ki, Maritta and L{\"o}yttyniemi, Eliisa and Pekurinen, Virve and Marttunen, Mauri and Anttila, Minna", title="The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study", journal="J Med Internet Res", year="2019", month="Mar", day="01", volume="21", number="3", pages="e11198", keywords="internet", keywords="online education", keywords="mental health", keywords="continuing education", abstract="Background: Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments. Objective: We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described. Methods: The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course. Results: Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages. Conclusions: Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed. ", doi="10.2196/11198", url="https://www.jmir.org/2019/3/e11198/", url="http://www.ncbi.nlm.nih.gov/pubmed/30821697" } @Article{info:doi/10.2196/12376, author="Vis, Christiaan and Ruwaard, Jeroen and Finch, Tracy and Rapley, Tim and de Beurs, Derek and van Stel, Henk and van Lettow, Britt and Mol, Mayke and Kleiboer, Annet and Riper, Heleen and Smit, Jan", title="Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals", journal="J Med Internet Res", year="2019", month="Feb", day="20", volume="21", number="2", pages="e12376", keywords="implementation science", keywords="eHealth", keywords="psychometrics", keywords="eMental health", keywords="normalization process theory", keywords="implementation assessment", abstract="Background: Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective: The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods: Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results: A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7\%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62?alpha?.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, $\chi$22=22.5, P?.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak ($\lambda$CA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47?r?.54, P?.05). Conclusions: NoMAD's theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices. ", doi="10.2196/12376", url="http://www.jmir.org/2019/2/e12376/", url="http://www.ncbi.nlm.nih.gov/pubmed/30785402" } @Article{info:doi/10.2196/11694, author="Andrews, A. Jacob and Brown, JE Laura and Hawley, S. Mark and Astell, J. Arlene", title="Older Adults' Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study", journal="J Med Internet Res", year="2019", month="Feb", day="13", volume="21", number="2", pages="e11694", keywords="mental health", keywords="older adults", keywords="technology", keywords="digital technology", keywords="Internet", keywords="apps", abstract="Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults' attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults' perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants' immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. ", doi="10.2196/11694", url="http://www.jmir.org/2019/2/e11694/", url="http://www.ncbi.nlm.nih.gov/pubmed/30758292" } @Article{info:doi/10.2196/10240, author="Bourla, Alexis and Ferreri, Florian and Ogorzelec, Laetitia and Peretti, Charles-Siegfried and Guinchard, Christian and Mouchabac, Stephane", title="Psychiatrists' Attitudes Toward Disruptive New Technologies: Mixed-Methods Study", journal="JMIR Ment Health", year="2018", month="Dec", day="14", volume="5", number="4", pages="e10240", keywords="acceptability", keywords="clinical decision support systems", keywords="computerized adaptive testing", keywords="digital phenotype", keywords="ecological momentary assessment", keywords="machine learning", keywords="mobile phone", keywords="professional culture", abstract="Background: Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. Objective: The aim of this study was to explore psychiatrists' perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. Methods: A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). Results: We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6\%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. Conclusions: This is the first study to assess psychiatrists' views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies. ", doi="10.2196/10240", url="http://mental.jmir.org/2018/4/e10240/", url="http://www.ncbi.nlm.nih.gov/pubmed/30552086" } @Article{info:doi/10.2196/10224, author="Zaheer, Salaha and Garofalo, Vanessa and Rodie, David and Perivolaris, Athina and Chum, Jenny and Crawford, Allison and Geist, Rose and Levinson, Andrea and Mitchell, Brian and Oslin, David and Sunderji, Nadiya and Mulsant, H. Benoit and ", title="Computer-Aided Telephone Support for Primary Care Patients with Common Mental Health Conditions: Randomized Controlled Trial", journal="JMIR Ment Health", year="2018", month="Dec", day="10", volume="5", number="4", pages="e10224", keywords="telemedicine", keywords="collaborative care", keywords="depression", keywords="anxiety", keywords="at-risk drinking", keywords="lay provider", keywords="family medicine", keywords="general practice", keywords="primary care psychiatry", abstract="Background: Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone. Objective: This analysis assesses patient's acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. Methods: The Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study is a randomized controlled trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for the treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion. Results: During the consent process, 17.1\% (114/667) patients referred to the study declined to participate and 57.0\% of them (65/114) attributed their refusal to research-related factors (ie, randomization and time commitment); a further 16.7\% (19/114) declined owing to the telephone delivery of the intervention. Among the 377 participants who were randomized to the 1-year intervention, the overall retention rate was 82.8\% (312/377). Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97\% (38/39) of comments related to the telephone components were positive with key reported positive attributes being accessibility, convenience, and privacy. Conclusions: Our results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy. Trial Registration: ClinicalTrials.gov NCT02345122; https://clinicaltrials.gov/ct2/show/NCT02345122 (Archived by WebCite at http://www.webcitation.org/73R9Q2cle) ", doi="10.2196/10224", url="http://mental.jmir.org/2018/4/e10224/", url="http://www.ncbi.nlm.nih.gov/pubmed/30530461" } @Article{info:doi/10.2196/10129, author="Miyoshi, Brand{\~a}o Newton Shydeo and Azevedo-Marques, De Jo{\~a}o Mazzoncini and Alves, Domingos and Azevedo-Marques, De Paulo Mazzoncini", title="An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration", journal="JMIR Ment Health", year="2018", month="Dec", day="07", volume="5", number="4", pages="e10129", keywords="eHealth", keywords="mental health", keywords="health information exchange", keywords="health information interoperability", keywords="medical record linkage", keywords="continuity of patient care", abstract="Background: The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries. Objective: The aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services. Methods: The proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the S{\~a}o Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution. Results: The eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients' identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91\% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40\% (45,678/248,248) in completeness and 1.10\% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication. Conclusions: The proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care. ", doi="10.2196/10129", url="http://mental.jmir.org/2018/4/e10129/", url="http://www.ncbi.nlm.nih.gov/pubmed/30530455" } @Article{info:doi/10.2196/aging.9130, author="Cruickshank, Callum and MacIntyre, J. Donald", title="Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey", journal="JMIR Aging", year="2018", month="Nov", day="22", volume="1", number="2", pages="e4", keywords="general psychiatry", keywords="internet access", keywords="memory assessment and treatment service", keywords="mobile phone", keywords="old age psychiatry", abstract="Background: It has been suggested that improving access to mental health services, supporting self-management, and increasing clinical productivity can be achieved through the delivery of technology-enabled care by personal mobile-based and internet-based services. There is little evidence available about whether working-age and older adults with mental health problems or their caregivers have access to these technologies or their confidence with these technologies. Objective: This study aimed to ascertain the prevalence and range of devices used to access the internet in patients and caregivers attending general and older adult psychiatry outpatient services and their confidence in using these technologies. Methods: We conducted an anonymous survey of 77 patients and caregivers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology-enabled care. Results: We found high levels of internet access and confidence in using the internet in working-age adults, their caregivers, and older adult caregivers but not in older adult patients. The smartphone usage predominated in working-age adults and their caregivers. Older adult caregivers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor. Conclusions: Access rates and uptake of internet-based services have the potential to be high in working-age adults and their caregivers but are likely to be markedly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial. ", doi="10.2196/aging.9130", url="http://aging.jmir.org/2018/2/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518247" } @Article{info:doi/10.2196/resprot.9722, author="Fern{\'a}ndez-{\'A}lvarez, Javier and D{\'i}az-Garc{\'i}a, Amanda and Vara, Dolores M. {\textordfeminine} and Molinari, Guadalupe and Colombo, Desir{\'e}e and Riva, Giuseppe and Ba{\~n}os, M. Rosa and Botella, Cristina", title="Clients' Experiences With Internet-Based Psychological Treatments for Mental Disorders: Protocol for a Metasynthesis of Qualitative Studies", journal="JMIR Res Protoc", year="2018", month="Nov", day="21", volume="7", number="11", pages="e183", keywords="barriers", keywords="clients' experiences", keywords="facilitators", keywords="internet-based treatment", keywords="metasynthesis", keywords="qualitative", abstract="Background: Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients' experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients' perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. Objective: The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. Methods: Elliot and Timulak's metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. Results: The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. Conclusions: We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training. Trial Registration: PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7). International Registered Report Identifier (IRRID): PRR1-10.2196/9722 ", doi="10.2196/resprot.9722", url="https://www.researchprotocols.org/2018/11/e183/", url="http://www.ncbi.nlm.nih.gov/pubmed/30463837" } @Article{info:doi/10.2196/mental.8816, author="Lawes-Wickwar, Sadie and McBain, Hayley and Mulligan, Kathleen", title="Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review", journal="JMIR Ment Health", year="2018", month="Nov", day="21", volume="5", number="4", pages="e62", keywords="severe mental disorders", keywords="telehealth", keywords="technology", keywords="systematic review", keywords="mobile phone", abstract="Background: People with severe mental illness (SMI) must receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly being used to assist in health care delivery using ``telehealth,'' which includes telephones and mobile phones, computers, remote sensors, the internet, and other devices, to provide immediate real-time information to service users to improve the management of chronic health conditions. Some initial findings have suggested that technology could improve the quality of life of people with SMI. Objective: In this systematic review, we aimed to identify the various uses and efficacy of telehealth technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Health Technology Assessment, CINAHL Plus, and NHS Economic Evaluations Database) to identify randomized controlled trials evaluating telehealth for adults with SMI published in English. Additional literature was identified through searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: Our search identified 31 articles describing 29 trials as eligible for the review. The included studies evaluated the use of computers to deliver cognitive rehabilitation (15 trials), patient education (3 trials), and Web-based self-management interventions (2 trials) and to support consultations (1 trial). Virtual reality was used to simulate work and social situations (2 trials) and to deliver cognitive training (1 trial). Telephones were used to prompt service users to take medications (3 trials) and to report symptoms to their health care team (1 trial). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective in improving medication adherence and reducing the severity of symptoms and inpatient days. Computer-assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. The results of this review should be taken in the context of varied quality in study design, with only 5 studies demonstrating a low risk of bias. Conclusions: A growing variety of telehealth technologies are being used to support the management of SMI. Specific technology types have been found to be effective for some outcomes (eg, telephone and remote medication monitoring for adherence to treatment), while other types of telehealth technologies (eg, delivery of patient education using computers) had no benefit over traditional nurse-based methods and were less acceptable to patients. Further research is warranted to establish the full potential benefits of telehealth for improving the quality of life in people with SMI, acceptability from the service user perspective, and cost-effectiveness. The findings of this review are limited by the poor quality of many of the studies reviewed. ", doi="10.2196/mental.8816", url="http://mental.jmir.org/2018/4/e62/", url="http://www.ncbi.nlm.nih.gov/pubmed/30463836" } @Article{info:doi/10.2196/10668, author="Sherifali, Diana and Ali, Usman Muhammad and Ploeg, Jenny and Markle-Reid, Maureen and Valaitis, Ruta and Bartholomew, Amy and Fitzpatrick-Lewis, Donna and McAiney, Carrie", title="Impact of Internet-Based Interventions on Caregiver Mental Health: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2018", month="Jul", day="03", volume="20", number="7", pages="e10668", keywords="internet", keywords="support", keywords="education", keywords="mental health", keywords="caregivers", keywords="chronic conditions", abstract="Background: The health of informal caregivers of adults with chronic conditions is increasingly vital since caregivers comprise a large proportion of supportive care to family members living in the community. Due to efficiency and reach, internet-based interventions for informal caregivers have the potential to mitigate the negative mental health outcomes associated with caregiving. Objective: The objective of this systematic review and meta-analysis was to examine the impact of internet-based interventions on caregiver mental health outcomes and the impact of different types of internet-based intervention programs. Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, and AgeLine databases were searched for randomized controlled trials or controlled clinical trials published from January 1995 to April 2017 that compared internet-based intervention programs with no or minimal internet-based interventions for caregivers of adults with at least 1 chronic condition. The inclusion criteria were studies that included (1) adult informal caregivers (aged 18 years or older) of adults living in the community with a chronic condition; (2) an internet-based intervention program to deliver education, support, or monitoring to informal caregivers; and (3) outcomes of mental health. Title and abstract and full-text screening were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Where possible, data for mental health outcomes were meta-analyzed. Results: The search yielded 7923 unique citations of which 290 studies were screened at full-text. Of those, 13 studies met the inclusion criteria; 11 were randomized controlled trials, 1 study was a controlled clinical trial, and 1 study comprised both study designs. Beneficial effects of any internet-based intervention program resulted in a mean decrease of 0.48 points (95\% CI --0.75 to --0.22) for stress and distress and a mean decrease of 0.40 points (95\% CI --0.58 to --0.22) for anxiety among caregivers. For studies that examined internet-based information and education plus professional psychosocial support, the meta-analysis results showed small to medium beneficial effect sizes of the intervention for the mental health outcomes of depression (--0.34; 95\% CI --0.63 to --0.05) and anxiety (--0.36; 95\% CI --0.66 to --0.07). Some suggestion of a beneficial effect on overall health for the use of information and education plus combined peer and professional support was also shown (1.25; 95\% CI 0.24 to 2.25). Overall, many studies were of poor quality and were rated at high risk of bias. Conclusions: The review found evidence for the benefit of internet-based intervention programs on mental health for caregivers of adults living with a chronic condition, particularly for the outcomes of caregiver depression, stress and distress, and anxiety. The types of interventions that predominated as efficacious included information and education with or without professional psychological support, and, to a lesser extent, with combined peer and psychological support. Further high-quality research is needed to inform the effectiveness of interactive, dynamic, and multicomponent internet-based interventions. Trial Registration: PROSPERO CRD42017075436; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=75436 (Archived by WebCite at http://www.webcitation.org/709M3tDvn) ", doi="10.2196/10668", url="http://www.jmir.org/2018/7/e10668/", url="http://www.ncbi.nlm.nih.gov/pubmed/29970358" } @Article{info:doi/10.2196/10148, author="Morris, R. Robert and Kouddous, Kareem and Kshirsagar, Rohan and Schueller, M. Stephen", title="Towards an Artificially Empathic Conversational Agent for Mental Health Applications: System Design and User Perceptions", journal="J Med Internet Res", year="2018", month="Jun", day="26", volume="20", number="6", pages="e10148", keywords="conversational agents", keywords="mental health", keywords="empathy", keywords="crowdsourcing", keywords="peer support", abstract="Background: Conversational agents cannot yet express empathy in nuanced ways that account for the unique circumstances of the user. Agents that possess this faculty could be used to enhance digital mental health interventions. Objective: We sought to design a conversational agent that could express empathic support in ways that might approach, or even match, human capabilities. Another aim was to assess how users might appraise such a system. Methods: Our system used