@Article{info:doi/10.2196/65163, author="Butorac, Isobel and McNaney, Roisin and Seguin, Paolo Joshua and Olivier, Patrick and Northam, C. Jaimie and Tully, A. Lucy and Carl, Talia and Carter, Adrian", title="Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study", journal="JMIR Pediatr Parent", year="2025", month="Apr", day="22", volume="8", pages="e65163", keywords="digital mental health", keywords="young people", keywords="cultural diversity", keywords="web-based and mobile health interventions", keywords="qualitative methods", keywords="user-centered design", keywords="human-computer interaction", abstract="Background: Approximately 39\% of young people (aged 16-24 y) experience mental ill health, but only 23\% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. Objective: The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based ``check-in'' tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. Methods: We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44\%; young people: n=10, 56\%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Results: Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. Conclusions: The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study's findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations. ", doi="10.2196/65163", url="https://pediatrics.jmir.org/2025/1/e65163" } @Article{info:doi/10.2196/55348, author="Steadman, Jack and Saunders, Rob and Freestone, Mark and Stewart, Robert", title="Subtyping Service Receipt in Personality Disorder Services in South London: Observational Validation Study Using Latent Profile Analysis", journal="Interact J Med Res", year="2025", month="Apr", day="15", volume="14", pages="e55348", keywords="latent profile analysis", keywords="latent variable mixture modeling", keywords="service use", keywords="personality disorder", keywords="applied health research", keywords="electronic health records", abstract="Background: Personality disorders (PDs) are typically associated with higher mental health service use; however, individual patterns of engagement among patients with complex needs are poorly understood. Objective: The study aimed to identify subgroups of individuals based on patterns of service receipt in secondary mental health services and examine how routinely collected information is associated with these subgroups. Methods: A sample of 3941 patients diagnosed with a personality disorder and receiving care from secondary services in South London was identified using health care records covering an 11-year period from 2007 to 2018. Basic demographic information, service use, and treatment data were included in the analysis. Service use measures included the number of contacts with clinical teams and instances of did-not-attend. Results: Using a large sample of 3941 patients with a diagnosis of PD, latent profile analysis identified 2 subgroups characterized by low and high service receipt, denoted as profile 1 (n=2879, 73.05\%) and profile 2 (n=1062, 26.95\%), respectively. A 2-profile solution (P<.01) was preferred over a 3-profile solution, which was nonsignificant. In unconditional (t3941,3939=19.53; P<.001; B=7.27; 95\% CI 6.54-8) and conditional (t3941,3937=?3.31; P<.001; B=?74.94; 95\% CI ?119.34 to ?30.56) models, cluster membership was significantly related to receipt of nursing contacts, over and above other team contacts. Conclusions: These results suggest that routinely collected data may be used to classify likely engagement subtypes among patients with complex needs. The algorithm identified factors associated with service use and has the potential to inform clinical decision-making to improve treatment for individuals with complex needs. ", doi="10.2196/55348", url="https://www.i-jmr.org/2025/1/e55348" } @Article{info:doi/10.2196/66301, author="Coffield, Edward and Kausar, Khadeja", title="Evaluating User Engagement With a Real-Time, Text-Based Digital Mental Health Support App: Cross-Sectional, Retrospective Study", journal="JMIR Form Res", year="2025", month="Apr", day="14", volume="9", pages="e66301", keywords="mental health support", keywords="text", keywords="app", keywords="utilization", keywords="mobile", keywords="on demand", keywords="scheduled", keywords="mHealth", keywords="mobile health", keywords="student", keywords="university", keywords="college", keywords="mental health", keywords="employee", keywords="job", keywords="work", keywords="occupational health", keywords="counselor", keywords="counseling", keywords="usage", keywords="engagement", keywords="self-reported", abstract="Background: Approximately 20\% of US adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health apps that provide 24-hour, real-time access to human support may improve access to mental health services. However, information is needed regarding how and why people engage with licensed counselors through a digital, real-time, text-based mental health support app in nonexperimental settings. Objective: This study aimed to evaluate how people engage with Counslr, a 24-hour, digital, mental health support app where users communicate in real time with human counselors through text messaging. Specifically, access patterns (eg, day of the week and time of session) and reasons for accessing the platform were examined. Furthermore, whether differences existed between session types (on-demand or scheduled) and membership types (education or noneducation) in regard to access patterns and why people accessed the platform were evaluated. Methods: The study population (users) consisted of students whose schools, universities, or colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based messaging in real time. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reasons for initiating the session. The data were stratified by membership type (education [students] or noneducation [employees]) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by membership and session types. Results: Most students (178/283, 62.9\%) and employees (28/44, 63.6\%) accessed Counslr through on-demand sessions. The average and median session times were 40 (SD 15.3) and 45 minutes. On-demand sessions (37.9 minutes) were shorter (P=.001) than scheduled sessions (43.5 minutes). Most users (262/327, 80.1\%) accessed Counslr between 7 PM and 5 AM. The hours that users accessed Counslr did not statistically differ by membership type (P=.19) or session type (P=.10). Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between membership and session types (P<.05) for some of the reasons why people initiated sessions. Conclusions: The novel findings of this study illustrate that real-time, digital mental health support apps, which offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services. Additional research is needed to evaluate the effectiveness of human-based apps such as Counslr and whether such apps can also address disparities in access to mental health support services among different demographic groups. ", doi="10.2196/66301", url="https://formative.jmir.org/2025/1/e66301" } @Article{info:doi/10.2196/66966, author="S{\o}rensen, Marie Nikita and Skaarnes, Helene and Mathiasen, Kim and Thastum, Mikael and Lomholt, Jeppesen Johanne", title="Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention", journal="JMIR Form Res", year="2025", month="Apr", day="8", volume="9", pages="e66966", keywords="user-centered design", keywords="digital treatment", keywords="digital mental health", keywords="internet-based", keywords="cognitive behavioral therapy", keywords="anxiety", keywords="adolescents", abstract="Background: Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation. Objective: This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework. Methods: The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback. Results: In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled ``humans'' received more votes as adolescents could better ``identify'' themselves with them. Communication should preferably be ``supportive'' and feel ``like a friend'' talking to them. Statements including praise---such as ``You're well on your way. How are you today?''---received the most votes (12 votes), whereas directive statements such as ``Tell us how your day has been?'' and ``How is practicing your steps going?'' received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks. Conclusions: Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice. ", doi="10.2196/66966", url="https://formative.jmir.org/2025/1/e66966" } @Article{info:doi/10.2196/65356, author="Starvaggi, Isabella and Lorenzo-Luaces, Lorenzo", title="Psychotherapy Access Barriers and Interest in Digital Mental Health Interventions Among Adults With Treatment Needs: Survey Study", journal="JMIR Ment Health", year="2025", month="Apr", day="1", volume="12", pages="e65356", keywords="psychotherapy", keywords="internet-based cognitive behavior therapy", keywords="internet-based interventions", keywords="guided self-help", keywords="public health", keywords="treatment access barriers", keywords="digital mental health", keywords="treatment attitudes", abstract="Background: Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs. Objective: This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals' structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH). Methods: We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9\%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants' self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them. Results: Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95\% CI 1.86-3.06; P<.001) and greater self-reported likelihood of using GSH (OR 2.25, 95\% CI 1.71-2.96; P<.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5\%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1\%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95\% CI 0.32-0.6; across all 3 barrier types, P<.001) and lower self-reported likelihood of using GSH (OR 0.61, 95\% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045). Conclusions: Our findings suggest that attitudinal barriers to traditional psychotherapy use may also serve as barriers to DMHI use, suggesting that disregarding the role of attitudinal barriers may limit the reach of DMHIs. Future research should seek to further understand the relationship between general treatment-seeking attitudes and attitudes about DMHIs to inform the design and marketing of DMHIs. ", doi="10.2196/65356", url="https://mental.jmir.org/2025/1/e65356", url="http://www.ncbi.nlm.nih.gov/pubmed/40168039" } @Article{info:doi/10.2196/55072, author="Wadman, Ruth and Walker, Lauren and Taylor, Olivia and Heron, Paul and Newbronner, Elizabeth and Spanakis, Panagiotis and Crosland, Suzanne and Peckham, Jane Emily", title="Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Mar", day="28", volume="27", pages="e55072", keywords="severe mental illness", keywords="internet use", keywords="qualitative", keywords="typology", keywords="protective strategies", keywords="digital divide", abstract="Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. ", doi="10.2196/55072", url="https://www.jmir.org/2025/1/e55072" } @Article{info:doi/10.2196/59691, author="Rooper, R. Isabel and Ortega, Adrian and Massion, A. Thomas and Lakhtakia, Tanvi and Kruger, Macarena and Parsons, M. Leah and Lipman, D. Lindsay and Azubuike, Chidiebere and Tack, Emily and Obleada, T. Katrina and Graham, K. Andrea", title="Optimizing Testimonials for Behavior Change in a Digital Intervention for Binge Eating: Human-Centered Design Study", journal="JMIR Form Res", year="2025", month="Mar", day="21", volume="9", pages="e59691", keywords="health behavior", keywords="health narratives", keywords="binge eating", keywords="user engagement", keywords="personalization", keywords="behavior change", keywords="digital health", keywords="intervention", keywords="human-centered design", keywords="behavioral health", keywords="preferences", abstract="Background: Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (eg, physical activity and healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions. Objective: We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multisession digital binge eating intervention. Methods: We applied human-centered design methods to learn users' preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as ``nudges'' for selecting positive behavior change strategies they could practice). We recruited target users of our multisession intervention to complete design sessions. Adults (N=22, 64\% self-identified as female; 32\% as non-Hispanic Black, 41\% as non-Hispanic White, and 27\% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis. Results: Most participants preferred designs with testimonials (vs without) for their motivation and validation of the intervention's efficacy. A few distrusted testimonials for appearing too ``commercial'' or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with ``how-to'' advice, whereas others preferred ``big picture'' success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allowed users to choose between actions (eg, behavioral strategies), participants preferred testimonials to be available across all actions but said that selectively delivering a testimonial with one action could ``nudge'' them to select it. Conclusions: Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users' most pertinent identities and tailor testimonials accordingly. Likewise, users' divided preferences for testimonial messaging (ie, ``big picture'' vs ``how-to'') suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as ``nudges'' within interventions---a ripe area for further inquiry---though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors. ", doi="10.2196/59691", url="https://formative.jmir.org/2025/1/e59691" } @Article{info:doi/10.2196/67454, author="Knapp, A. Ashley and Cohen, Katherine and Kruzan, P. Kaylee and Kornfield, Rachel and Herrera, Miguel and Pederson, B. Aderonke and Lee, Sydney and Macapagal, Kathryn and Roulston, A. Chantelle and Clarke, Kaleigh and Wijaya, Clarisa and Simmons, Robert and Jackson, Latonia and Kour, Simrandeep and Franco, Sandra and Mohr, C. David", title="Teen Perspectives on Integrating Digital Mental Health Programs for Teens Into Public Libraries (``I Was Always at the Library''): Qualitative Interview Study", journal="JMIR Form Res", year="2025", month="Mar", day="13", volume="9", pages="e67454", keywords="public libraries", keywords="digital mental health", keywords="teens", keywords="youth", keywords="adolescents", keywords="anxiety", keywords="mental health", keywords="implementation", keywords="safe spaces", keywords="mobile phone", keywords="smartphone", abstract="Background: Rising rates of anxiety among teens necessitate innovative approaches for implementing evidence-based mental health support. Public libraries, seen as safe spaces for patrons with marginalized identities, offer free public services such as broadband internet access. Many teens spend significant amounts of time in their local libraries due to the safety of this space as well as the trusted adults working there. The American Library Association has shifted its priorities to focus more on mental health through employing social workers and providing mental health programs. As such, public libraries may be promising sites for the implementation of digital mental health (DMH) programs for teens. Objective: This study aimed to examine how teens who attended their local public library experienced and managed their anxiety, what mental health supports they were interested in receiving, and how DMH programs and public libraries can meet their needs. Methods: We interviewed 16 teens aged 12-18 (mean 15.2, SD 2.0) years who used the library frequently at the time of the interviews. Of these teen patrons, 56\% (9/16) identified as female, 31\% (5/16) identified as male, and 12\% (2/16) identified as nonbinary. Most (11/16, 69\%) identified as either White or Black or African American individuals, with the remainder (5/16, 31\%) identifying as Hispanic or Latino or Chinese American individuals or with ?2 races. The interviews were individual and semistructured, designed to elicit recommendations for designing and implementing digital tools in libraries to improve teen mental health. Interview transcripts were coded by multiple coders using thematic analysis to synthesize key themes. Results: Teens reported experiencing uncontrollability, unpredictability, and anger related to their anxiety, which they managed using strategies such as guided breathing, distress tolerance, and social connection. They also talked about other helpful management techniques (eg, progressive muscle relaxation, journaling, and mood tracking). Teens underscored the importance of pairing mood tracking with daily activities to reveal patterns. They also stressed the significance of context and anxiety severity when choosing anxiety management strategies. Teens underscored the centrality of the public library in their lives and their view of it as a safe space where they can easily access resources and connect with friends and trusted adults. When considering the design of a DMH program implemented in libraries, they suggested including personalization for different identities, gamification, and simple navigation. Teens emphasized the importance of protecting their privacy within digital programs and that their end goal was to use the skills learned in the DMH program offline. Conclusions: Teens who frequently used their local public library expressed interest in receiving digital tools via libraries to help them manage anxiety. Their recommendations will help inform future research on the adaptation and implementation of DMH programs for teens in public libraries. ", doi="10.2196/67454", url="https://formative.jmir.org/2025/1/e67454" } @Article{info:doi/10.2196/60649, author="Dekel, Dana and Marchant, Amanda and Del Pozo Banos, Marcos and Mhereeg, Mohamed and Lee, Chim Sze and John, Ann", title="Exploring the Views of Young People, Including Those With a History of Self-Harm, on the Use of Their Routinely Generated Data for Mental Health Research: Web-Based Cross-Sectional Survey Study", journal="JMIR Ment Health", year="2025", month="Mar", day="12", volume="12", pages="e60649", keywords="self-harm", keywords="mental health", keywords="big data", keywords="survey", keywords="youth", abstract="Background: Secondary use of routinely collected health care data has great potential benefits in epidemiological studies primarily due to the large scale of preexisting data. Objective: This study aimed to engage respondents with and without a history of self-harm, gain insight into their views on the use of their data for research, and determine whether there were any differences in opinions between the 2 groups. Methods: We examined young people's views on the use of their routinely collected data for mental health research through a web-based survey, evaluating any differences between those with and without a history of self-harm. Results: A total of 1765 respondents aged 16 to 24 years were included. Respondents' views were mostly positive toward the use and linkage of their data for research purposes for public benefit, particularly with regard to the use of health care data (mental health or otherwise), and generally echoed existing evidence on the opinions of older age groups. Individuals who reported a history of self-harm and subsequently contacted health services more often reported being ``extremely likely'' or ``likely'' to share mental health data (contacted: 209/609, 34.3\%; 95\% CI 28.0-41.2; not contacted: 169/782, 21.6\%; 95\% CI 15.8-28.7) and physical health data (contacted: 117/609, 19.2\%; 95\% CI 12.7-27.8; not contacted: 96/782, 12.3\%; 95\% CI 6.7-20.9) compared with those who had not contacted services. Respondents were overall less likely to want to share their social media data, which they considered to be more personal compared to their health care data. Respondents stressed the importance of anonymity and the need for an appropriate ethical framework. Conclusions: Young people are aware, and they care about how their data are being used and for what purposes, irrespective of having a history of self-harm. They are largely positive about the use of health care data (mental or physical) for research and generally echo the opinions of older age groups raising issues around data security and the use of data for the public interest. ", doi="10.2196/60649", url="https://mental.jmir.org/2025/1/e60649" } @Article{info:doi/10.2196/63251, author="Cummins, R. Mollie and Ivanova, Julia and Soni, Hiral and Robbins, Zoe and Bunnell, E. Brian and L{\'o}pez, Esteban and Welch, M. Brandon", title="Telemedicine Prescribing by US Mental Health Care Providers: National Cross-Sectional Survey", journal="JMIR Form Res", year="2025", month="Mar", day="11", volume="9", pages="e63251", keywords="telemedicine", keywords="telehealth", keywords="telemental", keywords="provider", keywords="professional", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="prescribing", keywords="prescription", keywords="drug", keywords="pharmacology", keywords="pharmacotherapy", keywords="pharmaceutic", keywords="pharmaceutical", keywords="medication", keywords="mental health", keywords="digital health", keywords="informatics", keywords="buprenorphine", keywords="ketamine", keywords="cross sectional", keywords="survey", keywords="questionnaire", abstract="Background: In the postpandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. Objective: Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. Methods: We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test. Results: A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84\% (102/115) of health care providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8\% (17/115) to 19.1\% (30/115) of health care providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. Conclusions: These health care providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy making in the United States. ", doi="10.2196/63251", url="https://formative.jmir.org/2025/1/e63251" } @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/10.2196/69602, author="Meyerhoff, Jonah and Popowski, A. Sarah and Lakhtakia, Tanvi and Tack, Emily and Kornfield, Rachel and Kruzan, P. Kaylee and Krause, J. Charles and Nguyen, Theresa and Rushton, Kevin and Pisani, R. Anthony and Reddy, Madhu and Van Orden, A. Kimberly and Mohr, C. David", title="Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods", journal="JMIR Form Res", year="2025", month="Feb", day="26", volume="9", pages="e69602", keywords="mental health services", keywords="technology", keywords="therapy", keywords="computer assisted", keywords="SMS text messaging", abstract="Background: Young adults in the United States are experiencing accelerating rates of suicidal thoughts and behaviors but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with young adults who have lived experience of suicide-related thoughts and behaviors to optimize acceptability and use. Objective: This study aims to identify the needs, preferences, and features for an automated SMS text messaging--based safety planning service to support the self-management of suicide-related thoughts and behaviors among young adults. Methods: We enrolled 30 young adults (age 18-24 years) with recent suicide-related thoughts and behaviors to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants---creating a threaded digital conversation. Researcher-posted prompts centered on participants' experiences with suicide-related thought and behavior-related coping, safety planning, and technologies for suicide-related thought and behavior self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated SMS text messaging--based safety planning tool. Results: Young adult participants indicated that an automated digital SMS text message--based safety planning intervention must meet their needs in 2 ways. First, by empowering them to manage their symptoms on their own and support acquiring and using effective coping skills. Second, by leveraging young adults' existing social connections. Young adult participants also shared 3 key technological needs of an automated intervention: (1) transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program; (2) strong privacy practices---data security around how content within the intervention and how private data created by the intervention would be maintained and used was extremely important to young adult participants given the sensitive nature of suicide-related data; and (3) usability, convenience, and accessibility were particularly important to participants---this includes having an approachable and engaging message tone, customizable message delivery options (eg, length, number, content focus), and straightforward menu navigation. Young adult participants also highlighted specific features that could support core coping skill acquisition (eg, self-tracking, coping skill idea generation, reminders). Conclusions: Engaging young adults in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for suicide-related thoughts and behaviors. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency, and data privacy. ", doi="10.2196/69602", url="https://formative.jmir.org/2025/1/e69602" } @Article{info:doi/10.2196/68221, author="Nagra, Harpreet and Mines, A. Robert and Dana, Zara", title="Exploring the Impact of Digital Peer Support Services on Meeting Unmet Needs Within an Employee Assistance Program: Retrospective Cohort Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="25", volume="12", pages="e68221", keywords="digital peer support", keywords="peer support", keywords="EAPs", keywords="cost-effectiveness", keywords="SROI", abstract="Background: The World Health Organization estimates that 1 in 4 people worldwide will experience a mental disorder in their lifetime, highlighting the need for accessible support. Objective: This study evaluates the integration of digital peer support (DPS) into an employee assistance program (EAP), testing 3 hypotheses: (1) DPS may be associated with changes in EAP counseling utilization within a 5-session model; (2) DPS users experience reduced sadness, loneliness, and stress; and (3) DPS integration generates a positive social return on investment (SROI). Methods: The study analyzed EAP utilization within a 5-session model using pre-post analysis, sentiment changes during DPS chats via natural language processing models, and SROI outcomes. Results: Among 587 DPS chats, 432 (73.6\%) occurred after business hours, emphasizing the importance of 24/7 availability. A matched cohort analysis (n=72) showed that DPS reduced therapy sessions by 2.07 per participant (P<.001; Cohen d=1.77). Users' messages were evaluated for sentiments of sadness, loneliness, and stress on a 1-10 scale. Significant reductions were observed: loneliness decreased by 55.04\% (6.91 to 3.11), sadness by 57.5\% (6.84 to 2.91), and stress by 56.57\% (6.78 to 2.95). SROI analysis demonstrated value-to-investment ratios of US \$1.66 (loneliness), US \$2.50 (stress), and US \$2.58 (sadness) per dollar invested. Conclusions: Integrating DPS into EAPs provides significant benefits, including increased access, improved emotional outcomes, and a high SROI, reinforcing its value within emotional health support ecosystems. ", doi="10.2196/68221", url="https://humanfactors.jmir.org/2025/1/e68221", url="http://www.ncbi.nlm.nih.gov/pubmed/39998863" } @Article{info:doi/10.2196/66690, author="Meier-Diedrich, Eva and Esch, Tobias and H{\"a}gglund, Maria and Heinze, Martin and Hochwarter, Stefan and Speck, Justin and Wagener, Marie and Dahling, Volker and Schwarz, Julian", title="Experiences of Older Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Interview Study", journal="JMIR Aging", year="2025", month="Feb", day="24", volume="8", pages="e66690", keywords="psychiatry", keywords="eHealth", keywords="mental health", keywords="digital literacy", keywords="older patients", keywords="older adult", keywords="care partner", keywords="proxy access", keywords="open record access", keywords="Open Notes", keywords="patient portal", keywords="artificial intelligence", keywords="AI", abstract="Background: Older patients with serious mental illnesses such as cognitive disorders often rely on family members or spouses (care partners [CPs]) to meet their health care needs. CPs frequently lack essential information to fully understand the patients' illnesses and effectively support their treatment. Open Notes provide patients with digital access to their health care professionals' clinical notes and are associated with many positive outcomes, such as increased adherence and empowerment. However, older patients who use Open Notes may encounter use barriers such as limited digital literacy. Recent developments allow CPs to access Open Notes (proxy access) and receive valuable information, which holds significant potential for improving the care of older patients. Objective: This study explored the experiences, barriers, and opportunities of older mental health patients and their CPs related to using Open Notes. Furthermore, influencing factors and interdependencies were identified. Methods: Older patients (n=10) and their CPs (n=10) were provided with web-based proxy access to clinical documentation through a web-based patient portal. In-depth qualitative interviews (N=20) were conducted to explore experiences with this access. Data analysis was conducted in accordance with the constructivist grounded theory approach. Results: The prerequisites for using Open Notes with proxy access were sufficient digital literacy on the part of the patient or CP, as well as the establishment of a trusting relationship between patients and CPs. Access to Open Notes enabled patients and CPs to gain a deeper understanding of the illness and its treatment while also facilitating enhanced contact with health care professionals. This resulted in greater involvement in the treatment process but may also prompt changes in relationship dynamics---CPs are better equipped to support patients in their health care but may also tend to monitor or control them through Open Notes. As a result, the introduction of Open Notes was accompanied by mixed feelings. Conclusions: It is of utmost importance to provide older patients with comprehensive access to Open Notes to preserve their health autonomy. However, the involvement of CPs through proxy access is of great value in improving the care of older patients, especially those with cognitive impairments. ", doi="10.2196/66690", url="https://aging.jmir.org/2025/1/e66690" } @Article{info:doi/10.2196/68419, author="Rooper, R. Isabel and Liem, W. William and Burla, Martha and Gordon, Jacob and Baez, M. Lara and Kornfield, Rachel and Berry, L. Andrew B.", title="Designing Values Elicitation Technologies for Mental Health and Chronic Care Integration: User-Centered Design Approach", journal="JMIR Form Res", year="2025", month="Feb", day="19", volume="9", pages="e68419", keywords="chronic care management", keywords="anxiety", keywords="depression", keywords="values elicitation", keywords="eHealth", keywords="patient-centered care", keywords="technology-enabled services", keywords="human-centered design", keywords="multimorbidity", keywords="user-centered design", keywords="multiple chronic conditions", abstract="Background: Individuals with multiple chronic conditions (MCCs) and mental health challenges such as depression or anxiety have complex health needs and experience significant challenges with care coordination. Approaches to enhance care for patients with MCCs typically focus on eliciting patients' values to identify and align treatment priorities across patients and providers. However, these efforts are often hindered by both systems- and patient-level barriers, which are exacerbated for patients with co-occurring mental health symptoms. Technology-enabled services (TES) offer a promising avenue to facilitate values elicitation and promote patient-centered care for these patients, though TES have not yet been tailored to their unique needs. Objective: This study aimed to identify design and implementation considerations for TES that facilitate values elicitation among patients with MCCs and depression or anxiety. We sought to understand the preferences of both clinicians and patients for TES that could bridge the gap between mental and physical health care. Methods: Using human-centered design methods, we conducted 7 co-design workshops with 18 participants, including primary care clinicians, mental health clinicians, and patients with MCCs and depression or anxiety. Participants were introduced to TES prototypes that used various formats (eg, worksheets and artificial intelligence chatbots) to elicit and communicate patients' values. Prototypes were iteratively refined based on participant feedback. Data from these sessions were analyzed using reflexive thematic analysis to uncover themes related to service, technology, and implementation considerations. Results: Three primary themes were identified. (1) Service considerations: TES should help patients translate elicited values into actionable treatment plans and include low-burden, flexible activities to accommodate fluctuations in their mental health symptoms. Both patients and clinicians indicated that TES could be valuable for improving appointment preparation and patient-provider communication through interpersonal skill-building. (2) Technology considerations: Patients expressed openness to TES prototypes that used artificial intelligence, particularly those that provided concise summaries of appointment priorities. Visual aids and simplified language were highlighted as essential features to support accessibility for neurodiverse patients. (3) Implementation considerations: Clinicians and patients favored situating values elicitation in mental health care settings over primary care and preferred self-guided TES that patients could complete independently before appointments. Conclusions: Findings indicate that TES can address the unique needs of patients with MCCs and mental health challenges by facilitating values-based care. Key design considerations include ensuring TES flexibility to account for fluctuating mental health symptoms, facilitating skill-building for effective communication, and creating user-friendly technology interfaces. Future research should explore how TES can be integrated into health care settings to enhance care coordination and support patient-centered treatment planning. By aligning TES design with patient and clinician preferences, there is potential to bridge gaps in care for this complex patient population. ", doi="10.2196/68419", url="https://formative.jmir.org/2025/1/e68419" } @Article{info:doi/10.2196/63484, author="Hopkin, Gareth and Coole, Holly and Edelmann, Francesca and Ayiku, Lynda and Branson, Richard and Campbell, Paul and Cooper, Sophie and Salmon, Mark", title="Toward a New Conceptual Framework for Digital Mental Health Technologies: Scoping Review", journal="JMIR Ment Health", year="2025", month="Feb", day="19", volume="12", pages="e63484", keywords="digital mental health", keywords="digital health", keywords="mental health", keywords="eHealth", keywords="categorization", keywords="conceptual", keywords="framework", keywords="regulation", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="systematic", abstract="Background: Digital mental health technologies (DMHTs) are becoming more widely available and are seen as having the potential to improve the quality of mental health care. However, conversations around the potential impact of DMHTs can be impacted by a lack of focus on the types of technologies that are available. Several frameworks that could apply to DMHTs are available, but they have not been developed with comprehensive methods and have limitations. Objective: To address limitations with current frameworks, we aimed to identify existing literature on the categorization of DMHTs, to explore challenges with categorizing DMHTs for specific purposes, and to develop a new conceptual framework. Methods: We used an iterative approach to develop the framework. First, we completed a rapid review of the literature to identify studies that provided domains that could be used to categorize DMHTs. Second, findings from this review and associated issues were discussed by an expert working group, including professionals from a wide range of relevant settings. Third, we synthesized findings to develop a new conceptual framework. Results: The rapid review identified 3603 unique results, and hand searching identified another 3 potentially relevant papers. Of these, 24 papers were eligible for inclusion, which provided 10 domains to categorize DMHTs. The expert working group proposed a broad framework and based on the findings of the review and group discussions, we developed a new conceptual framework with 8 domains that represent important characteristics of DMHTs. These 8 domains are population, setting, platform or system, purpose, type of approach, human interaction, human responsiveness, and functionality. Conclusions: This conceptual framework provides a structure for various stakeholders to define the key characteristics of DMHTs. It has been developed with more comprehensive methods than previous attempts with similar aims. The framework can facilitate communication within the field and could undergo further iteration to ensure it is appropriate for specific purposes. ", doi="10.2196/63484", url="https://mental.jmir.org/2025/1/e63484" } @Article{info:doi/10.2196/66056, author="Wang, Jianli and Orpana, Heather and Carrington, Andr{\'e} and Kephart, George and Vasiliadis, Helen-Maria and Leikin, Benjamin", title="Development and Validation of Prediction Models for Perceived and Unmet Mental Health Needs in the Canadian General Population: Model-Based Synthetic Estimation Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="19", volume="11", pages="e66056", keywords="population risk prediction", keywords="development", keywords="validation", keywords="perceived mental health need", keywords="unmet mental health need", abstract="Background: Research has shown that perceptions of a mental health need are closely associated with service demands and are an important dimension in needs assessment. Perceived and unmet mental health needs are important factors in the decision-making process regarding mental health services planning and resources allocation. However, few prediction tools are available to be used by policy and decision makers to forecast perceived and unmet mental health needs at the population level. Objective: We aim to develop prediction models to forecast perceived and unmet mental health needs at the provincial and health regional levels in Canada. Methods: Data from 2018, 2019, and 2020 Canadian Community Health Survey and Canadian Urban Environment were used (n=65,000 each year). Perceived and unmet mental health needs were measured by the Perceived Needs for Care Questionnaire. Using the 2018 dataset, we developed the prediction models through the application of regression synthetic estimation for the Atlantic, Central, and Western regions. The models were validated in the 2019 and 2020 datasets at the provincial level and in 10 randomly selected health regions by comparing the observed and predicted proportions of the outcomes. Results: In 2018, a total of 17.82\% of the participants reported perceived mental health need and 3.81\% reported unmet mental health need. The proportions were similar in 2019 (18.04\% and 3.91\%) and in 2020 (18.1\% and 3.92\%). Sex, age, self-reported mental health, physician diagnosed mood and anxiety disorders, self-reported life stress and life satisfaction were the predictors in the 3 regional models. The individual based models had good discriminative power with C statistics over 0.83 and good calibration. Applying the synthetic models in 2019 and 2020 data, the models had the best performance in Ontario, Quebec, and British Columbia; the absolute differences between observed and predicted proportions were less than 1\%. The absolute differences between the predicted and observed proportion of perceived mental health needs in Newfoundland and Labrador (?4.16\% in 2020) and Prince Edward Island (4.58\% in 2019) were larger than those in other provinces. When applying the models in the 10 selected health regions, the models calibrated well in the health regions in Ontario and in Quebec; the absolute differences in perceived mental health needs ranged from 0.23\% to 2.34\%. Conclusions: Predicting perceived and unmet mental health at the population level is feasible. There are common factors that contribute to perceived and unmet mental health needs across regions, at different magnitudes, due to different population characteristics. Therefore, predicting perceived and unmet mental health needs should be region specific. The performance of the models at the provincial and health regional levels may be affected by population size. ", doi="10.2196/66056", url="https://publichealth.jmir.org/2025/1/e66056" } @Article{info:doi/10.2196/64445, author="Abdulazeem, Hebatullah and Borges do Nascimento, J{\'u}nior Israel and Weerasekara, Ishanka and Sharifan, Amin and Grandi Bianco, Victor and Cunningham, Ciara and Kularathne, Indunil and Deeken, Genevieve and de Barros, Jerome and Sathian, Brijesh and {\O}stengaard, Lasse and Lamontagne-Godwin, Frederique and van Hoof, Joost and Lazeri, Ledia and Redlich, Cassie and Marston, R. Hannah and Dos Santos, Alistair Ryan and Azzopardi-Muscat, Natasha and Yon, Yongjie and Novillo-Ortiz, David", title="Use of Digital Health Technologies for Dementia Care: Bibliometric Analysis and Report", journal="JMIR Ment Health", year="2025", month="Feb", day="10", volume="12", pages="e64445", keywords="people living with dementia", keywords="digital health technologies", keywords="bibliometric analysis", keywords="evidence-based medicine", abstract="Background: Dementia is a syndrome that compromises neurocognitive functions of the individual and that is affecting 55 million individuals globally, as well as global health care systems, national economic systems, and family members. Objective: This study aimed to determine the status quo of scientific production on use of digital health technologies (DHTs) to support (older) people living with dementia, their families, and care partners. In addition, our study aimed to map the current landscape of global research initiatives on DHTs on the prevention, diagnosis, treatment, and support of people living with dementia and their caregivers. Methods: A bibliometric analysis was performed as part of a systematic review protocol using MEDLINE, Embase, Scopus, Epistemonikos, the Cochrane Database of Systematic Reviews, and Google Scholar for systematic and scoping reviews on DHTs and dementia up to February 21, 2024. Search terms included various forms of dementia and DHTs. Two independent reviewers conducted a 2-stage screening process with disagreements resolved by a third reviewer. Eligible reviews were then subjected to a bibliometric analysis using VOSviewer to evaluate document types, authorship, countries, institutions, journal sources, references, and keywords, creating social network maps to visualize emergent research trends. Results: A total of 704 records met the inclusion criteria for bibliometric analysis. Most reviews were systematic, with a substantial number covering mobile health, telehealth, and computer-based cognitive interventions. Bibliometric analysis revealed that the Journal of Medical Internet Research had the highest number of reviews and citations. Researchers from 66 countries contributed, with the United Kingdom and the United States as the most prolific. Overall, the number of publications covering the intersection of DHTs and dementia has increased steadily over time. However, the diversity of reviews conducted on a single topic has resulted in duplicated scientific efforts. Our assessment of contributions from countries, institutions, and key stakeholders reveals significant trends and knowledge gaps, particularly highlighting the dominance of high-income countries in this research domain. Furthermore, our findings emphasize the critical importance of interdisciplinary, collaborative teams and offer clear directions for future research, especially in underrepresented regions. Conclusions: Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally. Trial Registration: PROSPERO CRD42024511241; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=511241 ", doi="10.2196/64445", url="https://mental.jmir.org/2025/1/e64445" } @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/10.2196/62974, author="Taher, Rayan and Stahl, Daniel and Shergill, Sukhi and Yiend, Jenny", title="The Safety of Digital Mental Health Interventions: Findings and Recommendations From a Qualitative Study Exploring Users' Experiences, Concerns, and Suggestions", journal="JMIR Hum Factors", year="2025", month="Feb", day="7", volume="12", pages="e62974", keywords="digital mental health", keywords="safety", keywords="user perspective", keywords="patient perspective", keywords="qualitative", keywords="risks", keywords="risk mitigation", keywords="deterioration", keywords="nonresponse", keywords="data safety", abstract="Background: The literature around the safety of digital mental health interventions (DMHIs) is growing. However, the user/patient perspective is still absent from