a corpus-based approach to simulate expressed empathy. Responses from an existing pool of online peer support data were repurposed by the agent and presented to the user. Information retrieval techniques and word embeddings were used to select historical responses that best matched a user's concerns. We collected ratings from 37,169 users to evaluate the system. Additionally, we conducted a controlled experiment (N=1284) to test whether the alleged source of a response (human or machine) might change user perceptions. Results: The majority of responses created by the agent (2986/3770, 79.20\%) were deemed acceptable by users. However, users significantly preferred the efforts of their peers (P<.001). This effect was maintained in a controlled study (P=.02), even when the only difference in responses was whether they were framed as coming from a human or a machine. Conclusions: Our system illustrates a novel way for machines to construct nuanced and personalized empathic utterances. However, the design had significant limitations and further research is needed to make this approach viable. Our controlled study suggests that even in ideal conditions, nonhuman agents may struggle to express empathy as well as humans. The ethical implications of empathic agents, as well as their potential iatrogenic effects, are also discussed. ", doi="10.2196/10148", url="http://www.jmir.org/2018/6/e10148/", url="http://www.ncbi.nlm.nih.gov/pubmed/29945856" } @Article{info:doi/10.2196/10521, author="Petersson, Lena and Erlingsd{\'o}ttir, Gudbj{\"o}rg", title="Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals", journal="JMIR Ment Health", year="2018", month="Jun", day="21", volume="5", number="2", pages="e10521", keywords="electronic health records", keywords="eHealth", keywords="telemedicine", keywords="postimplementation survey", keywords="health care surveys", keywords="mental health", keywords="Open Notes", keywords="psychiatry", keywords="health professionals", abstract="Background: This is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively. Objective: The objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Sk{\aa}ne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study. Methods: We distributed a full population Web-based questionnaire to psychiatric care professionals in Region Sk{\aa}ne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73\% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service. Results: A total of 41.5\% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients' questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62\%) and doctors (36/94, 38\%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40\% of the health care professionals (239/650, 36.8\%) reported that the Open Notes Service in psychiatry was a good idea. Conclusions: Most health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive. ", doi="10.2196/10521", url="http://mental.jmir.org/2018/2/e10521/", url="http://www.ncbi.nlm.nih.gov/pubmed/29929946" } @Article{info:doi/10.2196/mental.9777, author="Hatch, Ainslie and Hoffman, E. Julia and Ross, Ruth and Docherty, P. John", title="Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support", journal="JMIR Ment Health", year="2018", month="Jun", day="12", volume="5", number="2", pages="e46", keywords="biomedical technology", keywords="patient engagement", keywords="severe mental disorders", abstract="Background: Digital technology is increasingly being used to enhance health care in various areas of medicine. In the area of serious mental illness, it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools, as well as the resources and training necessary for these patients to facilitate the use of this technology. Objective: The aim of this study was to conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and health care professionals), barriers and facilitators for appropriate use, and resources needed to optimize the use of digital health tools in patients with serious mental illness. Methods: A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey, rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across three ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the CI of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts' responses to nine questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of digital health tools, (2) potential benefits or motivators and barriers or unintended consequences of digital health tool use, and (3) support and training for patients and health care professionals. Results: Among patient characteristics most likely to promote use of digital health tools, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain disease-associated signs and symptoms (eg, more severe symptoms, substance abuse problems, and a chaotic living situation) were considered likely to make it difficult for patients to use digital health tools. Enthusiasm among health care professionals for digital health tools and availability of staff and equipment to support their use were identified as variables to enable health care professionals to successfully incorporate digital health tools into their practices. The experts identified a number of potential benefits of and barriers to use of digital health tools by patients and health care professionals. Experts agreed that both health care professionals and patients would need to be trained in the use of these new technologies. Conclusions: These results provide guidance to the mental health field on how to optimize the development and deployment of digital health tools for patients with serious mental illness. ", doi="10.2196/mental.9777", url="http://mental.jmir.org/2018/2/e46/", url="http://www.ncbi.nlm.nih.gov/pubmed/29895514" } @Article{info:doi/10.2196/mental.9946, author="Grigorash, Alexander and O'Neill, Siobhan and Bond, Raymond and Ramsey, Colette and Armour, Cherie and Mulvenna, D. Maurice", title="Predicting Caller Type From a Mental Health and Well-Being Helpline: Analysis of Call Log Data", journal="JMIR Ment Health", year="2018", month="Jun", day="11", volume="5", number="2", pages="e47", keywords="data mining", keywords="machine learning", keywords="clustering", keywords="classification", keywords="mental health", keywords="suicide", abstract="Background: This paper presents an analysis of call data records pertaining to a telephone helpline in Ireland among individuals seeking mental health and well-being support and among those who are in a suicidal crisis. Objective: The objective of our study was to examine whether rule sets generated from decision tree classification, trained using features derived from callers' several initial calls, could be used to predict what caller type they would become. Methods: Machine learning techniques were applied to the call log data, and five distinct patterns of caller behaviors were revealed, each impacting the helpline capacity in different ways. Results: The primary findings of this study indicate that a significant model (P<.001) for predicting caller type from call log data obtained from the first 8 calls is possible. This indicates an association between callers' behavior exhibited during initial calls and their behavior over the lifetime of using the service. Conclusions: These data-driven findings contribute to advanced workload forecasting for operational management of the telephone-based helpline and inform the literature on helpline caller behavior in general. ", doi="10.2196/mental.9946", url="http://mental.jmir.org/2018/2/e47/", url="http://www.ncbi.nlm.nih.gov/pubmed/29891472" } @Article{info:doi/10.2196/10386, author="O'Connor, Marianne and Morgan, E. Katy and Bailey-Straebler, Suzanne and Fairburn, G. Christopher and Cooper, Zafra", title="Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists", journal="J Med Internet Res", year="2018", month="Jun", day="08", volume="20", number="6", pages="e10386", keywords="internet", keywords="web-centered", keywords="eating disorders", keywords="cognitive therapy", keywords="effective treatment", abstract="Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. Objective: The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit. Methods: A cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks. Results: A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9\%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9\% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95\% CI 3.1-3.8; P<.001). After training, 52\% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45\% (95\% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95\% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95\% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95\% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95\% CI 1.2-4.1). Conclusions: Independent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments. ", doi="10.2196/10386", url="http://www.jmir.org/2018/6/e10386/", url="http://www.ncbi.nlm.nih.gov/pubmed/29884606" } @Article{info:doi/10.2196/jmir.9716, author="Ospina-Pinillos, Laura and Davenport, A. Tracey and Ricci, S. Cristina and Milton, C. Alyssa and Scott, M. Elizabeth and Hickie, B. Ian", title="Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies", journal="J Med Internet Res", year="2018", month="May", day="28", volume="20", number="5", pages="e188", keywords="mental health", keywords="community-based participatory research", keywords="eHealth", abstract="Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R\&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R\&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional--recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available. ", doi="10.2196/jmir.9716", url="http://www.jmir.org/2018/5/e188/" } @Article{info:doi/10.2196/mental.9600, author="Hermes, Eric and Burrone, Laura and Perez, Elliottnell and Martino, Steve and Rowe, Michael", title="Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers", journal="JMIR Ment Health", year="2018", month="May", day="18", volume="5", number="2", pages="e42", keywords="cognitive behavioral therapy", keywords="internet-based therapy", keywords="health information technology", keywords="behavioral intervention technology", keywords="internet", keywords="Veterans", abstract="Background: Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. Objective: The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. Methods: The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. Results: A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. Conclusions: This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings. ", doi="10.2196/mental.9600", url="http://mental.jmir.org/2018/2/e42/", url="http://www.ncbi.nlm.nih.gov/pubmed/29776898" } @Article{info:doi/10.2196/10735, author="Apolin{\'a}rio-Hagen, Jennifer and Harrer, Mathias and K{\"a}hlke, Fanny and Fritsche, Lara and Salewski, Christel and Ebert, Daniel David", title="Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study", journal="JMIR Ment Health", year="2018", month="May", day="15", volume="5", number="2", pages="e10735", keywords="mental health", keywords="eHealth", keywords="attitude to computers", keywords="patient preference", keywords="cognitive therapy", keywords="acceptability of health care", keywords="stress, psychological", keywords="object attachment", abstract="Background: Internet interventions have been proposed to improve the accessibility and use of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their use. Objective: This study aimed to (1) determine attitudes toward guided internet interventions, (2) assess its acceptability compared with other internet-based formats, and (3) explore predictors of acceptance. Methods: A convenience-sample Web-based survey (N=646) assessed attitudes toward guided internet therapies (ie, perceived usefulness and helpfulness, and advantage relative to face-to-face therapy), preferences for delivery modes (ie, e-preference: guided internet interventions, unguided internet interventions, or videoconferencing psychotherapy), and potential predictors of attitudes and preferences: sociodemographics, help-seeking--related variables, attachment style, and perceived stress. Results: Although most participants perceived internet interventions as useful or helpful (426/646, 65.9\%), a few indicated their advantage relative to face-to-face therapy (56/646, 8.7\%). Most participants preferred guided internet interventions (252/646, 39.0\%) over videoconferencing psychotherapy (147/646, 22.8\%), unguided internet interventions (124/646, 19.2\%), and not using internet interventions (121/646, 18.8\%; missing data: 1/646, 0.2\%). Attachment avoidance and stress were related to e-preference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals who were aware of internet-based treatment ($\chi$26=12.8; P=.046). Conclusions: Participants assessed therapist-guided internet interventions as helpful, but not equivalent to face-to-face therapies. The vast majority (523/646, 81.0\%) of the participants were potentially willing to use internet-based approaches. In lieu of providing patients with only one specific low-intensity treatment, implementation concepts should offer several options, including guided internet interventions, but not limited to them. Conversely, our results also indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake. ", doi="10.2196/10735", url="http://mental.jmir.org/2018/2/e10735/", url="http://www.ncbi.nlm.nih.gov/pubmed/29764797" } @Article{info:doi/10.2196/jmir.9485, author="Feijt, A. Milou and de Kort, AW Yvonne and Bongers, MB Inge and IJsselsteijn, A. Wijnand", title="Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model", journal="J Med Internet Res", year="2018", month="Apr", day="24", volume="20", number="4", pages="e153", keywords="eHealth", keywords="mental health", keywords="psychology, clinical", keywords="diffusion of innovation", keywords="technology", abstract="Background: The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. Objective: The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. Methods: The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. Results: In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. Conclusions: The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options. ", doi="10.2196/jmir.9485", url="http://www.jmir.org/2018/4/e153/", url="http://www.ncbi.nlm.nih.gov/pubmed/29691215" } @Article{info:doi/10.2196/mental.8808, author="Booth, G. Richard and Allen, N. Britney and Bray Jenkyn, M. Krista and Li, Lihua and Shariff, Z. Salimah", title="Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis", journal="JMIR Ment Health", year="2018", month="Apr", day="06", volume="5", number="2", pages="e27", keywords="mental health", keywords="youth", keywords="adolescent", keywords="social media", keywords="population health", keywords="mass media", abstract="Background: Despite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let's Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can \$0.05 for each interaction with a campaign-specific username (@Bell\_LetsTalk). Objective: The intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada. Methods: Monthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health--related physician visit. Results: The inclusion of Twitter into the 2012 Bell Let's Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P<.001), whereas males of the same age cohort experienced a monthly increase from 9.7/1000 to 9.8/1000 (slope change of 0.052 following campaign, P<.001). Outpatient psychiatric services visit rates also increased for both male and female adolescents aged 10 to 17 years post campaign (slope change of 0.005, P=.02; slope change of 0.003, P=.005, respectively). For young adults aged 18 to 24 years, females who used primary health care experienced the most significant increases in mental health visit rates from 26.5/1000 in April 2006 to 29.2/1000 in April 2015 (slope change of 0.17 following campaign, P<.001). Conclusions: The 2012 Bell Let's Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services. ", doi="10.2196/mental.8808", url="http://mental.jmir.org/2018/2/e27/", url="http://www.ncbi.nlm.nih.gov/pubmed/29625954" } @Article{info:doi/10.2196/mental.9769, author="Vis, Christiaan and Mol, Mayke and Kleiboer, Annet and B{\"u}hrmann, Leah and Finch, Tracy and Smit, Jan and Riper, Heleen", title="Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors", journal="JMIR Ment Health", year="2018", month="Mar", day="16", volume="5", number="1", pages="e20", keywords="eMental health", keywords="implementation", keywords="routine practice", keywords="determinants of practices", keywords="RE-AIM", keywords="barriers and facilitators", keywords="mood disorders", keywords="review", abstract="Background: Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective: This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods: A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results: A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH. Conclusions: Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients' mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided. ", doi="10.2196/mental.9769", url="http://mental.jmir.org/2018/1/e20/", url="http://www.ncbi.nlm.nih.gov/pubmed/29549072" } @Article{info:doi/10.2196/jmir.8102, author="VanHeerwaarden, Nicole and Ferguson, Genevieve and Abi-Jaoude, Alexxa and Johnson, Andrew and Hollenberg, Elisa and Chaim, Gloria and Cleverley, Kristin and Eysenbach, Gunther and Henderson, Joanna and Levinson, Andrea and Robb, Janine and Sharpe, Sarah and Voineskos, Aristotle and Wiljer, David", title="The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research", journal="J Med Internet Res", year="2018", month="Mar", day="06", volume="20", number="3", pages="e79", keywords="students", keywords="transition-aged youth", keywords="mental health", keywords="substance use", keywords="eHealth", keywords="mobile apps", keywords="participatory action research", keywords="help-seeking", abstract="Background: Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings. Objective: The aim of this study was to describe the process of engaging with postsecondary students through the PDR approaches, with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with the PDR approaches, five student-led workshops, attended by 41 individuals, were facilitated to obtain feedback regarding the platform's usability and functionality and its potential value in a postsecondary setting. Various creative engagement activities were delivered to gather experiences and opinions, including semistructured focus groups, questionnaires, personas, journey mapping, and a world caf{\'e}. Innovative technological features and refinements were also brainstormed during the workshops. Results: By using PDR methods of engagement, participants knew that their ideas and recommendations would be applied. There was also an overall sense of respect and care integrated into each group, which facilitated an exchange of ideas and suggestions. Conclusions: The process of engaging with students to redesign the Thought Spot platform through PDR has been effective. Findings from these workshops will significantly inform new technological features within the app to enable positive help-seeking behaviors among students. These behaviors will be further explored in the second phase that involves a randomized controlled trial. ", doi="10.2196/jmir.8102", url="http://www.jmir.org/2018/3/e79/", url="http://www.ncbi.nlm.nih.gov/pubmed/29510970" } @Article{info:doi/10.2196/resprot.8813, author="Rice, Simon and Gleeson, John and Leicester, Steven and Bendall, Sarah and D'Alfonso, Simon and Gilbertson, Tamsyn and Killackey, Eoin and Parker, Alexandra and Lederman, Reeva and Wadley, Greg and Santesteban-Echarri, Olga and Pryor, Ingrid and Mawren, Daveena and Ratheesh, Aswin and Alvarez-Jimenez, Mario", title="Implementation of the Enhanced Moderated Online Social Therapy (MOST+) Model Within a National Youth E-Mental Health Service (eheadspace): Protocol for a Single Group Pilot Study for Help-Seeking Young People", journal="JMIR Res Protoc", year="2018", month="Feb", day="22", volume="7", number="2", pages="e48", keywords="internet", keywords="social networking", keywords="young adult", keywords="adolescent", keywords="mental heath", abstract="Background: There is a substantial need for youth electronic mental health (e-mental health) services. In addressing this need, our team has developed a novel moderated online social therapy intervention called enhanced moderated online social therapy (MOST+). MOST+ integrates real-time, clinician-delivered Web chat counseling, interactive user-directed online therapy, expert and peer moderation, and private and secure peer-to-peer social networking. MOST+ has been designed to give young people immediate, 24-hour access to anonymous, evidence-based, and short-term mental health care. Objective: The primary aims of this pilot study were to determine the feasibility, acceptability, and safety of the intervention. Secondary aims were to assess prepost changes in key psychosocial outcomes and collect qualitative data for future intervention refinement. Methods: MOST+ will be embedded within eheadspace, an Australian youth e-mental health service, and will be evaluated via an uncontrolled single-group study. Approximately 250 help-seeking young people (16-25 years) will be progressively recruited to the intervention from the eheadspace home page over the first 4 weeks of an 8-week intervention period. All participants will have access to evidence-based therapeutic content and integrated Web chat counseling. Additional access to moderated peer-to-peer social networking will be granted to individuals for whom it is deemed safe and appropriate, through a three-tiered screening process. Participants will be enrolled in the MOST+ intervention for 1 week, with the option to renew their enrollment across the duration of the pilot. Participants will complete a survey at enrollment to assess psychological well-being and other mental health outcomes. Additional assessment will occur following account deactivation (ie, after participant has opted not to renew their enrollment, or at trial conclusion) and will include an online survey and telephone interview assessing psychological well-being and experience of using MOST+. Results: Recruitment for the study commenced in October 2017. We expect to have initial results in March 2018, with more detailed qualitative and quantitative analyses to follow. Conclusions: This is the first Australia-wide research trial to pilot an online social media platform merging real-time clinical support, expert and peer moderation, interactive online therapy, and peer-to-peer social networking. The importance of the project stems from the need to develop innovative new models for the efficient delivery of responsive evidence-based online support to help-seeking young people. If successful, this research stands to complement and enhance e-mental health services in Australia. ", doi="10.2196/resprot.8813", url="http://www.researchprotocols.org/2018/2/e48/", url="http://www.ncbi.nlm.nih.gov/pubmed/29472177" } @Article{info:doi/10.2196/jmir.9109, author="March, Sonja and Day, Jamin and Ritchie, Gabrielle and Rowe, Arlen and Gough, Jeffrey and Hall, Tanya and Yuen, Jackie Chin Yan and Donovan, Leanne Caroline and Ireland, Michael", title="Attitudes Toward e-Mental Health Services in a Community Sample of Adults: Online Survey", journal="J Med Internet Res", year="2018", month="Feb", day="19", volume="20", number="2", pages="e59", keywords="eHealth", keywords="mHealth", keywords="consumer preference", keywords="attitude", abstract="Background: Despite evidence that e-mental health services are effective, consumer preferences still appear to be in favor of face-to-face services. However, the theory of planned behavior (TPB) suggests that cognitive intentions are more proximal to behavior and thus may have a more direct influence on service use. Investigating individual characteristics that influence both preferences and intentions to use e-mental health services is important for better understanding factors that might impede or facilitate the use of these services. Objective: This study explores predictors of preferences and intentions to access e-mental health services relative to face-to-face services. Five domains were investigated (demographics, technology factors, personality, psychopathology, and beliefs), identified from previous studies and informed by the Internet interventions model. We expected that more participants would report intentions to use e-mental health services relative to reported preferences for this type of support and that these 5 domains would be significantly associated with both intentions and preferences toward online services. Methods: A mixed sample of 308 community members and university students was recruited through social media and the host institution in Australia. Ages ranged between 17 and 68 years, and 82.5\% (254/308) were female. Respondents completed an online survey. Chi-square analysis and t tests were used to explore group differences, and logistic regression models were employed to explore factors predicting preferences and intentions. Results: Most respondents (85.7\%, 264/308) preferred face-to-face services over e-mental health services. Relative to preferences, a larger proportion of respondents (39.6\%, 122/308) endorsed intentions to use e-mental health services if experiencing mental health difficulties in the future. In terms of the 5 predictor domains, 95\% CIs of odds ratios (OR) derived from bootstrapped standard errors suggested that prior experience with online services significantly predicted intentions to use self-help (95\% CI 2.08-16.24) and therapist-assisted (95\% CI 1.71-11.90) online services in future. Being older predicted increased intentions to use therapist-assisted online services in future (95\% CI 1.01-1.06), as did more confidence using computers and the Internet (95\% CI 1.06-2.69). Technology confidence was also found to predict greater preference for online services versus face-to-face options (95\% CI 1.24-4.82), whereas higher doctor-related locus of control, or LOC (95\% CI 0.76-0.95), and extraversion (95\% CI 0.88-1.00) were predictive of lower likelihood of preferring online services relative to face-to-face services. Conclusions: Despite generally low reported preferences toward e-mental health services, intentions to access these services are higher, raising the question of how to best encourage translation of intentions into behavior (ie, actual use of programs). Strategies designed to ease people into new Internet-based mental health programs (to enhance confidence and familiarity) may be important for increasing the likelihood that they will return to such programs later. ", doi="10.2196/jmir.9109", url="http://www.jmir.org/2018/2/e59/", url="http://www.ncbi.nlm.nih.gov/pubmed/29459357" } @Article{info:doi/10.2196/mental.9140, author="Petersson, Lena and Erlingsd{\'o}ttir, Gudbj{\"o}rg", title="Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals", journal="JMIR Ment Health", year="2018", month="Feb", day="02", volume="5", number="1", pages="e11", keywords="electronic health record", keywords="eHealth", keywords="baseline survey", keywords="mental health", keywords="open notes", keywords="psychiatry", keywords="health professionals", abstract="Background: When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Sk{\aa}ne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Sk{\aa}ne. Objective: The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Sk{\aa}ne expect Open Notes to impact their patients and their own practice. Methods: A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Sk{\aa}ne in late 2015. The response rate was 28.86\% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. Results: The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60\% of both doctors (80/132, 60.6\%) and psychologists (55/90, 61\%) were concerned that they would be less candid in their documentation in the future. Conclusions: Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients. ", doi="10.2196/mental.9140", url="http://mental.jmir.org/2018/1/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/29396386" } @Article{info:doi/10.2196/jmir.8021, author="Mart{\'i}nez, Vania and Rojas, Graciela and Mart{\'i}nez, Pablo and Zitko, Pedro and Irarr{\'a}zaval, Mat{\'i}as and Luttges, Carolina and Araya, Ricardo", title="Remote Collaborative Depression Care Program for Adolescents in Araucan{\'i}a Region, Chile: Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Jan", day="31", volume="20", number="1", pages="e38", keywords="primary health care", keywords="depression", keywords="adolescents", keywords="Internet", keywords="telemedicine", keywords="medically underserved area", abstract="Background: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucan{\'i}a Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucan{\'i}a Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile's capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results: More than 60.3\% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9\% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=?4.3, 95\% CI ?7.2 to ?1.3). Conclusions: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) ", doi="10.2196/jmir.8021", url="https://www.jmir.org/2018/1/e38/", url="http://www.ncbi.nlm.nih.gov/pubmed/29386172" } @Article{info:doi/10.2196/jmir.8928, author="Quanbeck, Andrew and Gustafson, H. David and Marsch, A. Lisa and Chih, Ming-Yuan and Kornfield, Rachel and McTavish, Fiona and Johnson, Roberta and Brown, T. Randall and Mares, Marie-Louise and Shah, V. Dhavan", title="Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study", journal="J Med Internet Res", year="2018", month="Jan", day="30", volume="20", number="1", pages="e37", keywords="mobile health", keywords="mHealth", keywords="evidence-based practice", keywords="behavioral medicine", abstract="Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach---Seva reached 8.31\% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness---Patients who were given Seva had significant improvements in their risky drinking days (44\% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34\% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption---Patients sustained high levels of Seva use---between 53\% and 60\% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation---At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance---Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. ", doi="10.2196/jmir.8928", url="http://www.jmir.org/2018/1/e37/", url="http://www.ncbi.nlm.nih.gov/pubmed/29382624" } @Article{info:doi/10.2196/resprot.8260, author="Naheed, Aliya and Koly, Nahar Kamrun and Uddin Ahmed, Helal and Akhter, Shaheen and Uddin, Jalal M. M. and Smith Fawzi, C. Mary and Chandir, Subhash and Mannan, Muzharul and Hossain, Saima and Nelson, Charles and Munir, Kerim", title="Implementing a Mental Health Care Program and Home-Based Training for Mothers of Children With Autism Spectrum Disorder in an Urban Population in Bangladesh: Protocol for a Feasibility Assessment Study", journal="JMIR Res Protoc", year="2017", month="Dec", day="14", volume="6", number="12", pages="e251", keywords="depression", keywords="psychosocial", keywords="counseling", keywords="autism spectrum disorder", keywords="mothers", keywords="training", abstract="Background: Mothers of children with autism spectrum disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and developing countries. Mothers are the lifetime caregivers of children with ASD, and a high burden of depression can negatively impact their ability to provide care. However, access to mental health services in primary care is limited, given the scarcity of qualified providers in Bangladesh. Objective: We aim to pilot the feasibility of integrating mental health services for the mothers of children with ASD attending schools offering ASD care and improve skills of mothers for child care through a home-based training program. Methods: The study will be conducted in two selected schools in Dhaka in Bangladesh that have been offering services for ASD for more than 10 years. A female psychologist will be deployed at the schools to offer nonpharmacological services for all mothers having a depressive episode. Referral for pharmacological treatment will be made at the discretion of supervising psychiatrists. An ASD special educator will provide training to the mothers for enhancing their child care skills at home on a monthly basis. The proposed intervention package will be implemented over a period of 4-6 months, and the feasibility of the intervention will be assessed through a pre- and postintervention evaluation by obtaining the perspectives of various stakeholders involved in the implementation of mental health services and maternal training. The primary outcome will include assessment of acceptability, adaptability, demand, practicality, implementation, and integration of the package intervention in the school settings. The secondary outcomes will include assessment of: 1) the prevalence of maternal depression; 2) children's behavioral, social, and communication skills; and 3) the intervention participation costs incurred by institutions and families. Results: Between February and March 2017, 188 mothers of children with ASD were screened for depression following a written informed consent. Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Structured Clinical Interview for the DSM-IV (SCID-1) was administered to 66 mothers. In-depth interviews were conducted with 10 mothers and 8 various stakeholders. Between January-June 2017, the team finalized a draft psychosocial counseling module and a maternal training module. Between April-May 2017, mental health services were provided by psychologists to 41 mothers who attended the counseling centers at each school. Three special educators have been trained in June 2017 to initiate training of the participating mothers. Conclusions: This is the first study of a mental health intervention for mothers of children with ASD to reduce their burden of depression and improve the outcomes of their children. The findings will inform the provision of services for children with ASD and their mothers in Bangladesh and similar settings. ", doi="10.2196/resprot.8260", url="http://www.researchprotocols.org/2017/12/e251/", url="http://www.ncbi.nlm.nih.gov/pubmed/29242177" } @Article{info:doi/10.2196/mental.8369, author="O'Dea, Bridianne and King, Catherine and Subotic-Kerry, Mirjana and O'Moore, Kathleen and Christensen, Helen", title="School Counselors' Perspectives of a Web-Based Stepped Care Mental Health Service for Schools: Cross-Sectional Online Survey", journal="JMIR Ment Health", year="2017", month="Nov", day="20", volume="4", number="4", pages="e55", keywords="secondary schools", keywords="adolescent", keywords="counseling", keywords="internet", keywords="depression", abstract="Background: Mental health problems are common among youth in high school, and school counselors play a key role in the provision of school-based mental health care. However, school counselors occupy a multispecialist position that makes it difficult for them to provide care to all of those who are in need in a timely manner. A Web-based mental health service that offers screening, psychological therapy, and monitoring may help counselors manage time and provide additional oversight to students. However, for such a model to be implemented successfully, school counselors' attitudes toward Web-based resources and services need to be measured. Objective: This study aimed to examine the acceptability of a proposed Web-based mental health service, the feasibility of providing this type of service in the school context, and the barriers and facilitators to implementation as perceived by school counselors in New South Wales (NSW), Australia. Methods: This study utilized an online cross-sectional survey to measure school counselors' perspectives. Results: A total of 145 school counselors completed the survey. Overall, 82.1\% (119/145) thought that the proposed service would be helpful to students. One-third reported that they would recommend the proposed model, with the remaining reporting potential concerns. Years of experience was the only background factor associated with a higher level of comfort with the proposed service (P=.048). Personal beliefs, knowledge and awareness, Internet accessibility, privacy, and confidentiality were found to influence, both positively and negatively, the likelihood of school counselors implementing a Web-based school mental health service. Conclusions: The findings of this study confirmed that greater support and resources are needed to facilitate what is already a challenging and emotionally demanding role for school counselors. Although the school counselors in this study were open to the proposed service model, successful implementation will require that the issues outlined are carefully addressed. ", doi="10.2196/mental.8369", url="http://mental.jmir.org/2017/4/e55/", url="http://www.ncbi.nlm.nih.gov/pubmed/29158207" } @Article{info:doi/10.2196/mental.8491, author="Strand, Monica and Gammon, Deede and Eng, Sofie Lillian and Ruland, Cornelia", title="Exploring Working Relationships in Mental Health Care via an E-Recovery Portal: Qualitative Study on the Experiences of Service Users and Health Providers", journal="JMIR Ment Health", year="2017", month="Nov", day="14", volume="4", number="4", pages="e54", keywords="eHealth", keywords="recovery", keywords="mental health", keywords="psychiatry", keywords="user involvement", keywords="empowerment", keywords="working relationship", keywords="secure email", keywords="e-recovery", keywords="participatory research", abstract="Background: The quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood. Objective: The aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal. Methods: In this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user--generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed. Results: The thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users' and health providers' expectations for portal use were not aligned, and the consequences of not addressing these difficulties. Illustrative subthemes are initiative and responsibility, waiting for the other, feeling overwhelmed, and clarifications and agreements. Conclusions: The degree to which dyads benefited from using the e-recovery portal appeared to be mainly associated with the degree to which the dyads' relations were open and flexible before the portal was introduced. For those who experienced frustrations, the portal may have both exposed and added to suboptimal working relationships. Use of the