it. Understanding the user/patient perspective can ensure that professionals address issues that are significant to users/patients and help direct future research in the field. Objective: This qualitative study aims to explore DMHI users' experiences, views, concerns, and suggestions regarding the safety of DMHIs. Methods: We included individuals aged 18 years old or older, having experience in using a DMHI, and can speak and understand English without the need for a translator. Fifteen individual interviews were conducted. Deductive thematic analysis was used to analyze the data. Results: The analysis of the interview transcripts yielded 3 main themes: Nonresponse: A Concern, a Risk, and How Users Mitigate It, Symptom Deterioration and Its Management, and Concerns Around Data Privacy and How to Mitigate Them. Conclusions: The results of this study led to 7 recommendations on how the safety of DMHIs can be improved: provide ``easy access'' versions of key information, use ``approved by...'' badges, anticipate and support deterioration, provide real-time feedback, acknowledge the lack of personalization, responsibly manage access, and provide genuine crisis support. These recommendations arose from users' experiences and suggestions. If implemented, these recommendations can improve the safety of DMHIs and enhance users' experience. ", doi="10.2196/62974", url="https://humanfactors.jmir.org/2025/1/e62974" } @Article{info:doi/10.2196/65658, author="Ennis, Edel and Bond, Raymond and Mulvenna, Maurice and Sweeney, Colm", title="Understanding Individual Differences in Happiness Sources and Implications for Health Technology Design: Exploratory Analysis of an Open Dataset", journal="JMIR Form Res", year="2025", month="Jan", day="29", volume="9", pages="e65658", keywords="happiness", keywords="sexes", keywords="age", keywords="marital status", keywords="parents", keywords="affections", keywords="achievements", keywords="datasets", keywords="digital health", keywords="well-being", keywords="mental health", keywords="digital mental health interventions", keywords="regression analyses", keywords="evidence based", abstract="Background: Psychologists have developed frameworks to understand many constructs, which have subsequently informed the design of digital mental health interventions (DMHIs) aimed at improving mental health outcomes. The science of happiness is one such domain that holds significant applied importance due to its links to well-being and evidence that happiness can be cultivated through interventions. However, as with many constructs, the unique ways in which individuals experience happiness present major challenges for designing personalized DMHIs. Objective: This paper aims to (1) present an analysis of how sex may interact with age, marital status, and parental status to predict individual differences in sources of happiness, and (2) to present a preliminary discussion of how open datasets may contribute to the process of designing health-related technology innovations. Methods: The HappyDB is an open database of 100,535 statements of what people consider to have made them happy, with some people asking to consider the past 24 hours (49,831 statements) and some considering the last 3 months (50,704 statements). Demographic information is also provided. Binary logistic regression analyses are used to determine whether various groups differed in their likelihood of selecting or not selecting a category as a source of their happiness. Results: Sex and age interacted to influence what was selected as sources of happiness, with patterns being less consistent among female individuals in comparison with male individuals. For marital status, differences in sources of happiness were predominantly between married individuals and those who are divorced or separated, but these were the same for both sexes. Married, single, and widowed individuals were all largely similar in their likelihood of selecting each of the categories as a source of their happiness. However, there were some anomalies, and sex appeared to be important in these anomalies. Sex and parental status also interacted to influence what was selected as sources of happiness. Conclusions: Sex interacts with age, marital status, and parental status in the likelihood of reporting affection, bonding, leisure, achievement, or enjoying the moment as sources of happiness. The contribution of an open dataset to understanding individual differences in sources of happiness is discussed in terms of its potential role in addressing the challenges of designing DMHIs that are ethical, responsible, evidence based, acceptable, engaging, inclusive, and effective for users. The discussion considers how the content design of DMHIs in general may benefit from exploring new methods informed by diverse data sources. It is proposed that examining the extent to which insights from nondigital settings can inform requirements gathering for DMHIs is warranted. ", doi="10.2196/65658", url="https://formative.jmir.org/2025/1/e65658" } @Article{info:doi/10.2196/65222, 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/10.2196/59414, author="Saleem, Maham and Zafar, Shamsa and Klein, Thomas and Koesters, Markus and Bashir, Adnan and Fuhr, C. Daniela and Sikander, Siham and Zeeb, Hajo", title="A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan", journal="JMIR Form Res", year="2025", month="Jan", day="28", volume="9", pages="e59414", keywords="digital mental health", keywords="digital technology", keywords="digital intervention", keywords="Problem Management Plus", keywords="lay health worker programme", keywords="common mental health disorders", keywords="low- and middle-income countries", keywords="co-production", abstract="Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization--endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for ``lady health workers'' (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. ", doi="10.2196/59414", url="https://formative.jmir.org/2025/1/e59414", url="http://www.ncbi.nlm.nih.gov/pubmed/39874072" } @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/10.2196/67078, author="Schr{\"o}der, Rebekka and Hamer, Tim and Suhr, Ralf and K{\"o}nig, Lars", title="Attitudes Toward Psychotherapeutic Treatment and Health Literacy in a Large Sample of the General Population in Germany: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="24", volume="11", pages="e67078", keywords="health literacy", keywords="mental health literacy", keywords="attitude to health", keywords="cross-sectional studies", keywords="Germany", keywords="adults", keywords="representative", keywords="psychotherapy", abstract="Background: Prevalences of mental disorders are increasing worldwide. However, many people with mental health problems do not receive adequate treatment. An important factor preventing individuals from seeking professional help is negative attitudes toward psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes toward psychotherapy, but more research is needed in this area. Objective: This study aimed to examine how general and mental health literacy are associated with attitudes toward psychotherapeutic treatment in Germany. Additionally, associations between sociodemographic factors, experience with psychotherapy, and attitudes toward psychotherapy were explored. Methods: A random sample was drawn from a panel representative of the German-speaking population with internet access in Germany and invited to participate in the study via email. Overall, 2000 individuals aged ?16 years completed the web-based survey with standardized questionnaires in September and October 2022. Attitudes toward psychotherapy and both general and mental health literacy were assessed using the Questionnaire on Attitudes Towards Psychotherapeutic Treatment (QAPT) with 2 subscales (``positive attitudes'' and ``non-acceptance of society''), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy Tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. Additionally, basic sociodemographic information and information on personal and family experiences with psychotherapy were collected. Pearson correlations (age), ANOVAs (level of education and subjective social status), and t tests (experience with psychotherapy, gender, and migration background) were used to analyze how these relate to attitudes toward psychotherapy. Results: More favorable attitudes toward psychotherapy and lower perceived societal nonacceptance were found in those with higher general (r=0.14, P<.001; r=?0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=?0.23, P<.001, respectively). Participants with treatment experience for mental health problems (t1260.12=?10.40, P<.001, Cohen d=?0.49; t1050.95=3.06, P=.002, Cohen d=0.16) and who have relatives with treatment experience (t1912.06=?5.66, P<.001, Cohen d=?0.26; t1926=4.77, P<.001, Cohen d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, being a woman (t1992=?3.60, P<.001, Cohen d=?0.16), younger age (r=?0.11, P<.001), higher subjective social status (F2,1991=5.25, P=.005, $\eta$2=.005), and higher levels of education (F2,1983=22.27, P<.001, $\eta$2=.021) were associated with more positive attitudes toward psychotherapeutic treatment. Being a man (t1994=5.29, P<.001, Cohen d=0.24), younger age (r=?0.08, P<.001), and lower subjective social status (F2,1993=7.71, P<.001, $\eta$2=.008) were associated with higher perceived nonacceptance of psychotherapy. Conclusions: Positive associations between attitudes toward psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted health literacy interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes toward psychotherapeutic treatment and help-seeking behavior. ", doi="10.2196/67078", url="https://publichealth.jmir.org/2025/1/e67078", url="http://www.ncbi.nlm.nih.gov/pubmed/39854696" } @Article{info:doi/10.2196/57614, author="Romm, Lie Kristin and Skoge, Mari and Barrett, Ann Elizabeth and Berentzen, Lars-Christian and Bergsager, Dagfinn and Fugelli, P{\aa}l and Bjella, Thomas and Gardsjord, Strand Erlend and Kling, Kristine and Kruse, Hembre Sindre and Kv{\ae}rner, Jorunn Kari and Melle, Ingrid and Mork, Erlend and Ihler, Myhre Henrik and Rognli, Borger Eline and Simonsen, Carmen and V{\ae}rnes, Gunnar Tor and Aminoff, Ragnhild Sofie", title="A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability", journal="JMIR Form Res", year="2025", month="Jan", day="17", volume="9", pages="e57614", keywords="eHealth", keywords="shared decision-making", keywords="user involvement", keywords="user-centered design", keywords="mental disorder", keywords="mobile technology", keywords="illness course", keywords="recovery", keywords="mobile apps", keywords="mHealth", abstract="Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. Objective: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. Methods: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. Results: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. Conclusions: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings---from development to implementation---and to conduct further research on early health technology assessments to guide these processes. ", doi="10.2196/57614", url="https://formative.jmir.org/2025/1/e57614" } @Article{info:doi/10.2196/64873, author="Antolin Mu{\~n}iz, Marley and McMahan, M. Vanessa and Luna Marti, Xochitl and Brennan, Sarah and Tavasieff, Sophia and Rodda, N. Luke and Knoll, James and Coffin, O. Phillip", title="Identification of Behavioral, Clinical, and Psychological Antecedents of Acute Stimulant Poisoning: Development and Implementation of a Mixed Methods Psychological Autopsy Study", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e64873", keywords="psychological autopsy", keywords="acute stimulant poisoning", keywords="overdose", keywords="cocaine", keywords="methamphetamine", keywords="fentanyl", abstract="Background: Despite increasing fatal stimulant poisoning in the United States, little is understood about the mechanism of death. The psychological autopsy (PA) has long been used to distinguish the manner of death in equivocal cases, including opioid overdose, but has not been used to explicitly explore stimulant mortality. Objective: We aimed to develop and implement a large PA study to identify antecedents of fatal stimulant poisoning, seeking to maximize data gathering and ethical interactions during the collateral interviews. Methods: We ascertained death records from the California Electronic Death Reporting System (CA-EDRS) and the San Francisco Office of the County Medical Examiner (OCME) from June 2022 through December 2023. We selected deaths determined to be due to acute poisoning from cocaine or methamphetamine, which occurred 3?12 months prior and were not attributed to suicide or homicide. We identified 31 stimulant-fentanyl and 70 stimulant-no-opioid decedents. We sought 2 informants for each decedent, who were able to describe the decedent across their life course. Informants were at least 18 years of age, communicated with the decedent within the year before death, and were aware that the decedent had been using substances during that year. Upon completion of at least one informant interview conducted by staff with bachelor's or master's degrees, we collected OCME, medical record, and substance use disorder treatment data for the decedent. Planned analyses include least absolute shrinkage and selection operator regressions of quantitative data and thematic analyses of qualitative data. Results: We identified and interviewed at least one informant (N=141) for each decedent (N=101). Based on feedback during recruitment, we adapted language to improve rapport, including changing the term ``accidental death'' to ``premature death,'' offering condolences, and providing content warnings. As expected, family members were able to provide more data about the decedent's childhood and adolescence, and nonfamily informants provided more data regarding events proximal to death. We found that the interviews were stressful for both the interviewee and interviewer, especially when participants thought the study was intrusive or experienced significant grief during the interviews. Conclusions: In developing and implementing PA research on fatal stimulant poisoning, we noted the importance of recruitment language regarding cause of death and condolences with collateral informants. Compassion and respect were critical to facilitate the interview process and maintain an ethical framework. We discuss several barriers to success and lessons learned while conducting PA interviews, as well as recommendations for future PA studies. ", doi="10.2196/64873", url="https://formative.jmir.org/2025/1/e64873" } @Article{info:doi/10.2196/67627, author="Jayaraj, Gautham and Cao, Xiao and Horwitz, Adam and Rozwadowski, Michelle and Shea, Skyla and Hanauer, N. Shira and Hanauer, A. David and Tewari, Muneesh and Shedden, Kerby and Choi, Won Sung", title="Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e67627", keywords="mHealth", keywords="college", keywords="student", keywords="mental health", keywords="positive psychology", keywords="flourishing", keywords="COVID-19", keywords="wellbeing", keywords="mobile phone", keywords="SARS-CoV-2", keywords="coronavirus", keywords="pandemic", keywords="COVID", keywords="app", keywords="digital health", keywords="smartphone", keywords="eHealth", keywords="telehealth", keywords="telemedicine", keywords="longitudinal", keywords="higher education", keywords="depression", keywords="anxiety", keywords="loneliness", abstract="Background: The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care. Objective: This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes. Methods: A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness. Results: The findings indicated an evolving trajectory in students' mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=--2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=--2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=--5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=--7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=--8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=--10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors ($\beta$=.04, SE .016; t3974=2.17; P=.03). Conclusions: In this study, students' mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students' mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students' mental health outcomes. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 ", doi="10.2196/67627", url="https://www.jmir.org/2025/1/e67627" } @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/10.2196/63538, author="Kang, Boyoung and Hong, Munpyo", title="Development and Evaluation of a Mental Health Chatbot Using ChatGPT 4.0: Mixed Methods User Experience Study With Korean Users", journal="JMIR Med Inform", year="2025", month="Jan", day="3", volume="13", pages="e63538", keywords="mental health chatbot", keywords="Dr. CareSam", keywords="HoMemeTown", keywords="ChatGPT 4.0", keywords="large language model", keywords="LLM", keywords="cross-lingual", keywords="pilot testing", keywords="cultural sensitivity", keywords="localization", keywords="Korean students", abstract="Background: Mental health chatbots have emerged as a promising tool for providing accessible and convenient support to individuals in need. Building on our previous research on digital interventions for loneliness and depression among Korean college students, this study addresses the limitations identified and explores more advanced artificial intelligence--driven solutions. Objective: This study aimed to develop and evaluate the performance of HoMemeTown Dr. CareSam, an advanced cross-lingual chatbot using ChatGPT 4.0 (OpenAI) to provide seamless support in both English and Korean contexts. The chatbot was designed to address the need for more personalized and culturally sensitive mental health support identified in our previous work while providing an accessible and user-friendly interface for Korean young adults. Methods: We conducted a mixed methods pilot study with 20 Korean young adults aged 18 to 27 (mean 23.3, SD 1.96) years. The HoMemeTown Dr CareSam chatbot was developed using the GPT application programming interface, incorporating features such as a gratitude journal and risk detection. User satisfaction and chatbot performance were evaluated using quantitative surveys and qualitative feedback, with triangulation used to ensure the validity and robustness of findings through cross-verification of data sources. Comparative analyses were conducted with other large language models chatbots and existing digital therapy tools (Woebot [Woebot Health Inc] and Happify [Twill Inc]). Results: Users generally expressed positive views towards the chatbot, with positivity and support receiving the highest score on a 10-point scale (mean 9.0, SD 1.2), followed by empathy (mean 8.7, SD 1.6) and active listening (mean 8.0, SD 1.8). However, areas for improvement were noted in professionalism (mean 7.0, SD 2.0), complexity of content (mean 7.4, SD 2.0), and personalization (mean 7.4, SD 2.4). The chatbot demonstrated statistically significant performance differences compared with other large language models chatbots (F=3.27; P=.047), with more pronounced differences compared with Woebot and Happify (F=12.94; P<.001). Qualitative feedback highlighted the chatbot's strengths in providing empathetic responses and a user-friendly interface, while areas for improvement included response speed and the naturalness of Korean language responses. Conclusions: The HoMemeTown Dr CareSam chatbot shows potential as a cross-lingual mental health support tool, achieving high user satisfaction and demonstrating comparative advantages over existing digital interventions. However, the study's limited sample size and short-term nature necessitate further research. Future studies should include larger-scale clinical trials, enhanced risk detection features, and integration with existing health care systems to fully realize its potential in supporting mental well-being across different linguistic and cultural contexts. ", doi="10.2196/63538", url="https://medinform.jmir.org/2025/1/e63538" } @Article{info:doi/10.2196/63034, author="Tartaglia, Julia and Jaghab, Brendan and Ismail, Mohamed and H{\"a}nsel, Katrin and Meter, Van Anna and Kirschenbaum, Michael and Sobolev, Michael and Kane, M. John and Tang, X. Sunny", title="Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study", journal="JMIR Ment Health", year="2024", month="Dec", day="30", volume="11", pages="e63034", keywords="digital literacy", keywords="attitudes", keywords="mental health", keywords="digital health technology", keywords="cluster analysis", keywords="psychiatry", keywords="mobile phone", abstract="Background: Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients' digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. Objective: This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. Methods: A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. Results: A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9\%), Black (39/256, 15.2\%), Latinx (44/256, 17.2\%), Asian (59/256, 23\%), and other races and ethnicities (15/256, 5.7\%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75\%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42\%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75\% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. Conclusions: High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools. ", doi="10.2196/63034", url="https://mental.jmir.org/2024/1/e63034" } @Article{info:doi/10.2196/59372, author="Taylor, V. Kayla and Garchitorena, Laurent and Scaramutti-Gladfelter, Carolina and Wyrick, Mykayla and Grill, B. Katherine and Seixas, A. Azizi", title="A Digital Mental Health Solution to Improve Social, Emotional, and Learning Skills for Youth: Protocol for an Efficacy and Usability Study", journal="JMIR Res Protoc", year="2024", month="Dec", day="19", volume="13", pages="e59372", keywords="mental health", keywords="digital health", keywords="mHealth", keywords="usability", keywords="pilot study", keywords="United States", keywords="mental health crisis", keywords="Science Technology Engineering Math and Social and Emotional Learning", keywords="STEMSEL", keywords="efficacy", keywords="well-being", keywords="barriers", keywords="facilitators", keywords="resources", keywords="youth", keywords="adolescents", keywords="teenagers", keywords="students", keywords="feasibility", keywords="adoption", keywords="evidence-based", keywords="intervention", keywords="anxiety", keywords="depression", keywords="Neolth", keywords="digital app", abstract="Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth's functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study's completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention's efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/59372 ", doi="10.2196/59372", url="https://www.researchprotocols.org/2024/1/e59372" } @Article{info:doi/10.2196/56407, author="Pisani, R. Anthony and Wyman, A. Peter and Cero, Ian and Kelberman, Caroline and Gurditta, Kunali and Judd, Emily and Schmeelk-Cone, Karen and Mohr, David and Goldston, David and Ertefaie, Ashkan", title="Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="Dec", day="6", volume="11", pages="e56407", keywords="suicide prevention", keywords="text messaging", keywords="self-violence", keywords="self-harm", keywords="suicidal behavior", keywords="randomized controlled trial", keywords="adolescent", keywords="teenager", keywords="student", keywords="school", keywords="United States", keywords="Text4Strength", keywords="help-seeking attitude", keywords="coping", keywords="awareness", keywords="depression", keywords="mood disorder", keywords="mental health", abstract="Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10\% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength---a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363 ", doi="10.2196/56407", url="https://mental.jmir.org/2024/1/e56407" } @Article{info:doi/10.2196/53829, author="Foran, M. Heather and Kubb, Christian and Mueller, Janina and Poff, Spencer and Ung, Megan and Li, Margaret and Smith, Michael Eric and Akinyemi, Akinniyi and Kambadur, Melanie and Waller, Franziska and Graf, Mario and Boureau, Y-Lan", title="An Automated Conversational Agent Self-Help Program: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Dec", day="6", volume="26", pages="e53829", keywords="well-being", keywords="chatbot", keywords="randomized controlled trial", keywords="prevention", keywords="flourishing", abstract="Background: Health promotion and growth-based interventions can effectively improve individual well-being; however, significant gaps in access and utilization still exist. Objective: This study aims to develop and test the effectiveness and implementation of a new, widely targeted conversational agent prevention program (Zenny) designed to enhance well-being. Methods: A total of 1345 individuals in the United States were recruited online and randomly assigned to either (1) a self-help program intervention delivered via an automated conversational agent on WhatsApp or (2) an active control group that had access to evidence-based wellness resources available online. The primary outcomes were well-being (measured using the 5-item World Health Organization Well-being Scale), psychosocial flourishing (assessed with the Flourishing Scale), and positive psychological health (evaluated with the Mental Health Continuum-Short Form). Outcome measures were collected at baseline and again 1 month postassessment. All analyses were conducted using an intention-to-treat approach. Results: Both groups showed significant improvements in well-being (self-help program intervention group effect size: Cohen d=0.26, P<.001; active control group effect size: d=0.24, P<.001), psychosocial flourishing (intervention: d=0.19, P<.001; active control: d=0.18, P<.001), and positive psychological health (intervention: d=0.17, P=.001; active control: d=0.24, P<.001) at postassessment. However, there were no significant differences in effectiveness between the 2 groups (P ranged from .56 to .92). As hypothesized a priori, a greater number of days spent actively engaging with the conversational agent was associated with larger improvements in well-being at postassessment among participants in the intervention group ($\beta$=.109, P=.04). Conclusions: The findings from this study suggest that the free conversational agent wellness self-help program was as effective as evidence-based web resources. Further research should explore strategies to increase participant engagement over time, as only a portion of participants were actively involved, and higher engagement was linked to greater improvements in well-being. Long-term follow-up studies are also necessary to assess whether these effects remain stable over time. Trial Registration: ClinicalTrials.gov NCT06208566; https://clinicaltrials.gov/ct2/show/NCT06208566; OSF Registries osf.io/ahe2r; https://doi.org/10.17605/osf.io/ahe2r ", doi="10.2196/53829", url="https://www.jmir.org/2024/1/e53829", url="http://www.ncbi.nlm.nih.gov/pubmed/39641985" } @Article{info:doi/10.2196/60461, author="Golsong, Konstanze and Kaufmann, Luisa and Baldofski, Sabrina and Kohls, Elisabeth and Rummel-Kluge, Christine", title="Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e60461", keywords="mental health", keywords="eHealth", keywords="app", keywords="health care", keywords="app-based support", keywords="psychiatric symptoms", keywords="mobile phone", keywords="COVID-19", abstract="Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment--like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67\%) were analyzed; 17 (30\%) dropped out. Satisfaction with the app was high, with 53\% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79\% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47\%) of the completers trying relaxation modules and 71\% (27/38) regularly responding to the ecological momentary assessment--like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58\% (22/38) felt ``definitely'' or ``rather'' encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=--0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. ", doi="10.2196/60461", url="https://formative.jmir.org/2024/1/e60461", url="http://www.ncbi.nlm.nih.gov/pubmed/39630503" } @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/10.2196/55639, author="Aldridge, Grace and Wu, Ling and Seguin, Paolo Joshua and Robinson, Jennifer and Battaglia, Elizabeth and Olivier, Patrick and Yap, H. Marie B.", title="Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study", journal="JMIR Form Res", year="2024", month="Nov", day="22", volume="8", pages="e55639", keywords="co-design", keywords="service design", keywords="intervention", keywords="digital technology", keywords="parenting", keywords="children", keywords="technology", keywords="parenting program", keywords="health care services", keywords="adverse childhood experience", keywords="ACE", keywords="mental disorder", keywords="innovate", keywords="social services", keywords="community health", keywords="evidence-based", keywords="parenting intervention", abstract="Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent's capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite's design. Results: PaRK-Lite's hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents' empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. ", doi="10.2196/55639", url="https://formative.jmir.org/2024/1/e55639", url="http://www.ncbi.nlm.nih.gov/pubmed/39576676" } @Article{info:doi/10.2196/59831, author="Miller, J. Michael and Eberhart, G. Lindsay and Heliste, L. Jennifer and Tripuraneni, R. Bhaskara", title="Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e59831", keywords="digital mental health applications", keywords="DMHA", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="smartphone", keywords="user experience", keywords="engagement", keywords="implementation", keywords="Kaiser Permanente", abstract="Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7\%) completed the survey and 44 (37\%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66\%); 73\% (32/44) of the respondents were female, 73\% (32/44) of the respondents had at least a 4-year college degree, 41\% (18/44) of the respondents were Black or African American, and 39\% (17/44) of the respondents were White. Moreover, 27\% (12/44) of the respondents screened positive for anxiety symptoms, and 23\% (10/44) of the respondents screened positive for depression. Overall, 61\% (27/44) of the respondents reported DMHA use for ?6 months since referral, 36\% (16/44) reported use within the past 30 days, and 43\% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20\%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92\% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83\%). Of the 12 HCPs, 7 (58\%) were physicians and 5 (42\%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described ``typical patients'' referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. ", doi="10.2196/59831", url="https://formative.jmir.org/2024/1/e59831" } @Article{info:doi/10.2196/52788, author="Oudshoorn, Cathelijn and Frielink, Noud and Riper, Heleen and Embregts, Petri", title="Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals", journal="JMIR Form Res", year="2024", month="Nov", day="12", volume="8", pages="e52788", keywords="acceptance", keywords="health care professionals", keywords="intellectual disabilities", keywords="eHealth", keywords="disability", keywords="psychological therapy", keywords="support", keywords="cross-sectional survey", abstract="Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals' acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants' characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach $\alpha$=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. ", doi="10.2196/52788", url="https://formative.jmir.org/2024/1/e52788" } @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/10.2196/60165, author="Gentile, Alessandra and Kristian, Yan Yosua and Cini, Erica", title="Effectiveness of Computer-Based Psychoeducational Self-Help Platforms for Eating Disorders (With or Without an Associated App): Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="4", volume="13", pages="e60165", keywords="self-help", keywords="online self-help", keywords="eating disorders", keywords="anorexia nervosa", keywords="psychoeducational intervention", keywords="psychoeducation", keywords="binge eating", keywords="anorexia", keywords="bulimia", keywords="access to care", keywords="patient education", keywords="patient self-help", abstract="Background: Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms ({\textpm} associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. Objective: The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre-- and post--computer-based {\textpm} associated apps intervention clinical outcome of ED symptoms; pre-- and post--computer-based {\textpm} associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based {\textpm} associated apps comparison group, only in-person--delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. Results: The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. Conclusions: Self-help platforms are helpful first-stage resource in a tiered health care system. Trial Registration: PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw International Registered Report Identifier (IRRID): DERR1-10.2196/60165 ", doi="10.2196/60165", url="https://www.researchprotocols.org/2024/1/e60165", url="http://www.ncbi.nlm.nih.gov/pubmed/39495557" } @Article{info:doi/10.2196/60317, author="Ramirez, Ana and Kramer, Justin and Hazim, Katrina and Roberge, Jason", title="Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation", journal="JMIR Form Res", year="2024", month="Oct", day="31", volume="8", pages="e60317", keywords="telemedicine", keywords="telepsychiatry", keywords="adolescents", keywords="mental health", keywords="psychiatry", keywords="coaching", keywords="qualitative assessment", keywords="patient satisfaction", keywords="family engagement", keywords="depression", keywords="anxiety", keywords="suicidal ideation", abstract="Background: Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management (``Youth and Family Engagement'' [YFE] program). Objective: This study aims to explore patients' and parents' perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Methods: Semistructured interviews were conducted with adolescent patients (n=9, 56\%), parents (n=11, 92\%), and clinicians who placed patient referrals (n=6, 100\%). Interviews were in English (participants: 19/26, 73\%) or Spanish (parents: 7/11, 64\%), depending upon participants' preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. Results: The YFE program's structure was often mentioned as promoting engagement, with telephone appointments and health coaches' ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents' nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches' ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Conclusions: Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach--participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement. ", doi="10.2196/60317", url="https://formative.jmir.org/2024/1/e60317" } @Article{info:doi/10.2196/60589, author="Cross, Shane and Bell, Imogen and Nicholas, Jennifer and Valentine, Lee and Mangelsdorf, Shaminka and Baker, Simon and Titov, Nick and Alvarez-Jimenez, Mario", title="Use of AI in Mental Health Care: Community and Mental Health Professionals Survey", journal="JMIR Ment Health", year="2024", month="Oct", day="11", volume="11", pages="e60589", keywords="mental health", keywords="health care", keywords="AI", keywords="community members", keywords="mental health professional", keywords="web-based survey", keywords="Australia", keywords="descriptive statistic", keywords="thematic analysis", keywords="cost reduction", keywords="data security", keywords="digital health", keywords="digital intervention", keywords="artificial intelligence", abstract="Background: Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. Objective: This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). Methods: This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. Results: The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28\% (30/108) of CMs used AI, primarily for quick support (18/30, 60\%) and as a personal therapist (14/30, 47\%). Among MHPs, 43\% (37/86) used AI; mostly for research (24/37, 65\%) and report writing (20/37, 54\%). While the majority found AI to be generally beneficial (23/30, 77\% of CMs and 34/37, 92\% of MHPs), specific harms and concerns were experienced by 47\% (14/30) of CMs and 51\% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Conclusions: Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time. ", doi="10.2196/60589", url="https://mental.jmir.org/2024/1/e60589" } @Article{info:doi/10.2196/58428, author="Feng, Xiandong and Hu, Yinhuan and Pfaff, Holger and Liu, Sha and Xie, Jinzhu and Zhang, Zemiao", title="Exploring Client Preferences for Psychological Counselors in a Chinese Online Health Community: Longitudinal Study", journal="J Med Internet Res", year="2024", month="Oct", day="10", volume="26", pages="e58428", keywords="signaling theory", keywords="psychological counselor", keywords="online health communities", keywords="clients' choice", abstract="Background: Although online health communities are acknowledged for their role in bridging the supply-demand gap in mental health services, the client decision-making process in these environments remains underexplored. Objective: This study aimed to explore the impact of different signals presented on psychological counselors' home pages on clients' choices. Methods: Adopting signaling theory as the framework, this study classified information into online and offline signals and developed a theoretical model to examine client choice behaviors. We collected data from 487 psychological counselors in a leading Chinese online mental health community during March, June, September, and December 2023. Based on these data, we constructed a 4-period balanced panel dataset. A fixed effects model was used to analyze which signals influence clients' choices of psychological counselors. Results: Regarding online signals, the service price ($\beta$=0.186, P<.001) and online reputation ($\beta$=0.489, P=.002) of psychological counselors positively influence clients' choices. Concerning offline signals, psychological counselors' practical experience ($\beta$=0.007, P<.001) is positively related to clients' choices. Moreover, the results indicate that the relationship between a counselor's prosocial behavior and clients' choices is not linear but rather exhibits an inverted U-shape. Conclusions: This study reveals that the varied information provided by psychological counselors has distinct impacts on clients' choices in online health communities. It broadens the application of signaling theory to online behaviors and emphasizes the importance of both online and offline signals. These insights offer strategic guidance for counselors and online platforms to better meet potential clients' needs by optimizing the information presented on psychological counselors' home pages. ", doi="10.2196/58428", url="https://www.jmir.org/2024/1/e58428" } @Article{info:doi/10.2196/58890, author="Adjei-Banuah, Yaw Nhyira and Ayiku, Barkey Roberta Naa and Reichenberger, Veronika and Sasu, David and Mirzoev, Tolib and Murphy, Adrianna and Ohene, Sammy and Antwi, Edward and Agyepong, Akua Irene", title="Factors Influencing Primary Care Access for Common Mental Health Conditions Among Adults in West Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Oct", day="2", volume="13", pages="e58890", keywords="scoping review", keywords="mental health", keywords="noncommunicable disease", keywords="primary care", keywords="access", keywords="barriers", keywords="enablers", abstract="Background: Mental health conditions are expressed in various ways in different people, and access to health care for these conditions is affected by individual factors, health care provider factors, and contextual factors. These factors may be enablers or barriers to accessing primary care for mental health conditions. Studies have reported a gap in treatment for mental health conditions in many countries in West Africa due to barriers along the access pathway. However, to the best of our knowledge, there is yet to be a review of the factors influencing access to primary care for common mental health conditions among adults in West Africa. Objective: Our scoping review will explore the factors influencing access to primary care for common mental health conditions among adults aged 18 years and older in West Africa from 2002 to 2024. Methods: Our review will follow the approach to scoping reviews developed by Arksey and O'Malley in 2005. This approach has five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. We will search electronic databases (PubMed, Embase, PsycINFO, Cairn.info, and Google Scholar), source gray literature from relevant websites (the World Health Organization and country-specific websites), and manually explore reference lists of relevant studies to identify eligible records. Pairs of independent authors (NYA-B, RNBA, VR, or DS) will screen the titles, abstracts, and full texts of studies based on predefined eligibility criteria. We will use a data extraction tool adopted from the JBI Manual for Evidence Synthesis to chart the data. Deductive, thematic analysis will be used to categorize factors influencing access to mental health care under predetermined themes. New themes derived from the literature will also be charted. Results: Database searches were conducted between February 1, 2024, and February 12, 2024. As of July 2024, the review report is being drafted, and it will be disseminated through publication in a peer-reviewed journal. Conclusions: The results of the review will inform decision-making on policies, programs, and their implementation in West Africa to improve primary care access for mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/58890 ", doi="10.2196/58890", url="https://www.researchprotocols.org/2024/1/e58890" } @Article{info:doi/10.2196/58162, author="Turkington, Robin and Potts, Courtney and Mulvenna, Maurice and Bond, Raymond and O'Neill, Siobh{\'a}n and Ennis, Edel and Hardcastle, Katie and Scowcroft, Elizabeth and Moore, Ciaran and Hamra, Louise", title="Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis", journal="JMIR Ment Health", year="2024", month="Sep", day="19", volume="11", pages="e58162", keywords="crisis helplines", keywords="call duration", keywords="mental health", keywords="suicide", keywords="suicidal", keywords="suicide prevention", keywords="population-based", keywords="help-seeking behavior", keywords="Samaritans", keywords="UK", keywords="telephony", keywords="telephone", keywords="telephones", keywords="one-way analysis", keywords="call", keywords="calls", keywords="talk time", keywords="support", keywords="talk time differences", abstract="Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom's 4 countries or regions. Objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller's current region (intraregional calls) or routed to a branch that is in a different region from that of the caller's current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene's test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service. ", doi="10.2196/58162", url="https://mental.jmir.org/2024/1/e58162" } @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/10.2196/51481, author="Kim, Yeji and Kim, Soeun and Lee, Somin and Park, Jaeyu and Koyanagi, Ai and Smith, Lee and Kim, Seo Min and Fond, Guillaume and Boyer, Laurent and L{\'o}pez S{\'a}nchez, Felipe Guillermo and Dragioti, Elena and Kim, Jin Hyeon and Lee, Hayeon and Son, Yejun and Kim, Minji and Kim, Sunyoung and Yon, Keon Dong", title="National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="18", volume="10", pages="e51481", keywords="COVID-19", keywords="pandemic", keywords="epidemiology", keywords="South Korea", keywords="unmet health care", keywords="unmet dental care.", abstract="Background: Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. Objective: This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. Methods: We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. Results: From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53\%; 673,780, 24.95\%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase ($\beta$diff 0.10, 95\% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic ($\beta$diff 0.23, 95\% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the $\beta$ difference during the pandemic increased compared with prepandemic values. Conclusions: Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs. ", doi="10.2196/51481", url="https://publichealth.jmir.org/2024/1/e51481" } @Article{info:doi/10.2196/55882, author="Al-Adili, Lina and Malmqvist, Moa and Reinius, Maria and Helisp{\"a}{\"a} Rodriguez, Inka and Stenfors, Terese and Brommels, Mats", title="Implementation of a Recovery College Embedded in a Swedish Psychiatry Organization: Qualitative Case Study", journal="J Particip Med", year="2024", month="Sep", day="12", volume="16", pages="e55882", keywords="mental