goal module appeared to strengthen the person-centered nature of collaboration. A key question is how health providers balance between enabling service users' greater control over their care, without relinquishing responsibility for the quality of the working relationship, also when using an e-recovery portal. Implications for implementation are discussed. ", doi="10.2196/mental.8491", url="http://mental.jmir.org/2017/4/e54/", url="http://www.ncbi.nlm.nih.gov/pubmed/29138127" } @Article{info:doi/10.2196/mental.8168, author="Easton, Katherine and Diggle, Jacob and Ruethi-Davis, Mabel and Holmes, Megan and Byron-Parker, Darian and Nuttall, Jessica and Blackmore, Chris", title="Qualitative Exploration of the Potential for Adverse Events When Using an Online Peer Support Network for Mental Health: Cross-Sectional Survey", journal="JMIR Ment Health", year="2017", month="Oct", day="30", volume="4", number="4", pages="e49", keywords="digital technology", keywords="mental health", keywords="online peer support", keywords="adverse events", keywords="online survey", abstract="Background: Online peer support networks are a growing area of mental health support for offering social connection, identity, and support. However, it has been reported that not all individuals have a positive experience on such networks. The potential for adverse events within a moderated online peer support network is a new area of research exploration. Objective: The objective of the study was to determine if use of an online moderated peer networks leads to adverse events for users. Methods: Four biannual online surveys (October 2014 to March 2016) were conducted by a large national UK mental health charity, with users of their online peer support network exploring personal safety, moderation, experiences on the site, and how the site could be improved. Data were analyzed using thematic analysis by 2 independent researchers using a priori themes: negative experiences of moderation, social exclusion, contagion, negative interactions with other users, online relationships, co-rumination and collusion, and other. Results: In total, 2353 survey responses were logged with 197 (8.37\%) documenting an adverse event of negative experience. A dominant theme of negative experiences of moderation emerged (73/197, 37.1\%) with evidence of social exclusion (50/197, 25.4\%). Reading user posts was shown to be a cause of worry and distress for a few users, and analysis highlighted several instances of depressogenic and emotional contagion as well as some limited evidence of behavioral contagion (46/197, 23.4\%). Very limited evidence of co-rumination (1/197, 0.5\%) and no evidence of collusion were identified. Conclusions: Evidence of adverse events was identified at low levels in the sample of respondents, although we have no comparison data to indicate if levels are low compared with comparable platforms. Not all users of online peer support networks find them wholly beneficial. Research must explore what works for whom. The next stage of service development should consider which users may be likely to receive no benefit, or even deteriorate, as a result of using the service. ", doi="10.2196/mental.8168", url="http://mental.jmir.org/2017/4/e49/", url="http://www.ncbi.nlm.nih.gov/pubmed/29084710" } @Article{info:doi/10.2196/mental.6707, author="Paul, Louise Christine and Cox, Elizabeth Martine and Small, Julie Hannah and Boyes, W. Allison and O'Brien, Lorna and Rose, Karina Shiho and Baker, L. Amanda and Henskens, A. Frans and Kirkwood, Naomi Hannah and Roach, M. Della", title="Techniques for Improving Communication of Emotional Content in Text-Only Web-Based Therapeutic Communications: Systematic Review", journal="JMIR Ment Health", year="2017", month="Oct", day="24", volume="4", number="4", pages="e46", keywords="nonverbal communication", keywords="Internet", keywords="computer-assisted therapy", abstract="Background: Web-based typed exchanges are increasingly used by professionals to provide emotional support to patients. Although some empirical evidence exists to suggest that various strategies may be used to convey emotion during Web-based text communication, there has been no critical review of these data in patients with chronic conditions. Objectives: The objective of this review was to identify the techniques used to convey emotion in written or typed Web-based communication and assess the empirical evidence regarding impact on communication and psychological outcomes. Methods: An electronic search of databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library was conducted to identify literature published from 1990 to 2016. Searches were also conducted using Google Scholar, manual searching of reference lists of identified papers and manual searching of tables of contents for selected relevant journals. Data extraction and coding were completed by 2 reviewers (10.00\% [573/5731] of screened papers, at abstract/title screening stage; 10.0\% of screened [69/694] papers, at full-text screening stage). Publications were assessed against the eligibility criteria and excluded if they were duplicates, were not published in English, were published before 1990, referenced animal or nonhuman subjects, did not describe original research, were not journal papers, or did not empirically test the effect of one or more nonverbal communication techniques (for eg, smileys, emoticons, emotional bracketing, voice accentuation, trailers [ellipsis], and pseudowords) as part of Web-based or typed communication on communication-related variables, including message interpretation, social presence, the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes, including depression, anxiety, and distress. Results: A total of 6902 unique publications were identified. Of these, six publications met the eligibility criteria and were included in a narrative synthesis. All six studies addressed the effect of smileys or emoticons on participant responses, message interpretation, or social presence of the writer. None of these studies specifically targeted chronic conditions. It was found that emoticons were more effective in influencing the emotional impact of a message than no cue and that smileys and emoticons were able to convey a limited amount of emotion. No studies addressed other techniques for conveying emotion in written communication. No studies addressed the effects of any techniques on the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes (depression, anxiety, or distress). Conclusions: There is a need for greater empirical attention to the effects of the various proposed techniques for conveying emotion in Web-based typed communications to inform health service providers regarding best-practice communication skills in this setting. ", doi="10.2196/mental.6707", url="http://mental.jmir.org/2017/4/e46/", url="http://www.ncbi.nlm.nih.gov/pubmed/29066426" } @Article{info:doi/10.2196/mental.6888, author="Kingston, Dawn and Biringer, Anne and Veldhuyzen van Zanten, Sander and Giallo, Rebecca and McDonald, Sarah and MacQueen, Glenda and Vermeyden, Lydia and Austin, Marie-Paule", title="Pregnant Women's Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial", journal="JMIR Ment Health", year="2017", month="Oct", day="20", volume="4", number="4", pages="e42", keywords="pregnancy", keywords="mental health", keywords="screening", keywords="prenatal care", keywords="computers", abstract="Background: Pregnant women's perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. Objective: The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women's perceptions of risk and benefit of disclosure. Methods: Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women's perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. Results: Of the 675 eligible women approached, 636 (94.2\%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1\% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. Conclusions: Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women's vulnerability throughout the screening process with strategies such as addressing women's concerns, explaining the rationale for screening, and discussing how results will be used. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at?http://www.webcitation.org/6tRKtGC4M) ", doi="10.2196/mental.6888", url="http://mental.jmir.org/2017/4/e42/", url="http://www.ncbi.nlm.nih.gov/pubmed/29054833" } @Article{info:doi/10.2196/mental.8571, author="Heilemann, V. MarySue and Soderlund, D. Patricia and Kehoe, Priscilla and Brecht, Mary-Lynn", title="A Transmedia Storytelling Intervention With Interactive Elements to Benefit Latinas' Mental Health: Feasibility, Acceptability, and Efficacy", journal="JMIR Ment Health", year="2017", month="Oct", day="19", volume="4", number="4", pages="e47", keywords="depression", keywords="anxiety", keywords="transmedia", keywords="Internet", keywords="mental health", keywords="mood disorders", keywords="smartphone", abstract="Background: Latinos report higher rates of depression and anxiety than US whites but are less likely to receive care. Transmedia storytelling interventions accessible on the Internet via smartphones, tablets, and computers hold promise for reducing reluctance to explore or get help for symptoms because they are private, convenient, and can reach large numbers of people, including Latinas with mental health needs. Objective: The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mental health transmedia intervention for Latinas with elevated symptoms of depression, anxiety, or both. Methods: A total of 28 symptomatic English-speaking Latina women aged 21 to 48 years participated in a 6-week study using a within-group design. All aspects of the study were completed via telephone or Internet. Participants used their personal devices to engage the Web-based transmedia intervention (in English) that included story-based videos, a data-informed psychotherapeutic video, an interactive video sequence, and a blog written from the point of view of one of the characters with links to mental health resources. Perceived confidence to get help and perceived importance for seeking immediate help were both measured using single-item questions. Participants completed surveys at baseline (via telephone) and 1 and 6 weeks after media engagement that measured various factors, including depression (Patient Health Questionnaire; PHQ-9 and PHQ-8) and anxiety (Generalized Anxiety Disorder scale; GAD-7). A telephone interview was conducted within 72 hours of media engagement. Action taken or intentions to get help (single-item question) and talking about the videos with others (single-item question) were measured 1 and 6 weeks after media engagement. Repeated measures analysis of variance was used to assess change in depression (PHQ-8) and anxiety (GAD-7) before transmedia engagement and 1 and 6 weeks after. Spearman correlations evaluated the association of confidence and importance of getting help with action taken, anxiety, and depression. Results: All 28 Latinas (English speakers) who engaged with the transmedia remained in the 6-week study. Within 1 week of transmedia engagement, 39\% of women took action to get help, and 82\% discussed the media with others. Symptoms of depression (F2,54=9.0, P<.001) and anxiety (F2,54=18.7, P<.001) significantly reduced across time. Higher levels of confidence were significantly associated with actions taken at 1 (P=.005) and 6 weeks (P=.04), and higher levels of importance were significantly associated with actions taken at 1 (P=.009) and 6 weeks (P=.003). Higher levels of confidence were associated with lower levels of depression (P=.04) and anxiety (P=.01) at 6 weeks. Conclusions: Preliminary findings indicate a culturally tailored mental health transmedia intervention is a feasible approach that holds promise for engaging large numbers of symptomatic English-speaking Latina women to begin the process of seeking help, as well as decreasing symptoms of anxiety and depression. ", doi="10.2196/mental.8571", url="http://mental.jmir.org/2017/4/e47/", url="http://www.ncbi.nlm.nih.gov/pubmed/29051135" } @Article{info:doi/10.2196/mental.7889, author="Zwerenz, R{\"u}diger and Becker, Jan and Johansson, Robert and Frederick, J. Ronald and Andersson, Gerhard and Beutel, E. Manfred", title="Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial", journal="JMIR Ment Health", year="2017", month="Oct", day="16", volume="4", number="4", pages="e41", keywords="psychoanalytic psychotherapy", keywords="emotion-focused therapy", keywords="inpatients", keywords="aftercare", keywords="Internet", keywords="clinical trial", abstract="Background: Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions. Objective: The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders. Methods: A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT). Results: Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84\%, 58/69), anxiety (68\%, 47/69), personality disorder (38\%, 26/69), and depersonalization-derealization disorder (22\%, 15/69). A majority of the patients (86\%, 36/42) logged into the program, of which 86\% (31/36) completed the first unit. Satisfaction with the units mastered was rated as good (52\%, 16/31) and very good (26\%, 9/31). However, there was a steady decline of participation over the course of the program; only 36\% of the participants (13/36) participated throughout the trial completing at least 50\% of the sessions. According to the ITT analysis, participants improved statistically significantly and with moderate effect sizes (Cohen d) compared with the WLCG regarding depression (d=0.60), quality of life (d=0.53), and emotional competence (d=0.49). Effects were considerably stronger for the completers with respect to depression (d=1.33), quality of life (d=0.83), emotional competence (d=0.68), and general anxiety (d=0.62). Conclusions: Although overall program satisfaction and benefit of the program were favorable with respect to the indicators of emotional disorders, the rate of completion was low. Our findings point to the need to target the intervention more specifically to the needs and capabilities of participants and to the context of the intervention. Trial Registration: Clinicaltrials.gov NCT02671929; https://clinicaltrials.gov/ct2/show/NCT02671929 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb) ", doi="10.2196/mental.7889", url="http://mental.jmir.org/2017/4/e41/", url="http://www.ncbi.nlm.nih.gov/pubmed/29038094" } @Article{info:doi/10.2196/mhealth.7988, author="Mehralizade, Aydan and Schor, Shayna and Coleman, M. Chad and Oppenheim, E. Claire and Denckla, A. Christy and Borba, PC Christina and Henderson, C. David and Wolff, James and Crane, Sarah and Nettles-Gomez, Pamela and Pal, Avik and Milanovic, Snezana", title="Mobile Health Apps in OB-GYN-Embedded Psychiatric Care: Commentary", journal="JMIR Mhealth Uhealth", year="2017", month="Oct", day="06", volume="5", number="10", pages="e152", keywords="mHealth", keywords="eHealth", keywords="embedded psychiatric clinic", keywords="postpartum depression", keywords="mental health", keywords="OB-GYN", keywords="global health", keywords="reproductive health", doi="10.2196/mhealth.7988", url="http://mhealth.jmir.org/2017/10/e152/", url="http://www.ncbi.nlm.nih.gov/pubmed/28986335" } @Article{info:doi/10.2196/mental.6802, author="Tonn, Peter and Reuter, Christin Silja and Kuchler, Isabelle and Reinke, Britta and Hinkelmann, Lena and St{\"o}ckigt, Saskia and Siemoneit, Hanna and Schulze, Nina", title="Development of a Questionnaire to Measure the Attitudes of Laypeople, Physicians, and Psychotherapists Toward Telemedicine in Mental Health", journal="JMIR Ment Health", year="2017", month="Oct", day="03", volume="4", number="4", pages="e39", keywords="screening", keywords="questionnaire", keywords="e-mental health", keywords="remote consultation", keywords="attitude to computers", keywords="physician expectations", keywords="telemedicine", keywords="online-intervention", abstract="Background: In the field of psychiatry and psychotherapy, there are now a growing number of Web-based interventions, mobile phone apps, or treatments that are available via remote transmission screen worldwide. Many of these interventions have been shown to be effective in studies but still find little use in everyday therapeutic work. However, it is important that attitude and expectation toward this treatment are generally examined, because these factors have an important effect on the efficacy of the treatment. To measure the general attitude of the users and prescribers toward telemedicine, which may include, for instance, Web-based interventions or interventions through mobile phone apps, there are a small number of extensive tests. The results of studies based on small groups of patients have been published too, but there is no useful short screening tool to give an insight into the general population's attitude. We have developed a screening instrument that examines such attitude through a few graded questions. Objective: This study aimed to explore the Attitude toward Telemedicine in Psychiatry and Psychotherapy (ATiPP) and to evaluate the results of general population and some subgroups. Methods: In a three-step process, the questionnaire, which is available in three versions (laypeople, physicians, and psychologists), was developed. Afterwards, it was evaluated by four groups: population-representative laypeople, outpatients in different faculties, physicians, and psychotherapists. Results: The results were evaluated from a total of 1554 questionnaires. The sample population included 1000 laypeople, 455 outpatients, 62 physicians, and 37 psychotherapists. The reliability of all three versions of the questionnaire seemed good, as indicated by the Cronbach alpha values of .849 (the laypeople group), .80 (the outpatients' group), .827 (the physicians' group), and .855 (the psychotherapists' group). Conclusions: The ATiPP was found to be useful and reliable for measuring the attitudes toward the Web-based interventions in psychiatry and psychotherapy and should be used in different studies in this field in the future to evaluate and reflect the attitude of the participants. ", doi="10.2196/mental.6802", url="https://mental.jmir.org/2017/4/e39/", url="http://www.ncbi.nlm.nih.gov/pubmed/28974485" } @Article{info:doi/10.2196/mental.6982, author="Harris, WF Anthony and Kosic, Tanya and Xu, Jean and Walker, Chris and Gye, William and Redoblado Hodge, Antoinette", title="Web-Based Cognitive Remediation Improves Supported Employment Outcomes in Severe Mental Illness: Randomized Controlled Trial", journal="JMIR Ment Health", year="2017", month="Sep", day="20", volume="4", number="3", pages="e30", keywords="severe mental disorders", keywords="supported employment", keywords="cognitive function", keywords="cognitive remediation", keywords="randomized controlled trial", abstract="Background: Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. Objective: The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. Methods: A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. Results: At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. Conclusions: This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998\&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos) ", doi="10.2196/mental.6982", url="http://mental.jmir.org/2017/3/e30/", url="http://www.ncbi.nlm.nih.gov/pubmed/28931500" } @Article{info:doi/10.2196/jmir.6588, author="Erbe, Doris and Eichert, Hans-Christoph and Riper, Heleen and Ebert, Daniel David", title="Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review", journal="J Med Internet Res", year="2017", month="Sep", day="15", volume="19", number="9", pages="e306", keywords="mental health", keywords="Internet", keywords="psychotherapy", keywords="blended treatment", abstract="Background: Many studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions). Objective: The aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness. Methods: Studies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions (``inpatient,'' ``outpatient,'' ``face-to-face,'' or ``residential treatment''), which were combined with terms indicating Internet treatment (``internet,'' ``online,'' or ``web'') and terms indicating mental disorders (``mental health,'' ``depression,'' ``anxiety,'' or ``substance abuse''). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse). Results: We identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions. Conclusions: Several studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary. ", doi="10.2196/jmir.6588", url="http://www.jmir.org/2017/9/e306/", url="http://www.ncbi.nlm.nih.gov/pubmed/28916506" } @Article{info:doi/10.2196/jmir.7023, author="Hoermann, Simon and McCabe, L. Kathryn and Milne, N. David and Calvo, A. Rafael", title="Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review", journal="J Med Internet Res", year="2017", month="Jul", day="21", volume="19", number="8", pages="e267", keywords="chat", keywords="dialog system", keywords="remote psychotherapy", abstract="Background: Synchronous written conversations (or ``chats'') are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective: The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods: A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results: A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions: Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice. ", doi="10.2196/jmir.7023", url="http://www.jmir.org/2017/8/e267/", url="http://www.ncbi.nlm.nih.gov/pubmed/28784594" } @Article{info:doi/10.2196/mental.7600, author="Hanisch, Elisabeth Sabine and Birner, Walter Ulrich and Oberhauser, Cornelia and Nowak, Dennis and Sabariego, Carla", title="Development and Evaluation of Digital Game-Based Training for Managers to Promote Employee Mental Health and Reduce Mental Illness Stigma at Work: Quasi-Experimental Study of Program Effectiveness", journal="JMIR Ment Health", year="2017", month="Aug", day="04", volume="4", number="3", pages="e31", keywords="stigma", keywords="mental health", keywords="workplace", keywords="prevention", keywords="health promotion", keywords="leadership", keywords="eHealth", keywords="Internet", abstract="Background: To counteract the negative impact of mental health problems on business, organizations are increasingly investing in mental health intervention measures. However, those services are often underused, which, to a great extent, can be attributed to fear of stigmatization. Nevertheless, so far only a few workplace interventions have specifically targeted stigma, and evidence on their effectiveness is limited. Objective: The objective of this study was to develop and evaluate a digital game-based training program for managers to promote employee mental health and reduce mental illness stigma at work. Methods: We describe the empirical development of Leadership Training in Mental Health Promotion (LMHP), a digital game-based training program for leaders. A 1-group pre-post design and a 3-month follow-up were used for training evaluation. We applied multilevel growth models to investigate change over time in the dependent variables knowledge, attitudes, self-efficacy, and intentions to promote employee mental health in 48 managers of a global enterprise in the United Kingdom. Participants were mainly male (44/48, 92\%) and ranged in age from 32 to 58 (mean 46.0, SD 7.2) years. Results: We found a positive impact of the Web-based training program on managers' knowledge of mental health and mental illness (P<.001), on attitudes toward people with mental health problems (P<.01), and on their self-efficacy to deal with mental health situations at work (P<.001), with the exception of intentions to promote employee mental health, which was initially high. Conclusions: Results provide first evidence of the effectiveness of LMHP to positively affect managers' skills to promote employee mental health at work. Furthermore, the high rate of participation in LMHP (48/54, 89\%) supports the use of digital game-based interventions to increase user engagement and user experience in mental health programs at work. ", doi="10.2196/mental.7600", url="http://mental.jmir.org/2017/3/e31/", url="http://www.ncbi.nlm.nih.gov/pubmed/28778839" } @Article{info:doi/10.2196/jmir.7921, author="Lowenstein, Margaret and Bamgbose, Olusinmi and Gleason, Nathaniel and Feldman, D. Mitchell", title="Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry", journal="J Med Internet Res", year="2017", month="Aug", day="04", volume="19", number="8", pages="e279", keywords="mental health", keywords="primary care", keywords="health care delivery", keywords="teleconsultation", keywords="telehealth", keywords="Internet care delivery", abstract="Background: Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Objective: Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. Methods: We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Results: Depression was the most common consult template selected by PCPs (20/50, 40\%), followed by the generic template (12/50, 24\%) and anxiety (8/50, 16\%). Most questions (49/50, 98\%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56\%) and management (50/50, 100\%), responded in an average of 1.4 days, and recommended in-person consultation for 26\% (13/50) of patients. PCPs implemented psychiatrist recommendations 76\% (38/50) of the time. Conclusions: For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. ", doi="10.2196/jmir.7921", url="http://www.jmir.org/2017/8/e279/", url="http://www.ncbi.nlm.nih.gov/pubmed/28778852" } @Article{info:doi/10.2196/mental.6921, author="Prescott, Julie and Hanley, Terry and Ujhelyi, Katalin", title="Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support", journal="JMIR Ment Health", year="2017", month="Aug", day="02", volume="4", number="3", pages="e29", keywords="adolescence", keywords="Internet", keywords="social media, mental health", keywords="qualitative research", abstract="Background: The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. Objective: The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). Methods: Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. Results: The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do. Conclusions: This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective). ", doi="10.2196/mental.6921", url="http://mental.jmir.org/2017/3/e29/", url="http://www.ncbi.nlm.nih.gov/pubmed/28768607" } @Article{info:doi/10.2196/mental.7722, author="Batterham, J. Philip and Calear, L. Alison", title="Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey", journal="JMIR Ment Health", year="2017", month="Jun", day="30", volume="4", number="2", pages="e26", keywords="Internet interventions", keywords="mental health services", keywords="preferences", keywords="anxiety", keywords="depression", abstract="Background: Despite extensive evidence that Internet interventions are effective in treating mental health problems, uptake of Internet programs is suboptimal. It may be possible to make Internet interventions more accessible and acceptable through better understanding of community preferences for delivery of online programs. Objective: This study aimed to assess community preferences for components, duration, frequency, modality, and setting of Internet interventions for mental health problems. Methods: A community-based online sample of 438 Australian adults was recruited using social media advertising and administered an online survey on preferences for delivery of Internet interventions, along with scales assessing potential correlates of these preferences. Results: Participants reported a preference for briefer sessions, although they recognized a trade-off between duration and frequency of delivery. No clear preference for the modality of delivery emerged, although a clear majority preferred tailored programs. Participants preferred to access programs through a computer rather than a mobile device. Although most participants reported that they would seek help for a mental health problem, more participants had a preference for face-to-face sources only than online programs only. Younger, female, and more educated participants were significantly more likely to prefer Internet delivery. Conclusions: Adults in the community have a preference for Internet interventions with short modules that are tailored to individual needs. Individuals who are reluctant to seek face-to-face help may also avoid Internet interventions, suggesting that better implementation of existing Internet programs requires increasing acceptance of Internet interventions and identifying specific subgroups who may be resistant to seeking help. ", doi="10.2196/mental.7722", url="http://mental.jmir.org/2017/2/e26/", url="http://www.ncbi.nlm.nih.gov/pubmed/28666976" } @Article{info:doi/10.2196/mental.7716, author="Mu{\~n}oz-S{\'a}nchez, Juan-Luis and Delgado, Carmen and S{\'a}nchez-Prada, Andr{\'e}s and P{\'e}rez-L{\'o}pez, Mercedes and Franco-Mart{\'i}n, A. Manuel", title="Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study", journal="JMIR Ment Health", year="2017", month="Jun", day="27", volume="4", number="2", pages="e23", keywords="suicide", keywords="suicide attempt", keywords="self-harm", keywords="prevention", keywords="new technologies", keywords="Europe", abstract="Background: New technologies are an integral component of today's society and can complement existing suicide prevention programs. Here, we analyzed the use of new technologies in the prevention of suicide in 8 different European countries. Objective: The aim of this paper was to assess the opinions of professionals in incorporating such resources into the design of a suicide prevention program for the region of Zamora in Spain. This investigation, encompassed within the European project entitled European Regions Enforcing Actions against Suicide (EUREGENAS), includes 11 regions from 8 different countries and attempts to advance the field of suicide prevention in Europe. Methods: Using a specifically designed questionnaire, we assessed the opinions of 3 different groups of stakeholders regarding the use, frequency of use, facilitators, content, and format of new technologies for the prevention of suicide. The stakeholders were comprised of policy and public management professionals, professionals working in the area of mental health, and professionals related to the social area and non-governmental organizations (NGOs). A total of 416 participants were recruited in 11 regions from 8 different European countries. Results: The utility of the new technologies was valued positively in all 8 countries, despite these resources being seldom used in those countries. In all the countries, the factors that contributed most to facilitating the use of new technologies were accessibility and free of charge. Regarding the format of new technologies, the most widely preferred formats for use as a tool for the prevention of suicide were websites and email. The availability of information about signs of alarm and risk factors was the most relevant content for the prevention of suicide through the use of new technologies. The presence of a reference mental health professional (MHP) was also considered to be a key aspect. The countries differed in the evaluations given to the different formats suggesting that the cultural characteristics of the country should be taken into account. Conclusions: New technologies are much appreciated resources; however they are not often underused in the field of suicide prevention. The results of this exploratory study show that new technologies are indeed useful resources and should be incorporated into suicide prevention programs. ", doi="10.2196/mental.7716", url="http://mental.jmir.org/2017/2/e23/", url="http://www.ncbi.nlm.nih.gov/pubmed/28655705" } @Article{info:doi/10.2196/mental.7296, author="Lal, Shalini and Daniel, Winnie and Rivard, Lysanne", title="Perspectives of Family Members on Using Technology in Youth Mental Health Care: A Qualitative Study", journal="JMIR Ment Health", year="2017", month="Jun", day="23", volume="4", number="2", pages="e21", keywords="family", keywords="adolescent", keywords="young adult", keywords="technology", keywords="telemedicine", keywords="mental health services", keywords="psychotic disorders", abstract="Background: Information and communication technologies (ICTs) are increasingly recognized as having an important role in the delivery of mental health services for youth. Recent studies have evaluated young people's access and use of technology, as well as their perspectives on using technology to receive mental health information, services, and support; however, limited attention has been given to the perspectives of family members in this regard. Objective: The aim of this study was to explore the perspectives of family members on the use of ICTs to deliver mental health services to youth within the context of specialized early intervention for a first-episode psychosis (FEP). Methods: Six focus groups were conducted with family members recruited from an early intervention program for psychosis. Twelve family members participated in the study (target sample was 12-18, and recruitment efforts took place over the duration of 1 year). A 12-item semistructured focus group guide was developed to explore past experiences of technology and recommendations for the use of technology in youth mental health service delivery. A qualitative thematic analysis guided the identification and organization of common themes and patterns identified across the dataset. Results: Findings were organized by the following themes: access and use of technology, potential negative impacts of technology on youth in recovery, potential benefits of using technology to deliver mental health services to youth, and recommendations to use technology for (1) providing quality information in a manner that is accessible to individuals of diverse socioeconomic backgrounds, (2) facilitating communication with health care professionals and services, and (3) increasing access to peer support. Conclusions: To our knowledge, this is among the first (or the first) to explore the perspectives of family members of youth being treated for FEP on the use of technology for mental health care. Our results highlight the importance of considering diverse experiences and attitudes toward the role of technology in youth mental health, digital literacy skills, phases of recovery, and sociodemographic factors when engaging family members in technology-enabled youth mental health care research and practice. Innovative methods to recruit and elicit the perspectives of family members on this topic are warranted. It is also important to consider educational strategies to inform and empower family members on the role, benefits, and use of ICTs in relation to mental health care for FEP. ", doi="10.2196/mental.7296", url="http://mental.jmir.org/2017/2/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/28645887" } @Article{info:doi/10.2196/jmir.7864, author="Fairburn, G. Christopher and Allen, Elizabeth and Bailey-Straebler, Suzanne and O'Connor, E. Marianne and Cooper, Zafra", title="Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists", journal="J Med Internet Res", year="2017", month="Jun", day="16", volume="19", number="6", pages="e214", keywords="psychotherapy", keywords="training", keywords="dissemination", keywords="Internet", keywords="eating disorders", keywords="cognitive behavior therapy", abstract="Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3\%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95\% Cl --6.62 to --5.05; P<.001) with 42.5\% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. ", doi="10.2196/jmir.7864", url="http://www.jmir.org/2017/6/e214/", url="http://www.ncbi.nlm.nih.gov/pubmed/28623184" } @Article{info:doi/10.2196/jmir.6915, author="Denneson, M. Lauren and Cromer, Risa and Williams, B. Holly and Pisciotta, Maura and Dobscha, K. Steven", title="A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship", journal="J Med Internet Res", year="2017", month="Jun", day="14", volume="19", number="6", pages="e208", keywords="eHealth", keywords="physician-patient relations", keywords="mental health", keywords="patient-centered care", abstract="Background: As part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings. Objective: The aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care. Methods: We conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process. Results: OpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes. Conclusions: Our findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation. ", doi="10.2196/jmir.6915", url="http://www.jmir.org/2017/6/e208/", url="http://www.ncbi.nlm.nih.gov/pubmed/28615152" } @Article{info:doi/10.2196/mental.7878, author="Bird, Jennifer and Rotumah, Darlene and Bennett-Levy, James and Singer, Judy", title="Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers", journal="JMIR Ment Health", year="2017", month="May", day="29", volume="4", number="2", pages="e17", keywords="eMental Health", keywords="Aboriginal and Torres Strait Islanders", keywords="social and emotional wellbeing", keywords="health education", keywords="health promotion", keywords="mental health", keywords="indigenous health services", keywords="culturally appropriate technology", keywords="internet", keywords="implementation", keywords="training", abstract="Background: In Australia, mental health services are undergoing major systemic reform with eMental Health (eMH) embedded in proposed service models for all but those with severe mental illness. Aboriginal and Torres Strait Islander service providers have been targeted as a national priority for training and implementation of eMH into service delivery. Implementation studies on technology uptake in health workforces identify complex and interconnected variables that influence how individual practitioners integrate new technologies into their practice. To date there are only two implementation studies that focus on eMH and Aboriginal and Torres Strait Islander service providers. They suggest that the implementation of eMH in the context of Aboriginal and Torres Strait Islander populations may be different from the implementation of eMH with allied health professionals and mainstream health services. Objective: The objective of this study is to investigate how Aboriginal and Torres Strait Islander service providers in one regional area of Australia used eMH resources in their practice following an eMH training program and to determine what types of eMH resources they used. Methods: Individual semistructured qualitative interviews were conducted with a purposive sample of 16 Aboriginal and Torres Strait Islander service providers. Interviews were co-conducted by one indigenous and one