health", keywords="educational intervention", keywords="recovery college", keywords="implementation research approach", keywords="qualitative research", keywords="coproduction", abstract="Background: Recovery colleges are service user--led educational interventions aiming at empowering people with mental health issues and promoting recovery through peer learning. Despite the increasing interest in recovery colleges in recent years and the demonstrated beneficial effects for users, there is limited research addressing aspects that influence their implementation. This knowledge is necessary for the successful integration of such interventions in various contexts. Objective: This study aims to explore factors that influence the implementation of a recovery college embedded within a Swedish psychiatry organization. Methods: A qualitative case study of a recovery college based on semistructured interviews with 8 course participants, 4 course leaders, and 4 clinical staff was conducted. The transcripts were scrutinized with conventional content analysis, and the interpretation of results was guided by the Consolidated Framework for Implementation Research. Results: The findings highlight key areas that either hinder or promote the successful implementation of the recovery college. These areas included recruitment, resources, staff attitudes, and ways of organizing courses. Each area has elements that appear both as facilitators and barriers, demonstrating the duality of conditions. Conclusions: Allocating dedicated resources, engaging individuals with service user experience as organizers who are willing to share their personal experience, having an open-door policy, creating an open space for participants to share their experiences, and offering practical advice and written material are useful to create favorable conditions for a recovery college to reach its goals of empowering psychiatry service users. ", doi="10.2196/55882", url="https://jopm.jmir.org/2024/1/e55882" } @Article{info:doi/10.2196/56396, author="Van der Burgt, A. Margot C. and M{\'e}relle, Saskia and Brinkman, Willem-Paul and Beekman, F. Aartjan T. and Gilissen, Renske", title="Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="Sep", day="5", volume="11", pages="e56396", keywords="barrier reduction intervention", keywords="suicidal ideation", keywords="self-help", keywords="suicide prevention helpline", keywords="randomized controlled trial", keywords="help-seeking", keywords="suicide", keywords="RCT", keywords="self-test", keywords="effectiveness", keywords="prevention", keywords="middle-aged", keywords="behavioral", keywords="attitudinal", keywords="website visitors", keywords="website visitor", keywords="website", keywords="men", keywords="suicide prevention", abstract="Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70\% score high on the severity of suicidal thoughts, <10\% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was ``I don't think that my problems are serious enough.'' At the end of the trial, 33.1\% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7\%; odds ratio 0.87, 95\% CI 0.64?1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95\% CI 0.12?0.32, P?.001) and on satisfaction with the self-test (B=0.27, 95\% CI 0.01?0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. Trial Registration: ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/study/NCT05458830 International Registered Report Identifier (IRRID): RR2-10.2196/41078 ", doi="10.2196/56396", url="https://mental.jmir.org/2024/1/e56396" } @Article{info:doi/10.2196/51690, author="Vakili, Negar and Curran, A. Janet and Walls, Roisin and Phillips, Debbie and Miller, Alanna and Cassidy, Christine and Wozney, Lori", title="Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study", journal="JMIR Form Res", year="2024", month="Aug", day="27", volume="8", pages="e51690", keywords="patient satisfaction", keywords="satisfaction", keywords="cross-sectional", keywords="survey", keywords="surveys", keywords="engagement", keywords="usage", keywords="technology use", keywords="transitional", keywords="transition", keywords="coordinated care", keywords="service", keywords="services", keywords="feature", keywords="features", keywords="need", keywords="needs", keywords="transitional care", keywords="information science", keywords="human-computer interaction", keywords="health behavior", keywords="text-messaging", keywords="messaging", keywords="text messages", keywords="text message", keywords="SMS", keywords="mental health", keywords="persuasive system design", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", abstract="Background: For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message--based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. Objective: This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. Methods: A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70\%. Results: A total of 100 participants, predominantly non-White (n=47, 47\%), aged 20-26 years (n=59, 59\%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60\%), were selected. The majority (n=90, 90\%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45\% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100\%) than information domain items (4/9, 44\%) or motivation domain items (2/8, 25\%). A high level of consensus on importance ratings was reported in only 19\% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8\% (1/12) of the primary task support domain items and 100\% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27\% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Conclusions: Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions. ", doi="10.2196/51690", url="https://formative.jmir.org/2024/1/e51690", url="http://www.ncbi.nlm.nih.gov/pubmed/39190437" } @Article{info:doi/10.2196/63656, author="Poteat, C. Tonia and Reisner, L. Sari and Wirtz, L. Andrea and Mayo-Wilson, Jennings Larissa and Brown, Carter and Kornbluh, Wiley and Humphrey, Ash and Perrin, Nancy", title="A Microfinance Intervention With or Without Peer Support to Improve Mental Health Among Transgender and Nonbinary Adults (the Creating Access to Resources and Economic Support Study): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Aug", day="26", volume="13", pages="e63656", keywords="clinical trial", keywords="depression", keywords="anxiety", keywords="peer support", keywords="minority stress", keywords="cash transfer", keywords="COVID-19", abstract="Background: Transgender and nonbinary (TNB) people experience economic and psychosocial inequities that make them more likely to be subject to financial and mental health harms exacerbated by the COVID-19 pandemic. Sustainable, multilevel interventions are needed to address these harms. The onset of the COVID-19 pandemic galvanized many TNB-led organizations to provide emergency financial and peer support for TNB people negatively impacted by the pandemic. However, the efficacy of these interventions has not been evaluated. The Creating Access to Resources and Economic Support (CARES) study seeks to assess the efficacy of feasible, acceptable, and community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of the COVID-19 pandemic. Objective: The study aims to (1) compare the efficacy of microgrants with peer mentoring with that of microgrants without peer mentoring in reducing psychological distress, (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress, and (3) explore participants' intervention experiences and perceived efficacy. Methods: We will enroll 360 TNB adults into an embedded, mixed methods, 3-arm, and 12-month randomized controlled trial. Participants will be randomized 1:1:1 to arm A (enhanced usual care), which will receive a single microgrant plus monthly financial literacy education, arm B (extended microgrants), which will receive enhanced usual care plus monthly microgrants, or arm C (peer mentoring), which will receive extended microgrants combined with peer mentoring. All intervention arms last for 6 months, and participants complete semiannual, web-based surveys at 0, 6, and 12 months as well as brief process measures at 3 and 6 months. A subset of 36 participants, 12 (33\%) per arm, will complete longitudinal in-depth interviews at 3 and 9 months. Results: Full recruitment began on January 8, 2024, and, as of July 26, 2024, a total of 138 participants have enrolled. Recruitment is expected to be completed no later than March 31, 2025, and the final study visit will take place in March 2026. Conclusions: This national, web-based study will demonstrate whether an intervention tailored to reduce material hardship and improve peer support among TNB adults will reduce psychological distress. Its equitable, community-academic partnership will ensure the rapid dissemination of study findings. Trial Registration: ClinicalTrials.gov NCT05971160; https://clinicaltrials.gov/study/NCT05971160 International Registered Report Identifier (IRRID): DERR1-10.2196/63656 ", doi="10.2196/63656", url="https://www.researchprotocols.org/2024/1/e63656" } @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/10.2196/53794, 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/10.2196/56319, author="Franco, Pamela and Olhaberry, Marcia and Muzard, Antonia and Harismendy, {\'A}ngeles and Kelders, Saskia", title="Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach", journal="JMIR Form Res", year="2024", month="Aug", day="19", volume="8", pages="e56319", keywords="internet-based intervention", keywords="postpartum depression", keywords="user-centered development", keywords="perinatal mental health", keywords="user-centered design", keywords="mobile phone", abstract="Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders' openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype's final version. The resulting intervention, named Mam{\'a}, te entiendo (``Mom, I get you''), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. ", doi="10.2196/56319", url="https://formative.jmir.org/2024/1/e56319" } @Article{info:doi/10.2196/55965, author="AbouWarda, Horeya and Dolata, Mateusz and Schwabe, Gerhard", title="How Does an Online Mental Health Community on Twitter Empower Diverse Population Levels and Groups? A Qualitative Analysis of \#BipolarClub", journal="J Med Internet Res", year="2024", month="Aug", day="19", volume="26", pages="e55965", keywords="social media", keywords="Twitter", keywords="online mental health community", keywords="OMHC", keywords="empowerment processes", keywords="diverse population levels and groups", keywords="World Health Organization", keywords="WHO", keywords="Integrated People-Centred Health Services", keywords="IPCHS framework (Strategy 1)", abstract="Background: Social media, including online health communities (OHCs), are widely used among both healthy people and those with health conditions. Platforms like Twitter (recently renamed X) have become powerful tools for online mental health communities (OMHCs), enabling users to exchange information, express feelings, and socialize. Recognized as empowering processes, these activities could empower mental health consumers, their families and friends, and society. However, it remains unclear how OMHCs empower diverse population levels and groups. Objective: This study aimed to develop an understanding of how empowerment processes are conducted within OMHCs on Twitter by identifying members who shape these communities, detecting the types of empowerment processes aligned with the population levels and groups outlined in Strategy 1 of the Integrated People-Centred Health Services (IPCHS) framework by the World Health Organization (WHO), and clarifying members' involvement tendencies in these processes. Methods: We conducted our analysis on a Twitter OMHC called \#bipolarclub. We captured 2068 original tweets using its hashtag \#bipolarclub between December 19, 2022, and January 15, 2023. After screening, 547 eligible tweets by 182 authors were analyzed. Using qualitative content analysis, community members were classified by examining the 182 authors' Twitter profiles, and empowerment processes were identified by analyzing the 547 tweets and categorized according to the WHO's Strategy 1. Members' tendencies of involvement were examined through their contributions to the identified processes. Results: The analysis of \#bipolarclub community members unveiled 5 main classifications among the 182 members, with the majority classified as individual members (n=138, 75.8\%), followed by health care--related members (n=39, 21.4\%). All members declared that they experience mental health conditions, including mental health and general practitioner members, who used the community as consumers and peers rather than for professional services. The analysis of 547 tweets for empowerment processes revealed 3 categories: individual-level processes (6 processes and 2 subprocesses), informal carer processes (1 process for families and 1 process for friends), and society-level processes (1 process and 2 subprocesses). The analysis also demonstrated distinct involvement tendencies among members, influenced by their identities, with individual members engaging in self-expression and family awareness support and health care--related members supporting societal awareness. Conclusions: The examination of the \#bipolarclub community highlights the capability of Twitter-based OMHCs to empower mental health consumers (including those from underserved and marginalized populations), their families and friends, and society, aligning with the WHO's empowerment agenda. This underscores the potential benefits of leveraging Twitter for such objectives. This pioneering study is the very first to analyze how a single OMHC can empower diverse populations, offering various health care stakeholders valuable guidance and aiding them in developing consumer-oriented empowerment programs using such OMHCs. We also propose a structured framework that classifies empowerment processes in OMHCs, inspired by the WHO's Strategy 1 (IPCHS framework). ", doi="10.2196/55965", url="https://www.jmir.org/2024/1/e55965", url="http://www.ncbi.nlm.nih.gov/pubmed/39158945" } @Article{info:doi/10.2196/50978, author="Landman, Benjamin and Khoury, Elie and Cohen, Alicia and Trebossen, Vincent and Michel, Alexandre and Lefebvre, Aline and Delorme, Richard", title="Acceptance of a French e--Mental Health Information Website (Cl{\'e}Psy) for Families: A Web-Based Survey", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="15", volume="7", pages="e50978", keywords="mental health education", keywords="children", keywords="family", keywords="child", keywords="pediatrics", keywords="pediatric", keywords="mental health", keywords="parent", keywords="parents", keywords="parenting", keywords="psychiatry", keywords="website", keywords="acceptance", keywords="patient education", keywords="online information", keywords="health information", keywords="ease of use", keywords="usefulness", keywords="survey", keywords="surveys", keywords="user", keywords="experience", keywords="questionnaire", keywords="questionnaires", keywords="families", abstract="Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children's difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, Cl{\'e}Psy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3\%) or with their relatives (n=260, 82.1\%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. ", doi="10.2196/50978", url="https://pediatrics.jmir.org/2024/1/e50978" } @Article{info:doi/10.2196/56045, author="Saboor, Sundas and Medina, Adrian and Marciano, Laura", title="Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials", journal="JMIR Ment Health", year="2024", month="Aug", day="14", volume="11", pages="e56045", keywords="positive psychology", keywords="digital interventions", keywords="ill-being", keywords="well-being", keywords="systematic review", keywords="meta-analysis", keywords="smartphone", keywords="mobile phone", abstract="Background: The rising prevalence of mental health issues in children, adolescents, and young adults has become an escalating public health issue, impacting approximately 10\%-20\% of young people on a global scale. Positive psychology interventions (PPIs) can act as powerful mental health promotion tools to reach wide-ranging audiences that might otherwise be challenging to access. This increased access would enable prevention of mental disorders and promotion of widespread well-being by enhancing self-efficacy, thereby supporting the achievement of tangible objectives. Objective: We aimed to conduct a comprehensive synthesis of all randomized controlled trials and controlled trials involving children, adolescents, and young adults, encompassing both clinical and nonclinical populations, to comprehensively evaluate the effectiveness of digital PPIs in this age group. Methods: After a literature search in 9 electronic databases until January 12, 2023, and gray literature until April 2023, we carried out a systematic review of 35 articles, of which 18 (51\%) provided data for the meta-analysis. We included randomized controlled trials and controlled trials mainly based on web-based, digital, or smartphone-based interventions using a positive psychology framework as the main component. Studies included participants with a mean age of <35 years. Outcomes of PPIs were classified into indicators of well-being (compassion, life satisfaction, optimism, happiness, resilience, emotion regulation and emotion awareness, hope, mindfulness, purpose, quality of life, gratitude, empathy, forgiveness, motivation, and kindness) and ill-being (depression, anxiety, stress, loneliness, and burnout). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the selection of studies and data extraction. Quality assessment was performed following the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results: For well-being outcomes, meta-analytic results showed that PPIs augmented the feeling of purpose, gratitude, and hope (Hedges g=0.555), compassion (Hedges g=0.447), positive coping behaviors (Hedges g=0.421), body image--related outcomes (Hedges g=0.238), and positive mindset predisposition (Hedges g=0.304). For ill-being outcomes, PPIs reduced cognitive biases (Hedges g=--0.637), negative emotions and mood (Hedges g=--0.369), and stress levels (Hedges g=--0.342). Of note, larger effect sizes were found when a waiting list control group was considered versus a digital control group. A funnel plot showed no publication bias. Meta-regression analyses showed that PPIs tended to show a larger effect size on well-being outcomes in studies including young adults, whereas no specific effect was found for ill-being outcomes. Conclusions: Revised evidence suggests that PPIs benefit young people's well-being and mitigate ill-being symptoms. Digital platforms offer a unique way to address their mental health challenges, although not without limitations. Future research should explore how they work for the needs of the young population and further examine what specific PPIs or combination of interventions is most beneficial with respect to other digital control groups. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023420092; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=420092 ", doi="10.2196/56045", url="https://mental.jmir.org/2024/1/e56045" } @Article{info:doi/10.2196/46823, author="Chiang, Byron and Law, Wa Yik and Yip, Fai Paul Siu", title="Using Discrete-Event Simulation to Model Web-Based Crisis Counseling Service Operation: Evaluation Study", journal="JMIR Form Res", year="2024", month="Aug", day="7", volume="8", pages="e46823", keywords="discrete-event simulation", keywords="community operational research", keywords="queuing", keywords="web-based counseling", keywords="service management", keywords="repeat users", abstract="Background: According to the Organisation for Economic Co-operation and Development, its member states experienced worsening mental health during the COVID-19 pandemic, leading to an increase of 60\% to 1000\% in digital counseling access. Hong Kong, too, witnessed a surge in demand for crisis intervention services during the pandemic, attracting both nonrepeat and repeat service users during the process. As a result of the continuing demand, platforms offering short-term emotional support are facing an efficiency challenge in managing caller responses. Objective: This aim of this paper was to assess the queuing performance of a 24-hour text-based web-based crisis counseling platform using a Python-based discrete-event simulation (DES) model. The model evaluates the staff combinations needed to meet demand and informs service priority decisions. It is able to account for unbalanced and overlapping shifts, unequal simultaneous serving capacities among custom worker types, time-dependent user arrivals, and the influence of user type (nonrepeat users vs repeat users) and suicide risk on service durations. Methods: Use and queue statistics by user type and staffing conditions were tabulated from past counseling platform database records. After calculating the data distributions, key parameters were incorporated into the DES model to determine the supply-demand equilibrium and identify potential service bottlenecks. An unobserved-components time-series model was fitted to make 30-day forecasts of the arrival rate, with the results piped back to the DES model to estimate the number of workers needed to staff each work shift, as well as the number of repeat service users encountered during a service operation. Results: The results showed a marked increase (from 3401/9202, 36.96\% to 5042/9199, 54.81\%) in the overall conversion rate after the strategic deployment of human resources according to the values set in the simulations, with an 85\% chance of queuing users receiving counseling service within 10 minutes and releasing an extra 39.57\% (3631/9175) capacity to serve nonrepeat users at potential risk. Conclusions: By exploiting scientifically informed data models with DES, nonprofit web-based counseling platforms, even those with limited resources, can optimize service capacity strategically to manage service bottlenecks and increase service uptake. ", doi="10.2196/46823", url="https://formative.jmir.org/2024/1/e46823" } @Article{info:doi/10.2196/57082, author="Rouvere, Julien and Blanchard, E. Brittany and Johnson, Morgan and Griffith Fillipo, Isabell and Mosser, Brittany and Romanelli, Meghan and Nguyen, Theresa and Rushton, Kevin and Marion, John and Althoff, Tim and Are{\'a}n, A. Patricia and Pullmann, D. Michael", title="Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="7", volume="11", pages="e57082", keywords="Health Action Process Approach (HAPA)", keywords="digital health", keywords="health behavior", keywords="Mental Health America (MHA)", keywords="digital mental health engagement", keywords="mental health website", abstract="Background: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. Objective: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. Methods: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). Results: Participants chose to engage with the MHA website in 94.3\% (15,161/16,078) of the sessions. Perceived need ($\beta$=.66; P<.001), outcome expectancies ($\beta$=.49; P<.001), self-efficacy ($\beta$=.44; P<.001), and perceived risk ($\beta$=.17-.18; P<.001) significantly predicted intention, and intention ($\beta$=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage ($\beta$=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant ($\beta$=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1\% and 1.4\% of the variance in choice to engage and level of engagement, respectively. Conclusions: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement. ", doi="10.2196/57082", url="https://humanfactors.jmir.org/2024/1/e57082" } @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/10.2196/53980, author="Villarreal-Zegarra, David and Garc{\'i}a-Serna, Jackeline and Segovia-Bacilio, Piero and Mayo-Puchoc, Nikol and Navarro-Flores, Alba and Huarcaya-Victoria, Jeff", title="In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic", journal="JMIR Ment Health", year="2024", month="Jul", day="8", volume="11", pages="e53980", keywords="health care utilization", keywords="mental health use", keywords="COVID-19", keywords="mental health", keywords="health care", keywords="psychiatric care", keywords="teleconsultation", keywords="hospital", keywords="Peru", keywords="chronic", keywords="patient", keywords="patients", keywords="telemonitoring", abstract="Background: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world's highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. Objective: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. Methods: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (?0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. Results: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80\%) of the samples. Only 345,605/1,515,439 (22.81\%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. Conclusions: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users. ", doi="10.2196/53980", url="https://mental.jmir.org/2024/1/e53980", url="http://www.ncbi.nlm.nih.gov/pubmed/38976320" } @Article{info:doi/10.2196/53233, author="Turuba, Roxanne and Cormier, Willow and Zimmerman, Rae and Ow, Nikki and Zenone, Marco and Quintana, Yuri and Jenkins, Emily and Ben-David, Shelly and Raimundo, Alicia and Marcon, R. Alessandro and Mathias, Steve and Henderson, Jo and Barbic, Skye", title="Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth", journal="JMIR Infodemiology", year="2024", month="Jul", day="5", volume="4", pages="e53233", keywords="youth", keywords="adolescents", keywords="young adults", keywords="mental health", keywords="TikTok", keywords="social media", keywords="qualitative research", abstract="Background: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. Objective: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. Methods: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. Results: A total of 3 overarching themes were identified describing youth's experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. Conclusions: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online. ", doi="10.2196/53233", url="https://infodemiology.jmir.org/2024/1/e53233", url="http://www.ncbi.nlm.nih.gov/pubmed/38967966" } @Article{info:doi/10.2196/49431, author="Welsh, T. Ellen and McIntosh, E. Jennifer and Vuong, An and Cloud, G. Zoe C. and Hartley, Eliza and Boyd, H. James", title="Design of Digital Mental Health Platforms for Family Member Cocompletion: Scoping Review", journal="J Med Internet Res", year="2024", month="Jul", day="3", volume="26", pages="e49431", keywords="family therapy", keywords="family", keywords="couples", keywords="eHealth", keywords="digital health", keywords="platform", keywords="platforms", keywords="e--mental health", keywords="internet interventions", keywords="psychosocial interventions", keywords="psychosocial", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="scoping", keywords="mental health", keywords="utility", keywords="design", keywords="family caregiver", keywords="caregiver", keywords="parent", keywords="child", keywords="development", keywords="cocompletion", keywords="access", keywords="accessibility", keywords="engagement", keywords="families", keywords="dyad", keywords="dyadic", keywords="user engagement", keywords="user experience", keywords="mobile phone", abstract="Background: The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together. Objective: As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families. Methods: A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented. Results: Of the 9527 papers reviewed, 85 (0.89\%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver--care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself. Conclusions: In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation. ", doi="10.2196/49431", url="https://www.jmir.org/2024/1/e49431" } @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/10.2196/48298, 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/10.2196/55216, author="Mildrum Chana, Sof{\'i}a and {\'A}lvarez, Lorel{\'i} and Poe, Abigail and Bibriescas, Natashia and Wang, Hai Danny and DiFiglia, Stephanie and Azuero, Andr{\'e}s and Crowe, Michael and Puga, Frank", title="The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study", journal="JMIR Res Protoc", year="2024", month="Jun", day="13", volume="13", pages="e55216", keywords="dementia", keywords="caregivers", keywords="Hispanic", keywords="Latinx", keywords="mental health", keywords="daily diary", keywords="longitudinal", keywords="protocol", keywords="observational cohort study", keywords="cohort", keywords="Alzheimer's disease", keywords="Alzheimer", keywords="stress", keywords="burden", keywords="loneliness", keywords="well-being", abstract="Background: The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. Objective: The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for ``Nuestros D{\'i}as'' (Spanish for ``our days''), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. Methods: The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. Results: Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros D{\'i}as study, 78.9\% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4\%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. Conclusions: Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. International Registered Report Identifier (IRRID): DERR1-10.2196/55216 ", doi="10.2196/55216", url="https://www.researchprotocols.org/2024/1/e55216", url="http://www.ncbi.nlm.nih.gov/pubmed/38869929" } @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/10.2196/53976, author="Kabukye, K. Johnblack and Namagembe, Rosemary and Nakku, Juliet and Kiberu, Vincent and Sj{\"o}linder, Marie and Nilsson, Susanne and Wamala-Larsson, Caroline", title="Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach", journal="JMIR Hum Factors", year="2024", month="Jun", day="6", volume="11", pages="e53976", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="digital solution", keywords="digital solutions", keywords="digital intervention", keywords="digital interventions", keywords="mental health", keywords="awareness", keywords="Uganda", keywords="Africa", keywords="African", keywords="user centred", keywords="user centered", keywords="design", keywords="qualitative", keywords="focus group", keywords="focus groups", keywords="call centre", keywords="call centres", keywords="call center", keywords="call centers", keywords="mental", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="cocreated", keywords="cocreation", keywords="service", keywords="services", keywords="mobile phone", abstract="Background: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. Objective: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. Methods: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. Results: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24{\texttimes}7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7\%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4\%) calls stopped at the interactive voice response, 231 (64.7\%) calls were answered by call agents, and 22 (6.2\%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. Conclusions: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption. ", doi="10.2196/53976", url="https://humanfactors.jmir.org/2024/1/e53976", url="http://www.ncbi.nlm.nih.gov/pubmed/38843515" } @Article{info:doi/10.2196/53406, author="Sawyer, Chelsea and Carney, Rebekah and Hassan, Lamiece and Bucci, Sandra and Sainsbury, John and Lovell, Karina and Torous, John and Firth, Joseph", title="Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals", journal="JMIR Hum Factors", year="2024", month="Jun", day="5", volume="11", pages="e53406", keywords="digital health", keywords="behavior change", keywords="mental health care professionals", keywords="physical health", keywords="lifestyle intervention", keywords="qualitative", keywords="thematic analysis", keywords="service optimization", keywords="mobile phone", abstract="Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. ", doi="10.2196/53406", url="https://humanfactors.jmir.org/2024/1/e53406", url="http://www.ncbi.nlm.nih.gov/pubmed/38837191" } @Article{info:doi/10.2196/47546, author="Gonz{\'a}lez-Spinoglio, Leticia and Monistrol-Mula, Anna and Vindrola-Padros, Cecilia and Aguilar-Ortiz, Salvatore and Carreras, Bernat and Haro, Maria Josep and Felez-Nobrega, Mireia", title="Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study", journal="J Med Internet Res", year="2024", month="May", day="29", volume="26", pages="e47546", keywords="COVID-19 pandemic", keywords="digital technology", keywords="health care professionals", keywords="long-term care", keywords="mental health", keywords="well-being", keywords="digital mental health", keywords="digital mental health interventions", keywords="mobile phone", abstract="Background: The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. Objective: This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. Methods: We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. Results: The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. Conclusions: More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees' well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic. ", doi="10.2196/47546", url="https://www.jmir.org/2024/1/e47546", url="http://www.ncbi.nlm.nih.gov/pubmed/38809605" } @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/10.2196/56204, author="Chalker, A. Samantha and Serafez, Jesus and Imai, Yuki and Stinchcomb, Jeffrey and Mendez, Estefany and Depp, A. Colin and Twamley, W. Elizabeth and Fortuna, L. Karen and Goodman, Marianne and Chinman, Matthew", title="Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT) for US Veterans With Serious Mental Illness: Community Engagement Approach", journal="J Particip Med", year="2024", month="May", day="23", volume="16", pages="e56204", keywords="suicide prevention", keywords="advisor", keywords="veterans", keywords="recovery", keywords="community", keywords="peer specialist", keywords="peer support", keywords="serious mental illness", keywords="participatory design", keywords="community engagement", keywords="lived experience", abstract="Background: Peer specialists are hired, trained, and accredited to share their lived experience of psychiatric illness to support other similar individuals through the recovery process. There are limited data on the role of peer specialists in suicide prevention, including their role in intervention development. Objective: To better understand peer specialists within the Veterans Health Administration (VHA), we followed partnership community engagement and a formative research approach to intervention development to (1) identify barriers, facilitators, and perceptions of VHA peer specialists delivering a suicide prevention service and (2) develop and refine an intervention curriculum based on an evidence-informed preliminary intervention framework for veterans with serious mental illness (SMI). Methods: Following the community engagement approach, VHA local and national peer support and mental health leaders, veterans with SMI, and veteran peer specialists met to develop a preliminary intervention framework. Next, VHA peer specialist advisors (n=5) and scientific advisors (n=6) participated in respective advisory boards and met every 2-4 months for more than 18 months via videoconferencing to address study objectives. The process used was a reflexive thematic analysis after each advisory board meeting. Results: The themes discussed included (1) the desire for suicide prevention training for peer specialists, (2) determining the role of VHA peer specialists in suicide prevention, (3) integration of recovery themes in suicide prevention, and (4) difficulties using safety plans during a crisis. There were no discrepancies in thematic content between advisory boards. Advisor input led to the development of Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT). SUPPORT includes training in general suicide prevention and a peer specialist--delivered intervention for veterans with SMI at an increased suicide risk. This training aims to increase the competence and confidence of peer specialists in suicide prevention and the intervention supports veterans with SMI at an increased suicide risk through their recovery process. Conclusions: This paper intends to document the procedures taken in suicide prevention intervention development, specifically those led by peer specialists, and to be a source for future research developing and evaluating similar interventions. Trial Registration: ClinicalTrials.gov NCT05537376; https://classic.clinicaltrials.gov/ct2/show/NCT05537376 ", doi="10.2196/56204", url="https://jopm.jmir.org/2024/1/e56204", url="http://www.ncbi.nlm.nih.gov/pubmed/38781010" } @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/10.2196/55102, author="Zhao, Haiyan and Zhou, Ye and Che, Chin Chong and Chong, Chan Mei and Zheng, Yu and Hou, Yuzhu and Chen, Canjuan and Zhu, Yantao", title="Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="29", volume="13", pages="e55102", keywords="fear of cancer recurrence", keywords="dyadic coping ability", keywords="gastric cancer", keywords="intervention", keywords="nursing", keywords="protocol", keywords="psychological", keywords="marital self-disclosure", abstract="Background: Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the ``intimacy and relationship processes in couples' psychosocial adaptation'' model. Objective: The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses. Methods: This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People's Hospital will be assigned to an experimental group, while participants from Taizhou People's Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory. Results: Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024. Conclusions: This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled. Trial Registration: ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549 International Registered Report Identifier (IRRID): DERR1-10.2196/55102 ", doi="10.2196/55102", url="https://www.researchprotocols.org/2024/1/e55102", url="http://www.ncbi.nlm.nih.gov/pubmed/38684089" } @Article{info:doi/10.2196/54478, author="Lemmer, Diana and Moessner, Markus and Arnaud, Nicolas and Baumeister, Harald and Mutter, Agnes and Klemm, Sarah-Lena and K{\"o}nig, Elisa and Plener, Paul and Rummel-Kluge, Christine and Thomasius, Rainer and Kaess, Michael and Bauer, Stephanie", title="The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Apr", day="24", volume="26", pages="e54478", keywords="help seeking", keywords="mental health", keywords="stigma", keywords="mental health literacy", keywords="psychoeducation", keywords="web-based experiment", keywords="web-based randomized controlled trial", keywords="microinterventions", keywords="video-based interventions", abstract="Background: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. Objective: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. Methods: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25\%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. Results: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Conclusions: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. Trial Registration: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110 ", doi="10.2196/54478", url="https://www.jmir.org/2024/1/e54478", url="http://www.ncbi.nlm.nih.gov/pubmed/38656779" } @Article{info:doi/10.2196/46764, author="Soneson, Emma and Howarth, Emma and Weir, Alison and Jones, B. Peter and Fazel, Mina", title="Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="23", volume="26", pages="e46764", keywords="mental health", keywords="children", keywords="schools", keywords="teachers", keywords="training", keywords="digital intervention", keywords="pupil mental health", keywords="mental health training", keywords="intervention", keywords="empowerment", keywords="student", keywords="pupil", keywords="support", keywords="school staff", keywords="web-based training", abstract="Background: Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. Objective: We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health. Methods: We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. Results: A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4\%) completed T2 questionnaires, and 70 (64.8\%) completed T3 questionnaires; 54 (50\%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10\%; medianT2=10\%; medianT3=7.4\%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. Conclusions: The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support. ", doi="10.2196/46764", url="https://www.jmir.org/2024/1/e46764", url="http://www.ncbi.nlm.nih.gov/pubmed/38652534" } @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/10.2196/49780, author="Lorenzo-Luaces, Lorenzo and Wasil, Akash and Kacmarek, N. Corinne and DeRubeis, Robert", title="Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study", journal="JMIR Form Res", year="2024", month="Apr", day="11", volume="8", pages="e49780", keywords="digital mental health", keywords="ethnicity", keywords="health disparities", keywords="internet-based CBT", keywords="cognitive behavioral therapy", keywords="intervention", keywords="mental health", keywords="mental health care", keywords="race", keywords="therapy", abstract="Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants' willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one's income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. ", doi="10.2196/49780", url="https://formative.jmir.org/2024/1/e49780", url="http://www.ncbi.nlm.nih.gov/pubmed/38602769" } @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/10.2196/56002, 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/10.2196/45987, author="Eager, Sharon and Killaspy, Helen and C, Joanna and Mezey, Gillian and McPherson, Peter and Downey, Megan and Thompson, Georgina and Lloyd-Evans, Brynmor", title="A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study", journal="Interact J Med Res", year="2024", month="Mar", day="13", volume="13", pages="e45987", keywords="social inclusion", keywords="supported accommodation", keywords="mental health", keywords="digital health", keywords="care planning", abstract="Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through ``think-aloud'' testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10\% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. ", doi="10.2196/45987", url="https://www.i-jmr.org/2024/1/e45987", url="http://www.ncbi.nlm.nih.gov/pubmed/38477978" } @Article{info:doi/10.2196/48894, author="Worthington, A. Michelle and Christie, H. Richard and Masino, J. Aaron and Kark, M. Sarah", title="Identifying Unmet Needs in Major Depressive Disorder Using a Computer-Assisted Alternative to Conventional Thematic Analysis: Qualitative Interview Study With Psychiatrists", journal="JMIR Form Res", year="2024", month="Mar", day="1", volume="8", pages="e48894", keywords="consumer health informatics", keywords="interview", keywords="major depressive disorder", keywords="medical informatics applications", keywords="needs assessment", keywords="psychiatry and psychology", abstract="Background: The development of digital health tools that are clinically relevant requires a deep understanding of the unmet needs of stakeholders, such as clinicians and patients. One way to reveal unforeseen stakeholder needs is through qualitative research, including stakeholder interviews. However, conventional qualitative data analytical approaches are time-consuming and resource-intensive, rendering them untenable in many industry settings where digital tools are conceived of and developed. Thus, a more time-efficient process for identifying clinically relevant target needs for digital tool development is needed. Objective: The objective of this study was to address the need for an accessible, simple, and time-efficient alternative to conventional thematic analysis of qualitative research data through text analysis of semistructured interview transcripts. In addition, we sought to identify important themes across expert psychiatrist advisor interview transcripts to efficiently reveal areas for the development of digital tools that target unmet clinical needs. Methods: We conducted 10 (1-hour-long) semistructured interviews with US-based psychiatrists treating major depressive disorder. The interviews were conducted using an interview guide that comprised open-ended questions predesigned to (1) understand the clinicians' experience of the care management process and (2) understand the clinicians' perceptions of the patients' experience of the care management process. We then implemented a hybrid analytical approach that combines computer-assisted text analyses with deductive analyses as an alternative to conventional qualitative thematic analysis to identify word combination frequencies, content categories, and broad themes characterizing unmet needs in the care management process. Results: Using this hybrid computer-assisted analytical approach, we were able to identify several key areas that are of interest to clinicians in the context of major depressive disorder and would be appropriate targets for digital tool development. Conclusions: A hybrid approach to qualitative research combining computer-assisted techniques with deductive techniques provides a time-efficient approach to identifying unmet needs, targets, and relevant themes to inform digital tool development. This can increase the likelihood that useful and practical tools are built and implemented to ultimately improve health outcomes for patients. ", doi="10.2196/48894", url="https://formative.jmir.org/2024/1/e48894", url="http://www.ncbi.nlm.nih.gov/pubmed/38427407" } @Article{info:doi/10.2196/49110, author="Milton, Alyssa and Ozols A?M, Ingrid and Cassidy, Tayla and Jordan, Dana and Brown, Ellie and Arnautovska, Urska and Cook, Jim and Phung, Darren and Lloyd-Evans, Brynmor and Johnson, Sonia and Hickie, Ian and Glozier, Nick", title="Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study", journal="JMIR Form Res", year="2024", month="Feb", day="23", volume="8", pages="e49110", keywords="self-management", keywords="serious mental illness", keywords="self-care", keywords="digital health tools", keywords="blended interventions", keywords="peer support", keywords="mobile phone", abstract="Background: Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. Objective: This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. Methods: This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ?18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. Results: The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals' unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. Conclusions: There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step. ", doi="10.2196/49110", url="https://formative.jmir.org/2024/1/e49110", url="http://www.ncbi.nlm.nih.gov/pubmed/38393768" } @Article{info:doi/10.2196/49317, author="Haack, M. Lauren and Armstrong, C. Courtney and Travis, Kate and Aguilera, Adrian and Darrow, M. Sabrina", title="HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let's Text!): Pilot Feasibility and Acceptability Study", journal="JMIR Ment Health", year="2024", month="Feb", day="19", volume="11", pages="e49317", keywords="depression", keywords="adolescents", keywords="evidence-based intervention", keywords="texting", keywords="SMS text message", keywords="cognitive behavioral therapy", keywords="CBT", keywords="group CBT", keywords="shelter-in-place", keywords="COVID-19", keywords="mobile health", keywords="mHealth", keywords="therapy", keywords="cognitive", keywords="behavior", keywords="web-based therapy", keywords="e-therapy", keywords="youth", keywords="young adults", keywords="mobile phone", abstract="Background: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants' texts. Objective: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system's impact on adolescents' group CBT engagement and, ultimately, depression outcomes. Methods: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85\%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. Results: All (n=17, 100\%) research participants invited agreed to receive HealthySMS messages, and 94\% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. Conclusions: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants' qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research. ", doi="10.2196/49317", url="https://mental.jmir.org/2024/1/e49317", url="http://www.ncbi.nlm.nih.gov/pubmed/38373030" } @Article{info:doi/10.2196/48182, author="Fran{\c{c}}ois, Julien and Audrain-Pontevia, Anne-Fran{\c{c}}oise and Boudhra{\^a}, Sana and Vial, St{\'e}phane", title="Assessing the Influence of Patient Empowerment Gained Through Mental Health Apps on Patient Trust in the Health Care Provider and Patient Compliance With the Recommended Treatment: Cross-sectional Study", journal="J Med Internet Res", year="2024", month="Feb", day="12", volume="26", pages="e48182", keywords="patient empowerment", keywords="patient compliance", keywords="patient trust", keywords="mental health app", keywords="mental health", abstract="Background: In chronic mental illness, noncompliance with treatment significantly worsens the illness course and outcomes for patients. Considering that nearly 1 billion people worldwide experience mental health issues, including 1 of 5 Canadians in any given year, finding tools to lower noncompliance in these populations is critical for health care systems. A promising avenue is apps that make mental health services more accessible to patients. However, little is known regarding the impact of the empowerment gained from mental health apps on patient compliance with recommended treatment. Objective: This study aimed to investigate the impact of patient empowerment gained through mental health apps on patient trust in the health care provider and patient compliance with the recommended treatment. Methods: A cross-sectional web-based survey was conducted in Canada. Eligible participants were Canadian adults diagnosed with chronic mental health disorders who were using at least one of the following apps: Dialogue, MindBeacon, Deprexis, Ginger, Talkspace, BetterHelp, MindStrong, Mindshift, Bloom, Headspace, and Calm. A total of 347 valid questionnaires were collected and analyzed using partial least-squares structural equation modeling. Trust in the health care provider and patient compliance were measured with multiple-item scales adapted from existing scales. Patient empowerment was conceived and measured as a higher-order construct encompassing the following 2 dimensions: patient process and patient outcome. All the items contributing to the constructs in the model were measured with 7-point Likert scales. The reliability and validity of the measurement model were assessed, and the path coefficients of the structural model were estimated. Results: The results clearly show that patient empowerment gained through mental health apps positively influenced patient trust in the health care provider ($\beta$=.306; P<.001). Patient trust in the health care provider had a positive effect on patient compliance ($\beta$=.725; P<.001). The direct relationship between patient empowerment and patient compliance was not significant ($\beta$=.061, P=.23). Interestingly, the data highlight that the effect of patient empowerment on patient compliance was fully mediated by trust in the health care provider ($\beta$=.222; P<.001). The results show that patient empowerment gained through the mental health app involves 2 dimensions: a process and an outcome. Conclusions: This study shows that for individuals living with mental health disorders, empowerment gained through mental health apps enhances trust in the health care provider. It reveals that patient empowerment impacts patient compliance but only through the full mediating effect of patient trust in the health care provider, indicating that patient trust is a critical variable to enhance patient compliance. Hence, our results confirm that health care systems could encourage the use of mental health apps to favor a climate that facilitates patients' trust in health care provider recommendations, possibly leading to better compliance with the recommended treatment. ", doi="10.2196/48182", url="https://www.jmir.org/2024/1/e48182", url="http://www.ncbi.nlm.nih.gov/pubmed/38345851" } @Article{info:doi/10.2196/51704, author="Jagayat, Kaur Jasleen and Kumar, Anchan and Shao, Yijia and Pannu, Amrita and Patel, Charmy and Shirazi, Amirhossein and Omrani, Mohsen and Alavi, Nazanin", title="Incorporating a Stepped Care Approach Into Internet-Based Cognitive Behavioral Therapy for Depression: Randomized Controlled Trial", journal="JMIR Ment Health", year="2024", month="Feb", day="9", volume="11", pages="e51704", keywords="internet-based cognitive behavioral therapy", keywords="i-CBT", keywords="major depressive disorder", keywords="MDD", keywords="stepped care", keywords="digital mental health care", keywords="mobile phone", abstract="Background: Depression is a hidden burden, yet it is a leading cause of disability worldwide. Despite the adverse effects of depression, fewer than one-third of patients receive care. Internet-based cognitive behavioral therapy (i-CBT) is an effective treatment for depression, and combining i-CBT with supervised care could make the therapy scalable and effective. A stepped care model is a framework for beginning treatment with an effective and low-intensity intervention while adapting care based on the patient's needs. Objective: This study investigated the efficacy of a stepped care i-CBT model for depression based on changes in self-reported depressive symptoms. Methods: In this single-blinded, randomized controlled trial, participants were allocated to either the i-CBT--only group (28/56, 50\%) or the i-CBT with stepped care group (28/56, 50\%). Both groups received a 13-week i-CBT program tailored for depression. The i-CBT program was provided through a secure, online mental health clinic called the Online Psychotherapy Tool. Participants read through the sessions and completed the assignments related to each session. Participants in the stepped care group received additional interventions from their care provider based on standard questionnaire scores (ie, Patient Health Questionnaire--9 [PHQ-9], Quick Inventory of Depressive Symptomatology [QIDS], and Quality of Life Enjoyment and Satisfaction Questionnaire--Short Form) and their assignment responses. From lowest to highest intensity, the additional interventions included SMS text messages, phone calls, video calls, or a video call with a psychiatrist. Results: For this study, 56 participants were recruited to complete an i-CBT program (n=28, 50\%; mean age 37.9; SD 13.08 y; 7/28, 27\% were men) or an i-CBT with stepped care program (n=28, 50\%; mean age 40.6; SD 14.28 y; 11/28, 42\% were men). The results of this study indicate that the i-CBT program was effective in significantly reducing depressive symptoms, as measured by the PHQ-9 (F4,80=9.95; P<.001) and QIDS (F2,28=5.73; P=.008); however, there were no significant differences in the reduction of depressive symptoms between the 2 groups (PHQ-9: F4,80=0.43; P=.78; QIDS: F2,28=3.05; P=.06). The stepped care group was not significantly better in reducing depressive symptoms than the i-CBT group (PHQ-9, P=.79; QIDS, P=.06). Although there were no significant differences observed between the number of participants who completed the program between the groups ($\chi$21=2.6; P=.10), participants in the stepped care group, on average, participated in more sessions than those who prematurely terminated participation in the i-CBT group (t55=?2; P=.03; 95\% CI --4.83 to --0.002). Conclusions: Implementing a stepped care approach in i-CBT is an effective treatment for depression, and the stepped care model can assist patients to complete more sessions in their treatment. Trial Registration: Clinicaltrials.gov NCT04747873; https://clinicaltrials.gov/study/NCT04747873 ", doi="10.2196/51704", url="https://mental.jmir.org/2024/1/e51704", url="http://www.ncbi.nlm.nih.gov/pubmed/38173167" } @Article{info:doi/10.2196/46746, author="Burke, Colin and Triplett, Cynthia and Rubanovich, Kseniya Caryn and Karnaze, M. Melissa and Bloss, S. Cinnamon", title="Attitudes Toward School-Based Surveillance of Adolescents' Social Media Activity: Convergent Parallel Mixed Methods Survey", journal="JMIR Form Res", year="2024", month="Feb", day="6", volume="8", pages="e46746", keywords="social media", keywords="surveillance", keywords="privacy", keywords="public health", keywords="students", keywords="schools", keywords="social media monitoring", keywords="SMM", keywords="school safety", keywords="mental health", keywords="adolescents", abstract="Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults' overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. ", doi="10.2196/46746", url="https://formative.jmir.org/2024/1/e46746", url="http://www.ncbi.nlm.nih.gov/pubmed/38319696" } @Article{info:doi/10.2196/46637, author="Fischer-Grote, Linda and F{\"o}ssing, Vera and Aigner, Martin and Fehrmann, Elisabeth and Boeckle, Markus", title="Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis", journal="JMIR Ment Health", year="2024", month="Feb", day="5", volume="11", pages="e46637", keywords="COVID-19 pandemic", keywords="online/digital mental health intervention", keywords="e-mental health", keywords="anxiety", keywords="social functioning", keywords="depression", keywords="well-being", keywords="psychological distress", keywords="eating disorder", keywords="COVID-19 symptoms", abstract="Background: The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. Objective: This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. Methods: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. Results: We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95\% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95\% CI --0.68 to --0.17) and a large significant effect for depression (SMD=1.31, 95\% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19--related symptoms were found. Conclusions: The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required. ", doi="10.2196/46637", url="https://mental.jmir.org/2024/1/e46637", url="http://www.ncbi.nlm.nih.gov/pubmed/38315524" } @Article{info:doi/10.2196/48008, author="Moll, Jonas and Myreteg, Gunilla and Rexhepi, Hanife", title="Experiences of Patients With Mental Health Issues Having Web-Based Access to Their Records: National Patient Survey", journal="JMIR Ment Health", year="2024", month="Feb", day="2", volume="11", pages="e48008", keywords="patient accessible electronic health record", keywords="patient portal", keywords="patient experiences", keywords="mental health", keywords="eHealth", keywords="national survey", keywords="digital mental health", keywords="digital health", abstract="Background: Sharing mental health notes through patient accessible electronic health records (PAEHRs) is controversial. Many psychiatric organizations and regions in Sweden have resisted the implementation, as clinicians worry about possible harms when patients are reading their notes. Despite the documented benefits of PAEHRs, there is still a lack of knowledge regarding whether patients with mental health issues could reap similar benefits of reading their notes as other patient groups. Objective: The aim of the study is to examine the use, attitudes, and experiences of patients with mental health issues by reading their notes in the PAEHR and, moreover, whether their experiences differ from other patient groups, and if so, how. Methods: A national patient survey was conducted with answers from 2587 patients from different patient groups. In total, 504 respondents (19.5\%) indicated that they experienced a mental health disease. Answers from this patient group were compared to the answers from all other respondents. Survey questions related to attitudes, information usage, and effects on contacts with care were selected for analysis. Mann-Whitney U tests were used to detect groupwise differences. Results: Patients with mental health issues use PAEHRs for checking that they have received the right care (mean\_mental health 2.83, SD\_mental health 1.39; mean\_others 2.62, SD\_others 1.37; P=.002) or suspected inaccuracies (mean\_mental health 2.55, SD\_mental health 1.34; mean\_others 2.31, SD\_others 1.30; P=.001), blocking access for professionals in other specialties (mean\_mental health 3.43, SD\_mental health 1.46; mean\_others 3.04, SD\_others 1.42; P<.001), and checking which care professionals have accessed their record (mean\_mental health 4.28, SD\_mental health 1.14; mean\_others 4.05, SD\_others 1.25; P<.001) to a significantly higher degree than other patients. On the other hand, the results show that a significantly lower proportion of patients with mental health issues (mean\_mental health 3.38, SD\_mental health 1.21; mean\_others 3.52, SD\_others 1.18; P=.02) believe that PAEHRs help them in shared decision-making compared to other patient groups. Conclusions: Patients with mental health issues who took part in the survey, as a group, express some minor differences in both the use of the PAEHR and their experiences regarding its usefulness, as compared to other patients, as a group. This patient group shows a slightly higher interest in 2 types of use: checking for accuracy of care in the record and blocking access to mental health notes for professionals from other parts of the health care system. Compared to other patient groups, these patients are less likely to experience that the PAEHR is a support in shared decision-making. The study indicates that the benefits of PAEHR on a general level are the same for this patient group as for other patients. The study does not support clinicians' worry about possible harm to this patient group. Further research is however needed. ", doi="10.2196/48008", url="https://mental.jmir.org/2024/1/e48008", url="http://www.ncbi.nlm.nih.gov/pubmed/38306158" } @Article{info:doi/10.2196/48880, author="Schr{\"o}der, Sonja and Buntrock, Claudia and Neumann, Louisa and M{\"u}ller, L. J{\"u}rgen and Fromberger, Peter", title="Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jan", day="26", volume="8", pages="e48880", keywords="mHealth", keywords="web-based intervention", keywords="acceptance", keywords="Unified Theory of Acceptance and Use of Technology", keywords="UTAUT", keywords="sexual offenses against children", keywords="child abuse", keywords="child pornography", keywords="children", keywords="sexual offense", keywords="cross-sectional study", keywords="community", keywords="anxiety", keywords="psychiatry", abstract="Background: Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown. Objective: For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry. Methods: This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline. Results: Most participants (61.1\%, 69/113), reported high acceptance, while 36.3\% (41/113) of them indicated moderate acceptance, and 2.7\% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2\% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95\% CI 0.16-0.64; P=.001) and SI (B=0.183, 95\% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants' belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect. Conclusions: For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants' attitudes toward web-based interventions were important in predicting acceptance. Trial Registration: German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256 ", doi="10.2196/48880", url="https://formative.jmir.org/2024/1/e48880", url="http://www.ncbi.nlm.nih.gov/pubmed/38277200" } @Article{info:doi/10.2196/46941, author="Messina, Anna and Amati, Rebecca and Annoni, Maria Anna and Bano, Beatrice and Albanese, Emiliano and Fiordelli, Maddalena", title="Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach", journal="JMIR Form Res", year="2024", month="Jan", day="24", volume="8", pages="e46941", keywords="informal caregivers", keywords="iSupport", keywords="dementia", keywords="digital interventions", keywords="mHealth", keywords="community-based participatory research", keywords="community", keywords="caregiver", keywords="mental distress", keywords="physical distress", keywords="support", keywords="development", abstract="Background: Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Objective: Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. Methods: We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. Results: The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from ``lesson'' to ``chapter'' and from ``suffering from'' dementia to ``affected by'' dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Conclusions: Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context. ", doi="10.2196/46941", url="https://formative.jmir.org/2024/1/e46941", url="http://www.ncbi.nlm.nih.gov/pubmed/38265857" } @Article{info:doi/10.2196/49577, author="Rogan, Jessica and Bucci, Sandra and Firth, Joseph", title="Health Care Professionals' Views on the Use of Passive Sensing, AI, and Machine Learning in Mental Health Care: Systematic Review With Meta-Synthesis", journal="JMIR Ment Health", year="2024", month="Jan", day="23", volume="11", pages="e49577", keywords="artificial intelligence", keywords="machine learning", keywords="passive sensing", keywords="mental health care", keywords="clinicians", keywords="views", keywords="meta-synthesis", keywords="review", keywords="mental health", keywords="health care", keywords="health care professionals", keywords="psychology", keywords="psychiatry", keywords="mental health professionals", keywords="mobile phone", abstract="Background: Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential barriers to and facilitators of their implementation. Objective: This study aims to review, critically appraise, and synthesize qualitative findings relating to the views of mental health care professionals on the use of passive sensing and AI in mental health care. Methods: A systematic search of qualitative studies was performed using 4 databases. A meta-synthesis approach was used, whereby studies were analyzed using an inductive thematic analysis approach within a critical realist epistemological framework. Results: Overall, 10 studies met the eligibility criteria. The 3 main themes were uses of passive sensing and AI in clinical practice, barriers to and facilitators of use in practice, and consequences for service users. A total of 5 subthemes were identified: barriers, facilitators, empowerment, risk to well-being, and data privacy and protection issues. Conclusions: Although clinicians are open-minded about the use of passive sensing and AI in mental health care, important factors to consider are service user well-being, clinician workloads, and therapeutic relationships. Service users and clinicians must be involved in the development of digital technologies and systems to ensure ease of use. The development of, and training in, clear policies and guidelines on the use of passive sensing and AI in mental health care, including risk management and data security procedures, will also be key to facilitating clinician engagement. The means for clinicians and service users to provide feedback on how the use of passive sensing and AI in practice is being received should also be considered. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022331698; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=331698 ", doi="10.2196/49577", url="https://mental.jmir.org/2024/1/e49577", url="http://www.ncbi.nlm.nih.gov/pubmed/38261403" } @Article{info:doi/10.2196/48945, author="Calear, L. Alison and Batterham, J. Philip and McCallum, M. Sonia and Banfield, Michelle and Moore, Elizabeth and Johnson, Natalie and Morse, R. Alyssa", title="Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study", journal="JMIR Form Res", year="2024", month="Jan", day="18", volume="8", pages="e48945", keywords="mental health services", keywords="youth", keywords="navigation tool", keywords="mental health", keywords="website", keywords="user experience", keywords="design", keywords="service", keywords="services", keywords="access", keywords="accessibility", keywords="health care system", abstract="Background: Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. Objective: This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. Methods: A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. Results: A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. Conclusions: This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support. ", doi="10.2196/48945", url="https://formative.jmir.org/2024/1/e48945", url="http://www.ncbi.nlm.nih.gov/pubmed/38236625" } @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/10.2196/50222, author="H{\o}gsdal, Helene and Kyrrestad, Henriette and Rye, Marte and Kaiser, Sabine", title="Exploring Adolescents' Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Jan", day="15", volume="8", pages="e50222", keywords="mental health applications", keywords="mental health", keywords="adolescents", keywords="adolescent", keywords="youth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="opinion", keywords="opinions", keywords="cross sectional", keywords="survey", keywords="surveys", keywords="questionnaire", abstract="Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents' attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, ``What do you think about mental health apps in general?''). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30\% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1\%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3\%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8\%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5\%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. ", doi="10.2196/50222", url="https://formative.jmir.org/2024/1/e50222", url="http://www.ncbi.nlm.nih.gov/pubmed/38224474" } @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/10.2196/45905, author="Leo, P. Hannah and Folk, B. Johanna and Rodriguez, Christopher and Tolou-Shams, Marina", title="Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals", journal="JMIR Form Res", year="2023", month="Dec", day="29", volume="7", pages="e45905", keywords="foster youth", keywords="telehealth", keywords="family-based interventions", keywords="mental health", abstract="Background: Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. Objective: This study aims to understand child welfare system professionals' perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. Methods: This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. Results: Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68\%), White individuals (n=10, 53\%), and social workers (n=8, 42\%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. Conclusions: Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin. ", doi="10.2196/45905", url="https://formative.jmir.org/2023/1/e45905", url="http://www.ncbi.nlm.nih.gov/pubmed/38157238" } @Article{info:doi/10.2196/52901, author="Smith, A. Katharine and Ostinelli, G. Edoardo and Ede, Roger and Allard, Lisa and Thomson, Michaela and Hewitt, Kiran and Brown, Petra and Zangani, Caroline and Jenkins, Matthew and Hinze, Verena and Ma, George and Pothulu, Prajnesh and Henshall, Catherine and Malhi, S. Gin and Every-Palmer, Susanna and Cipriani, Andrea", title="Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation", journal="JMIR Ment Health", year="2023", month="Dec", day="22", volume="10", pages="e52901", keywords="evidence synthesis", keywords="guidelines", keywords="mental health", keywords="systematic review", keywords="focus group", keywords="survey", keywords="COVID-19", keywords="pandemic", keywords="digital health", keywords="eHealth", keywords="mobile phone", abstract="Background: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. Objective: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. Methods: The impact and clinical utility of the OxPPL guidance were assessed using clinicians' feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. Results: Overall, 80.2\% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1\% (133/182) stated that the guidance was relevant to their service, 59.3\% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9\% (78/182) that they had shared or would share the guidance, and 80.2\% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. Conclusions: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates. ", doi="10.2196/52901", url="https://mental.jmir.org/2023/1/e52901", url="http://www.ncbi.nlm.nih.gov/pubmed/38133912" } @Article{info:doi/10.2196/49243, author="Rioux, Charlie and Fulp, C. Delaney and Haley, N. Parker and LaBelle, L. Jenna and Aasted, E. Mary and Lambert, K. Kasie and Donohue, T. Madison and Mafu, T. Nkatheko", title="Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study", journal="JMIR Res Protoc", year="2023", month="Dec", day="6", volume="12", pages="e49243", keywords="anxiety", keywords="biological sensitivity to context", keywords="depression", keywords="diathesis-stress", keywords="highly sensitive person", keywords="moderation", keywords="resilience", keywords="sensory processing reactivity", keywords="substance use", keywords="vantage sensitivity", abstract="Background: Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy. Objective: The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses. Methods: We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson. Results: The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months. Conclusions: The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals. International Registered Report Identifier (IRRID): PRR1-10.2196/49243 ", doi="10.2196/49243", url="https://www.researchprotocols.org/2023/1/e49243", url="http://www.ncbi.nlm.nih.gov/pubmed/38055312" } @Article{info:doi/10.2196/49074, author="Kim, Seoyun and Cha, Junyeop and Kim, Dongjae and Park, Eunil", title="Understanding Mental Health Issues in Different Subdomains of Social Networking Services: Computational Analysis of Text-Based Reddit Posts", journal="J Med Internet Res", year="2023", month="Nov", day="30", volume="25", pages="e49074", keywords="mental health", keywords="sentiment analysis", keywords="mental disorder", keywords="text analysis", keywords="NLP", keywords="natural language processing", keywords="clustering", abstract="Background: Users increasingly use social networking services (SNSs) to share their feelings and emotions. For those with mental disorders, SNSs can also be used to seek advice on mental health issues. One available SNS is Reddit, in which users can freely discuss such matters on relevant health diagnostic subreddits. Objective: In this study, we analyzed the distinctive linguistic characteristics in users' posts on specific mental disorder subreddits (depression, anxiety, bipolar disorder, borderline personality disorder, schizophrenia, autism, and mental health) and further validated their distinctiveness externally by comparing them with posts of subreddits not related to mental illness. We also confirmed that these differences in linguistic formulations can be learned through a machine learning process. Methods: Reddit posts uploaded by users were collected for our research. We used various statistical analysis methods in Linguistic Inquiry and Word Count (LIWC) software, including 1-way ANOVA and subsequent post hoc tests, to see sentiment differences in various lexical features within mental health--related subreddits and against unrelated ones. We also applied 3 supervised and unsupervised clustering methods for both cases after extracting textual features from posts on each subreddit using bidirectional encoder representations from transformers (BERT) to ensure that our data set is suitable for further machine learning or deep learning tasks. Results: We collected 3,133,509 posts of 919,722 Reddit users. The results using the data indicated that there are notable linguistic differences among the subreddits, consistent with the findings of prior research. The findings from LIWC analyses revealed that patients with each mental health issue show significantly different lexical and semantic patterns, such as word count or emotion, throughout their online social networking activities, with P<.001 for all cases. Furthermore, distinctive features of each subreddit group were successfully identified through supervised and unsupervised clustering methods, using the BERT embeddings extracted from textual posts. This distinctiveness was reflected in the Davies-Bouldin scores ranging from 0.222 to 0.397 and the silhouette scores ranging from 0.639 to 0.803 in the former case, with scores of 1.638 and 0.729, respectively, in the latter case. Conclusions: By taking a multifaceted approach, analyzing textual posts related to mental health issues using statistical, natural language processing, and machine learning techniques, our approach provides insights into aspects of recent lexical usage and information about the linguistic characteristics of patients with specific mental health issues, which can inform clinicians about patients' mental health in diagnostic terms to aid online intervention. Our findings can further promote research areas involving linguistic analysis and machine learning approaches for patients with mental health issues by identifying and detecting mentally vulnerable groups of people online. ", doi="10.2196/49074", url="https://www.jmir.org/2023/1/e49074", url="http://www.ncbi.nlm.nih.gov/pubmed/38032730" } @Article{info:doi/10.2196/50522, author="Buck, Benjamin and Wingerson, Mary and Whiting, Erica and Snyder, Jaime and Monroe-DeVita, Maria and Ben-Zeev, Dror", title="User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial", journal="JMIR Ment Health", year="2023", month="Nov", day="30", volume="10", pages="e50522", keywords="caregiving", keywords="psychosis", keywords="mobile health", keywords="mHealth", keywords="user-centered design", keywords="mobile phone", keywords="artificial intelligence", keywords="AI", abstract="Background: Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. Objective: The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. Methods: We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. Results: In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91\%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). Conclusions: To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis. ", doi="10.2196/50522", url="https://mental.jmir.org/2023/1/e50522", url="http://www.ncbi.nlm.nih.gov/pubmed/38032692" } @Article{info:doi/10.2196/51423, author="Pozuelo, R. Julia and Moffett, D. Bianca and Davis, Meghan and Stein, Alan and Cohen, Halley and Craske, G. Michelle and Maritze, Meriam and Makhubela, Princess and Nabulumba, Christine and Sikoti, Doreen and Kahn, Kathleen and Sodi, Tholene and and van Heerden, Alastair and O'Mahen, A. Heather", title="User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study", journal="JMIR Form Res", year="2023", month="Nov", day="30", volume="7", pages="e51423", keywords="depression", keywords="adolescents", keywords="mental health app", keywords="behavioral activation", keywords="user-centered design", keywords="low- and middle-income countries", keywords="mobile phone", abstract="Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (``episodes'') played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention's feasibility, acceptability, and efficacy in reducing depressive symptoms. ", doi="10.2196/51423", url="https://formative.jmir.org/2023/1/e51423", url="http://www.ncbi.nlm.nih.gov/pubmed/38032691" } @Article{info:doi/10.2196/46253, author="Demetry, Youstina and Wasteson, Elisabet and Lindegaard, Tomas and Abuleil, Amjad and Geranmayeh, Anahita and Andersson, Gerhard and Shahnavaz, Shervin", title="Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study", journal="JMIR Form Res", year="2023", month="Nov", day="24", volume="7", pages="e46253", keywords="internet-based interventions", keywords="cultural adaptation", keywords="Arabic", keywords="youth", keywords="depression", keywords="anxiety", keywords="refugees", keywords="mental health", keywords="Arabic-speaking youth", keywords="mental disorder", keywords="psychological intervention", abstract="Background: Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. Objective: This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. Methods: A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. Results: The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. Conclusions: The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation. ", doi="10.2196/46253", url="https://formative.jmir.org/2023/1/e46253", url="http://www.ncbi.nlm.nih.gov/pubmed/37999955" } @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/10.2196/44299, author="Nazarov, Anthony and Fikretoglu, Deniz and Liu, Aihua and Born, Jennifer and Michaud, Kathy and Hendriks, Tonya and B{\'e}langer, AH St{\'e}phanie and Do, T. Minh and Lam, Quan and Brooks, Brenda and King, Kristen and Sudom, Kerry and Jetly, Rakesh and Garber, Bryan and Thompson, Megan", title="Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics", journal="JMIR Res Protoc", year="2023", month="Nov", day="6", volume="12", pages="e44299", keywords="mental health", keywords="military", keywords="Canadian Armed Forces", keywords="operational organization", keywords="logistics support", keywords="health care", keywords="moral distress", keywords="moral injury", keywords="deployment", keywords="risk factors", keywords="COVID-19", keywords="quarantine", keywords="readiness", keywords="well-being", keywords="resilience", keywords="long-term care facility", keywords="centre de soins de longue dur{\'e}e", keywords="survey", keywords="older adult", keywords="qualitative interviews", keywords="quantitative", abstract="Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19--related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93\%), 582 (22.43\%), and 497 (19.15\%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF--specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 ", doi="10.2196/44299", url="https://www.researchprotocols.org/2023/1/e44299", url="http://www.ncbi.nlm.nih.gov/pubmed/37676877" } @Article{info:doi/10.2196/49846, author="Cross, Shane and Nicholas, Jennifer and Mangelsdorf, Shaminka and Valentine, Lee and Baker, Simon and McGorry, Patrick and Gleeson, John and Alvarez-Jimenez, Mario", title="Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study", journal="JMIR Form Res", year="2023", month="Nov", day="3", volume="7", pages="e49846", keywords="adolescence", keywords="adolescent", keywords="blended care", keywords="blended", keywords="co-design", keywords="development", keywords="digital health", keywords="digital intervention", keywords="digital mental health", keywords="framework", keywords="hybrid", keywords="mental health", keywords="model", keywords="platform", keywords="self-determination theory", keywords="service", keywords="services", keywords="theory of change", keywords="therapy", keywords="youth mental health", keywords="youth", abstract="Background: Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. Objective: The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. Methods: We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. Results: The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. Conclusions: The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact. ", doi="10.2196/49846", url="https://formative.jmir.org/2023/1/e49846", url="http://www.ncbi.nlm.nih.gov/pubmed/37921858" } @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/10.2196/46909, author="Medich, Melissa and Cannedy, L. Shay and Hoffmann, C. Lauren and Chinchilla, Y. Melissa and Pila, M. Jose and Chassman, A. Stephanie and Calderon, A. Ronald and Young, S. Alexander", title="Clinician and Patient Perspectives on the Use of Passive Mobile Monitoring and Self-Tracking for Patients With Serious Mental Illness: User-Centered Approach", journal="JMIR Hum Factors", year="2023", month="Oct", day="24", volume="10", pages="e46909", keywords="serious mental illness", keywords="mobile health", keywords="mental health", keywords="passive sensing", keywords="health informatics", keywords="behavior", keywords="self-tracking", keywords="monitoring", keywords="mental illness", keywords="prevention", keywords="acceptability", keywords="usability", keywords="usefulness", keywords="application", keywords="tool", keywords="management", keywords="mobile phone", abstract="Background: Early intervention in mental health crises can prevent negative outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect the worsening of serious mental illness (SMI). This technology may benefit patients with SMI, but little is known about health IT acceptability among this population or their mental health clinicians. Objective: We used the Health Information Technology Acceptability Model to analyze the acceptability and usability of passive mobile monitoring and self-tracking among patients with serious mental illness and their mental health clinicians. Methods: Data collection took place between December 2020 and June 2021 in 1 Veterans Administration health care system. Interviews with mental health clinicians (n=16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with patients with SMI (n=3 groups) and individual usability tests (n=8) elucidated patient attitudes about engaging in health IT and perceptions of its usefulness as a tool for self-tracking and improving mental health assessments. Results: Clinicians discussed the utility of web-based data dashboards to monitor patients with SMI health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care, capturing behaviors patients do not self-report, watching trends, and receiving alerts. Clinicians' concerns included increased workloads tied to dashboard data review, lack of experience using health IT in clinical care, and how SMI patients' associated paranoia and financial instability would impact patient uptake. Despite concerns, all mental health clinicians stated that they would recommend it. Almost all patients with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health clinicians. They found the mobile app easy to navigate and dashboards easy to find and understand. Patient concerns centered on privacy and ``government tracking,'' and their phone's battery life and data plans. Despite concerns, most reported that they would use it. Conclusions: Many people with SMI would like to have mobile informatics tools that can support their illness and recovery. Similar to other populations (eg, older adults, people experiencing homelessness) this population presents challenges to adoption and implementation. Health care organizations will need to provide resources to address these and support successful illness management. Clinicians are supportive of technological approaches, with adapting informatics data into their workflow as the primary challenge. Despite clear challenges, technological developments are increasingly designed to be acceptable to patients. The research development--clinical deployment gap must be addressed by health care systems, similar to computerized cognitive training. It will ensure clinicians operate at the top of their skill set and are not overwhelmed by administrative tasks, data summarization, or reviewing data that do not indicate a need for intervention. International Registered Report Identifier (IRRID): RR2-10.2196/39010 ", doi="10.2196/46909", url="https://humanfactors.jmir.org/2023/1/e46909", url="http://www.ncbi.nlm.nih.gov/pubmed/37874639" } @Article{info:doi/10.2196/48758, author="Thomson, Louise and Hassard, Juliet and Frost, Alexandra and Bartle, Craig and Yarker, Joanna and Munir, Fehmidah and Kneller, Richard and Marwaha, Steven and Daly, Guy and Russell, Sean and Meyer, Caroline and Vaughan, Benjamin and Newman, Kristina and Blake, Holly", title="Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Oct", day="24", volume="12", pages="e48758", keywords="acceptability", keywords="anxiety", keywords="burnout", keywords="cluster randomised control trial", keywords="depression", keywords="digital training", keywords="feasibility", keywords="intervention", keywords="managers", keywords="mental health", keywords="stress", keywords="usability", keywords="work", keywords="workplace", abstract="Background: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. Objective: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. Methods: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. Results: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. Conclusions: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. Trial Registration: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019 International Registered Report Identifier (IRRID): DERR1-10.2196/48758 ", doi="10.2196/48758", url="https://www.researchprotocols.org/2023/1/e48758", url="http://www.ncbi.nlm.nih.gov/pubmed/37874612" } @Article{info:doi/10.2196/44887, author="Prado, Silva Aneliana da and Kohls, Elisabeth and Baldofski, Sabrina and Rummel-Kluge, Christine and Freitas, Lucas Joanneliese de", title="Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study", journal="JMIR Form Res", year="2023", month="Oct", day="13", volume="7", pages="e44887", keywords="support group", keywords="online group", keywords="COVID-19 pandemic", keywords="higher education", keywords="graduate students", keywords="university students", keywords="mental health", keywords="online intervention", keywords="internet intervention", keywords="e--mental health", keywords="mental health promotion", keywords="feasibility", keywords="students", keywords="acceptability", abstract="Background: The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion. Objective: This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022). Methods: Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire--9 [PHQ-9]), and participants' quality of life (abbreviated World Health Organization Quality of Life assessment). A 9--answer option questionnaire and open-ended questions also assessed the group's perceived positive and negative outcomes. Results: The total sample comprised 32 participants. Most (23/32, 72\%) were doctoral students. Credibility and expectancy scores were high. Participants' satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants' experiences (T2: 29/32, 91\%; T3: 27/32, 84\%) and felt encouraged to take better care of themselves (T2: 22/32, 69\%; T3: 24/32, 75\%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9\% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87). Conclusions: Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants' quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances. ", doi="10.2196/44887", url="https://formative.jmir.org/2023/1/e44887", url="http://www.ncbi.nlm.nih.gov/pubmed/37831483" } @Article{info:doi/10.2196/48152, author="Beltzer, L. Miranda