non-indigenous interviewer. A sample of transcripts were coded and thematically analyzed by each interviewer and then peer reviewed. Consensus codes were then applied to all transcripts and themes identified. Results: It was found that 9 of the 16 service providers were implementing eMH resources into their routine practice. The findings demonstrate that participants used eMH resources for supporting social inclusion, informing and educating, assessment, case planning and management, referral, responding to crises, and self and family care. They chose a variety of types of eMH resources to use with their clients, both culturally specific and mainstream. While they referred clients to online treatment programs, they used only eMH resources designed for mobile devices in their face-to-face contact with clients. Conclusions: This paper provides Aboriginal and Torres Strait islander service providers and the eMH field with findings that may inform and guide the implementation of eMH resources. It may help policy developers locate this workforce within broader service provision planning for eMH. The findings could, with adaptation, have wider application to other workforces who work with Aboriginal and Torres Strait Islander clients. The findings highlight the importance of identifying and addressing the particular needs of minority groups for eMH services and resources. ", doi="10.2196/mental.7878", url="http://mental.jmir.org/2017/2/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/28554880" } @Article{info:doi/10.2196/jmir.7524, author="Gammon, Deede and Strand, Monica and Eng, Sofie Lillian and B{\o}r{\o}sund, Elin and Varsi, Cecilie and Ruland, Cornelia", title="Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study", journal="J Med Internet Res", year="2017", month="May", day="02", volume="19", number="5", pages="e145", keywords="recovery", keywords="eHealth", keywords="mental health", keywords="psychiatry", keywords="user involvement", keywords="empowerment", keywords="working relationships", keywords="participatory research", keywords="secure email", keywords="e-recovery", abstract="Background: Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective: The aim was to illustrate uses and experiences with the secure e-recovery portal ``ReConnect'' as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods: ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results: Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users' control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30\%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions: Regardless of providers' portal use, service users' control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users' autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). ", doi="10.2196/jmir.7524", url="http://www.jmir.org/2017/5/e145/", url="http://www.ncbi.nlm.nih.gov/pubmed/28465277" } @Article{info:doi/10.2196/mental.6186, author="Apolin{\'a}rio-Hagen, Jennifer and Kemper, Jessica and St{\"u}rmer, Carolina", title="Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review", journal="JMIR Ment Health", year="2017", month="Apr", day="03", volume="4", number="2", pages="e10", keywords="mental health", keywords="eHealth", keywords="acceptability of healthcare", keywords="public opinion", keywords="attitude to computers", keywords="patient preference", keywords="diffusion of innovation", keywords="cognitive therapy", keywords="computer literacy", keywords="review", abstract="Background: Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems. Objective: This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies. Methods: We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs. Results: The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or ``e-awareness'' and intentions to use e-mental health services were weak or inconsistent. Conclusions: Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care. ", doi="10.2196/mental.6186", url="http://mental.jmir.org/2017/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/28373153" } @Article{info:doi/10.2196/mental.4751, author="Bernecker, L. Samantha and Banschback, Kaitlin and Santorelli, D. Gennarina and Constantino, J. Michael", title="A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey", journal="JMIR Ment Health", year="2017", month="Jan", day="19", volume="4", number="1", pages="e5", keywords="computer-assisted instruction", keywords="eHealth", keywords="mental health", keywords="self care", keywords="self-help", keywords="peer support", keywords="social support", abstract="Background: Self-guided mental health interventions that are disseminated via the Web have the potential to circumvent barriers to treatment and improve public mental health. However, self-guided interventions often fail to attract consumers and suffer from user nonadherence. Uptake of novel interventions could be improved by consulting consumers from the beginning of the development process in order to assess their interest and their preferences. Interventions can then be tailored using this feedback to optimize appeal. Objective: The aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs. Methods: We surveyed consumers via Amazon's Mechanical Turk to estimate interest in the self-help and peer support program. We assessed associations between demographic and clinical characteristics and interest in the program, and we obtained feedback on desired features of the program. Results: Overall, 63.9\% (378/592) of respondents said that they would try the program; interest was lower but still substantial among those who were not willing or able to access traditional mental health services. Female gender, lower income, and openness to using psychotherapy were the most consistent predictors of interest in the program. The majority of respondents, although not all, preferred romantic partners or close friends as peer counselors and would be most likely to access the program if the training course were accessed on a stand-alone website. In general, respondents valued training in active listening skills. Conclusions: In light of the apparent public interest in this program, Web-disseminated self-help and peer support interventions have enormous potential to fill gaps in mental health care. The results of this survey can be used to inform the design of such interventions. ", doi="10.2196/mental.4751", url="http://mental.jmir.org/2017/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/28104578" } @Article{info:doi/10.2196/jmir.6269, author="Bennett-Levy, James and Singer, Judy and DuBois, Simon and Hyde, Kelly", title="Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals?", journal="J Med Internet Res", year="2017", month="Jan", day="11", volume="19", number="1", pages="e1", keywords="e-mental health", keywords="indigenous populations", keywords="Aboriginal and Torres Strait Islander peoples", keywords="professional supervision", keywords="professional consultation", keywords="service implementation", keywords="health education", keywords="mobile apps", abstract="Background: With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective: The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods: A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results: Uptake of e-MH among the consultation group was moderate (22\%-30\% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers' lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions: A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH's health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients. ", doi="10.2196/jmir.6269", url="http://www.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28077347" } @Article{info:doi/10.2196/medinform.6512, author="Riahi, Sanaz and Fischler, Ilan and Stuckey, I. Melanie and Klassen, E. Philip and Chen, John", title="The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study", journal="JMIR Med Inform", year="2017", month="Jan", day="05", volume="5", number="1", pages="e1", keywords="electronic health records", keywords="health information management", keywords="medical informatics", keywords="mental health", keywords="organizational innovation", keywords="psychiatry", keywords="quality improvement", abstract="Background: Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective: The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods: The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results: Medication and patient scan rates have been greater than 95\% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7\%, which resulted in cost savings of more than Can \$1.4 million (US \$1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions: EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. ", doi="10.2196/medinform.6512", url="http://medinform.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28057607" } @Article{info:doi/10.2196/jmir.6511, author="Robotham, Dan and Satkunanathan, Safarina and Doughty, Lisa and Wykes, Til", title="Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up", journal="J Med Internet Res", year="2016", month="Nov", day="22", volume="18", number="11", pages="e309", keywords="digital divide", keywords="socioeconomic factors", keywords="technology", keywords="mobile phone", keywords="psychotic disorders", keywords="distance counseling", abstract="Background: Nearly everyone in society uses the Internet in one form or another. The Internet is heralded as an efficient way of providing mental health treatments and services. However, some people are still excluded from using Internet-enabled technology through lack of resources, skills, and confidence. Objective: Five years ago, we showed that people with severe mental illness were at risk of digital exclusion, especially middle-aged patients with psychosis and/or people from black or minority ethnic groups with psychosis. An understanding of the breadth of potential digital exclusion is vital for the implementation of digital health services. The aim of this study is to understand the context of digital exclusion for people who experience mental illness. Methods: We conducted a survey involving people with a primary diagnosis of psychosis or depression in London, United Kingdom. A total of 241 participants were recruited: 121 with psychosis and 120 with depression. The majority of surveys were collected face-to-face (psychosis: n=109; depression: n=71). Participants answered questions regarding familiarity, access, use, motivation, and confidence with Internet-enabled technologies (ie, computers and mobile phones). Variables predicting digital exclusion were identified in regression analyses. The results were compared with the survey conducted in 2011. Results: Digital exclusion has declined since 2011. Online survey collection introduced biases into the sample, masking those who were likely to be excluded. Only 18.3\% (20/109) of people with psychosis in our sample were digitally excluded, compared with 30\% (28/93) in 2011 ($\chi$21=3.8, P=.04). People with psychosis had less confidence in using the Internet than people with depression ($\chi$21=7.4, P=.004). Only 9.9\% (24/241) of participants in the total sample were digitally excluded, but the majority of these people had psychosis (n=20). Those with psychosis who were digitally excluded were significantly older than their included peers (t30=3.3, P=.002) and had used services for longer (t97=2.5, P=.02). Younger people were more likely to use mobile phones. Digitally excluded participants cited a lack of knowledge as a barrier to digital inclusion, and most wanted to use the Internet via computers (rather than mobile phones). Conclusions: Digital exclusion is lower, but some remain excluded. Facilitating inclusion among this population means helping them develop skills and confidence in using technology, and providing them with access. Providing mobile phones without basic information technology training may be counterproductive because excluded people may be excluded from mobile technology too. An evidence-based digital inclusion strategy is needed within the National Health Service to help digitally excluded populations access Internet-enabled services. ", doi="10.2196/jmir.6511", url="http://www.jmir.org/2016/11/e309/", url="http://www.ncbi.nlm.nih.gov/pubmed/27876684" } @Article{info:doi/10.2196/jmir.6483, author="Kipping, Sarah and Stuckey, I. Melanie and Hernandez, Alexandra and Nguyen, Tan and Riahi, Sanaz", title="A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation", journal="J Med Internet Res", year="2016", month="Nov", day="16", volume="18", number="11", pages="e294", keywords="efficiency, organizational", keywords="electronic health records", keywords="mental health", keywords="mental disorders", keywords="patient activation", abstract="Background: Treatment for mental illness has shifted from focusing purely on treatment of symptoms to focusing on personal recovery. Patient activation is an important component of the recovery journey. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown. Objective: To conduct a benefits evaluation of a Web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on (1) patient activation, (2) recovery, (3) productivity, and (4) administrative efficiencies. Methods: All registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal and those who did not were designated as ``users'' and ``nonusers,'' respectively. All patients received usual treatment. Users had Web-based access to view parts of their electronic medical record, view upcoming appointments, and communicate with their health care provider. Users could attend portal training or support sessions led by either the engagement coordinator or peer support specialists. A subset of patients who created and utilized their portal account completed 2 Web-based surveys at baseline (just after enrollment; n=91) and at follow-up (6 and 10 months; n=65). The total score of the Mental Health Recovery Measure (MHRM) was a proxy for patient activation and the individual domains measured recovery. The System and Use Survey Tool (SUS) examined the use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and nonusers missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation. Results: A total of 461 patients (44.0\% male, n=203) registered for the portal, which was used 4761 times over the 1-year follow-up period. The majority of uses (95.34\%, 4539/4761) were for e-views. The overall MHRM score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at combined follow-up (P=.01). Of the 8 recovery domains, 7 were increased at follow-up (all P<.05). The odds of a portal user attending an appointment were 67\% (CI 56\%-79\%) greater than that of nonusers over the follow-up period. Compared with 2014, over 2015 there was an 86\% and 57\% decrease in requests for information in users and nonusers, respectively. The SUS revealed that users felt an increased sense of autonomy and found the portal to be user-friendly, helpful, and efficient but felt that more information should be accessible. Conclusions: The benefits evaluation suggested that access to personal health records via patient portals may improve patient activation, recovery scores, and organizational efficiencies in a tertiary level mental health care facility. ", doi="10.2196/jmir.6483", url="http://www.jmir.org/2016/11/e294/", url="http://www.ncbi.nlm.nih.gov/pubmed/27852556" } @Article{info:doi/10.2196/mental.5837, author="Puszka, Stefanie and Dingwall, M. Kylie and Sweet, Michelle and Nagel, Tricia", title="E-Mental Health Innovations for Aboriginal and Torres Strait Islander Australians: A Qualitative Study of Implementation Needs in Health Services", journal="JMIR Ment Health", year="2016", month="Sep", day="19", volume="3", number="3", pages="e43", keywords="eHealth", keywords="Indigenous health services", keywords="mental health services", keywords="diffusion of innovation", keywords="culturally appropriate technology", abstract="Background: Electronic mental health (e-mental health) interventions offer effective, easily accessible, and cost effective treatment and support for mental illness and well-being concerns. However, e-mental health approaches have not been well utilized by health services to date and little is known about their implementation in practice, particularly in diverse contexts and communities. Objective: This study aims to understand stakeholder perspectives on the requirements for implementing e-mental health approaches in regional and remote health services for Indigenous Australians. Methods: Qualitative interviews were conducted with 32 managers, directors, chief executive officers (CEOs), and senior practitioners of mental health, well-being, alcohol and other drug and chronic disease services. Results: The implementation of e-mental health approaches in this context is likely to be influenced by characteristics related to the adopter (practitioner skill and knowledge, client characteristics, communication barriers), the innovation (engaging and supportive approach, culturally appropriate design, evidence base, data capture, professional development opportunities), and organizational systems (innovation-systems fit, implementation planning, investment). Conclusions: There is potential for e-mental health approaches to address mental illness and poor social and emotional well-being amongst Indigenous people and to advance their quality of care. Health service stakeholders reported that e-mental health interventions are likely to be most effective when used to support or extend existing health services, including elements of client-driven and practitioner-supported use. Potential solutions to obstacles for integration of e-mental health approaches into practice were proposed including practitioner training, appropriate tool design using a consultative approach, internal organizational directives and support structures, adaptations to existing systems and policies, implementation planning and organizational and government investment. ", doi="10.2196/mental.5837", url="http://mental.jmir.org/2016/3/e43/", url="http://www.ncbi.nlm.nih.gov/pubmed/27644259" } @Article{info:doi/10.2196/mental.5988, author="Rickwood, Debra and Webb, Marianne and Kennedy, Vanessa and Telford, Nic", title="Who Are the Young People Choosing Web-based Mental Health Support? Findings From the Implementation of Australia's National Web-based Youth Mental Health Service, eheadspace", journal="JMIR Ment Health", year="2016", month="Aug", day="25", volume="3", number="3", pages="e40", keywords="mental health", keywords="adolescent", keywords="help-seeking behavior", keywords="telemedicine", keywords="counseling", keywords="Internet", abstract="Background: The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia's national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type. Objective: The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center. Methods: Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015). Results: More eheadspace than headspace center clients were female (78.1\% compared with 59.1\%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6\% compared with 73.2\%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients. Conclusions: The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care. ", doi="10.2196/mental.5988", url="http://mental.jmir.org/2016/3/e40/", url="http://www.ncbi.nlm.nih.gov/pubmed/27562729" } @Article{info:doi/10.2196/mental.5675, author="Hungerbuehler, Ines