and Meyerhoff, Jonah and Popowski, A. Sarah and Mohr, C. David and Kornfield, Rachel", title="Mental Health Self-Tracking Preferences of Young Adults With Depression and Anxiety Not Engaged in Treatment: Qualitative Analysis", journal="JMIR Form Res", year="2023", month="Oct", day="6", volume="7", pages="e48152", keywords="self-tracking", keywords="self-monitoring", keywords="self-help", keywords="depression", keywords="anxiety", keywords="young adults", keywords="mHealth", keywords="technology", keywords="qualitative analysis", keywords="focus group", keywords="personal informatics", keywords="mood", keywords="thematic analysis", abstract="Background: Despite the high prevalence of anxiety and depression among young adults, many do not seek formal treatment. Some may turn to digital mental health tools for support instead, including to self-track moods, behaviors, and other variables related to mental health. Researchers have sought to understand processes and motivations involved in self-tracking, but few have considered the specific needs and preferences of young adults who are not engaged in treatment and who seek to use self-tracking to support mental health. Objective: This study seeks to assess the types of experiences young adults not engaged in treatment have had with digital self-tracking for mood and other mental health data and to assess how young adults not seeking treatment want to engage in self-tracking to support their mental health. Methods: We conducted 2 online asynchronous discussion groups with 50 young adults aged 18 years to 25 years who were not engaged in treatment. Participants were recruited after indicating moderate to severe symptoms of depression or anxiety on screening surveys hosted on the website of Mental Health America. Participants who enrolled in the study responded anonymously to discussion prompts on a message board, as well as to each other's responses, and 3 coders performed a thematic analysis of their responses. Results: Participants had mixed experiences with self-tracking in the past, including disliking when tracking highlighted unwanted behaviors and discontinuing tracking for a variety of reasons. They had more positive past experiences tracking behaviors and tasks they wanted to increase, using open-ended journaling, and with gamified elements to increase motivation. Participants highlighted several design considerations they wanted self-tracking tools to address, including building self-understanding; organization, reminders, and structure; and simplifying the self-tracking experience. Participants wanted self-tracking to help them identify their feelings and how their feelings related to other variables like sleep, exercise, and events in their lives. Participants also highlighted self-tracking as useful for motivating and supporting basic activities and tasks of daily living during periods of feeling overwhelmed or low mood and providing a sense of accomplishment and stability. Although self-tracking can be burdensome, participants were interested and provided suggestions for simplifying the process. Conclusions: These young adults not engaged in treatment reported interest in using self-tracking to build self-understanding as a goal in and of itself or as a first step in contemplating and preparing for behavior change or treatment-seeking. Alexithymia, amotivation, and feeling overwhelmed may serve both as barriers to self-tracking and opportunities for self-tracking to help. ", doi="10.2196/48152", url="https://formative.jmir.org/2023/1/e48152", url="http://www.ncbi.nlm.nih.gov/pubmed/37801349" } @Article{info:doi/10.2196/51096, author="Francis-Oliviero, Florence and Loubi{\`e}res, C{\'e}line and Grov{\'e}, Christine and Marinucci, Alexandra and Shankland, Rebecca and Salamon, R{\'e}da and Perez, Emmanuelle and Garancher, Laure and Galera, C{\'e}dric and Gaillard, Elsa and Orri, Massimiliano and Gonz{\'a}lez-Caballero, Luis Juan and Montagni, Ilaria", title="Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study", journal="JMIR Res Protoc", year="2023", month="Oct", day="5", volume="12", pages="e51096", keywords="child", keywords="mental health", keywords="literacy", keywords="intervention", keywords="scale", abstract="Background: Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population. Objective: This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL. Methods: Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model. Results: The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Sant{\'e} Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health. Conclusions: After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages. International Registered Report Identifier (IRRID): PRR1-10.2196/51096 ", doi="10.2196/51096", url="https://www.researchprotocols.org/2023/1/e51096", url="http://www.ncbi.nlm.nih.gov/pubmed/37796588" } @Article{info:doi/10.2196/49998, author="Giovanelli, Alison and Sanchez Karver, Tahilin and Roundfield, D. Katrina and Woodruff, Sean and Wierzba, Catherine and Wolny, J. and Kaufman, R. Michelle", title="The Appa Health App for Youth Mental Health: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="4", volume="7", pages="e49998", keywords="digital mental health", keywords="youth mentoring", keywords="cognitive behavioral therapy", keywords="teenager", keywords="adolescent", keywords="mobile phone", abstract="Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100\% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85\% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. ", doi="10.2196/49998", url="https://formative.jmir.org/2023/1/e49998", url="http://www.ncbi.nlm.nih.gov/pubmed/37792468" } @Article{info:doi/10.2196/46757, author="G{\'o}mez-Restrepo, Carlos and Sarmiento-Su{\'a}rez, Jos{\'e} Mar{\'i}a and Alba-Saavedra, Magda and Calvo-Valderrama, Gabriela Maria and Rinc{\'o}n-Rodr{\'i}guez, Javier Carlos and Bird, Jane Victoria and Priebe, Stefan and van Loggerenberg, Francois", title="Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post--Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial", journal="JMIR Form Res", year="2023", month="Oct", day="4", volume="7", pages="e46757", keywords="mental health", keywords="digital intervention", keywords="psychosocial intervention", keywords="armed conflict", keywords="adolescents", keywords="school", keywords="DIALOG+", keywords="DIALOG+S", keywords="mobile phone", abstract="Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post--armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 ", doi="10.2196/46757", url="https://formative.jmir.org/2023/1/e46757", url="http://www.ncbi.nlm.nih.gov/pubmed/37792465" } @Article{info:doi/10.2196/51235, author="Polusny, A. Melissa and Marquardt, A. Craig and Hubbling, Michelle and Campbell, Hagel Emily and Arbisi, A. Paul and Davenport, D. Nicholas and Lim, O. Kelvin and Lissek, Shmuel and Schaefer, D. Jonathan and Sponheim, R. Scott and Masten, S. Ann and Noorbaloochi, Siamak", title="Adaptation in Young Military Recruits: Protocol for the Advancing Research on Mechanisms of Resilience (ARMOR) Prospective Longitudinal Study", journal="JMIR Res Protoc", year="2023", month="Oct", day="4", volume="12", pages="e51235", keywords="study protocol", keywords="military personnel", keywords="longitudinal studies", keywords="resilience", keywords="adaptive behavior", keywords="stress", keywords="adversity", keywords="mechanisms", keywords="protective factors", abstract="Background: Military services provide a unique opportunity for studying resilience, a dynamic process of successful adaptation (ie, doing well in terms of functioning and symptoms) in response to significant adversity. Despite the tremendous interest in positive adaptation among military service members, little is known about the processes underlying their resilience. Understanding the neurobiological, cognitive, and social mechanisms underlying adaptive functioning following military stressor exposure is essential for enhancing the resilience of military service members. Objective: The primary objective of the Advancing Research on Mechanisms of Resilience (ARMOR) longitudinal study is to characterize the trajectories of positive adaptation among young military recruits in response to basic combat training (BCT), a well-defined, uniform, and 10-week period of intense stress (aim 1), and identify promotive and protective processes contributing to individual variations in resilience (aim 2). The secondary objective is to investigate the pathways by which neurobehavioral markers of self-regulation assessed using electroencephalography and magnetic resonance imaging contribute to adaptive trajectories (aim 3). Methods: ARMOR is an ongoing, prospective longitudinal cohort study of young military recruits who recently joined the National Guard but have not yet shipped out for BCT. Participants (N=1201) are assessed at 5 time points over the initial >2 years of military service beginning before BCT (baseline) and followed up at 2 weeks and 6, 12, and 18 months after BCT. Participants complete web-based questionnaires assessing vulnerability and protective factors, mental health, and socioemotional functioning at each time point and a battery of neurocognitive tests at time 0. A subset of participants also complete structured diagnostic interviews and additional self-report measures and perform neurobehavioral tasks before and after BCT during electroencephalography sessions and before BCT only during magnetic resonance imaging sessions. Results: This UG3/UH3 project was initially funded in August 2017, with the UG3 pilot work completed at the end of 2018. The UH3 phase of the project was funded in March 2019. Study enrollment for the UH3 phase began on April 14, 2019, and ended on October 16, 2021. A total of 1201 participants are enrolled in the study. Follow-up data collection for the UH3 phase is ongoing and projected to continue through February 2024. We will disseminate the findings through conferences, webinars, open access publications, and communications with participants and stakeholders. Conclusions: The ARMOR study provides a rich data set to identify the predictors and mechanisms of resilient and nonresilient outcomes in the context of military stressors, which are intended to empirically inform the development of prevention and intervention strategies to enhance the resilience of military trainees and potentially other young people facing significant life challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/51235 ", doi="10.2196/51235", url="https://www.researchprotocols.org/2023/1/e51235", url="http://www.ncbi.nlm.nih.gov/pubmed/37792432" } @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/10.2196/49684, author="Jo, Eunkyung and Kouaho, Whitney-Jocelyn and Schueller, M. Stephen and Epstein, A. Daniel", title="Exploring User Perspectives of and Ethical Experiences With Teletherapy Apps: Qualitative Analysis of User Reviews", journal="JMIR Ment Health", year="2023", month="Sep", day="22", volume="10", pages="e49684", keywords="teletherapy", keywords="therapy", keywords="ethical guidelines", keywords="ethics", keywords="qualitative research", keywords="digital mental health", keywords="mobile phone", abstract="Background: Teletherapy apps have emerged as a promising alternative to traditional in-person therapy, especially after the COVID-19 pandemic, as they help overcome a range of geographical and emotional barriers to accessing care. However, the rapid proliferation of teletherapy apps has occurred in an environment in which development has outpaced the various regulatory and ethical considerations of this space. Thus, researchers have raised concerns about the ethical implications and potential risks of teletherapy apps given the lack of regulation and oversight. Teletherapy apps have distinct aims to more directly replicate practices of traditional care, as opposed to mental health apps, which primarily provide supplemental support, suggesting a need to examine the ethical considerations of teletherapy apps from the lens of existing ethical guidelines for providing therapy. Objective: In this study, we examined user reviews of commercial teletherapy apps to understand user perceptions of whether and how ethical principles are followed and incorporated. Methods: We identified 8 mobile apps that (1) provided teletherapy on 2 dominant mobile app stores (Google Play and Apple App Store) and (2) had received >5000 app reviews on both app stores. We wrote Python scripts (Python Software Foundation) to scrape user reviews from the 8 apps, collecting 3268 user reviews combined across 2 app stores. We used thematic analysis to qualitatively analyze user reviews, developing a codebook drawing from the ethical codes of conduct for psychologists, psychiatrists, and social workers. Results: The qualitative analysis of user reviews revealed the ethical concerns and opportunities of teletherapy app users. Users frequently perceived unprofessionalism in their teletherapists, mentioning that their therapists did not listen to them, were distracted during therapy sessions, and did not keep their appointments. Users also noted technical glitches and therapist unavailability on teletherapy apps that might affect their ability to provide continuity of care. Users held varied opinions on the affordability of those apps, with some perceiving them as affordable and others not. Users further brought up that the subscription model resulted in unfair pricing and expressed concerns about the lack of cost transparency. Users perceived that these apps could help promote access to care by overcoming geographical and social constraints. Conclusions: Our study suggests that users perceive commercial teletherapy apps as adhering to many ethical principles pertaining to therapy but falling short in key areas regarding professionalism, continuity of care, cost fairness, and cost transparency. Our findings suggest that, to provide high-quality care, teletherapy apps should prioritize fair compensation for therapists, develop more flexible and transparent payment models, and invest in measures to ensure app stability and therapist availability. Future work is needed to develop standards for teletherapy and improve the quality and accessibility of those services. ", doi="10.2196/49684", url="https://mental.jmir.org/2023/1/e49684", url="http://www.ncbi.nlm.nih.gov/pubmed/37738085" } @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/10.2196/49999, author="Tolou-Shams, Marina and Ramaiya, Megan and Lara Salas, Jannet and Ezimora, Ifunanya and Shumway, Martha and Duerr Berrick, Jill and Aguilera, Adrian and Borsari, Brian and Dauria, Emily and Friedling, Naomi and Holmes, Crystal and Grandi, Adam", title="A Family-Based Mental Health Navigator Intervention for Youth in the Child Welfare System: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="12", volume="12", pages="e49999", keywords="randomized clinical trial", keywords="foster care", keywords="child welfare--involved youth", keywords="navigator interventions", keywords="digital health technology", keywords="implementation science", keywords="community engagement", abstract="Background: Youth in the child welfare system (child welfare--involved [CWI] youth) have high documented rates of mental health symptoms and experience significant disparities in mental health care services access and engagement. Adolescence is a developmental stage that confers increased likelihood of experiencing mental health symptoms and the emergence of disorders that can persist into adulthood. Despite a high documented need for evidence-based mental health services for CWI youth, coordination between child welfare and mental health service systems to increase access to care remains inadequate, and engagement in mental health services is low. Navigator models developed in the health care field to address challenges of service access, fragmentation, and continuity that affect the quality of care provide a promising approach to increase linkage to, and engagement in, mental health services for CWI youth. However, at present, there is no empirically supported mental health navigator model to address the unique and complex mental health needs of CWI youth and their families. Objective: Using a randomized controlled trial, this study aims to develop and test a foster care family navigator (FCFN) model to improve mental health service outcomes for CWI adolescents (aged 12-17 years). Methods: The navigator model leverages an in-person navigator and use of adjunctive digital health technology to engage with, and improve, care coordination, tracking, and monitoring of mental health service needs for CWI youth and families. In total, 80 caregiver-youth dyads will be randomized to receive either the FCFN intervention or standard of care (clinical case management services): 40 (50\%) to FCFN and 40 (50\%) to control. Qualitative exit interviews will inform the feasibility and acceptability of the services received during the 6-month period. The primary trial outcomes are mental health treatment initiation and engagement. Other pre- and postservice outcomes, such as proportion screened and time to screening, will also be evaluated. We hypothesize that youth receiving the FCFN intervention will have higher rates of mental health treatment initiation and engagement than youth receiving standard of care. Results: We propose enrollment of 80 dyads by March 2024, final data collection by September 2024, and the publication of main findings in March 2025. After final data analysis and writing of the results, the resulting manuscripts will be submitted to journals for dissemination. Conclusions: This study will be the first to produce empirically driven conclusions and recommendations for implementing a family mental health navigation model for CWI youth with long-standing and unaddressed disparities in behavioral health services access. The study findings have potential to have large-scale trial applicability and be feasible and acceptable for eventual system implementation and adoption. Trial Registration: ClinicalTrials.gov NCT04506437; https://www.clinicaltrials.gov/study/NCT04506437 International Registered Report Identifier (IRRID): DERR1-10.2196/49999 ", doi="10.2196/49999", url="https://www.researchprotocols.org/2023/1/e49999", url="http://www.ncbi.nlm.nih.gov/pubmed/37698896" } @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/10.2196/47917, author="Gliske, Kate and Berry, R. Katie and Ballard, Jaime and Schmidt, Clare and Kroll, Elizabeth and Kohlmeier, Jonathan and Killian, Michael and Fenkel, Caroline", title="Predicting Youth and Young Adult Treatment Engagement in a Transdiagnostic Remote Intensive Outpatient Program: Latent Profile Analysis", journal="JMIR Form Res", year="2023", month="Sep", day="7", volume="7", pages="e47917", keywords="youth", keywords="young adult", keywords="virtual", keywords="mental health", keywords="intensive outpatient treatment", keywords="latent profile analysis", keywords="personalized treatment", abstract="Background: The youth mental health crisis in the United States continues to worsen, and research has shown poor mental health treatment engagement. Despite the need for personalized engagement strategies, there is a lack of research involving youth. Due to complex youth developmental milestones, there is a need to better understand clinical presentation and factors associated with treatment engagement to effectively identify and tailor beneficial treatments. Objective: This quality improvement investigation sought to identify subgroups of clients attending a remote intensive outpatient program (IOP) based on clinical acuity data at intake, to determine the factors associated with engagement outcomes for clients who present in complex developmental periods and with cooccurring conditions. The identification of these subgroups was used to inform programmatic decisions within this remote IOP system. Methods: Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Participants included clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using 5 indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic factors and treatment engagement outcomes. Results: Among the 2924 participants, 4 profiles of clinical acuity were identified: a low-acuity profile (n=943, 32.25\%), characterized by minimal anxiety, depression, and self-harm, and 3 high-acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm (high acuity+low self-harm: n=1452, 49.66\%; high acuity+moderate self-harm: n=203, 6.94\%; high acuity+high self-harm: n=326, 11.15\%). Age, gender, transgender identity, and sexual orientation were significantly associated with profile membership. Clients identified as sexually and gender-marginalized populations were more likely to be classified into high-acuity profiles than into the low-acuity profile (eg, for clients who identified as transgender, high acuity+low self-harm: odds ratio [OR] 2.07, 95\% CI 1.35-3.18; P<.001; high acuity+moderate self-harm: OR 2.85, 95\% CI 1.66-4.90; P<.001; high acuity+high self-harm: OR 3.67, 95\% CI 2.45-5.51; P<.001). Race was unrelated to the profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low-acuity and high-acuity+low--self-harm profiles attended an average of 4 fewer treatment sessions compared with youth in the high-acuity+moderate--self-harm and high-acuity+high--self-harm profiles (?23=27.6, P<.001). Individuals in the high-acuity+low--self-harm profile completed treatment at a significantly lower rate relative to the other 2 high-acuity profiles (?23=13.4, P=.004). Finally, those in the high-acuity+high--self-harm profile were significantly less likely to disengage early relative to youth in all other profiles (?23=71.12, P<.001). Conclusions: This investigation represents a novel application for identifying subgroups of adolescents and young adults based on clinical acuity data at intake to identify patterns in treatment engagement outcomes. Identifying subgroups that differentially engage in treatment is a critical first step toward targeting engagement strategies for complex populations. ", doi="10.2196/47917", url="https://formative.jmir.org/2023/1/e47917", url="http://www.ncbi.nlm.nih.gov/pubmed/37676700" } @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/10.2196/47577, author="Fan, Qiping and DuBose, Logan and Ory, G. Marcia and Lee, Shinduk and Hoang, Minh-Nguyet and Vennatt, Jeswin and Kew, Lin Chung and Doyle, David and Falohun, Tokunbo", title="Financial, Legal, and Functional Challenges of Providing Care for People Living With Dementia and Needs for a Digital Platform: Interview Study Among Family Caregivers", journal="JMIR Aging", year="2023", month="Sep", day="5", volume="6", pages="e47577", keywords="family caregiver", keywords="Alzheimer disease", keywords="dementia", keywords="caregiving challenges", keywords="digital health", keywords="community-based participatory research", keywords="mobile phone", abstract="Background: Alzheimer disease and Alzheimer disease--related dementia represent complex neuropathologies directly challenging individuals, their families, and communities in the United States. To support persons living with dementia, family or informal caregivers often encounter complex financial, psychological, and physical challenges. A widely used solution such as a consolidated web-based assistance or guidance platform is missing, compounding care challenges. Objective: In preparation for designing an internet-based artificial intelligence--driven digital resource platform, a qualitative interview study was conducted to characterize the challenges and needs of family caregivers in the United States. Methods: A semistructured interview topic guide in English was developed by engaging community partners and research partnerships. Family caregiver participants were purposefully recruited via various means, such as word of mouth, local dementia community service providers, digital recruitment emails, flyers, and social media. Interested individuals were first invited to complete an eligibility screening survey, and eligible individuals were then contacted to arrange a web-based in-depth interview via Zoom (Zoom Video Communications) from January 1, 2022, to May 31, 2022. A follow-up survey was administered in May 2022 to provide an overview of the participants' demographics, socioeconomic characteristics, and caregiving information. Thematic analysis in a framework approach was used to identify and organize themes and the study findings. Results: Following the prescreening of 150 eligible respondents, 20\% (30/150) individuals completed both the interviews and follow-up survey, allowing for an in-depth look into the challenges, experiences, and expectations of primary caregivers of people living with dementia. Most participants (20/30, 67\%) were primary caregivers of persons with dementia, and 93\% (28/30) had provided care for at least a year. Most participants were aged >50 years (25/30, 83\%), female (23/30, 77\%), White (25/30, 83\%), and non-Hispanic (27/30, 90\%) and held a bachelor's or graduate degree (22/30, 73\%). Collectively, all participants acknowledged challenges in caring for people living with dementia. Thematic analyses elicited the challenges of caregiving related to functional care needs and financial and legal challenges. In addition, participants identified the need for an integrative digital platform where information could be supplied to foster education, share resources, and provide community support, enabling family caregivers to improve the quality of care and reducing caregiver burden. Conclusions: This study emphasized the difficulties associated with the family caregiver role and the expectations and potential for a supportive web-based platform to mitigate current challenges within the caregiving role. ", doi="10.2196/47577", url="https://aging.jmir.org/2023/1/e47577", url="http://www.ncbi.nlm.nih.gov/pubmed/37526513" } @Article{info:doi/10.2196/49670, author="Kegelaers, Jolan and Baetens, Imke and Soyez, Veerle and Van Heel, Martijn and Van Hove, Lisa and Wylleman, Paul", title="Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project", journal="JMIR Res Protoc", year="2023", month="Aug", day="18", volume="12", pages="e49670", keywords="children", keywords="physical activity", keywords="psychological symptoms", keywords="sport", keywords="well-being", keywords="youth", abstract="Background: Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people's specific needs, challenges, and motivations when designing novel mental health promotion interventions. Objective: The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program. Methods: A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence. Results: Participant recruitment will commence in September 2023. The full project will be completed by March 2027. Conclusions: With this intervention, we aim to provide a direct contribution to the promotion of children and young people's mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations. International Registered Report Identifier (IRRID): PRR1-10.2196/49670 ", doi="10.2196/49670", url="https://www.researchprotocols.org/2023/1/e49670", url="http://www.ncbi.nlm.nih.gov/pubmed/37594846" } @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/10.2196/44681, author="Lukka, Lauri and Karhulahti, Veli-Matti and Palva, Matias J.", title="Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study", journal="JMIR Hum Factors", year="2023", month="Jul", day="10", volume="10", pages="e44681", keywords="clinical practice", keywords="digital mental health interventions", keywords="intervention design", keywords="mental health applications", keywords="mental health professionals", keywords="teletherapy", keywords="mobile phone", abstract="Background: Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. Objective: This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. Methods: A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. Results: We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability---it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs' digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. Conclusions: MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them. ", doi="10.2196/44681", url="https://humanfactors.jmir.org/2023/1/e44681", url="http://www.ncbi.nlm.nih.gov/pubmed/37428520" } @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/10.2196/41521, author="Ecclestone, Amy and Linden, Brooke and Monaghan, Caitlin and Zheng, Sally", title="Canada's Student Mental Health Network: Protocol for a Comprehensive Program Evaluation", journal="JMIR Res Protoc", year="2023", month="Jun", day="22", volume="12", pages="e41521", keywords="health promotion", keywords="higher education", keywords="mental health", keywords="postsecondary", keywords="program evaluation", keywords="stress", keywords="students", keywords="university", keywords="well-being", abstract="Background: Prevalence estimates for mental health--related problems, including above-average stress, psychological distress, and symptoms of mental illnesses have increased significantly among Canadian postsecondary students. As demand for downstream mental treatment has surpassed many institutions' abilities to deliver timely care, there is a need for innovative upstream supports that foster mental health promotion and mental illness prevention among this population. Objective: Supported by an extensive network of student volunteers, Canada's?Student Mental Health Network is a virtual, one-stop shop for centralized mental health education and evidence-based resources tailored to postsecondary students. This article describes a protocol for the comprehensive evaluation of the Network. Methods: Development of the Network was developed using a participatory action research framework. Network content is created and curated by students and reviewed by subject matter experts. The proposed program evaluation will include both a formative process evaluation and a summative impact assessment to determine the feasibility, acceptability, and utility of the Network in addition to assessing change in the 3 primary outcomes of interest: mental health literacy, perceived social support, and help-seeking behavior. Participants will be recruited directly from the Network website using a ``rolling'' recruitment approach to allow for continuous data collection and evaluation. A combination of qualitative (ie, interviews) and quantitative (ie, surveys) methods of data collection will be used. Results: The process of evaluation of the Network will begin in September 2022, collecting data for 1 year. In September 2023, the impact evaluation will begin using the same follow-up schedule. Data collection will then remain ongoing to facilitate the continued evaluation of the Network. Reports detailing evaluation data will be released annually. Conclusions: The Network is a novel and innovative method of delivering universal mental health promotion to Canadian postsecondary students by providing centralized and freely accessible mental health education and resources, created by students and validated by subject matter experts. The continued creation and curation of resources for the Network will be ongoing to meet the evolving needs of the target population. International Registered Report Identifier (IRRID): PRR1-10.2196/41521 ", doi="10.2196/41521", url="https://www.researchprotocols.org/2023/1/e41521", url="http://www.ncbi.nlm.nih.gov/pubmed/37347511" } @Article{info:doi/10.2196/38696, author="O'Callaghan, Erin and Belanger, Heather and Lucero, Steven and Boston, Shannon and Winsberg, Mirene", title="Consumer Expectations and Attitudes About Psychotherapy: Survey Study", journal="JMIR Form Res", year="2023", month="Jun", day="8", volume="7", pages="e38696", keywords="internet", keywords="survey", keywords="psychotherapy", keywords="telehealth, psychiatry, mental health", abstract="Background: Although mental illness is common among adults in the United States, access to, and public perception of, mental health care continue to present as key barriers to care. Objective: Given the importance of attitudes toward, and perceptions of, mental health treatment in the successful access to mental health care and treatment of mental health issues, the primary goal of this survey study was to further investigate consumer perspectives of psychotherapy among adults in the United States; specifically, adding to the literature by investigating perceptions of both the general public and patients receiving telehealth. More specifically, the aims were to better understand openness to, and satisfaction with, therapy; perceptions, preferences, and expectations around therapy; and perceptions of psychotropic medication. Methods: An electronic survey was administered to current and former patients (those receiving psychotherapy) of Brightside, a nationwide telehealth company, as well as to the general public; both were convenience samples. Using the same survey questions, Brightside surveyed its own members (using Qualtrics; Qualtrics International Inc) and the general population (using SurveyMonkey's Audience tool; Momentive). This survey included questions about basic participant demographics, as well as questions about current mental health treatment, perceptions about therapy, and therapists' qualities. Results: A total of 714 people completed the survey. The data were fairly evenly split between those collected from Brightside patients (368/714, 51.5\%) and those collected from the general public (346/714, 48.5\%). Combining both samples, overall participation was 67.1\% (479/714) women; 73.1\% (522/714) White, 7.3\% (52/714) Asian, 6.7\% (48/714) African American, and 7.4\% (53/714) Hispanic or Latinx; largely aged 25 to 34 years (255/714, 35.7\%) or 35 to 44 years (187/714, 26.2\%); from either the Mid-Atlantic (131/714, 18.3\%) or South Atlantic (129/714, 18.1\%) regions of the country; and most (402/714, 56.3\%) earning annual salaries of US \$30,000 to US \$100,000. There were generally favorable perceptions of both psychotherapy and psychiatric medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. The most commonly held perception of psychotherapy duration was indefinite (250/714, 35\%). Very few (58/714, 8.1\%) thought that therapy typically lasts 1 to 3 months. Most of the participants (414/714, 58\%) thought that evidence-based practice was important. Conclusions: Public education is needed to increase awareness of the typical duration and cost of psychotherapy. There seem to be generally favorable perceptions of both psychotherapy and psychotropic medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. Practitioners and those marketing their services might consider using their marketing campaigns to counter some of the more common falsely held beliefs. ", doi="10.2196/38696", url="https://formative.jmir.org/2023/1/e38696", url="http://www.ncbi.nlm.nih.gov/pubmed/37289494" } @Article{info:doi/10.2196/40111, author="Dingwall, M. Kylie and Povey, Josie and Sweet, Michelle and Friel, Jaylene and Shand, Fiona and Titov, Nickolai and Wormer, Julia and Mirza, Tamoor and Nagel, Tricia", title="Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People", journal="JMIR Hum Factors", year="2023", month="Jun", day="7", volume="10", pages="e40111", keywords="digital mental health", keywords="First Nations", keywords="Indigenous", keywords="young people", keywords="feasibility study", keywords="digital health", keywords="mental health", keywords="depression", keywords="mHealth", keywords="mobile app", keywords="aboriginal", keywords="acceptibility", keywords="youth", abstract="Background: Despite young First Nations Australians being typically healthy, happy, and connected to family and culture, high rates of emotional distress, suicide, and self-harm are also observed. Differing worldviews of service providers and First Nations young people regarding illness and treatment practices, language differences, culturally inappropriate service models, geographical remoteness, and stigma can all inhibit access to appropriate mental health support. Mental health treatments delivered digitally (digital mental health; dMH) offer flexible access to evidence-based, nonstigmatizing, low-cost treatment and early intervention on a broad scale. There is a rapidly growing use and acceptance of these technologies among young First Nations people. Objective: The objective was to assess the feasibility, acceptability, and use of the newly developed Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app and determine the feasibility of study procedures in preparation for future assessments of effectiveness. Methods: This was a nonrandomized pre-post study using mixed methods. First Nations young people aged 12-25 years who provided consent (with parental consent where appropriate) and possessed the ability to navigate a simple app with basic English literacy were included. Researchers conducted one face-to-face 20-minute session with participants to introduce and orient them to the AIMhi-Y app. The app integrates culturally adapted low-intensity cognitive behavioral therapy (CBT), psychoeducation, and mindfulness-based activities. Participants received supportive text messages weekly throughout the 4-week intervention period and completed assessments of psychological distress, depression, anxiety, substance misuse, help-seeking, service use, and parent-rated strengths and difficulties at baseline and 4 weeks. Qualitative interviews and rating scales were completed at 4 weeks to gain feedback on subjective experience, look and style, content, overall rating, check-ins, and involvement in the study. App use data were collected. Results: Thirty young people (17 males and 13 females) aged between 12 and 18 (mean 14.0, SD 1.55) years were assessed at baseline and 4 weeks. Repeated measures 2-tailed t tests showed improvements in well-being measures that were statistically and clinically significant for psychological distress (Kessler Psychological Distress Scale, 10-item) and depressive symptoms (Patient Health Questionnaire, 2-item). Participants spent on average 37 minutes in the app. The app was rated positively, with mean ratings of 4 out of 5 points (on scales of 1-5). Participants reported that they found the app easy to use, culturally relevant, and useful. The feasibility of the study was demonstrated with a 62\% recruitment rate, a 90\% retention rate, and high study acceptability ratings. Conclusions: This study supports earlier research suggesting that dMH apps that are appropriately designed with and for the target populations are a feasible and acceptable means of lowering symptoms for mental health disorders among First Nations youth. ", doi="10.2196/40111", url="https://humanfactors.jmir.org/2023/1/e40111", url="http://www.ncbi.nlm.nih.gov/pubmed/37285184" } @Article{info:doi/10.2196/45234, author="Gan, Q. Daniel Z. and McGillivray, Lauren and Larsen, Erik Mark and Bloomfield, Taylor and Torok, Michelle", title="Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach", journal="JMIR Form Res", year="2023", month="Jun", day="6", volume="7", pages="e45234", keywords="eHealth", keywords="digital mental health", keywords="smartphone app", keywords="engagement", keywords="youth suicide prevention", keywords="qualitative methods", keywords="suicide", keywords="development", keywords="youth", keywords="mental health", keywords="support", keywords="user-centered", keywords="design", keywords="survey", keywords="interview", keywords="prototype", keywords="prevention", keywords="participatory design", keywords="mobile phone", abstract="Background: Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions. Objective: This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy---a smartphone app that helps young people manage suicidal thoughts. Methods: Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings---from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population---with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops. Results: Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components. Conclusions: This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health. ", doi="10.2196/45234", url="https://formative.jmir.org/2023/1/e45234", url="http://www.ncbi.nlm.nih.gov/pubmed/37279058" } @Article{info:doi/10.2196/44812, author="O'Sullivan, Shaunagh and van Berkel, Niels and Kostakos, Vassilis and Schmaal, Lianne and D'Alfonso, Simon and Valentine, Lee and Bendall, Sarah and Nelson, Barnaby and Gleeson, F. John and Alvarez-Jimenez, Mario", title="Understanding What Drives Long-term Engagement in Digital Mental Health Interventions: Secondary Causal Analysis of the Relationship Between Social Networking and Therapy Engagement", journal="JMIR Ment Health", year="2023", month="May", day="22", volume="10", pages="e44812", keywords="digital intervention", keywords="digital health", keywords="youth mental health", keywords="psychotic disorders", keywords="usage metrics", keywords="log data", keywords="social networking", abstract="Background: Low engagement rates with digital mental health interventions are a major challenge in the field. Multicomponent digital interventions aim to improve engagement by adding components such as social networks. Although social networks may be engaging, they may not be sufficient to improve clinical outcomes or lead users to engage with key therapeutic components. Therefore, we need to understand what components drive engagement with digital mental health interventions overall and what drives engagement with key therapeutic components. Objective: Horyzons was an 18-month digital mental health intervention for young people recovering from first-episode psychosis, incorporating therapeutic content and a private social network. However, it is unclear whether use of the social network leads to subsequent use of therapeutic content or vice versa. This study aimed to determine the causal relationship between the social networking and therapeutic components of Horyzons. Methods: Participants comprised 82 young people (16-27 years) recovering from first-episode psychosis. Multiple convergent cross mapping was used to test causality, as a secondary analysis of the Horyzons intervention. Multiple convergent cross mapping tested the direction of the relationship between each pair of social and therapeutic system usage variables on Horyzons, using longitudinal usage data. Results: Results indicated that the social networking aspects of Horyzons were most engaging. Posting on the social network drove engagement with all therapeutic components (r=0.06-0.36). Reacting to social network posts drove engagement with all therapeutic components (r=0.39-0.65). Commenting on social network posts drove engagement with most therapeutic components (r=0.11-0.18). Liking social network posts drove engagement with most therapeutic components (r=0.09-0.17). However, starting a therapy pathway led to commenting on social network posts (r=0.05) and liking social network posts (r=0.06), and completing a therapy action led to commenting on social network posts (r=0.14) and liking social network posts (r=0.15). Conclusions: The online social network was a key driver of long-term engagement with the Horyzons intervention and fostered engagement with key therapeutic components and ingredients of the intervention. Online social networks can be further leveraged to engage young people with therapeutic content to ensure treatment effects are maintained and to create virtuous cycles between all intervention components to maintain engagement. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12614000009617; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12614000009617 ", doi="10.2196/44812", url="https://mental.jmir.org/2023/1/e44812", url="http://www.ncbi.nlm.nih.gov/pubmed/37213197" } @Article{info:doi/10.2196/43780, author="Baldofski, Sabrina and Kohls, Elisabeth and Efe, Zeki and Eckert, Melanie and Saee, Shadi and Thomas, Julia and Wundrack, Richard and Rummel-Kluge, Christine", title="The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study", journal="JMIR Ment Health", year="2023", month="May", day="17", volume="10", pages="e43780", keywords="online intervention", keywords="e-mental health", keywords="online chat", keywords="hotline", keywords="text-based", keywords="children", keywords="adolescents", keywords="young adults", keywords="psychopathology", keywords="help-seeking", abstract="Background: Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person. Objective: This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking. Methods: This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey. Results: The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3\%), a school psychologist or school social worker (52/225, 23.1\%), and the user's parents (45/225, 20.0\%). Of the 247 users, 120 (48.6\%) indicated that they contacted the recommended service or person, and of these, 87 (72.5\%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0\%), improvement of self-efficacy (55/120, 45.8\%), and symptom recognition (40/120, 33.3\%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2\%), lack of mental health literacy (59/127, 46.5\%), need for self-reliance and autonomy (53/127, 41.7\%), and negative family beliefs regarding help services (53/127, 41.7\%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being. Conclusions: The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy. Trial Registration: Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68 ", doi="10.2196/43780", url="https://mental.jmir.org/2023/1/e43780", url="http://www.ncbi.nlm.nih.gov/pubmed/37195747" } @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/10.2196/42420, author="Baba, Ayako and Bunji, Kyosuke", title="Prediction of Mental Health Problem Using Annual Student Health Survey: Machine Learning Approach", journal="JMIR Ment Health", year="2023", month="May", day="10", volume="10", pages="e42420", keywords="student counseling", keywords="health survey", keywords="machine learning", keywords="mental health problem", keywords="response time", abstract="Background: One of the reasons why students go to counseling is being called on based on self-reported health survey results. However, there is no concordant standard for such calls. Objective: This study aims to develop a machine learning (ML) model to predict students' mental health problems in 1 year and the following year using the health survey's content and answering time (response time, response time stamp, and answer date). Methods: Data were obtained from the responses of 3561 (62.58\%) of 5690 undergraduate students from University A in Japan (a national university) who completed the health survey in 2020 and 2021. We performed 2 analyses; in analysis 1, a mental health problem in 2020 was predicted from demographics, answers for the health survey, and answering time in the same year, and in analysis 2, a mental health problem in 2021 was predicted from the same input variables as in analysis 1. We compared the results from different ML models, such as logistic regression, elastic net, random forest, XGBoost, and LightGBM. The results with and without answering time conditions were compared using the adopted model. Results: On the basis of the comparison of the models, we adopted the LightGBM model. In this model, both analyses and conditions achieved adequate performance (eg, Matthews correlation coefficient [MCC] of with answering time condition in analysis 1 was 0.970 and MCC of without answering time condition in analysis 1 was 0.976; MCC of with answering time condition in analysis 2 was 0.986 and that of without answering time condition in analysis 2 was 0.971). In both analyses and in both conditions, the response to the questions about campus life (eg, anxiety and future) had the highest impact (Gain 0.131-0.216; Shapley additive explanations 0.018-0.028). Shapley additive explanations of 5 to 6 input variables from questions about campus life were included in the top 10. In contrast to our expectation, the inclusion of answering time--related variables did not exhibit substantial improvement in the prediction of students' mental health problems. However, certain variables generated based on the answering time are apparently helpful in improving the prediction and affecting the prediction probability. Conclusions: These results demonstrate the possibility of predicting mental health across years using health survey data. Demographic and behavioral data, including answering time, were effective as well as self-rating items. This model demonstrates the possibility of synergistically using the characteristics of health surveys and advantages of ML. These findings can improve health survey items and calling criteria. ", doi="10.2196/42420", url="https://mental.jmir.org/2023/1/e42420", url="http://www.ncbi.nlm.nih.gov/pubmed/37163323" } @Article{info:doi/10.2196/44980, author="Jenkins, Matthew and Gardiner, Tracey and Pekepo, Crystal and Ramritu, P?yal and Drysdale, Briony and Every-Palmer, Susanna and Chinn, Victoria", title="Developing a System of Health Support for Young People Experiencing First-Episode Psychosis: Protocol for a Co-design Process", journal="JMIR Res Protoc", year="2023", month="May", day="2", volume="12", pages="e44980", keywords="psychosis", keywords="health", keywords="well-being", keywords="co-design", keywords="lived experience", keywords="early intervention", abstract="Background: People living with psychosis face a substantially increased risk of poor psychological well-being and physical health and premature mortality. Encouraging positive health behaviors from an early stage is crucial to the health and well-being of this population but is often overshadowed by symptom management within early intervention services. Objective: Experience-based co-design is a participant-centered approach that aims to combine service user narratives with service design methods to design systems of support for health and well-being. This study aims to use experience-based co-design principles to co-design a system that supports the health and well-being of young people experiencing first-episode psychosis (FEP), which considers the lived experience of these people within the context of early intervention services. We also aim to develop a set of principles to guide future systems to support the health and well-being of young people experiencing FEP. Methods: Up to 15 young people living with FEP aged 16 to 24 years who are service users of early intervention services in psychosis, their immediate support networks (family or friends), and health professionals involved with early intervention services in psychosis will be invited to participate in a series of co-design workshops. Data will be collected in various forms, including expressive forms (eg, art and spoken word) and traditional methods (interview transcription and surveys), with phenomenographic and thematic analyses being used to understand these data. Furthermore, the co-design process will draw upon indigenous (M?ori) knowledge and the lived experience of mental health services from the perspectives of the members of the research team. The co-design process will be evaluated in terms of acceptability from the perspective of service users via rating scales and interviews. The study will be conducted within the Lower North Island in Aotearoa New Zealand. Results: Data collection will be performed between August 2022 and February 2023. Drawing from extended consultations with service users and service providers, we have developed a robust co-design process with which we intend to collect rich qualitative and quantitative data. The results of this process will be used to create a system of support that can be immediately applied and as preliminary evidence for funding and resource applications to deliver and evaluate a ``full'' version of the co-designed system of support. Conclusions: The co-designed system of support and accompanying set of principles will offer a potentially impactful health and well-being intervention for young people experiencing FEP in Aotearoa New Zealand. Furthermore, making the co-design process transparent will further the field in terms of providing a blueprint for this form of participant-focused research. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001323718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384775\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/44980 ", doi="10.2196/44980", url="https://www.researchprotocols.org/2023/1/e44980", url="http://www.ncbi.nlm.nih.gov/pubmed/37129953" } @Article{info:doi/10.2196/43929, author="Ellis, Michael Donovan and Anderson, Lyn Page", title="Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis", journal="JMIR Ment Health", year="2023", month="Apr", day="27", volume="10", pages="e43929", keywords="acceptability", keywords="Black American", keywords="iCBT", keywords="internet-based cognitive behavioral therapy", keywords="digital treatment", keywords="confirmatory factor analysis", keywords="bifactor model", abstract="Background: Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment. Objective: This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample. Methods: Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit. Results: The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models. Conclusions: The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored. ", doi="10.2196/43929", url="https://mental.jmir.org/2023/1/e43929", url="http://www.ncbi.nlm.nih.gov/pubmed/37103983" } @Article{info:doi/10.2196/45305, author="Berry, R. Katie and Gliske, Kate and Schmidt, Clare and Ballard, Jaime and Killian, Michael and Fenkel, Caroline", title="The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis", journal="JMIR Form Res", year="2023", month="Apr", day="20", volume="7", pages="e45305", keywords="adolescents", keywords="family therapy", keywords="intensive outpatient", keywords="mental health", keywords="treatment engagement", keywords="young adults", abstract="Background: ?Early treatment dropout among youths and young adults (28\%-75\%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. Objective: ?We aimed to examine whether family members' participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient's treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Methods: ?Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample's baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Results: ?Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ?1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38\% vs 75.00\%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2\% vs 445/752, 59.2\%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95\% CI 1.3-1.4). Conclusions: ?Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families. ", doi="10.2196/45305", url="https://formative.jmir.org/2023/1/e45305", url="http://www.ncbi.nlm.nih.gov/pubmed/37079372" } @Article{info:doi/10.2196/44064, author="Rifkin-Zybutz, Raphael and Turner, Nicholas and Derges, Jane and Bould, Helen and Sedgewick, Felicity and Gooberman-Hill, Rachael and Linton, Myles-Jay and Moran, Paul and Biddle, Lucy", title="Digital Technology Use and Mental Health Consultations: Survey of the Views and Experiences of Clinicians and Young People", journal="JMIR Ment Health", year="2023", month="Apr", day="17", volume="10", pages="e44064", keywords="internet", keywords="adolescent", keywords="child", keywords="mental health", keywords="anxiety", keywords="patient-physician relationship", abstract="Background: Digital technologies play an increasingly important role in the lives of young people and have important effects on their mental health. Objective: We aimed to explore 3 key areas of the intersection between digital technology and mental health: the views and experiences of young people and clinicians about digital technology and mental health; implementation and barriers to the UK national guidance recommendation---that the discussion of digital technology use should form a core part of mental health assessment; and how digital technology might be used to support existing consultations. Methods: Two cross-sectional web-based surveys were conducted in 2020 between June and December, with mental health clinicians (n=99) and young people (n=320). Descriptive statistics were used to summarize the proportions. Multilinear regression was used to explore how the answers varied by gender, sexuality, and age. Thematic analysis was used to explore the contents of the extended free-text answers. Anxiety was measured using the Generalized Anxiety Disorder Questionnaire-7 (GAD-7). Results: Digital technology use was ubiquitous among young people, with positive and negative aspects acknowledged by both clinicians and young people. Negative experiences were common (131/284, 46.1\%) and were associated with increased anxiety levels among young people (GAD-7 3.29; 95\% CI 1.97-4.61; P<.001). Although the discussion of digital technology use was regarded as important by clinicians and acceptable by young people, less than half of clinicians (42/85, 49.4\%) routinely asked about the use of digital technology and over a third of young people (48/121, 39.6\%) who had received mental health care had never been asked about their digital technology use. The conversations were often experienced as unhelpful. Helpful conversations were characterized by greater depth and exploration of how an individual's digital technology use related to mental health. Despite most clinicians (59/83, 71.1\%) wanting training, very few (21/86, 24.4\%) reported receiving training. Clinicians were open to viewing mental health data from apps or social media to help with consultations. Although young people were generally, in theory, comfortable sharing such data with health professionals, when presented with a binary choice, most reported not wanting to share social media (84/117, 71.8\%) or app data (67/118, 56.8\%) during consultations. Conclusions: Digital technology use was common, and negative experiences were frequent and associated with anxiety. Over a third of young people were not asked about their digital technology use during mental health consultations, and potentially valuable information about relevant negative experiences on the web was not being captured during consultations. Clinicians would benefit from having access to training to support these discussions with young people. Although young people recognized that app data could be helpful to clinicians, they appeared hesitant to share their own data. This finding suggests that data sharing has barriers that need to be further explored. ", doi="10.2196/44064", url="https://mental.jmir.org/2023/1/e44064", url="http://www.ncbi.nlm.nih.gov/pubmed/37067869" } @Article{info:doi/10.2196/44756, author="Evans-Chase, Michelle and Solomon, Phyllis and Peralta, Bethany and Kornmann, Rachel and Fenkel, Caroline", title="Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment", journal="JMIR Form Res", year="2023", month="Apr", day="11", volume="7", pages="e44756", keywords="depression", keywords="IOP", keywords="LGBTQ+", keywords="mental health", keywords="telehealth", keywords="youth", keywords="young adult", abstract="Background: Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. Objective: The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. Methods: Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. Results: Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23\%) identified as nongender binary and 60\% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference --6.06) were seen in depression between intake and discharge (t967=--24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53\%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). Conclusions: Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth. ", doi="10.2196/44756", url="https://formative.jmir.org/2023/1/e44756", url="http://www.ncbi.nlm.nih.gov/pubmed/37040155" } @Article{info:doi/10.2196/43115, author="Derges, Jane and Bould, Helen and Gooberman-Hill, Rachael and Moran, Paul and Linton, Myles-Jay and Rifkin-Zybutz, Raphael and Biddle, Lucy", title="Mental Health Practitioners' and Young People's Experiences of Talking About Social Media During Mental Health Consultations: Qualitative Focus Group and Interview Study", journal="JMIR Form Res", year="2023", month="Apr", day="7", volume="7", pages="e43115", keywords="young people", keywords="digital technology and social media", keywords="mental health consultations", keywords="clinician and young people's experiences", abstract="Background: Increasing concerns among mental health care professionals have focused on the impact of young people's use of digital technology and social media on their mental well-being. It has been recommended that the use of digital technology and social media be routinely explored during mental health clinical consultations with young people. Whether these conversations occur and how they are experienced by both clinicians and young people are currently unknown. Objective: This study aimed to explore mental health practitioners' and young people's experiences of talking about young people's web-based activities related to their mental health during clinical consultations. Web-based activities include use of social media, websites, and messaging. Our aim was to identify barriers to effective communication and examples of good practice. In particular, we wanted to obtain the views of young people, who are underrepresented in studies, on their social media and digital technology use related to mental health. Methods: A qualitative study was conducted using focus groups (11 participants across 3 groups) with young people aged 16 to 24 years and interviews (n=8) and focus groups (7 participants across 2 groups) with mental health practitioners in the United Kingdom. Young people had experience of mental health problems and support provided by statutory mental health services or third-sector organizations. Practitioners worked in children and young people's mental health services, statutory services, or third-sector organizations such as a university counseling service. Thematic analysis was used to analyze the data. Results: Practitioners and young people agreed that talking about young people's web-based activities and their impact on mental health is important. Mental health practitioners varied in their confidence in doing this and were keen to have more guidance. Young people said that practitioners seldom asked about their web-based activities, but when asked, they often felt judged or misunderstood. This stopped them from disclosing difficult web-based experiences and precluded useful conversations about web-based safety and how to access appropriate web-based support. Young people supported the idea of guidance or training for practitioners and were enthusiastic about sharing their experiences and being involved in the training or guidance provided to practitioners. Conclusions: Practitioners would benefit from structured guidance and professional development to enable them to support young people in feeling more willing to disclose and talk about their web-based experiences and their impact on their mental health. This is reflected in practitioners' desire for guidance to improve their confidence and skills to safely support young people in navigating the challenges of the web-based world. Young people want to feel comfortable discussing their web-based activities during their consultations with mental health practitioners, both in tackling the challenges and using the opportunity to discuss their experiences, gain support, and develop coping strategies related to web-based safety. ", doi="10.2196/43115", url="https://formative.jmir.org/2023/1/e43115", url="http://www.ncbi.nlm.nih.gov/pubmed/37027182" } @Article{info:doi/10.2196/34147, author="Daemen, Maud and van Amelsvoort, Therese and and Reininghaus, Ulrich", title="Momentary Self-esteem as a Process Underlying the Association Between Childhood Trauma and Psychosis: Experience Sampling Study", journal="JMIR Ment Health", year="2023", month="Apr", day="5", volume="10", pages="e34147", keywords="psychosis", keywords="self-esteem", keywords="childhood trauma", keywords="childhood adversity", keywords="experience sampling method", keywords="ecological momentary assessment", abstract="Background: Exposure to childhood trauma is associated with an increased risk of developing and maintaining psychotic symptoms later in life. Self-esteem might be an important psychological process underlying the association between childhood trauma and psychosis, but there is only limited evidence to support this claim, especially in daily life. Objective: In this study, we aimed to investigate whether exposure to childhood trauma (physical, emotional, and sexual abuse and physical and emotional neglect) moderates the cross-sectional and temporal associations between self-esteem and psychotic experiences in patients with psychotic disorders, their first-degree relatives, and controls. Methods: We assessed momentary self-esteem and psychotic experiences in daily life using the experience sampling method in 139 patients with psychotic disorders, 118 first-degree relatives of patients with psychotic disorders, and 111 controls. Childhood trauma was measured using the Childhood Trauma Questionnaire. We fitted linear mixed models and added two-way and three-way interaction terms to test the hypotheses. Results: The association between momentary self-esteem and psychotic experiences in daily life was modified by prior exposure to high versus low levels of several types of childhood trauma, that is, physical ($\chi$22=24.9, family-wise error-corrected P<.001) and sexual abuse ($\chi$22=15.9, P<.001) and physical neglect ($\chi$22=116.7, P<.001). Specifically, momentary self-esteem was associated with more intense psychotic experiences in patients exposed to high versus low levels of physical neglect, in relatives exposed to high versus low levels of physical abuse, and in relatives and controls exposed to high versus low levels of sexual abuse. When investigating temporal order, the results showed no evidence that childhood trauma modified the temporal associations between self-esteem at tn-1 and psychotic experiences at tn or those between psychotic experiences at tn-1 and self-esteem at tn. Conclusions: The association between self-esteem and psychotic experiences in daily life was found to be stronger in those exposed to high versus low levels of several types of childhood trauma (ie, physical abuse, sexual abuse, and physical neglect). ", doi="10.2196/34147", url="https://mental.jmir.org/2023/1/e34147", url="http://www.ncbi.nlm.nih.gov/pubmed/37018034" } @Article{info:doi/10.2196/43942, author="Bautista, Justine and Schueller, M. Stephen", title="Understanding the Adoption and Use of Digital Mental Health Apps Among College Students: Secondary Analysis of a National Survey", journal="JMIR Ment Health", year="2023", month="Mar", day="22", volume="10", pages="e43942", keywords="mental health", keywords="mental health apps", keywords="college students", keywords="digital health", keywords="app", keywords="anxiety", abstract="Background: Increasing rates of mental health diagnoses in college students signal the need for new opportunities to support the mental health of this population. With many mental health apps being efficacious, they may be a promising resource for college campuses to provide support to their students. However, it is important to understand why (or why not) students might want to use apps and their desired features. Objective: Information on students' interest in mental health apps may inform which apps are to be provided and how campuses can support their use. This study aimed to understand the interest and hesitation in app use and the relationship between mental health needs, as defined by depression, anxiety, and positive mental health, and app use. Methods: The web-based Healthy Minds Study collected information on mental health needs, perceptions, and service use across colleges and universities. We used a sample of 989 participants who completed the survey between 2018 and 2020 and an elective module on digital mental health. We analyzed the elective module responses using a mixed methods approach, including both descriptive and inferential statistics, along with thematic coding for open text responses. Results: The Results from this study revealed that anxiety (b=?0.07; P<.001), but not depression (b=0.03; P=.12) and positive mental health (b=?0.02; P=.17), was a significant predictor of app adoption. Prominent qualitative findings indicated that the most desired app features included tips and advice, access to resources and information, and on-demand support that involves interaction throughout the day. The participants also suggested an overall desire for human interaction to be integrated into an app. As predicted, hesitancy was encountered, and the qualitative results suggested that there was a lack of interest in the adoption of mental health app and preference. Conclusions: The findings from this study underscore that simply providing digital mental health apps as tools may be insufficient to support their use in college campuses. Although many students were open to using a mental health app, hesitation and uncertainty were common in the participant responses. Working with colleges and universities to increase digital literacy and provide resources that allow students to gauge when app use is appropriate may be helpful when implementing mental health apps as resources in college campuses. ", doi="10.2196/43942", url="https://mental.jmir.org/2023/1/e43942", url="http://www.ncbi.nlm.nih.gov/pubmed/36947115" } @Article{info:doi/10.2196/38504, author="Mak, S. Winnie W. and Ng, Man Sin and Leung, T. Florence H.", title="A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design", journal="JMIR Form Res", year="2023", month="Mar", day="22", volume="7", pages="e38504", keywords="user-centered design", keywords="qualitative research", keywords="usability testing", keywords="mental health", keywords="self-care", keywords="stratified stepped care", keywords="internet-based psychological interventions", abstract="Background: Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users' continued adoption and practice of self-care for their mental health. Objective: The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users' perceptions on mental self-care and feedback on the platform design and incorporates them into the design. Methods: The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach. Results: In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses. Conclusions: The design process and findings presented in the study are important in developing a user-centric platform to optimize users' acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users' perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web. ", doi="10.2196/38504", url="https://formative.jmir.org/2023/1/e38504", url="http://www.ncbi.nlm.nih.gov/pubmed/36947112" } @Article{info:doi/10.2196/38042, author="Elledge, K. Daniel and Lee, Craddock Simon and Stewart, M. Sunita and Pop, Radu and Trivedi, H. Madhukar and Hughes, L. Jennifer", title="Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study", journal="JMIR Form Res", year="2023", month="Mar", day="22", volume="7", pages="e38042", keywords="youth", keywords="prevention", keywords="resilience", keywords="mental health app", keywords="mobile phone", abstract="Background: Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes. Objective: This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience. Methods: In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use. Results: Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback. Conclusions: Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research. ", doi="10.2196/38042", url="https://formative.jmir.org/2023/1/e38042", url="http://www.ncbi.nlm.nih.gov/pubmed/36947113" } @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/10.2196/38632, author="Malhotra, Bhavya and Sahoo, Jagannath and Gupta, Mansi and Joshi, Ashish", title="The Design, Development, and Implementation of a Web-Enabled Informatics Platform to Enhance the Well-being of Individuals Aged 18-24 Years: Protocol for an Experimental Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="3", volume="12", pages="e38632", keywords="well-being", keywords="mental health", keywords="nutrition", keywords="youth", keywords="digital health", keywords="interventions", keywords="India", keywords="health", keywords="lifestyle", abstract="Background: Well-being is multidimensional, complex, and dynamic in nature. It is an amalgam of physical and mental health, essential for disease prevention and the promotion of a healthy life. Objective: This study aims to explore the features that impact the well-being of individuals between 18 and 24 years of age in an Indian setting. It further aims to design, develop, and evaluate the usefulness and effectiveness of a web-based informatics platform or stand-alone intervention to enhance the well-being of individuals aged 18-24 years in an Indian setting. Methods: This study follows a mixed method approach to identify factors influencing the well-being of individuals in the age group of 18-24 years in an Indian setting. The college-going students in this age group from the states of Uttarakhand (urban settings of Dehradun) and Uttar Pradesh (urban settings of Meerut) will be enrolled. They will be randomly allocated to the control and intervention groups. The participants in the intervention group will have access to the web-based well-being platform. Results: This study will examine the factors that influence the well-being of individuals aged 18-24 years. It will also facilitate the design and development of the web-based platform or stand-alone intervention, which will enhance the well-being of individuals in the age group of 18-24 years in an Indian setting. Furthermore, the results of this study will help generate a well-being index for individuals to plan tailored interventions. The 60 in-depth interviews have been conducted as of September 30, 2022. Conclusions: The study will help understand the factors that influence the well-being of individuals. The findings of this study will help in the design and development of the web-based platform or stand-alone intervention to enhance the well-being of individuals in the age group of 18-24 years in an Indian setting. International Registered Report Identifier (IRRID): PRR1-10.2196/38632 ", doi="10.2196/38632", url="https://www.researchprotocols.org/2023/1/e38632", url="http://www.ncbi.nlm.nih.gov/pubmed/36867449" } @Article{info:doi/10.2196/35659, author="Choi, Isabella and Mestroni, Gemma and Hunt, Caroline and Glozier, Nick", title="Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Feb", day="17", volume="7", pages="e35659", keywords="help seeking", keywords="mental health", keywords="international students", keywords="Chinese international students", keywords="mental health awareness", abstract="Background: The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students. Objective: This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application's uptake and engagement. Methods: The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person's symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement. Results: A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4\% (122/908) in the schools' Chinese student enrollment. Most participants (76/130, 58.5\%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67\% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74\%), stress (17/31, 55\%), and sleep (15/31, 48\%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10\% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement. Conclusions: There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students' mental health literacy, stigma, and help seeking. ", doi="10.2196/35659", url="https://formative.jmir.org/2023/1/e35659", url="http://www.ncbi.nlm.nih.gov/pubmed/36800231" } @Article{info:doi/10.2196/41663, author="Batterham, Philip and Gulliver, Amelia and Sunderland, Matthew and Farrer, Louise and Kay-Lambkin, Frances and Trias, Angelica and Calear, Alison", title="Factors Influencing Community Participation in Internet Interventions Compared With Research Trials: Observational Study in a Nationally Representative Adult Cohort", journal="J Med Internet Res", year="2023", month="Feb", day="2", volume="25", pages="e41663", keywords="mental health", keywords="uptake", keywords="engagement", keywords="internet", keywords="research participation", keywords="implementation", abstract="Background: Digital mental health (DMH) programs can be effective in treating and preventing mental health problems. However, community engagement with these programs can be poor. Understanding the barriers and enablers of DMH program use may assist in identifying ways to increase the uptake of these programs, which have the potential to provide broad-scale prevention and treatment in the community. Objective: In this study, we aimed to identify and compare factors that may influence participation in DMH programs in practice and research trials, identify any respondent characteristics that are associated with these factors, and assess the relationship between intentions to use DMH programs and actual uptake. Methods: Australian adults aged ?18 years were recruited from market research panels to participate in the study. The sample was representative of the Australian adult population based on age, gender, and location. Participants completed a cross-sectional web-based survey assessing demographic characteristics, mental health symptom measures, attitudes and use of DMH programs in practice and in research studies, and the factors influencing their use in both settings. Results: Across both research and practice, trust in the organization delivering the service or trial was the top-ranked factor influencing participation, followed by anonymity or privacy and adequate information. There was little variation in rankings across demographic groups, including intentions to use DMH programs or mental health status. Intentions to use DMH programs were a strong predictor of both current (odds ratio 2.50, 99\% CI 1.41-4.43; P<.001) and past (odds ratio 2.98, 99\% CI 1.71-5.19; P<.001) use behaviors. Conclusions: Efforts to increase the uptake of DMH programs or participation in research trials should focus on clearly communicating the following to users: the legitimacy of the organization delivering the program, security and use of participant data, and effectiveness of DMH programs. ", doi="10.2196/41663", url="https://www.jmir.org/2023/1/e41663", url="http://www.ncbi.nlm.nih.gov/pubmed/36729613" } @Article{info:doi/10.2196/38822, author="Triplett, S. Noah and Johnson, Clara and Kiche, Sharon and Dastrup, Kara and Nguyen, Julie and Daniels, Alayna and Mbwayo, Anne and Amanya, Cyrilla and Munson, Sean and Collins, Y. Pamela and Weiner, J. Bryan and Dorsey, Shannon", title="Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study", journal="JMIR Form Res", year="2023", month="Feb", day="2", volume="7", pages="e38822", keywords="task shifting", keywords="human-centered design", keywords="supervision", keywords="global mental health", keywords="acceptability", keywords="feasibility", keywords="mobile phone", abstract="Background: Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered. Objective: Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision. Methods: Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants' choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis. Results: Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support. Conclusions: Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools. International Registered Report Identifier (IRRID): RR2-10.1186/s43058-020-00102-9 ", doi="10.2196/38822", url="https://formative.jmir.org/2023/1/e38822", url="http://www.ncbi.nlm.nih.gov/pubmed/36729591" } @Article{info:doi/10.2196/43840, author="Winstone, Lizzy and Mars, Becky and Ferrar, Jennifer and Moran, Paul and Penton-Voak, Ian and Grace, Lydia and Biddle, Lucy", title="Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study", journal="JMIR Ment Health", year="2023", month="Jan", day="31", volume="10", pages="e43840", keywords="self-harm", keywords="lived experience stories", keywords="web-based support", keywords="self-help", keywords="recovery", keywords="focus groups", abstract="Background: The positive and negative effects of interacting with web-based content on mental health, and especially self-harm, are well documented. Lived experience stories are one such type of static web-based content, frequently published on health care or third-sector organization websites, as well as social media and blogs, as a form of support for those seeking help via the web. Objective: This study aimed to increase understanding about how people who self-harm engage with and evaluate web-based lived experience stories. Methods: Overall, 4 web-based focus groups were conducted with 13 people with recent self-harm experience (aged 16-40 years). In total, 3 example lived experience stories were read aloud to participants, who were then asked to share their reactions to the stories. Participants were also encouraged to reflect on stories previously encountered on the web. Data were analyzed thematically. Results: Overall, 5 themes were generated: stories of recovery from self-harm and their emotional impact, impact on self-help and help-seeking behaviors, identifying with the narrator, authenticity, and language and stereotyping. Conclusions: Lived experience stories published on the web can provide a valuable form of support for those experiencing self-harm. They can be motivating and empowering for the reader, and they have the potential to distract readers from urges to self-harm. However, these effects may be moderated by age, and narratives of recovery may demoralize older readers. Our findings have implications for organizations publishing lived experience content and for community guidelines and moderators of web-based forums in which users share their stories. These include the need to consider the narrator's age and the relatability and authenticity of their journey and the need to avoid using stigmatizing language. ", doi="10.2196/43840", url="https://mental.jmir.org/2023/1/e43840", url="http://www.ncbi.nlm.nih.gov/pubmed/36719729" } @Article{info:doi/10.2196/43253, author="Rochford, Ben and Pendse, Sachin and Kumar, Neha and De Choudhury, Munmun", title="Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data", journal="JMIR Ment Health", year="2023", month="Jan", day="30", volume="10", pages="e43253", keywords="mental health", keywords="search engine algorithms", keywords="digital mental health", keywords="health equity", abstract="Background: In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals. Objective: We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web. Methods: We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons. Results: We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03\%, SD 0.44\%), depression (mean 1.15\%, SD 0.27\%), fatigue (mean 1.21\%, SD 0.28\%), and headache (mean 1.03\%, SD 0.23\%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02\%, SD 0.02\%), psychosis (mean 0.37\%, SD 0.06\%), and attention-deficit/hyperactivity disorder (mean 0.77\%, SD 0.10\%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05\%, SD 0.04\%) than in nonshortage areas (mean 0.10\%, SD 0.03\%; Q<.0003), more so when a shortage area is rural (mean 0.024\%, SD 0.029\%; Q<2 {\texttimes} 10--12). Conclusions: This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care. ", doi="10.2196/43253", url="https://mental.jmir.org/2023/1/e43253", url="http://www.ncbi.nlm.nih.gov/pubmed/36716082" } @Article{info:doi/10.2196/39206, author="Rutter, A. Lauren and Howard, Jacqueline and Lakhan, Prabhvir and Valdez, Danny and Bollen, Johan and Lorenzo-Luaces, Lorenzo", title="``I Haven't Been Diagnosed, but I Should Be''---Insight Into Self-diagnoses of Common Mental Health Disorders: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Jan", day="13", volume="7", pages="e39206", keywords="assessment", keywords="depression", keywords="anxiety", keywords="self-report", keywords="social media", abstract="Background: In recent years, social media has become a rich source of mental health data. However, there is a lack of web-based research on the accuracy and validity of self-reported diagnostic information available on the web. Objective: An analysis of the degree of correspondence between self-reported diagnoses and clinical indicators will afford researchers and clinicians higher levels of trust in social media analyses. We hypothesized that self-reported diagnoses would correspond to validated disorder-specific severity questionnaires across 2 large web-based samples. Methods: The participants of study 1 were 1123 adults from a national Qualtrics panel (mean age 34.65, SD 12.56 years; n=635, 56.65\% female participants,). The participants of study 2 were 2237 college students from a large university in the Midwest (mean age 19.08, SD 2.75 years; n=1761, 75.35\% female participants). All participants completed a web-based survey on their mental health, social media use, and demographic information. Additionally, the participants reported whether they had ever been diagnosed with a series of disorders, with the option of selecting ``Yes''; ``No, but I should be''; ``I don't know''; or ``No'' for each condition. We conducted a series of ANOVA tests to determine whether there were differences among the 4 diagnostic groups and used post hoc Tukey tests to examine the nature of the differences. Results: In study 1, for self-reported mania (F3,1097=2.75; P=.04), somatic symptom disorder (F3,1060=26.75; P<.001), and alcohol use disorder (F3,1097=77.73; P<.001), the pattern of mean differences did not suggest that the individuals were accurate in their self-diagnoses. In study 2, for all disorders but bipolar disorder (F3,659=1.43; P=.23), ANOVA results were consistent with our expectations. Across both studies and for most conditions assessed, the individuals who said that they had been diagnosed with a disorder had the highest severity scores on self-report questionnaires, but this was closely followed by individuals who had not been diagnosed but believed that they should be diagnosed. This was especially true for depression, generalized anxiety, and insomnia. For mania and bipolar disorder, the questionnaire scores did not differentiate individuals who had been diagnosed from those who had not. Conclusions: In general, if an individual believes that they should be diagnosed with an internalizing disorder, they are experiencing a degree of psychopathology similar to those who have already been diagnosed. Self-reported diagnoses correspond well with symptom severity on a continuum and can be trusted as clinical indicators, especially in common internalizing disorders such as depression and generalized anxiety disorder. Researchers can put more faith into patient self-reports, including those in web-based experiments such as social media posts, when individuals report diagnoses of depression and anxiety disorders. However, replication and further study are recommended. ", doi="10.2196/39206", url="https://formative.jmir.org/2023/1/e39206", url="http://www.ncbi.nlm.nih.gov/pubmed/36637885" } @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/10.2196/40933, 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/10.2196/34754, author="De Veirman, M. Ann E. and Thewissen, Viviane and Spruijt, G. Matthijs and Bolman, W. Catherine A.", title="Factors Associated With Intention and Use of e--Mental Health by Mental Health Counselors in General Practices: Web-Based Survey", journal="JMIR Form Res", year="2022", month="Dec", day="20", volume="6", number="12", pages="e34754", keywords="mental health counselors", keywords="general practices", keywords="e--mental health", keywords="adoption readiness", keywords="eligibility for e--mental health", keywords="e--mental health use", keywords="mental health", keywords="eHealth", abstract="Background: Mental health care counselors have a high intention to use e--mental health (EMH), whereas actual use is limited. Facilitating future use requires insight into underlying factors as well as eligibility criteria that mental health care counselors use in their decision to apply EMH. Objective: The aim of this study was to unfold the intention and underlying reasons for mental health counselors to use EMH and to unveil the criteria they use to estimate patient eligibility for EMH. The theoretical framework was based on the reasoned action approach model, the Unified Theory of Acceptance and Use of Technology, and the Measurement Instrument for Determinants of Innovation model. Methods: To empirically validate our theoretical model, a web-based survey was conducted among mental health care counselors (n=132). To unveil the eligibility criteria, participants were asked to rank their reasons for considering EMH suitable or unsuitable for a patient. Results: The mean intention to use EMH was positive (mean 4.04, SD 0.64). The mean use of EMH before the COVID-19 pandemic was 38\% (mean 0.38, SD 0.22), and it was 49\% (mean 0.49, SD 0.25) during the pandemic. In total, 57\% of the patient population was considered eligible for EMH. Usefulness and benefits ($\beta$=.440; P<.001), Task perception ($\beta$=.306; P=.001), and Accessibility ($\beta$=.140; P=.02) explained the intention to use EMH (F3,131=54.151; P<.001; R2=0.559). In turn, intention explained patient eligibility (F1,130=34.716; P<.001; R2=0.211), whereas intention and patient eligibility explained EMH use (F2,129=41.047; P<.001; R2=0.389). Patient eligibility partially mediated the relationship between intention to use EMH and EMH use, with a larger direct effect (c{\textasciiacutex}=0.116; P<.001) than indirect effect (c=0.065, 95\% CI 0.035-0.099; P<.001). Mental health counselors assessed patients' eligibility for EMH mainly through the availability of computers and the internet and patient motivation. Conclusions: To stimulate the use of EMH, intention and patient eligibility need to be influenced. Intention, in turn, can be enhanced by addressing the perceived usefulness and benefits of EMH, perceived accessibility, and task perception. Access to a computer and patients' motivation to use EMH are important in facilitating patient eligibility. To cause an impact with EMH in general practice, mental health counselors need to be convinced of the benefits of EMH and transfer this enthusiasm to the patient. It is recommended to involve mental health counselors in the development of EMH to increase the (perceived) added value and use. ", doi="10.2196/34754", url="https://formative.jmir.org/2022/12/e34754", url="http://www.ncbi.nlm.nih.gov/pubmed/36538357" } @Article{info:doi/10.2196/38496, author="Nicol, Ginger and Jansen, Madeline and Haddad, Rita and Ricchio, Amanda and Yingling, D. Michael and Schweiger, A. Julia and Keenoy, Katie and Evanoff, A. Bradley and Newcomer, W. John", title="Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria", journal="JMIR Form Res", year="2022", month="Dec", day="13", volume="6", number="12", pages="e38496", keywords="obesity", keywords="mentally ill people/persons", keywords="health services", keywords="mobile health", abstract="Background: Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. Objective: We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Methods: Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80\% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. Results: A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40\% (10/26) were Black and 60\% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. Conclusions: These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI. ", doi="10.2196/38496", url="https://formative.jmir.org/2022/12/e38496", url="http://www.ncbi.nlm.nih.gov/pubmed/36512399" } @Article{info:doi/10.2196/41482, author="Stefancic, Ana and Rogers, Tyler R. and Styke, Sarah and Xu, Xiaoyan and Buchsbaum, Richard and Nossel, Ilana and Cabassa, J. Leopoldo and Stroup, Scott T. and Kimhy, David", title="Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians", journal="JMIR Ment Health", year="2022", month="Nov", day="4", volume="9", number="11", pages="e41482", keywords="first-episode psychosis", keywords="early psychosis", keywords="coordinated specialty care", keywords="mental health treatment", keywords="shared decision-making", keywords="mobile health", keywords="smartphone apps", keywords="qualitative", keywords="digital psychiatry", keywords="mobile phone", abstract="Background: Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. Objective: This qualitative study sought clinicians' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. Methods: Following the app's initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app's design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications?Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. Results: The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers' clinical judgment (eg, need for clinically relevant information), and organizations' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention's scope, concerns regarding dilution of the intervention's core components, and concerns about increasing patient burden while using the app. Conclusions: FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients---the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. Trial Registration: ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6 ", doi="10.2196/41482", url="https://mental.jmir.org/2022/11/e41482", url="http://www.ncbi.nlm.nih.gov/pubmed/36331539" } @Article{info:doi/10.2196/35538, author="Su, Langting and Anderson, Lyn Page", title="User Behavior of a Publicly Available, Free-to-Use, Self-guided mHealth App for Depression: Observational Study in a Global Sample", journal="JMIR Form Res", year="2022", month="Oct", day="25", volume="6", number="10", pages="e35538", keywords="mHealth", keywords="depression", keywords="smartphone", keywords="mobile app", keywords="digital health", keywords="global mental health", keywords="MoodTools", keywords="mobile health", keywords="mental health", keywords="mobile phone", keywords="low- and middle-income countries", abstract="Background: Reducing the burden of depression is a global health concern. Self-guided mobile health (mHealth) apps are one approach to address this problem. However, there is little research on self-guided mHealth apps in a global sample or on how they are used in the real world. These gaps in our knowledge must be addressed to bring the promise of mHealth apps for reducing the global burden of depression closer to reality. Objective: The purpose of this study is to examine the naturalistic user behavior of MoodTools, a publicly available, free-to-use, self-guided mHealth app designed to improve symptoms of depression, in a global community sample. Methods: Mobile analytics data were collected from all unique downloads of the Android version of MoodTools between March 1, 2016, and February 28, 2018. Due to the deidentification and data aggregation process, no demographic or personal identifying information was tied to individual user data. All information was stored in aggregated, anonymized data files on Google Analytics' storage database. Google's software development kit was used to securely capture data about the number of downloads, location of downloads, number of app sessions, frequency and duration of app sessions, time between app sessions, and user retention, allowing for examination of which app's tools were viewed and for how long, including Information (psychoeducation), Test (self-monitoring using the Patient Health Questionnaire [PHQ-9]), Thought Diary (targeting negative cognitions), Activities (behavioral activation), Videos (curated from YouTube), and Safety Plan (safety plan development and links to quickly access crisis management resources). Results: MoodTools was used by 158,930 people from 198 countries, including countries where English was not the primary language and in low- and middle-income countries. After the initial download, 51.14\% (n=81,277) of users returned to the app after the initial download, and retention rates decreased with each subsequent app session. The typical person used the app for 3 sessions for a total of 12 minutes over 90 days. The most frequently visited tools were Test and Thought Diary (n=393,549, 24.32\%). On average, users completed and reviewed the results of the PHQ-9 for 49 seconds and 53 seconds, respectively, and spent 3 minutes and 5 seconds on Thought Diary. Conclusions: Self-guided mHealth apps could be one approach (among the many needed) to reduce the burden of depression. Observational data collected in this study show a global interest in MoodTools, including in low- and middle-income countries and countries where English is not the primary language. Future research is needed to determine whether people who use self-guided apps experience improvement in depressive symptoms, and if so, what ``dosage'' provides a meaningful benefit. ", doi="10.2196/35538", url="https://formative.jmir.org/2022/10/e35538", url="http://www.ncbi.nlm.nih.gov/pubmed/36282559" } @Article{info:doi/10.2196/37657, author="Rice, Kevin and Seidman, Joshua and Mahoney, Oneil", title="A Health Equity--Oriented Research Agenda Requires Comprehensive Community Engagement", journal="J Particip Med", year="2022", month="Sep", day="30", volume="14", number="1", pages="e37657", keywords="mental health", keywords="community-based participatory action research", keywords="health equity", keywords="serious mental illness", keywords="health policy", keywords="research", keywords="community", keywords="engagement", keywords="disparity", keywords="participatory care", keywords="consumers", doi="10.2196/37657", url="https://jopm.jmir.org/2022/1/e37657", url="http://www.ncbi.nlm.nih.gov/pubmed/36178726" } @Article{info:doi/10.2196/39482, author="Garrote-C{\'a}mara, Elena Maria and Ju{\'a}rez-Vela, Ra{\'u}l and Sufrate-Sorzano, Teresa and Durante, Angela and Ferrara, Paolo and Terzoni, Stefano and P{\'e}rez, Jes{\'u}s and Santolalla-Arnedo, Iv{\'a}n", title="Transcultural Adaptation of and Theoretical Validation Models for the Spanish Version of the Nurses' Global Assessment of Suicide Risk Scale: Protocol for a Multicenter Cross-sectional Study", journal="JMIR Res Protoc", year="2022", month="Sep", day="21", volume="11", number="9", pages="e39482", keywords="mental health", keywords="suicide", keywords="psychiatric nursing", keywords="Spanish", keywords="translate", keywords="translation", keywords="scale", keywords="measurement", keywords="assessment", keywords="adapt", keywords="adaptation", keywords="cultural", keywords="transcultural", keywords="suicidal", keywords="nurse", keywords="nursing", keywords="psychiatric", keywords="public health", keywords="prevention", keywords="treatment", keywords="risk", keywords="development", keywords="lethal", keywords="patient", keywords="scientific literature", keywords="variables", keywords="reliability", keywords="validate", keywords="validity", keywords="tool", keywords="Nurse{\textasciiacute}s Global Assessment of Suicide Risk", keywords="psychometric", abstract="Background: The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses' Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments. Objective: The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors. Methods: The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool's internal structure. The tool's reliability will be assessed by exploring internal consistency and calculating the Cronbach $\alpha$ coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is <.05 for the null hypothesis of sphericity, the null hypothesis will be rejected. Results: Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023. Conclusions: We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management. International Registered Report Identifier (IRRID): PRR1-10.2196/39482 ", doi="10.2196/39482", url="https://www.researchprotocols.org/2022/9/e39482", url="http://www.ncbi.nlm.nih.gov/pubmed/3612975" } @Article{info:doi/10.2196/34230, author="Henshall, Catherine and Ostinelli, Edoardo and Harvey, Jade and Davey, Zoe and Aghanenu, Bemigho and Cipriani, Andrea and Attenburrow, Mary-Jane", title="Examining the Effectiveness of Web-Based Interventions to Enhance Resilience in Health Care Professionals: Systematic Review", journal="JMIR Med Educ", year="2022", month="Sep", day="6", volume="8", number="3", pages="e34230", keywords="resilience", keywords="health care professionals", keywords="depression", keywords="psychological stress", keywords="internet", keywords="mental health", abstract="Background: Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals' mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety outcomes. Strategies to improve the psychological health and well-being of health care staff have been highlighted as a critical priority worldwide. The concept of resilience for health care professionals as a tool for negotiating workplace adversity has gained increasing prominence. Objective: This systematic review aims to examine the effectiveness of web-based interventions to enhance resilience in health care professionals. Methods: We searched the PubMed, CINAHL, PsycINFO, and Ovid SP databases for relevant records published after 1990 until July 2021. We included studies that focused on internet-delivered interventions aiming at enhancing resilience. Study quality was assessed with the Risk of Bias 2 tool for randomized controlled trial designs and Joanna Briggs Institute critical appraisal tool for other study designs. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42021253190). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Results: A total of 8 studies, conducted between 2014 and 2020 and involving 1573 health care workers, were included in the review. In total, 4 randomized controlled trial designs and 4 pre- and postdesign studies were conducted across a range of international settings and health care disciplines. All of these studies aimed to evaluate the impact of web-based interventions on resilience or related symptoms in health care professionals involved in patient-facing care. Interventions included various web-based formats and therapeutic approaches over variable time frames. One randomized controlled trial directly measured resilience, whereas the remaining 3 used proxy measures to measure psychological concepts linked to resilience. Three pretest and posttest studies directly measured resilience, whereas the fourth study used a proxy resilience measure. Owing to the heterogeneity of outcome measures and intervention designs, meta-analysis was not possible, and qualitative data synthesis was undertaken. All studies found that resilience or proxy resilience levels were enhanced in health care workers following the implementation of web-based interventions. The overall risk of bias of all 8 studies was low. Conclusions: The findings indicate that web-based interventions designed to enhance resilience may be effective in clinical practice settings and have the potential to provide support to frontline staff experiencing prolonged workplace stress across a range of health care professional groups. However, the heterogeneity of included studies means that findings should be interpreted with caution; more web-based interventions need rigorous testing to further develop the evidence base. Trial Registration: PROSPERO CRD42021253190; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=253190 ", doi="10.2196/34230", url="https://mededu.jmir.org/2022/3/e34230", url="http://www.ncbi.nlm.nih.gov/pubmed/36066962" } @Article{info:doi/10.2196/37285, author="Grodberg, David and Bridgewater, Jesse and Loo, Theoren and Bravata, Dena", title="Examining the Relationship Between Pediatric Behavioral Health and Parent Productivity Through a Parent-Reported Survey in the Time of COVID-19: Exploratory Study", journal="JMIR Form Res", year="2022", month="Aug", day="18", volume="6", number="8", pages="e37285", keywords="adolescent", keywords="child, family health", keywords="mental health", keywords="behavioral health", keywords="stress", keywords="protective factors", keywords="productivity", keywords="COVID-19", abstract="Background: Pediatric behavioral health needs skyrocketed during the COVID-19 pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families' behavioral health needs. Objective: The aim of this study is to investigate the associations of known pediatric behavioral health risk factors and parents' reports of workplace productivity. Methods: A clinical research team at Brightline---a virtual, pediatric behavioral health solution---drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents' reports of workplace productivity. Results: Participants (N=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children's behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents' workplace productivity. Conclusions: This survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first step in understanding the relationship between these variables. The results from this study can empower parents by providing insights to help manage their child's behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers. ", doi="10.2196/37285", url="https://formative.jmir.org/2022/8/e37285", url="http://www.ncbi.nlm.nih.gov/pubmed/35616439" } @Article{info:doi/10.2196/35661, author="Choi, Isabella and Petrie, Katherine and Einboden, Rochelle and Collins, Daniel and Ryan, Rose and Johnston, David and Harvey, B. Samuel and Glozier, Nicholas and Wray, Alexis and Deady, Mark", title="Apprentices' Attitudes Toward Using a Mental Health Mobile App to Support Healthy Coping: Mixed Methods Study", journal="JMIR Hum Factors", year="2022", month="Aug", day="18", volume="9", number="3", pages="e35661", keywords="apprentice", keywords="coping strategies", keywords="mental health", keywords="app", keywords="wellbeing", keywords="focus group", keywords="coping behaviour", abstract="Background: Apprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them. Objective: This study explored (1) apprentices' interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content. Methods: A mixed methods study was conducted with 54 apprentices (50/54 male, 93\%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. Results: Only 11\% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87\%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78\%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing; (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation; (3) cognitive approaches, including defusing from thoughts and cognitive reframing; and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep. Conclusions: There is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group. ", doi="10.2196/35661", url="https://humanfactors.jmir.org/2022/3/e35661", url="http://www.ncbi.nlm.nih.gov/pubmed/35980733" } @Article{info:doi/10.2196/37640, author="Li, H. Sophie and Achilles, R. Melinda and Werner-Seidler, Aliza and Beames, R. Joanne and Subotic-Kerry, Mirjana and O'Dea, Bridianne", title="Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review", journal="JMIR Ment Health", year="2022", month="Aug", day="17", volume="9", number="8", pages="e37640", keywords="adherence", keywords="youth", keywords="digital", keywords="cognitive behavioral therapy", keywords="review", keywords="mobile phone", abstract="Background: Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. Objective: This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. Methods: A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. Results: There were 32 manuscripts that met the inclusion criteria, of which 28 (88\%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. Conclusions: Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. Trial Registration: PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram ", doi="10.2196/37640", url="https://mental.jmir.org/2022/8/e37640", url="http://www.ncbi.nlm.nih.gov/pubmed/35976180" } @Article{info:doi/10.2196/39807, author="Iyer, Ravi and Nedeljkovic, Maja and Meyer, Denny", title="Using Voice Biomarkers to Classify Suicide Risk in Adult Telehealth Callers: Retrospective Observational Study", journal="JMIR Ment Health", year="2022", month="Aug", day="15", volume="9", number="8", pages="e39807", keywords="voice biometrics", keywords="suicide prevention", keywords="machine learning", keywords="telehealth", keywords="suicide", keywords="risk prediction", keywords="prediction model", keywords="voice biomarker", keywords="mental health", abstract="Background: Artificial intelligence has the potential to innovate current practices used to detect the imminent risk of suicide and to address shortcomings in traditional assessment methods. Objective: In this paper, we sought to automatically classify short segments (40 milliseconds) of speech according to low versus imminent risk of suicide in a large number (n=281) of telephone calls made to 2 telehealth counselling services in Australia. Methods: A total of 281 help line telephone call recordings sourced from On The Line, Australia (n=266, 94.7\%) and 000 Emergency services, Canberra (n=15, 5.3\%) were included in this study. Imminent risk of suicide was coded for when callers affirmed intent, plan, and the availability of means; level of risk was assessed by the responding counsellor and reassessed by a team of clinical researchers using the Columbia Suicide Severity Rating Scale (=5/6). Low risk of suicide was coded for in an absence of intent, plan, and means and via Columbia suicide Severity Scale Ratings (=1/2). Preprocessing involved normalization and pre-emphasis of voice signals, while voice biometrics were extracted using the statistical language r. Candidate predictors were identified using Lasso regression. Each voice biomarker was assessed as a predictor of suicide risk using a generalized additive mixed effects model with splines to account for nonlinearity. Finally, a component-wise gradient boosting model was used to classify each call recording based on precoded suicide risk ratings. Results: A total of 77 imminent-risk calls were compared with 204 low-risk calls. Moreover, 36 voice biomarkers were extracted from each speech frame. Caller sex was a significant moderating factor ($\beta$=--.84, 95\% CI --0.85, --0.84; t=6.59, P<.001). Candidate biomarkers were reduced to 11 primary markers, with distinct models developed for men and women. Using leave-one-out cross-validation, ensuring that the speech frames of no single caller featured in both training and test data sets simultaneously, an area under the precision or recall curve of 0.985 was achieved (95\% CI 0.97, 1.0). The gamboost classification model correctly classified 469,332/470,032 (99.85\%) speech frames. Conclusions: This study demonstrates an objective, efficient, and economical assessment of imminent suicide risk in an ecologically valid setting with potential applications to real-time assessment and response. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000486729; https://www.anzctr.org.au/ACTRN12622000486729.aspx ", doi="10.2196/39807", url="https://mental.jmir.org/2022/8/e39807", url="http://www.ncbi.nlm.nih.gov/pubmed/35969444" } @Article{info:doi/10.2196/37973, author="Fong, C. Tiffany H. and Mak, S. Winnie W.", title="The Effects of Internet-Based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma With Mediation by Interactivity and Stigma Content: Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Aug", day="12", volume="24", number="8", pages="e37973", keywords="mental illness stigma", keywords="internet-based", keywords="interactivity", keywords="storytelling", keywords="social distance", keywords="microaggression", abstract="Background: Mental illness stigma has been a global concern, owing to its adverse effects on the recovery of people with mental illness, and may delay help-seeking for mental health because of the concern of being stigmatized. With technological advancement, internet-based interventions for the reduction of mental illness stigma have been developed, and these effects have been promising. Objective: This study aimed to examine the differential effects of internet-based storytelling programs, which varied in the levels of interactivity and stigma content, in reducing mental illness stigma. Methods: Using an experimental design, this study compared the effects of 4 storytelling websites that varied in the levels of interactivity and stigma content. Specifically, the conditions included an interactive website with stigma-related content (combo condition), a noninteractive website with stigma-related content (stigma condition), an interactive website without stigma-related content (interact condition), and a noninteractive website without stigma-related content (control condition). Participants were recruited via mass emails to all students and staff of a public university and via social networking sites. Eligible participants were randomized into the following four conditions: combo (n=67), stigma (n=65), interact (n=64), or control (n=67). The participants of each group viewed the respective web pages at their own pace. Public stigma, microaggression, and social distance were measured on the web before the experiment, after the experiment, and at the 1-week follow-up. Perceived autonomy and immersiveness, as mediators, were assessed after the experiment. Results: Both the combo (n=66) and stigma (n=65) conditions were effective in reducing public stigma and microaggression toward people with mental illness after the experiment and at the 1-week follow-up. However, none of the conditions had significant time{\texttimes}condition effects in reducing the social distance from people with mental illness. The interact condition (n=64) significantly reduced public stigma after the experiment (P=.02) but not at the 1-week follow-up (P=.22). The control condition (n=67) did not significantly reduce all outcomes associated with mental illness stigma. Perceived autonomy was found to mediate the effect of public stigma (P=.56), and immersiveness mediated the effect of microaggression (P=.99). Conclusions: Internet-based storytelling programs with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although only its difference with internet-based storytelling programs with stigma-related content was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was more critical than interactivity in reducing stigma. Future stigma reduction efforts should prioritize the production of effective stigma content on their web pages, followed by considering the value of incorporating interactivity in future internet-based storytelling programs. Trial Registration: ClinicalTrials.gov NCT05333848; https://clinicaltrials.gov/ct2/show/NCT05333848 ", doi="10.2196/37973", url="https://www.jmir.org/2022/8/e37973", url="http://www.ncbi.nlm.nih.gov/pubmed/35969460" } @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/10.2196/35685, author="Jerrott, Susan and Clark, Sharon and Chorney, Jill and Coulombe, Aimee and Wozney, Lori", title="Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study", journal="JMIR Form Res", year="2022", month="Aug", day="2", volume="6", number="8", pages="e35685", keywords="text messaging", keywords="youth", keywords="mental health", keywords="waiting list", keywords="informatics", keywords="health behavior", keywords="self-care", keywords="mental health literacy", keywords="caregivers", keywords="transdiagnostic", abstract="Background: Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. Objective: To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. Methods: A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. Results: A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54\% (22/41) and 44\%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88\%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88\%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73\%) and would recommend them to others (16/22, 73\%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. Conclusions: Results are preliminary but show that brief, core skill--focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention. ", doi="10.2196/35685", url="https://formative.jmir.org/2022/8/e35685", url="http://www.ncbi.nlm.nih.gov/pubmed/35738559" } @Article{info:doi/10.2196/37169, author="Graziani, Grant and Aylward, S. Brandon and Kunkle, Sarah and Shih, Emily", title="Changes in Resilience Following Engagement With a Virtual Mental Health System: Real-world Observational Study", journal="JMIR Form Res", year="2022", month="Jul", day="29", volume="6", number="7", pages="e37169", keywords="behavioral coaching", keywords="psychological resilience", keywords="mental health", keywords="telehealth", abstract="Background: Digital health services can serve as scalable solutions to address the growing demand for mental health care. However, more research is needed to better understand the association between engagement with care and improvements in subclinical outcomes. Objective: This study aims to fill this research gap by examining the relationship between members' engagement with the Ginger platform and changes in their psychological resilience. Methods: We conducted a retrospective observational study of 3272 members who accessed Ginger, an on-demand mental health service, between January 2021 and November 2021. Each member completed the 10-item Connor-Davidson Resilience Scale questionnaire, a measure of psychological resilience, at baseline and again during a 6- to 16-week follow-up window. Depression and anxiety symptoms (9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder) were also measured. Linear regression was used to identify the association between engagement with Ginger's multiple care modalities and changes in resilience. Moderator analysis was conducted to test whether clinical depression or anxiety at baseline moderated the relationship between engagement level and changes in resilience. Results: Of the 3272 members, 2683 (82\%) reported low resilience at baseline. The mean change in resilience was 0.77 (SD 5.50) points. Linear regression models showed that age and census region did not predict changes in resilience; however, male members showed larger improvements (coefficient=0.58; P=.04). Baseline mental health outcomes, including resilience and depression and anxiety symptoms, were strong predictors of changes in resilience. Every point decrease in baseline resilience is associated with a 0.28-point increase in change in resilience (P<.001), and members with no or mild depression and anxiety at baseline saw changes in resilience that were 1.44 points (P<.001) larger than their clinical counterparts. Engagement with the Ginger system predicted changes in resilience. Members who engaged with Ginger coaching, clinical services, or both improved their resilience by 1.82, 1.55, and 1.40 points, respectively (P<.001), more than those who only engaged with Ginger content. Screening negative for moderate to severe depression and anxiety at baseline was associated with larger improvements in resilience (coefficient=1.30; P<.001); however, subclinical status was not shown to be a moderator for the association between level of engagement and changes in resilience. Conclusions: Engagement with Ginger services was associated with improvements in resilience. Members who engaged in coaching or clinical care had significantly larger improvements compared with those who only engaged in self-guided content, regardless of whether a member screened positive for clinical depression or anxiety at baseline. ", doi="10.2196/37169", url="https://formative.jmir.org/2022/7/e37169", url="http://www.ncbi.nlm.nih.gov/pubmed/35904875" } @Article{info:doi/10.2196/30230, author="Franco, H. Olivia and Calkins, E. Monica and Giorgi, Salvatore and Ungar, H. Lyle and Gur, E. Raquel and Kohler, G. Christian and Tang, X. Sunny", title="Feasibility of Mobile Health and Social Media--Based Interventions for Young Adults With Early Psychosis and Clinical Risk for Psychosis: Survey Study", journal="JMIR Form Res", year="2022", month="Jul", day="8", volume="6", number="7", pages="e30230", keywords="social media", keywords="psychosis", keywords="clinical high risk", keywords="technology", keywords="digital health", abstract="Background: Digital technology, the internet, and social media are increasingly investigated as promising means for monitoring symptoms and delivering mental health treatment. These apps and interventions have demonstrated preliminary acceptability and feasibility, but previous reports suggest that access to technology may still be limited among individuals with psychotic disorders relative to the general population. Objective: We evaluated and compared access to and use of technology and social media in young adults with psychotic disorders (PD), young adults with clinical risk for psychosis (CR), and psychosis-free youths (PF). Methods: Participants were recruited through a coordinated specialty care clinic dedicated toward early psychosis as well as ongoing studies. We surveyed 21 PD, 23 CR, and 15 PF participants regarding access to technology and use of social media, specifically Facebook and Twitter. Statistical analyses were conducted in R. Categorical variables were compared among groups using Fisher exact test, continuous variables were compared using 1-way ANOVA, and multiple linear regressions were used to evaluate for covariates. Results: Access to technology and social media were similar among PD, CR, and PF participants. Individuals with PD, but not CR, were less likely to post at a weekly or higher frequency compared to PF individuals. We found that decreased active social media posting was unique to psychotic disorders and did not occur with other psychiatric diagnoses or demographic variables. Additionally, variation in age, sex, and White versus non-White race did not affect posting frequency. Conclusions: For young people with psychosis spectrum disorders, there appears to be no ``technology gap'' limiting the implementation of digital and mobile health interventions. Active posting to social media was reduced for individuals with psychosis, which may be related to negative symptoms or impairment in social functioning. ", doi="10.2196/30230", url="https://formative.jmir.org/2022/7/e30230", url="http://www.ncbi.nlm.nih.gov/pubmed/35802420" } @Article{info:doi/10.2196/34102, author="Blair, A. Samari and Brockmann, N. Andrea and Arroyo, M. Kelsey and Carpenter, A. Chelsea and Ross, M. Kathryn", title="Awareness, Acceptability, and Perceived Effectiveness of Text-Based Therapy Among Graduate Students: Cross-sectional Study", journal="JMIR Mhealth Uhealth", year="2022", month="Jul", day="7", volume="10", number="7", pages="e34102", keywords="mental health", keywords="text-based therapy", keywords="graduate students", abstract="Background: Research has suggested that there is a mental health crisis occurring among graduate students in the United States. Moreover, many students go without effective treatment owing to the limited availability of mental and behavioral health resources on college campuses. Text-based therapy may represent a viable method for increasing access to mental health support for graduate students, but little is known regarding its acceptability in this population. Objective: The purpose of this study was to assess how graduate students perceive text-based therapy and their likelihood of seeking out this form of therapy. Methods: In total, 265 graduate students completed a cross-sectional web-based survey that included multiple-choice and open-ended questions assessing their perceptions of text-based therapy and the likelihood of seeking out this form of therapy. Chi-square tests, ANOVAs, and nonparametric Wilcoxon signed-rank tests were used to examine differences in multiple-choice questions. The constant comparative method was used for qualitative analyses of the open-ended question responses. Results: Participants (n=265) were predominately non-Hispanic White (166/265, 62.6\%) and female (167/265, 63\%) with a mean age of 28.3 (SD 5.1) years. Over half of the participants (139/265, 52.5\%) were not aware that text-based therapy existed; however, 65.3\% (173/265) reported that they would consider using text-based services, if available. In comparison to face-to-face therapy, participants reported being less likely to seek out text-based therapy and perceived it as less effective (P<.001). Qualitative results indicated that participants were concerned about the ability to effectively communicate and build rapport through text-based therapy and thought that this modality may be more effective for some mental and behavioral health concerns than others. Moreover, participants noted that text-based therapy would be best implemented as a way to supplement, rather than replace, face-to-face services. Conclusions: Altogether, the results of this study suggest that text-based therapy holds the potential to increase access to and use of mental and behavioral health services; however, graduate students remain concerned about its effectiveness and the optimal methods of implementation. Future research should investigate how therapeutic processes (eg, effective communication and rapport-building) can be facilitated in digital environments and how text-based therapy could be best implemented to supplement and extend, rather than replace, face-to-face services. ", doi="10.2196/34102", url="https://mhealth.jmir.org/2022/7/e34102", url="http://www.ncbi.nlm.nih.gov/pubmed/35797098" } @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/10.2196/38162, author="Stiles-Shields, Colleen and Batts, R. Kathryn and Reyes, M. Karen and Archer, Joseph and Crosby, Sharad and Draxler, M. Janel and Lennan, Nia and Held, Philip", title="Digital Screening and Automated Resource Identification System to Address COVID-19--Related Behavioral Health Disparities: Feasibility Study", journal="JMIR Form Res", year="2022", month="Jun", day="22", volume="6", number="6", pages="e38162", keywords="digital mental health", keywords="underserved", keywords="health disparities", keywords="COVID-19", keywords="screening", keywords="referral", keywords="mental health", keywords="digital health", keywords="feasibility study", keywords="mobile app", keywords="mHealth", keywords="mobile health", keywords="emotional need", keywords="digital health tool", keywords="health resource", keywords="health care cost", abstract="Background: Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. Objective: This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant's responses. Methods: Individuals aged ?15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant's responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. Results: A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3\%) completed the screening tool and 86 (40.6\%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56\%, 54/96), and domains related to alcohol or substance use were the least frequent (4\%, 4/96). The most frequently requested support areas were finances (33\%, 32/96), transportation (26\%, 25/96), and food (24\%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65\%, 39/60) as well as the length of time it took to answer the questions (90\%, 54/60), which they found easy to answer (87\%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. ", doi="10.2196/38162", url="https://formative.jmir.org/2022/6/e38162", url="http://www.ncbi.nlm.nih.gov/pubmed/35696607" } @Article{info:doi/10.2196/33036, author="Antoniou, Mark and Estival, Dominique and Lam-Cassettari, Christa and Li, Weicong and Dwyer, Anne and Neto, Almeida Ab{\`i}lio de", title="Predicting Mental Health Status in Remote and Rural Farming Communities: Computational Analysis of Text-Based Counseling", journal="JMIR Form Res", year="2022", month="Jun", day="21", volume="6", number="6", pages="e33036", keywords="e-mental health", keywords="text-based", keywords="counseling", keywords="Linguistic Inquiry and Word Count", keywords="LIWC", keywords="depression", keywords="anxiety", keywords="stress", abstract="Background: Australians living in rural and remote areas are at elevated risk of mental health problems and must overcome barriers to help seeking, such as poor access, stigma, and entrenched stoicism. e-Mental health services circumvent such barriers using technology, and text-based services are particularly well suited to clients concerned with privacy and self-presentation. They allow the client to reflect on the therapy session after it has ended as the chat log is stored on their device. The text also offers researchers an opportunity to analyze language use patterns and explore how these relate to mental health status. Objective: In this project, we investigated whether computational linguistic techniques can be applied to text-based communications with the goal of identifying a client's mental health status. Methods: Client-therapist text messages were analyzed using the Linguistic Inquiry and Word Count tool. We examined whether the resulting word counts related to the participants' presenting problems or their self-ratings of mental health at the completion of counseling. Results: The results confirmed that word use patterns could be used to differentiate whether a client had one of the top 3 presenting problems (depression, anxiety, or stress) and, prospectively, to predict their self-rated mental health after counseling had been completed. Conclusions: These findings suggest that language use patterns are useful for both researchers and clinicians trying to identify individuals at risk of mental health problems, with potential applications in screening and targeted intervention. ", doi="10.2196/33036", url="https://formative.jmir.org/2022/6/e33036", url="http://www.ncbi.nlm.nih.gov/pubmed/35727623" } @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/10.2196/35086, 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/10.2196/36758, author="Archie, Suzanne and Palaniyappan, Lena and Olagunju, T. Andrew and Johnson, Natasha and Kozloff, Nicole and Sadeh, Elham and Bardell, Andrea and Baines, Alexandra and Anderson, K. Kelly and Ayonrinde, Oyedeji and Ferrari, Manuela", title="Insights About Cannabis and Psychosis Using Video Games for Young People With a First Episode of Psychosis, Particularly Those From Black Racialized Communities: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2022", month="May", day="20", volume="11", number="5", pages="e36758", keywords="first-episode psychosis", keywords="cannabis use", keywords="knowledge translation", keywords="Black youth", keywords="video games", abstract="Background: Cannabis use disorder among young people with a first episode of psychosis contributes to relapse, hospitalization, and impaired functioning. However, few studies have examined what young people with early phase psychosis, particularly those from Black racialized communities, understand or appreciate about this relationship, even though they may be at risk. There are no formally tested knowledge translation strategies that disseminate these research findings for young people with emerging psychosis from Black racialized communities. Objective: This study aims to conceptualize what young people with early phase psychosis/cannabis use disorder understand about the relationship between cannabis and psychosis, focusing on people from racialized backgrounds. This study also aims to assess whether the knowledge translation product, the ``Back to Reality Series,'' increases awareness of the impact of cannabis use on psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Methods: Qualitative analysis will reveal themes from qualitative interviews about cannabis and psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Perceptions before and after exposure to the Back to Reality Series will be qualitatively analyzed. A control game will be used for comparison, and scores on a quiz after playing the Back to Reality Series will be quantitatively analyzed to establish whether the Back to Reality Series raises awareness of the effects of cannabis on psychosis. An advisory council involving young people from Black communities, family members, and clinicians will bring community perspectives to this research. Results: We began recruiting participants for this study in September 2021. We will complete data collection on demographic and clinical factors, qualitative interviews, and quantitative assessments of the Back to Reality Series. Conclusions: The voices of young people from racialized backgrounds will generate preliminary data to inform early psychosis programs, addressing cannabis use in this population. The findings may advance the use of a new knowledge translation product that deals with gaps in knowledge about cannabis use for people experiencing early phase psychosis, particularly those from racialized communities. International Registered Report Identifier (IRRID): DERR1-10.2196/36758 ", doi="10.2196/36758", url="https://www.researchprotocols.org/2022/5/e36758", url="http://www.ncbi.nlm.nih.gov/pubmed/35389874" } @Article{info:doi/10.2196/35057, author="Tsoi, S. Emily W. and Mak, S. Winnie W. and Ho, Y. Connie Y. and Yeung, Y. Gladys T.", title="A Web-Based Stratified Stepped Care Mental Health Platform (TourHeart): Semistructured Interviews With Stakeholders", journal="JMIR Hum Factors", year="2022", month="May", day="13", volume="9", number="2", pages="e35057", keywords="stepped care", keywords="recovery", keywords="engagement", keywords="eHealth", keywords="mental health", keywords="mental well-being", keywords="psychological intervention", abstract="Background: TourHeart, a web-based stratified stepped care mental health platform, is a one-stop solution that integrates psychoeducation and other well-being promotional tools for mental health promotion and mental illness prevention and evidence-based, low-intensity psychological interventions for the treatment of people with anxiety and depressive symptoms. Instead of focusing only on symptom reduction, the platform aims to be person-centered and recovery-oriented, and continual feedback from stakeholders is sought. Understanding the perspectives of users and service providers enables platform developers to fine-tune both the design and content of the services for enhanced service personalization and personal recovery. Objective: This qualitative study evaluated a web-based mental health platform by incorporating the perspectives of both users and service providers who administered the platform and provided coaching services. The platform included both web-based and offline services targeting adults along the mental health spectrum based on the two-continua model of mental health and mental illness. Methods: Interview questions were designed based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM). Views on offline services, the design of the web-based platform, user experience, and the contents of the platform were explored using semistructured interviews. A total of 27 service users and 22 service providers were recruited using purposive criterion sampling. A hybrid thematic analysis was performed to identify salient aspects of users' and providers' experiences with and views of the platform. Results: Totally, 3 broad themes (namely, the quality of the platform, drivers for platform use, and coaching services) emerged from the interview data that highlighted users' views of and experiences with the web-based platform. The platform's general esthetics, operations, and contents were found to be critical features and drivers for continued use. Although coaching services were indispensable, participants preferred the autonomy and anonymity associated with web-based mental health services. Conclusions: This study highlights the importance of web-based mental health services being easy to