and Valiengo, Leandro and Loch, A. Alexandre and R{\"o}ssler, Wulf and Gattaz, F. Wagner", title="Home-Based Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial", journal="JMIR Ment Health", year="2016", month="Aug", day="03", volume="3", number="3", pages="e36", keywords="telemedicine", keywords="telehealth", keywords="eHealth, videoconferencing", keywords="psychiatry", keywords="outpatient", keywords="home-care services", keywords="mental health", keywords="depression", abstract="Background: There is a tremendous opportunity for innovative mental health care solutions such as psychiatric care through videoconferencing to increase the number of people who have access to quality care. However, studies are needed to generate empirical evidence on the use of psychiatric outpatient care via videoconferencing, particularly in low- and middle-income countries and clinically unsupervised settings. Objective: The objective of this study was to evaluate the effectiveness and feasibility of home-based treatment for mild depression through psychiatric consultations via videoconferencing. Methods: A randomized controlled trial with a 6- and 12-month follow-up including adults with mild depression treated in an ambulatory setting was conducted. In total, 107 participants were randomly allocated to the videoconferencing intervention group (n=53) or the face-to-face group (F2F; n=54). The groups did not differ with respect to demographic characteristics at baseline. The F2F group completed monthly follow-up consultations in person. The videoconferencing group received monthly follow-up consultations with a psychiatrist through videoconferencing at home. At baseline and after 6 and 12 months, in-person assessments were conducted with all participants. Clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence were assessed. Results: The severity of depression decreased significantly over the 12-month follow-up in both the groups. There was a significant difference between groups regarding treatment outcomes throughout the follow-up period, with better results in the videoconferencing group. There were 4 relapses in the F2F group and only 1 in the videoconferencing group. No significant differences between groups regarding mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence, or medication compliance were found. However, after 6 months, the rate of dropouts was significantly higher in the F2F group (18.5\% vs 5.7\% in the videoconferencing group, P<.05). Conclusions: Psychiatric treatment through videoconferencing in clinically unsupervised settings can be considered feasible and as effective as standard care (in-person treatment) for depressed outpatients with respect to clinical outcomes, patient satisfaction, therapeutic relationship, treatment adherence, and medication compliance. These results indicate the potential of telepsychiatry to extend access to psychiatric care to remote and underserved populations. ClinicalTrial: Clinicaltrials.gov NCT01901315; https://clinicaltrials.gov/ct2/show/NCT01901315 (Archived by WebCite at http://www.webcitation.org/6jBTrIVwg) ", doi="10.2196/mental.5675", url="http://mental.jmir.org/2016/3/e36/", url="http://www.ncbi.nlm.nih.gov/pubmed/27489204" } @Article{info:doi/10.2196/mental.6068, author="Rai, Minnie and Vigod, N. Simone and Hensel, M. Jennifer", title="Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study", journal="JMIR Ment Health", year="2016", month="Aug", day="01", volume="3", number="3", pages="e35", keywords="e-communication", keywords="mental health", keywords="technology", keywords="barriers", keywords="social media", abstract="Background: With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. Objective: To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. Methods: We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Results: Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91\% (62/68), and 59\% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. Conclusions: A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services. ", doi="10.2196/mental.6068", url="http://mental.jmir.org/2016/3/e35/", url="http://www.ncbi.nlm.nih.gov/pubmed/27480108" } @Article{info:doi/10.2196/humanfactors.5640, author="Percival, Jennifer and McGregor, Carolyn", title="An Evaluation of Understandability of Patient Journey Models in Mental Health", journal="JMIR Hum Factors", year="2016", month="Jul", day="28", volume="3", number="2", pages="e20", keywords="patient-journey modeling", keywords="process modeling", keywords="technology integration", keywords="health information technology", abstract="Background: There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives: This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method: Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results: The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions: The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot case study to a more diversified group of clinicians and health care support workers. ", doi="10.2196/humanfactors.5640", url="http://humanfactors.jmir.org/2016/2/e20/", url="http://www.ncbi.nlm.nih.gov/pubmed/27471006" } @Article{info:doi/10.2196/mental.4961, author="Carron-Arthur, Bradley and Reynolds, Julia and Bennett, Kylie and Bennett, Anthony and Cunningham, Alastair John and Griffiths, Margaret Kathleen", title="Community Structure of a Mental Health Internet Support Group: Modularity in User Thread Participation", journal="JMIR Mental Health", year="2016", month="May", day="30", volume="3", number="2", pages="e20", keywords="internet", keywords="support group", keywords="social network", keywords="modularity", keywords="mental health", keywords="super user", abstract="Background: Little is known about the community structure of mental health Internet support groups, quantitatively. A greater understanding of the factors, which lead to user interaction, is needed to explain the design information of these services and future research concerning their utility. Objective: A study was conducted to determine the characteristics of users associated with the subgroup community structure of an Internet support group for mental health issues. Methods: A social network analysis of the Internet support group BlueBoard (blueboard.anu.edu.au) was performed to determine the modularity of the community using the Louvain method. Demographic characteristics age, gender, residential location, type of user (consumer, carer, or other), registration date, and posting frequency in subforums (depression, generalized anxiety, social anxiety, panic disorder, bipolar disorder, obsessive compulsive disorder, borderline personality disorder, eating disorders, carers, general (eg, ``chit chat''), and suggestions box) of the BlueBoard users were assessed as potential predictors of the resulting subgroup structure. Results: The analysis of modularity identified five main subgroups in the BlueBoard community. Registration date was found to be the largest contributor to the modularity outcome as observed by multinomial logistic regression. The addition of this variable to the final model containing all other factors improved its classification accuracy by 46.3\%, that is, from 37.9\% to 84.2\%. Further investigation of this variable revealed that the most active and central users registered significantly earlier than the median registration time in each group. Conclusions: The five subgroups resembled five generations of BlueBoard in distinct eras that transcended discussion about different mental health issues. This finding may be due to the activity of highly engaged and central users who communicate with many other users. Future research should seek to determine the generalizability of this finding and investigate the role that highly active and central users may play in the formation of this phenomenon. ", doi="10.2196/mental.4961", url="http://mental.jmir.org/2016/2/e20/", url="http://www.ncbi.nlm.nih.gov/pubmed/27242012" } @Article{info:doi/10.2196/mental.5169, author="Eichenberg, Christiane and Sawyer, Adam", title="Do Patients Look Up Their Therapists Online? An Exploratory Study Among Patients in Psychotherapy", journal="JMIR Mental Health", year="2016", month="May", day="26", volume="3", number="2", pages="e22", keywords="therapist-targeted googling", keywords="patient-targeted googling", keywords="Internet", keywords="patient-therapist relationship", abstract="Background: The use of the Internet as a source of health information is growing among people who experience mental health difficulties. The increase in Internet use has led to questions about online information-seeking behaviors, for example, how psychotherapists and patients use the Internet to ascertain information about each other. The notion of psychotherapists seeking information about their patients online (patient-targeted googling, PTG) has been identified and explored. However, the idea of patients searching for information online about their psychotherapists (therapist-targeted googling, TTG) and the associated motives and effects on the therapeutic relationship remain unclear. Objective: This study investigated former and current German-speaking psychotherapy patients' behavior and attitudes relating to TTG. In addition, patients' methods of information gathering, motives, and success in searching for information were examined. Furthermore, patients' experiences and perceptions of PTG were explored. Methods: Overall, 238 former and current psychotherapy patients responded to a new questionnaire specifically designed to assess the frequency, motives, use, and outcomes of TTG as well as experiences and perceptions of PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking therapy platforms and self-help forums. Results: Of the 238 former and current patients who responded, 106 (44.5\%) had obtained information about their therapists; most of them (n=85, 80.2\%) had used the Internet for this. Besides curiosity, motives behind information searches included the desire to get to know the therapist better by attempting to search for both professional and private information. TTG appeared to be associated with phases of therapy in which patients felt that progress was not being made. Patients being treated for personality disorders appear to engage more frequently in TTG (rphi = 0.21; P=.004). In general, however, information about therapists sought for online was often not found. Furthermore, most patients refrained from telling their therapist about their information searches. Conclusions: Patients appear to engage in TTG to obtain both professional and private information about their psychotherapists. TTG can be viewed as a form of client-initiated disclosure. It is therefore important to include TTG as a subject in therapists' education and also to raise awareness within patient education. This investigation provides the first findings into TTG to begin debate on this subject. ", doi="10.2196/mental.5169", url="http://mental.jmir.org/2016/2/e22/", url="http://www.ncbi.nlm.nih.gov/pubmed/27230433" } @Article{info:doi/10.2196/mental.4534, author="Wentzel, Jobke and van der Vaart, Rosalie and Bohlmeijer, T. Ernst and van Gemert-Pijnen, C. Julia E. W.", title="Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care", journal="JMIR Mental Health", year="2016", month="Feb", day="09", volume="3", number="1", pages="e9", keywords="blended care", keywords="Internet-delivered cognitive behavior therapy", keywords="mental health care", keywords="online", keywords="shared decision making", doi="10.2196/mental.4534", url="http://mental.jmir.org/2016/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/26860537" } @Article{info:doi/10.2196/resprot.5206, author="Ewen, Victoria and Mushquash, R. Aislin and Bailey, Kathleen and Haggarty, M. John and Dama, Sumeet and Mushquash, J. Christopher", title="Same-Day Counseling: Study Protocol for the Evaluation of a New Mental Health Service", journal="JMIR Res Protoc", year="2016", month="Feb", day="03", volume="5", number="1", pages="e22", keywords="single-session counseling", keywords="mental health services", keywords="outpatient", keywords="program evaluation", keywords="access", abstract="Background: Single-session counseling is being implemented across Canada to increase the accessibility and availability of mental health services. Despite increasing use, existing research on single-session counseling is sparse and has methodological limitations. In addition, some stakeholders are skeptical that this model of care can support meaningful change for clients. Objective: The aim of this study is to evaluate a new single-session counseling program (called Same-Day Counseling) offered in an outpatient community mental health clinic in Northwestern Ontario, Canada. Methods: Clients who attend Same-Day Counseling services will be given the opportunity to participate in the program evaluation. Those who consent will complete measures before their session, after their session, and at 1-month follow-up. Data will provide information on who accesses Same-Day Counseling (eg, typical presenting problems, symptom severity), client satisfaction with services, and whether clients benefit from the services (eg, improved functioning and reduced symptom severity). Results: Data collection is underway with 80 participants having completed baseline measures and 55 participants having completed follow-up measures. Data collection is expected to conclude in December 2015. Conclusions: This study is designed to contribute to the literature regarding the integration of single-session counseling into ongoing mental health services, with additional attention to methodological rigour. Our approach will help to address ongoing concerns regarding the implementation of single-session counseling, and inform health care providers and policy makers regarding the utility of this model for addressing the mental health care need of the community. ", doi="10.2196/resprot.5206", url="http://www.researchprotocols.org/2016/1/e22/", url="http://www.ncbi.nlm.nih.gov/pubmed/26842891" } @Article{info:doi/10.2196/resprot.4428, author="Newton, S. Amanda and Wozney, Lori and Bagnell, Alexa and Fitzpatrick, Eleanor and Curtis, Sarah and Jabbour, Mona and Johnson, David and Rosychuk, J. Rhonda and Young, Michael and Ohinmaa, Arto and Joyce, Anthony and McGrath, Patrick", title="Increasing Access to Mental Health Care With Breathe, an Internet-Based Program for Anxious Adolescents: Study Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2016", month="Jan", day="29", volume="5", number="1", pages="e18", keywords="anxiety", keywords="etherapy", keywords="cognitive behavioral therapy", keywords="adolescents", keywords="mental health", keywords="Internet", keywords="intervention", keywords="pilot", keywords="randomized controlled trial", abstract="Background: There is a demand to make first-line treatments, including cognitive behavioural therapy (CBT) for adolescent anxiety disorders, more widely available. Internet-based CBT is proposed to circumvent access and availability barriers and reduce health care system costs. Recent reviews suggest more evidence is needed to establish the treatment effects of Internet-based CBT in children and adolescents and to determine related economic impacts. Objective: This pilot trial aims to collect the necessary data to inform the planning of a full-scale RCT to test the effectiveness of the Internet-based CBT program Breathe (Being Real, Easing Anxiety: Tools Helping Electronically). Methods: We are conducting a 27-month, 2-arm parallel-group, pilot randomized controlled trial (RCT). Outcomes will inform the planning of a full-scale RCT aimed to test the effectiveness of Internet-based CBT with a population of adolescents with moderate to mild anxiety problems. In the pilot RCT we will: (1) define a minimal clinically important difference (MCID) for the primary outcome measure (total anxiety score using the Multidimensional Anxiety Scale for Children); (2) determine a sample size for the full-scale RCT; (3) estimate recruitment and retention rates; (4) measure intervention acceptability to inform critical intervention changes; (5) determine the use of co-interventions; and (6) conduct a cost-consequence analysis to inform a cost-effectiveness analysis in the full-scale RCT. Adolescents aged 13-17 years seeking care for an anxiety complaint from a participating emergency department, mobile or school-based crisis team, or primary care clinic are being screened for interest and eligibility. Enrolled adolescents are being randomly allocated to either 8 weeks of Internet-based CBT with limited telephone and e-mail support, or a control group with access to a static webpage listing anxiety resources. Adolescents are randomly assigned using a computer generated allocation sequence. Data are being collected at baseline, treatment completion, and at a 3-month follow-up. Results: Currently, adolescents are being enrolled in the study. Enrolment is taking place between March 2014 and February 2016; data collection will conclude May 2016. We expect that analysis and results will be available by August 2016. Conclusions: In many communities, the resources available for front-line anxiety treatment are outweighed by the need for care. This pilot RCT is an essential step to designing a robust RCT to evaluate the effectiveness of an Internet-based CBT program for adolescents with moderate to mild anxiety problems. Trial Registration: Clinicaltrials.gov NCT02059226; http://clinicaltrials.gov/ct2/show/NCT02059226 (Archived by WebCite at http://www.webcitation.org/6epF8v7k4) ", doi="10.2196/resprot.4428", url="http://www.researchprotocols.org/2016/1/e18/", url="http://www.ncbi.nlm.nih.gov/pubmed/26825111" } @Article{info:doi/10.2196/humanfactors.4336, author="Orlowski, Simone and Matthews, Ben and Bidargaddi, Niranjan and Jones, Gabrielle and Lawn, Sharon and Venning, Anthony and Collin, Philippa", title="Mental Health Technologies: Designing With Consumers", journal="JMIR Human Factors", year="2016", month="Jan", day="28", volume="3", number="1", pages="e4", keywords="design thinking", keywords="participatory design", keywords="mental health", keywords="technology", doi="10.2196/humanfactors.4336", url="http://humanfactors.jmir.org/2016/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/27026210" } @Article{info:doi/10.2196/jmir.4827, author="Meurk, Carla and Leung, Janni and Hall, Wayne and Head, W. Brian and Whiteford, Harvey", title="Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research", journal="J Med Internet Res", year="2016", month="Jan", day="13", volume="18", number="1", pages="e10", keywords="telemedicine", keywords="e-health", keywords="e-mental health", keywords="e-therapy", keywords="Internet", keywords="online", keywords="cognitive behavioural therapy", keywords="anxiety", keywords="anxiety disorders", keywords="depression", keywords="depressive disorder", keywords="Australia", keywords="research translation", keywords="evidence-informed policy", keywords="implementation", abstract="Background: Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services. Objective: We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base. Methods: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance. Results: The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed. Conclusions: Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary. ", doi="10.2196/jmir.4827", url="http://www.jmir.org/2016/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/26764181" } @Article{info:doi/10.2196/jmir.4306, author="Eichenberg, Christiane and Herzberg, Y. Philipp", title="Do Therapists Google Their Patients? A Survey Among Psychotherapists", journal="J Med Internet Res", year="2016", month="Jan", day="05", volume="18", number="1", pages="e3", keywords="patient-targeted googling (PTG)", keywords="Internet", keywords="patient-therapist relationship", keywords="professional-patient relationship, professional guidelines", keywords="educational curriculum", abstract="Background: The increasing use of the Internet and its array of social networks brings new ways for psychotherapists to find out information about their patients, often referred to as patient-targeted googling (PTG). However, this topic has been subject to little empirical research; there has been hardly any attention given to it in Germany and the rest of Europe and it has not been included in ethical guidelines for psychotherapy despite the complex ethical issues it raises. Objective: This study explored German psychotherapists' behavior and experiences related to PTG, investigated how these vary with sociodemographic factors and therapeutic background, and explored the circumstances in which psychotherapists considered PTG to be appropriate or not. Methods: A total of 207 psychotherapists responded to a newly developed questionnaire that assessed their experience of and views on PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking professional therapy platforms. Results: Most therapists (84.5\%, 174/207) stated that they had not actively considered the topic of PTG. However, 39.6\% (82/207) said that they had already looked for patient information online (eg, when they suspected a patient may have been lying) and 39.3\% (81/207) knew colleagues or supervisors who had done so. Only 2.4\% (5/207) of therapists had come across PTG during their education and training. Conclusions: It is essential to provide PTG as a part of therapists' education and training. Furthermore, the complex problems concerning PTG should be introduced into codes of ethics to provide explicit guidance for psychotherapists in practice. This report provides initial suggestions to open up debate on this topic. ", doi="10.2196/jmir.4306", url="http://www.jmir.org/2016/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/26733210" } @Article{info:doi/10.2196/resprot.4416, author="Ruggiero, J. Kenneth and Bunnell, E. Brian and Andrews III, R. Arthur and Davidson, M. Tatiana and Hanson, F. Rochelle and Danielson, Kmett Carla and Saunders, E. Benjamin and Soltis, Kathryn and Yarian, Caleb and Chu, Brian and Adams, W. Zachary", title="Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment", journal="JMIR Res Protoc", year="2015", month="Dec", day="30", volume="4", number="4", pages="e143", keywords="technology", keywords="mobile health", keywords="child mental health treatment", keywords="feasibility test", keywords="fidelity", keywords="patient engagement", keywords="traumatic stress", abstract="Background: Children need access to high quality mental health care. Effective treatments now exist for a wide range of mental health conditions. However, these interventions are delivered with variable effectiveness in traditional mental health service settings. Innovative solutions are needed to improve treatment delivery quality and effectiveness. Objective: The aim of this study was to develop a scalable, sustainable technology-based approach to improve the quality of care in child mental health treatment. Methods: A tablet-based resource was developed with input from mental health training experts, mental health providers, and patients. A series of qualitative data collection phases (ie, expert interviews, patient and provider focus groups, usability testing) guided the initial concept and design of the resource, and then its refinement. The result was an iPad-based ``e-workbook'' designed to improve child engagement and provider fidelity in implementation of a best-practice treatment. We are currently conducting a small scale randomized controlled trial to evaluate the feasibility of e-workbook facilitated child mental health treatment with 10 providers and 20 families recruited from 4 local community-based mental health clinics. Results: Usability and focus group testing yielded a number of strong, favorable reactions from providers and families. Recommendations for refining the e-workbook also were provided, and these guided several improvements to the resource prior to initiating the feasibility trial, which is currently underway. Conclusions: This study aimed to develop and preliminarily evaluate a tablet-based application to improve provider fidelity and child engagement in child mental health treatment. If successful, this approach may serve as a key step toward making best-practice treatment more accessible to children and families. As various technologies continue to increase in popularity worldwide and within the health care field more specifically, it is essential to rigorously test the usability, feasibility, acceptability, and effectiveness of novel health technology solutions. It is also essential to ensure that patients and providers drive decision making that supports the development of these resources to ensure that they can be seamlessly integrated into practice. Trial Registration: Clinicaltrials.gov NCT01915160; https://clinicaltrials.gov/ct2/show/NCT01915160 (Archived by WebCite at http://www.webcitation.org/6cPIiQDpu) ", doi="10.2196/resprot.4416", url="http://www.researchprotocols.org/2015/4/e143/", url="http://www.ncbi.nlm.nih.gov/pubmed/26717906" } @Article{info:doi/10.2196/mental.4418, author="Ali, Kathina and Farrer, Louise and Gulliver, Amelia and Griffiths, M. Kathleen", title="Online Peer-to-Peer Support for Young People With Mental Health Problems: A Systematic Review", journal="JMIR Mental Health", year="2015", month="May", day="19", volume="2", number="2", pages="e19", keywords="mental health", keywords="Internet", keywords="young people", keywords="peer-to-peer support", keywords="Internet support groups", keywords="technology", keywords="systematic reviews", abstract="Background: Adolescence and early adulthood are critical periods for the development of mental disorders. Online peer-to-peer communication is popular among young people and may improve mental health by providing social support. Previous systematic reviews have targeted Internet support groups for adults with mental health problems, including depression. However, there have been no systematic reviews examining the effectiveness of online peer-to-peer support in improving the mental health of adolescents and young adults. Objective: The aim of this review was to systematically identify available evidence for the effectiveness of online peer-to peer support for young people with mental health problems. Methods: The PubMed, PsycInfo, and Cochrane databases were searched using keywords and Medical Subject Headings (MeSH) terms. Retrieved abstracts (n=3934) were double screened and coded. Studies were included if they (1) investigated an online peer-to-peer interaction, (2) the interaction discussed topics related to mental health, (3) the age range of the sample was between 12 to 25 years, and (4) the study evaluated the effectiveness of the peer-to-peer interaction. Results: Six studies satisfied the inclusion criteria for the current review. The studies targeted a range of mental health problems including depression and anxiety (n=2), general psychological problems (n=1), eating disorders (n=1), and substance use (tobacco) (n=2). The majority of studies investigated Internet support groups (n=4), and the remaining studies focused on virtual reality chat sessions (n=2). In almost all studies (n=5), the peer support intervention was moderated by health professionals, researchers or consumers. Studies employed a range of study designs including randomized controlled trials (n=3), pre-post studies (n=2) and one randomized trial. Overall, two of the randomized controlled trials were associated with a significant positive outcome in comparison to the control group at post-intervention. In the remaining four studies, peer-to-peer support was not found to be effective. Conclusions: This systematic review identified an overall lack of high-quality studies examining online peer-to-peer support for young people. Given that peer support is frequently used as an adjunct to Internet interventions for a variety of mental health conditions, there is an urgent need to determine the effectiveness of peer support alone as an active intervention. ", doi="10.2196/mental.4418", url="http://mental.jmir.org/2015/2/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543923" } @Article{info:doi/10.2196/jmir.4254, author="Younes, Nadia and Chollet, Aude and Menard, Estelle and Melchior, Maria", title="E-Mental Health Care Among Young Adults and Help-Seeking Behaviors: A Transversal Study in a Community Sample", journal="J Med Internet Res", year="2015", month="May", day="15", volume="17", number="5", pages="e123", keywords="Internet", keywords="mental health services", keywords="young adult", keywords="epidemiology", keywords="health care disparities", abstract="Background: The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. Objective: In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Methods: Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen's behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents' income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Results: Overall, 8.65\% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7\% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95\% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95\% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95\% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2\%, 51/77 vs 52.4\%, 186/355, P=.03). Conclusions: E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care. ", doi="10.2196/jmir.4254", url="http://www.jmir.org/2015/5/e123/", url="http://www.ncbi.nlm.nih.gov/pubmed/25979680" } @Article{info:doi/10.2196/mental.4294, author="Gulliver, Amelia and Bennett, Kylie and Bennett, Anthony and Farrer, M. Louise and Reynolds, Julia and Griffiths, M. Kathleen", title="Privacy Issues in the Development of a Virtual Mental Health Clinic for University Students: A Qualitative Study", journal="JMIR Mental Health", year="2015", month="Mar", day="31", volume="2", number="1", pages="e9", keywords="university", keywords="student", keywords="mental health", keywords="internet", keywords="virtual clinic", keywords="qualitative", abstract="Background: There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services. Objective: To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic. Methods: There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context. Results: The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic. Conclusions: Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences. ", doi="10.2196/mental.4294", url="http://mental.jmir.org/2015/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543915" } @Article{info:doi/10.2196/mental.3954, author="East, Lynette Marlene and Havard, C. Byron", title="Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System", journal="JMIR Mental Health", year="2015", month="Mar", day="31", volume="2", number="1", pages="e10", keywords="clinical efficacy", keywords="counselors", keywords="ethical codes", keywords="innovation diffusion", keywords="instructional technology", keywords="mental health", keywords="mHealth", keywords="mobile health", keywords="smartphone", doi="10.2196/mental.3954", url="http://mental.jmir.org/2015/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543907" } @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" } @Article{info:doi/10.2196/mental.3890, author="Farrer, Louise and Gulliver, Amelia and Chan, KY Jade and Bennett, Kylie and Griffiths, M. Kathleen", title="A Virtual Mental Health Clinic for University Students: A Qualitative Study of End-User Service Needs and Priorities", journal="JMIR Mental Health", year="2015", month="Feb", day="11", volume="2", number="1", pages="e2", keywords="university", keywords="student", keywords="mental health", keywords="online", keywords="qualitative", abstract="Background: Help seeking for mental health problems among university students is low, and Internet-based interventions such as virtual clinics have the potential to provide private, streamlined, and high quality care to this vulnerable group. Objective: The objective of this study was to conduct focus groups with university students to obtain input on potential functions and features of a university-specific virtual clinic for mental health. Methods: Participants were 19 undergraduate students from an Australian university between 19 and 24 years of age. Focus group discussion was structured by questions that addressed the following topics: (1) the utility and acceptability of a virtual mental health clinic for students, and (2) potential features of a virtual mental health clinic. Results: Participants viewed the concept of a virtual clinic for university students favorably, despite expressing concerns about privacy of personal information. Participants expressed a desire to connect with professionals through the virtual clinic, for the clinic to provide information tailored to issues faced by students, and for the clinic to enable peer-to-peer interaction. Conclusions: Overall, results of the study suggest the potential for virtual clinics to play a positive role in providing students with access to mental health support. ", doi="10.2196/mental.3890", url="http://mental.jmir.org/2015/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543908" } @Article{info:doi/10.2196/mental.3926, author="Forchuk, Cheryl and Donelle, Lorie and Ethridge, Paige and Warner, Laura", title="Client Perceptions of the Mental Health Engagement Network: A Secondary Analysis of an Intervention Using Smartphones and Desktop Devices for Individuals Experiencing Mood or Psychotic Disorders in Canada", journal="JMIR Mental Health", year="2015", month="Jan", day="21", volume="2", number="1", pages="e1", keywords="mental health", keywords="mobile health", keywords="eHealth", keywords="personal health records", keywords="mood disorders", keywords="psychotic disorders", keywords="mental disorders", abstract="Background: The use of innovative technologies in mental health care has the potential to improve system efficiency, enhance quality of care, and increase patient engagement. The Mental Health Engagement Network (MHEN) project developed, delivered, and evaluated an interactive Web-based personal health record, the Lawson SMART Record (LSR), to assist mental health clients in managing their care and connecting with their care providers. This paper presents a secondary analysis of data collected in the MHEN project regarding clients' perceptions of technology and the use of these technologies in their care. Objective: We aimed to answer six questions: (1) What is the level of comfort with technology within a sample of individuals experiencing mood or psychotic disorders? (2) How easy to use and helpful are the MHEN technologies from the perspective of individuals experiencing a mental illness? (3) Are there differences in how helpful or useful individuals find the smartphone compared to the LSR? (4) Are there specific functions of MHEN technologies (eg, reminders for medications or appointments) that are more valued than others? (5) What are the other ways that individuals are using MHEN technologies in their daily lives? (6) How likely are individuals to be able to retain and maintain their smartphone? Methods: Mental health clients aged 18-80 (N=400) and diagnosed with a mood or psychotic disorder were provided with a smartphone (iPhone 4S) and participating care providers (n=52) were provided with a tablet (iPad) in order to access and engage with the LSR. A delayed implementation design with mixed methods was used. Survey and interview data were collected over the course of 18 months through semistructured interviews conducted by experienced research assistants every 6 months post-implementation of the intervention. Paired t tests were used to determine differences between 6 and 12-month data for perceptions of the MHEN technologies. A paired t test was used to examine whether differences existed between perceptions of the smartphone and the LSR at 12 months post-implementation. Results: Due to dropout or loss of contact, 394 out of 400 individuals completed the study. At the end of the study, 52 devices were lost or unusable. Prior to the intervention, participants reported being comfortable using technology. Perceptions of the MHEN technologies and their functions were generally positive. Positive perceptions of the smartphone increased over time (P=.002), while positive perceptions of the LSR decreased over time (P<.001). Conclusions: Quantitative and qualitative findings from this analysis demonstrated that these technologies positively impacted the lives of individuals experiencing severe mental illnesses and dispeled some of the myths regarding retention of technology among marginalized populations. This secondary analysis supported the acceptability of using mental health technologies within this population and provided considerations for future development. Trial Registration: ClinicalTrials.gov NCT01473550; http://clinicaltrials.gov/show/NCT01473550 (Archived by WebCite at http://www.webcitation.org/6SLNcoKb8). ", doi="10.2196/mental.3926", url="http://mental.jmir.org/2015/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543906" } @Article{info:doi/10.2196/mental.3840, author="Tedim Cruz, V{\'i}tor and Pais, Joana and Ruano, Luis and Mateus, C{\'a}tia and Colunas, M{\'a}rcio and Alves, Iv{\^a}nia and Barreto, Rui and Conde, Eduardo and Sousa, Andreia and Ara{\'u}jo, Isabel and Bento, Virg{\'i}lio and Coutinho, Paula and Rocha, Nelson and ", title="Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training -- COGWEB Network", journal="JMIR Mental Health", year="2014", month="Nov", day="27", volume="1", number="1", pages="e2", keywords="cognitive training", keywords="neurorehabilitation", keywords="eHealth systems", keywords="memory clinic", keywords="collaborative network", keywords="stroke", keywords="dementia", keywords="schizophrenia", keywords="mental health services", abstract="Background: Cognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector. Objective: The objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB). Methods: The setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled. Results: The network included 68 professionals from 41 centers, (33/41) 80\% clinical, (8/41) 19\% nonclinical. A total of 298 patients received cognitive training; 45.3\% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6\%), (2) structural brain lesions (63/298, 21.1\%), (3) autoimmune (40/298, 13.4\%), (4) schizophrenia (30/298, 10.1\%), and (5) others (50/298, 16.8\%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education. Conclusions: Over its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden. ", doi="10.2196/mental.3840", url="http://www.jmir.org/2014/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543902" }