navigate and understand, being user-centric, and providing adequate guidance in self-help. It also confirms existing design standards and recommendations and suggests that more rigorous, iterative user experience research and robust evaluation should be conducted in the future adaptation of web-based stratified stepped care services, so that they can be more personalized and better promote personal recovery. ", doi="10.2196/35057", url="https://humanfactors.jmir.org/2022/2/e35057", url="http://www.ncbi.nlm.nih.gov/pubmed/35560109" } @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/10.2196/34769, author="Batterham, J. Philip and Gulliver, Amelia and Kurz, Ella and Farrer, M. Louise and Vis, Christiaan and Schuurmans, Josien and Calear, L. Alison", title="The Effect of Dissemination Pathways on Uptake and Relative Costs for a Transdiagnostic, Self-guided Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation: Comparative Implementation Study", journal="J Med Internet Res", year="2022", month="May", day="6", volume="24", number="5", pages="e34769", keywords="implementation", keywords="mental health", keywords="adherence", keywords="uptake", keywords="internet", abstract="Background: Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community. Objective: This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies. Methods: Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program---a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants. Results: Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73\%), in general practice (16/1014, 1.58\%), and in pharmacy (7/1014, 0.69\%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US \$4.87 per user on social media, US \$557 per user for general practitioner clinics, and US \$1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity. Conclusions: The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113 ", doi="10.2196/34769", url="https://www.jmir.org/2022/5/e34769", url="http://www.ncbi.nlm.nih.gov/pubmed/35522458" } @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/10.2196/37292, author="Fassnacht, B. Daniel and Ali, Kathina and van Agteren, Joep and Iasiello, Matthew and Mavrangelos, Teri and Furber, Gareth and Kyrios, Michael", title="A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program", journal="JMIR Ment Health", year="2022", month="May", day="5", volume="9", number="5", pages="e37292", keywords="COVID-19", keywords="mental health", keywords="well-being", keywords="depression", keywords="anxiety", keywords="online", keywords="digital", keywords="intervention", keywords="Be Well Plan", keywords="health outcome", keywords="online health", keywords="digital health", keywords="health intervention", keywords="primary outcome", keywords="cognition", keywords="randomized control trial", keywords="resilience", keywords="participant satisfaction", keywords="student", abstract="Background: A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. Objective: This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants' engagement and satisfaction with the program. Methods: A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. Results: Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6\%, intervention group; n=89, 41.4\%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5\%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3\%) attended at least 4 sessions, and 25 (33.3\%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9\%) were either very satisfied (n=31, 66\%) or satisfied (n=16, 34\%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time {\texttimes} group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3\%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. Conclusions: The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk ", doi="10.2196/37292", url="https://mental.jmir.org/2022/5/e37292", url="http://www.ncbi.nlm.nih.gov/pubmed/35471196" } @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/10.2196/34832, author="Nozawa, Kyosuke and Ishii, Ayaka and Asaoka, Hiroki and Iwanaga, Mai and Kumakura, Yousuke and Oyabu, Yuri and Shinozaki, Tomohiro and Imamura, Kotaro and Kawakami, Norito and Miyamoto, Yuki", title="Effectiveness of an Online Peer Gatekeeper Training Program for Postsecondary Students on Suicide Prevention in Japan: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Apr", day="26", volume="11", number="4", pages="e34832", keywords="gatekeeper", keywords="suicide prevention", keywords="mental health", keywords="youth", keywords="school", keywords="student", keywords="peer support", keywords="depression", keywords="self-efficacy", keywords="suicide", keywords="prevention", keywords="online training", keywords="online program", keywords="protocol", keywords="RCT", keywords="control trial", abstract="Background: Postsecondary student suicide is one of Japan's most severe public health problems. Gatekeeper training (GKT) programs are a generally recommended suicide prevention intervention in Japan. For suicide countermeasures, an online program tailored to students may enhance self-efficacy as a gatekeeper. Objective: This study aims to describe a research protocol to investigate the effect of a newly developed internet-delivered online peer GKT program to improve postsecondary student self-efficacy as gatekeepers for suicide countermeasures in Japan. Methods: This study is a 2-arm, parallel, randomized controlled trial with a 1:1 (intervention: waiting list) allocation. Participants (n=320) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or waiting list control group. An approximately 85-minute, 6-section, internet-based gatekeeper program for postsecondary students has been developed that includes videos to help participants acquire skills as gatekeepers. The intervention group will complete the program within 10 days. The primary outcome, self-efficacy as a gatekeeper, is measured using the Gatekeeper Self-Efficacy Scale at baseline, immediately after taking the program, and 2 months after the survey after completing the program follow-up. To compare the primary outcomes, a t test, where the significance level is 5\% (2-sided), will be used to test the intervention effect on an intention-to-treat basis. Results: The study was at the stage of data collection at the time of submission. We recruited participants for this study during August and September 2021, and data collection will continue until December 2021. The data analysis related to the primary outcome will start in December 2021, and we hope to publish the results in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of an online GKT program for postsecondary students to improve self-efficacy as a gatekeeper using a randomized controlled trial design. The study will explore the potential of an online peer gatekeeper program for postsecondary students that can be disseminated online to a large number of students with minimal cost. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000045325; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr\_view.cgi?recptno=R000051685 International Registered Report Identifier (IRRID): DERR1-10.2196/34832 ", doi="10.2196/34832", url="https://www.researchprotocols.org/2022/4/e34832", url="http://www.ncbi.nlm.nih.gov/pubmed/35471412" } @Article{info:doi/10.2196/32146, author="Vega, Julio and Bell, T. Beth and Taylor, Caitlin and Xie, Jue and Ng, Heidi and Honary, Mahsa and McNaney, Roisin", title="Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating", journal="JMIR Ment Health", year="2022", month="Apr", day="25", volume="9", number="4", pages="e32146", keywords="eating disorder", keywords="binge eating", keywords="mental health", keywords="mobile sensing", keywords="context-aware computing", keywords="NAP", keywords="EMA", keywords="mobile phone", abstract="Background: Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). Objective: The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. Methods: This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38\% binge eating and n=5, 63\% comparisons) consented. Results: The findings showed unique differences in the types of sensor data that were triangulated with the individuals' episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants' awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. Conclusions: This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population. ", doi="10.2196/32146", url="https://mental.jmir.org/2022/4/e32146", url="http://www.ncbi.nlm.nih.gov/pubmed/35086064" } @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/10.2196/36794, author="McCallum, Meaghan and Ho, Suh Annabell and Mitchell, Siobhan Ellen and May, N. Christine and Behr, Heather and Ritschel, Lorie and Mochrie, Kirk and Michaelides, Andreas", title="Feasibility, Acceptability, and Preliminary Outcomes of a Cognitive Behavioral Therapy--Based Mobile Mental Well-being Program (Noom Mood): Single-Arm Prospective Cohort Study", journal="JMIR Form Res", year="2022", month="Apr", day="15", volume="6", number="4", pages="e36794", keywords="mHealth", keywords="mobile mental health", keywords="mental health", keywords="stress", keywords="anxiety", abstract="Background: The prevalence of anxiety, depression, and general distress has risen in recent years. Mobile mental health programs have been found to provide support to nonclinical populations and may overcome some of the barriers associated with traditional in-person treatment; however, researchers have voiced concerns that many publicly available mobile mental health programs lack evidence-based theoretical foundations, peer-reviewed research, and sufficient engagement from the public. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of Noom Mood, a commercial mobile cognitive behavioral therapy-- and mindfulness-based program. Methods: In this single-arm prospective cohort study, individuals who joined Noom Mood between August and October 2021 completed surveys at baseline and 4-week follow-up. Per-protocol analyses included those who completed both surveys (n=113), and intention-to-treat analyses included all participants (N=185). Results: A majority of the sample reported that the program is easy to use, they felt confident recommending the program to a friend, and they perceived the program to be effective at improving stress and anxiety. There were significant improvements in anxiety symptoms, perceived stress, depressive feelings, emotion regulation, and optimism in both the per-protocol and intention-to-treat analyses (all P<.001). Participants reported benefiting most from learning skills (eg, breathing and cognitive reframing techniques), interacting with the program features, and gaining awareness of their emotions and thought patterns. Participants also made a number of suggestions to improve product functionality and usability. Conclusions: Results suggest that Noom Mood is feasible and acceptable to participants, with promising preliminary outcomes. Future studies should build on these results to evaluate the effects of Noom Mood using more rigorous designs. ", doi="10.2196/36794", url="https://formative.jmir.org/2022/4/e36794", url="http://www.ncbi.nlm.nih.gov/pubmed/35436218" } @Article{info:doi/10.2196/28135, author="Wilhelm, Kay and Handley, Tonelle and McHugh, Catherine and Lowenstein, David and Arrold, Kristy", title="The Quality of Internet Websites for People Experiencing Psychosis: Pilot Expert Assessment", journal="JMIR Form Res", year="2022", month="Apr", day="15", volume="6", number="4", pages="e28135", keywords="psychosis", keywords="schizophrenia", keywords="DISCERN", keywords="quality", keywords="websites", keywords="mental health", keywords="Australia", keywords="health information", keywords="patients", keywords="consumers", keywords="accessibility", keywords="patient empowerment", keywords="reliability", keywords="eHealth", keywords="electronic health", keywords="website", abstract="Background: Clinicians need to be able to assess the quality of the available information to aid clinical decision-making. The internet has become an important source of health information for consumers and their families. Objective: This study aimed to rate the quality of websites with psychosis-related information (to provide clinicians with a basis for recommending material to guide clinical decision-making with consumers and their families), using a validated instrument as well as a purpose-developed checklist, and consider improvement in quality over a 4-year period. Methods: Two measures of website quality were used: the DISCERN scale and the Psychosis Website Quality Checklist (PWQC). Terms related to psychosis, including ``psychotic,'' ``psychosis,'' ``schizophrenia,'' ``delusion,'' and ``hallucination,'' were entered into Google, and the first 25 results were analyzed. In total, 6 raters with varying health professional backgrounds were used to evaluate the websites across two time points: January-March 2014 and January-March 2018. Results: Of the 25 websites rated, only the 6 highest ranked websites achieved a DISCERN score, indicating that they were of ``good'' quality (51-62 out of a possible 75), while the mean score of the websites (mean 43.96, SD 12.08) indicated an overall ``fair'' quality. The PWQC revealed that websites scored highly on ``availability and usability'' (mean 16.82, SD 3.96) but poorly on ``credibility'' (mean 20.99, SD 6.68), ``currency'' (mean 5.16, SD 2.62), and ``breadth and accuracy'' (mean 77.87, SD 23.20). Most sites lacked information about early intervention, recreational drug use and suicide risk, with little change in content over time. Stating an editorial or review process on the website (found in 56\% of websites) was significantly associated with a higher quality score on both scales (the DISCERN scale, P=.002; the PWQC, P=.006). Conclusions: The information on the internet available for clinicians to recommend to people affected by psychosis tended to be of ``fair'' quality. While higher-quality websites exist, it is generally not easy way to assess this on face value. Evidence of an editorial or review process was one indicator of website quality. While sites generally provided basic clinical information, most lacked material addressing weighing up risks and benefits of medication and alternatives, the role of coercive treatment and other more contentious issues. Insufficient emphasis is placed on detailed information on early intervention and importance of lifestyle modifications or how families and friends can contribute. These are likely to be the very answers that consumers and carers are seeking and this gap contributes to unmet needs among this group. We suggest that clinicians should be aware of what is available and where there are gaps. ", doi="10.2196/28135", url="https://formative.jmir.org/2022/4/e28135", url="http://www.ncbi.nlm.nih.gov/pubmed/35436206" } @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/10.2196/32558, 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/10.2196/29211, 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/10.2196/33685, author="Stupinski, Marie Anne and Alshaabi, Thayer and Arnold, V. Michael and Adams, Lydia Jane and Minot, R. Joshua and Price, Matthew and Dodds, Sheridan Peter and Danforth, M. Christopher", title="Quantifying Changes in the Language Used Around Mental Health on Twitter Over 10 Years: Observational Study", journal="JMIR Ment Health", year="2022", month="Mar", day="30", volume="9", number="3", pages="e33685", keywords="mental health", keywords="stigma", keywords="natural language processing", abstract="Background: Mental health challenges are thought to affect approximately 10\% of the global population each year, with many of those affected going untreated because of the stigma and limited access to services. As social media lowers the barrier for joining difficult conversations and finding supportive groups, Twitter is an open source of language data describing the changing experience of a stigmatized group. Objective: By measuring changes in the conversation around mental health on Twitter, we aim to quantify the hypothesized increase in discussions and awareness of the topic as well as the corresponding reduction in stigma around mental health. Methods: We explored trends in words and phrases related to mental health through a collection of 1-, 2-, and 3-grams parsed from a data stream of approximately 10\% of all English tweets from 2010 to 2021. We examined temporal dynamics of mental health language and measured levels of positivity of the messages. Finally, we used the ratio of original tweets to retweets to quantify the fraction of appearances of mental health language that was due to social amplification. Results: We found that the popularity of the phrase mental health increased by nearly two orders of magnitude between 2012 and 2018. We observed that mentions of mental health spiked annually and reliably because of mental health awareness campaigns as well as unpredictably in response to mass shootings, celebrities dying by suicide, and popular fictional television stories portraying suicide. We found that the level of positivity of messages containing mental health, while stable through the growth period, has declined recently. Finally, we observed that since 2015, mentions of mental health have become increasingly due to retweets, suggesting that the stigma associated with the discussion of mental health on Twitter has diminished with time. Conclusions: These results provide useful texture regarding the growing conversation around mental health on Twitter and suggest that more awareness and acceptance has been brought to the topic compared with past years. ", doi="10.2196/33685", url="https://mental.jmir.org/2022/3/e33685", url="http://www.ncbi.nlm.nih.gov/pubmed/35353049" } @Article{info:doi/10.2196/34760, author="Villarreal-Zegarra, David and Alarcon-Ruiz, A. Christoper and Melendez-Torres, GJ and Torres-Puente, Roberto and Navarro-Flores, Alba and Cavero, Victoria and Ambrosio-Melgarejo, Juan and Rojas-Vargas, Jefferson and Almeida, Guillermo and Albitres-Flores, Leonardo and Romero-Cabrera, B. Alejandra and Huarcaya-Victoria, Jeff", title="Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews", journal="JMIR Ment Health", year="2022", month="Mar", day="29", volume="9", number="3", pages="e34760", keywords="telemedicine", keywords="digital health", keywords="internet-based intervention", keywords="mental health", keywords="mental disorders", keywords="systematic reviews", keywords="qualitative research", keywords="realist review", keywords="mHealth", keywords="eHealth", keywords="telehealth", abstract="Background: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. Objective: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. Methods: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. Results: A total of 21 systematic reviews were included in the study. Among these, 90\% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. Conclusions: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020203811 International Registered Report Identifier (IRRID): RR2-10.12688/f1000research.27150.2 ", doi="10.2196/34760", url="https://mental.jmir.org/2022/3/e34760", url="http://www.ncbi.nlm.nih.gov/pubmed/35348469" } @Article{info:doi/10.2196/25715, author="{\"O}eren, Mariliis and Jordan, Iain and Coughlin, Deborah and Turnbull, Sophie", title="Improving Access to Behavioral Strategies to Improve Mental Well-being With an Entertaining Breakfast Show App: Feasibility Evaluation Study", journal="JMIR Form Res", year="2022", month="Mar", day="23", volume="6", number="3", pages="e25715", keywords="mental well-being", keywords="mental health", keywords="smartphone", keywords="mobile app", keywords="education", keywords="entertainment", keywords="psychotherapy", keywords="feasibility", keywords="mobile phone", abstract="Background: Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. Objective: The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants' subjective experiences of using Wakey! Methods: The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. Results: In total, 5413 people fit the inclusion criteria and were included in the final sample---65.62\% (3520/5364) women, 61.07\% (3286/5381) aged between 25 and 44 years, 61.61\% (2902/4710) in employment, 8.92\% (420/4710) belonging to the lower socioeconomic group, and 8.09\% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. Conclusions: This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. Trial Registration: ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296 ", doi="10.2196/25715", url="https://formative.jmir.org/2022/3/e25715", url="http://www.ncbi.nlm.nih.gov/pubmed/35319468" } @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/10.2196/30966, 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/10.2196/31780, author="Greenwood, Hannah and Krzyzaniak, Natalia and Peiris, Ruwani and Clark, Justin and Scott, Mae Anna and Cardona, Magnolia and Griffith, Rebecca and Glasziou, Paul", title="Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials", journal="JMIR Ment Health", year="2022", month="Mar", day="11", volume="9", number="3", pages="e31780", keywords="telemedicine", keywords="psychology", keywords="mental health", keywords="psychotherapy", keywords="primary health care", keywords="behavioral sciences", keywords="systematic review", abstract="Background: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. Methods: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. Results: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95\% CI ?0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95\% CI ?0.40 to 0.39), function (SMD 0.13, 95\% CI ?0.16 to 0.42), working alliance client (SMD 0.11, 95\% CI ?0.34 to 0.57), working alliance therapist (SMD ?0.16, 95\% CI ?0.91 to 0.59), and client satisfaction (SMD 0.12, 95\% CI ?0.30 to 0.53), or at any other time point (3, 6, and 12 months). Conclusions: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions. ", doi="10.2196/31780", url="https://mental.jmir.org/2022/3/e31780", url="http://www.ncbi.nlm.nih.gov/pubmed/35275081" } @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/10.2196/34221, author="Thangavel, Gomathi and Memedi, Mevludin and Hedstr{\"o}m, Karin", title="Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review", journal="JMIR Ment Health", year="2022", month="Mar", day="7", volume="9", number="3", pages="e34221", keywords="social isolation", keywords="loneliness", keywords="review", keywords="ICT", keywords="older adults", keywords="customization", keywords="mobile phone", abstract="Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77\%) evaluated the usability and acceptance aspects, and few studies (11/39, 28\%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. ", doi="10.2196/34221", url="https://mental.jmir.org/2022/3/e34221", url="http://www.ncbi.nlm.nih.gov/pubmed/35254273" } @Article{info:doi/10.2196/34901, author="Sifat, S. Munjireen and Saperstein, L. Sandra and Tasnim, Naima and Green, M. Kerry", title="Motivations Toward Using Digital Health and Exploring the Possibility of Using Digital Health for Mental Health in Bangladesh University Students: Cross-sectional Questionnaire Study", journal="JMIR Form Res", year="2022", month="Mar", day="4", volume="6", number="3", pages="e34901", keywords="digital health", keywords="mental health", keywords="Bangladesh", keywords="university students", keywords="mental health service use", keywords="mobile phone", abstract="Background: Digital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low. Objective: The objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH. Methods: This study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH. Results: Social influence (adjusted odds ratio [aOR] 1.68, 95\% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95\% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95\% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95\% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95\% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95\% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95\% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95\% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non--stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95\% CI 1.10-3.80; P=.02). Conclusions: Overall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health. ", doi="10.2196/34901", url="https://formative.jmir.org/2022/3/e34901", url="http://www.ncbi.nlm.nih.gov/pubmed/35254267" } @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/10.2196/33704, author="Houben-Wilke, Sarah and Go{\"e}rtz, MJ Yvonne and Delbressine, M. Jeannet and Vaes, W. Anouk and Meys, Roy and Machado, VC Felipe and van Herck, Maarten and Burtin, Chris and Posthuma, Rein and Franssen, ME Frits and Vijlbrief, Herman and Spies, Yvonne and van 't Hul, J. Alex and Spruit, A. Martijn and Janssen, JA Daisy", title="The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study", journal="JMIR Ment Health", year="2022", month="Feb", day="24", volume="9", number="2", pages="e33704", keywords="SARS-CoV-2", keywords="corona", keywords="COVID-19", keywords="post-traumatic stress disorder", keywords="anxiety", keywords="depression", keywords="PASC", abstract="Background: The psychological impact of COVID-19 can be substantial. However, knowledge about long-term psychological outcomes in patients with COVID-19 is scarce. Objective: In this longitudinal, observational study, we aimed to reveal symptoms of posttraumatic stress disorder (PTSD) and symptoms of anxiety and depression up to 6 months after the onset of COVID-19--related symptoms in patients with confirmed COVID-19 and persistent complaints. To demonstrate the impact in nonhospitalized patients, we further aimed to compare these outcomes between nonhospitalized and hospitalized patients. Methods: Demographics, symptoms of PTSD (Trauma Screening Questionnaire [TSQ] ?6 points) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS] ?8 points) were assessed at 3 and 6 months after the onset of COVID-19--related symptoms in members of online long COVID-19 peer support groups. Results: Data from 239 patients with confirmed COVID-19 (198/239, 82.8\% female; median age: 50 [IQR 39-56] years) were analyzed. At the 3-month follow-up, 37.2\% (89/239) of the patients had symptoms of PTSD, 35.6\% (85/239) had symptoms of anxiety, and 46.9\% (112/239) had symptoms of depression, which remained high at the 6-month follow-up (64/239, 26.8\%, P=.001; 83/239, 34.7\%, P=.90; 97/239, 40.6\%, P=.08, respectively; versus the 3-month follow-up). TSQ scores and HADS anxiety and depression scores were strongly correlated at the 3- and 6-month follow-ups (r=0.63-0.71, P<.001). Symptoms of PTSD, anxiety, and depression were comparable between hospitalized (n=62) and nonhospitalized (n=177) patients. Conclusions: A substantial percentage of patients with confirmed COVID-19 and persistent complaints reported symptoms of PTSD, anxiety, or depression 3 and 6 months after the onset of COVID-19--related symptoms. The prevalence rates of symptoms of PTSD, anxiety, and depression were comparable between hospitalized and nonhospitalized patients and merely improved over time. Health care professionals need to be aware of these psychological complications and intervene on time in post-COVID-19 patients with persistent complaints. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. ", doi="10.2196/33704", url="https://mental.jmir.org/2022/2/e33704", url="http://www.ncbi.nlm.nih.gov/pubmed/35200155" } @Article{info:doi/10.2196/31909, author="Agarwal, K. Anish and Southwick, Lauren and Schneider, Rachelle and Pelullo, Arthur and Ortiz, Robin and Klinger, V. Elissa and Gonzales, E. Rachel and Rosin, Roy and Merchant, M. Raina", title="Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study", journal="JMIR Ment Health", year="2022", month="Feb", day="23", volume="9", number="2", pages="e31909", keywords="COVID-19", keywords="mHealth", keywords="CHW", keywords="digital health", keywords="platform", keywords="crowdsource", keywords="support", keywords="community", keywords="health system", keywords="monitoring", keywords="virtual care", keywords="text message", keywords="model", keywords="community health worker", keywords="pilot study", keywords="feasibility", abstract="Background: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. Objective: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. Methods: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19--related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. Results: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29\%). Overall, 77\% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. Conclusions: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support. ", doi="10.2196/31909", url="https://mental.jmir.org/2022/2/e31909", url="http://www.ncbi.nlm.nih.gov/pubmed/35037886" } @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/10.2196/27781, author="Batchelor, Rachel and Gulshan, Sarah and Shritharan, Halpana and Williams, Elen and Henderson, Claire and Gillard, Steve and Woodham, A. Luke and Cornelius, Victoria and Elkes, Jack and Sin, Jacqueline", title="Perceived Acceptability and Experiences of a Digital Psychoeducation and Peer Support Intervention (COPe-support): Interview Study With Carers Supporting Individuals With Psychosis", journal="J Med Internet Res", year="2022", month="Feb", day="2", volume="24", number="2", pages="e27781", keywords="eHealth", keywords="family carers", keywords="qualitative research", keywords="psychosis", keywords="peer support", keywords="web-based psychoeducation", keywords="mobile phone", abstract="Background: Web-based mental health interventions offer a novel, accessible, and self-paced approach to care delivery to family carers (ie, relatives and close friends who support a loved one with psychosis). We coproduced COPe-support (Carers fOr People with Psychosis e-support), a psychoeducational intervention delivered via an enriched web-based learning environment with network support from professionals and peers. In addition to the rigorous investigation of the effectiveness of COPe-support on the well-being of carers and mental health outcomes, it is imperative to understand the experiences of using the web-based intervention by carers and its associated web-based implementation and facilitation strategies. Objective: This study aims to explore the experiences of carers and perceived acceptability of COPe-support and its different components, how carers found engagement with COPe-support affected their own well-being and caregiving, and the ideas of carers for improving COPe-support and its delivery to inform any future wider implementation. Methods: We conducted a qualitative study, individually interviewing 35 carers, following their use of COPe-support for 8 months through a web-based, randomized controlled trial across England. A semistructured guide with open-ended questions was used to explore the experiences of carers and perceived acceptability of the intervention and their ideas to improve the provision. All interviews were conducted remotely through mobile phones or internet communication media, audio recorded and transcribed verbatim. We used a thematic analysis framework to analyze the data. Results: Three key themes were identified: remote, flexible, and personalized support; impacts on well-being and outlook on caregiving; and future implementation and integration with existing services. Overall, carers found COPe-support a flexible source of knowledge and support from professionals and peers that they could personalize to suit their own needs and convenience. Participants described gaining self-confidence, hope, and a sense of connectivity with others in a similar situation, which helped ameliorate isolation and perceived stigma. Most importantly, COPe-support promoted self-care among the carers themselves. Participants' experiences, use, and activity on COPe-support varied greatly and differed among carers of various ages and levels of computer literacy. Conclusions: Nearly all participants had a positive experience with COPe-support and supported its wider implementation as a beneficial adjunctive support resource for carers in the future. Any future scale-up of such an intervention needs to consider feedback from carers and suggestions for further improvement. These included having more graphics and audiovisual content materials, improving the navigation, and building in more interactional and customization options to suit various user styles, such as emoji reactions, live web-based chat, opting in and out of updates, and choosing the frequency of reminders. To ensure successful implementation, we should also consider factors pertinent to reaching more carers and integrating the web-based resources with other conventional services. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 89563420; https://www.isrctn.com/ISRCTN89563420 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-02528-w ", doi="10.2196/27781", url="https://www.jmir.org/2022/2/e27781", url="http://www.ncbi.nlm.nih.gov/pubmed/35107439" } @Article{info:doi/10.2196/30766, author="Kaveladze, T. Benjamin and Wasil, R. Akash and Bunyi, B. John and Ramirez, Veronica and Schueller, M. Stephen", title="User Experience, Engagement, and Popularity in Mental Health Apps: Secondary Analysis of App Analytics and Expert App Reviews", journal="JMIR Hum Factors", year="2022", month="Jan", day="31", volume="9", number="1", pages="e30766", keywords="mental health apps", keywords="engagement", keywords="user experience", keywords="digital mental health", keywords="user retention", abstract="Background: User experience and engagement are critical elements of mental health apps' abilities to support users. However, work examining the relationships among user experience, engagement, and popularity has been limited. Understanding how user experience relates to engagement with and popularity of mental health apps can demonstrate the relationship between subjective and objective measures of app use. In turn, this may inform efforts to develop more effective and appealing mental health apps and ensure that they reach wide audiences. Objective: We aimed to examine the relationship among subjective measures of user experience, objective measures of popularity, and engagement in mental health apps. Methods: We conducted a preregistered secondary data analysis in a sample of 56 mental health apps. To measure user experience, we used expert ratings on the Mobile App Rating Scale (MARS) and consumer ratings from the Apple App Store and Google Play. To measure engagement, we acquired estimates of monthly active users (MAU) and user retention. To measure app popularity, we used download count, total app revenue, and MAU again. Results: MARS total score was moderately positively correlated with app-level revenue (Kendall rank [T]=0.30, P=.002), MAU (T=0.39, P<.001), and downloads (T=0.41, P<.001). However, the MARS total score and each of its subscales (Engagement, Functionality, Aesthetics, and Information) showed extremely small correlations with user retention 1, 7, and 30 days after downloading. Furthermore, the total MARS score only correlated with app store rating at T=0.12, which, at P=.20, did not meet our threshold for significance. Conclusions: More popular mental health apps receive better ratings of user experience than less popular ones. However, user experience does not predict sustained engagement with mental health apps. Thus, mental health app developers and evaluators need to better understand user experience and engagement, as well as to define sustained engagement, what leads to it, and how to create products that achieve it. This understanding might be supported by better collaboration between industry and academic teams to advance a science of engagement. ", doi="10.2196/30766", url="https://humanfactors.jmir.org/2022/1/e30766", url="http://www.ncbi.nlm.nih.gov/pubmed/35099398" } @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/10.2196/32430, 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/10.2196/28300, author="Moltrecht, Bettina and Patalay, Praveetha and Bear, Alice Holly and Deighton, Jessica and Edbrooke-Childs, Julian", title="A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned", journal="JMIR Form Res", year="2022", month="Jan", day="19", volume="6", number="1", pages="e28300", keywords="mHealth", keywords="participatory design", keywords="emotion regulation", keywords="interdisciplinary development", keywords="child mental health", abstract="Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient--clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children's mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. ", doi="10.2196/28300", url="https://formative.jmir.org/2022/1/e28300", url="http://www.ncbi.nlm.nih.gov/pubmed/35044312" } @Article{info:doi/10.2196/34103, author="Sierk, Anika and Travers, Eoin and Economides, Marcos and Loe, Sheng Bao and Sun, Luning and Bolton, Heather", title="A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index", journal="JMIR Ment Health", year="2022", month="Jan", day="17", volume="9", number="1", pages="e34103", keywords="mental health", keywords="well-being", keywords="mHealth", keywords="measurement", abstract="Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs. ", doi="10.2196/34103", url="https://mental.jmir.org/2022/1/e34103", url="http://www.ncbi.nlm.nih.gov/pubmed/35037895" } @Article{info:doi/10.2196/28183, author="Wang, Qian and Xie, Luyao and Song, Bo and Di, Jiangli and Wang, Linhong and Mo, Kit-Han Phoenix", title="Effects of Social Media Use for Health Information on COVID-19--Related Risk Perceptions and Mental Health During Pregnancy: Web-Based Survey", journal="JMIR Med Inform", year="2022", month="Jan", day="13", volume="10", number="1", pages="e28183", keywords="COVID-19", keywords="pregnant", keywords="social media use", keywords="risk perception", keywords="worry", keywords="depression", abstract="Background: Social media has become an important source of health information during the COVID-19 pandemic. Very little is known about the potential mental impact of social media use on pregnant women. Objective: This study aims to examine the association between using social media for health information and risk perception for COVID-19, worry due to COVID-19, and depression among pregnant women in China. Methods: A total of 4580 pregnant women were recruited from various provinces of China. The participants completed a cross-sectional, web-based survey in March 2020. Results: More than one-third (1794/4580, 39.2\%) of the participants reported always using social media for obtaining health information. Results of structural equation modeling showed that the frequency of social media use for health information was positively associated with perceived susceptibility ($\beta$=.05; P<.001) and perceived severity ($\beta$=.12; P<.001) of COVID-19, which, in turn, were positively associated with worry due to COVID-19 ($\beta$=.19 and $\beta$=.72, respectively; P<.001). Perceived susceptibility ($\beta$=.09; P<.001), perceived severity ($\beta$=.08; P<.001), and worry due to COVID-19 ($\beta$=.15; P<.001) all had a positive association with depression. Bootstrapping analysis showed that the indirect effects of frequency of social media use for health information on both worry due to COVID-19 ($\beta$=.09, 95\% CI 0.07-0.12) and depression ($\beta$=.05, 95\% CI 0.02-0.07) were statistically significant. Conclusions: This study provides empirical evidence on how social media use for health information might have a negative impact on the mental health of pregnant women. Interventions are needed to equip this population with the skills to use social media properly and with caution. ", doi="10.2196/28183", url="https://medinform.jmir.org/2022/1/e28183", url="http://www.ncbi.nlm.nih.gov/pubmed/34762065" } @Article{info:doi/10.2196/27631, author="Gunn, M. Kate and Skaczkowski, Gemma and Dollman, James and Vincent, D. Andrew and Short, E. Camille and Brumby, Susan and Barrett, Alison and Harrison, Nathan and Turnbull, Deborah", title="Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell", journal="JMIR Hum Factors", year="2022", month="Jan", day="11", volume="9", number="1", pages="e27631", keywords="farm", keywords="agriculture", keywords="rural", keywords="drought", keywords="mental health", keywords="stress", keywords="coping", keywords="online intervention", keywords="acceptance and commitment therapy", abstract="Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9\%) female, aged 21-73 years; 95.5\% (149/156) residing in inner regional to very remote Australia, and 68.2\% (107/157) ``sheep, cattle and/or grain farmers.'' Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies---ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health--related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1\% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions: Sequential integration of research evidence, expert knowledge, and farmers' preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526 ", doi="10.2196/27631", url="https://humanfactors.jmir.org/2022/1/e27631", url="http://www.ncbi.nlm.nih.gov/pubmed/35014963" } @Article{info:doi/10.2196/33438, author="Shalaby, Reham and Vuong, Wesley and Eboreime, Ejemai and Surood, Shireen and Greenshaw, J. Andrew and Agyapong, Opoku Vincent Israel", title="Patients' Expectations and Experiences With a Mental Health--Focused Supportive Text Messaging Program: Mixed Methods Evaluation", journal="JMIR Form Res", year="2022", month="Jan", day="11", volume="6", number="1", pages="e33438", keywords="supportive text messages", keywords="patients' experience", keywords="mental health", keywords="mixed methods", abstract="Background: Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. Objective: In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers' experiences. Methods: This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2\% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). Results: Out of 89 participants, 36 (40\%) completed the follow-up survey. The principal findings were that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on the subscriber's sex at birth or primary diagnosis. The patients' initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. Conclusions: Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services. ", doi="10.2196/33438", url="https://formative.jmir.org/2022/1/e33438", url="http://www.ncbi.nlm.nih.gov/pubmed/35014972" } @Article{info:doi/10.2196/30565, author="Burn, Anne-Marie and Ford, J. Tamsin and Stochl, Jan and Jones, B. Peter and Perez, Jesus and Anderson, K. Joanna", title="Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study", journal="JMIR Form Res", year="2022", month="Jan", day="10", volume="6", number="1", pages="e30565", keywords="mental health", keywords="assessment", keywords="young people", keywords="youth", keywords="schools", keywords="computerized adaptive testing", keywords="mobile apps", keywords="user-centered design", keywords="coproduction", keywords="qualitative study", abstract="Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles---an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. ", doi="10.2196/30565", url="https://formative.jmir.org/2022/1/e30565", url="http://www.ncbi.nlm.nih.gov/pubmed/35006079" } @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/10.2196/30000, author="Saleem, Maham and K{\"u}hne, Lisa and De Santis, Karolina Karina and Christianson, Lara and Brand, Tilman and Busse, Heide", title="Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review", journal="JMIR Ment Health", year="2021", month="Dec", day="20", volume="8", number="12", pages="e30000", keywords="digital interventions", keywords="mental health promotion", keywords="engagement", keywords="scoping review", keywords="mobile phone", abstract="Background: Digital interventions offer a solution to address the high demand for mental health promotion, especially when facing physical contact restrictions or lacking accessibility. Engagement with digital interventions is critical for their effectiveness; however, retaining users' engagement throughout the intervention is challenging. It remains unclear what strategies facilitate engagement with digital interventions that target mental health promotion. Objective: Our aim is to conduct a scoping review to investigate user engagement strategies and methods to evaluate engagement with digital interventions that target mental health promotion in adults. Methods: This scoping review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. The search was conducted in 7 electronic databases from inception to April 2020. The inclusion criteria for studies were as follows: adult (aged ?18 years) users of digital interventions for mental health promotion from the general population; any digital intervention for mental health promotion; and user engagement strategies described in the intervention design. We extracted the following data items: study characteristics, digital intervention (type and engagement strategy), evaluation of engagement strategy (method and result specifying whether the strategy was effective at facilitating engagement), and features of engagement (extent of use and subjective experience of users). Results: A total of 2766 studies were identified, of which 16 (0.58\%) met the inclusion criteria. The 16 studies included randomized controlled trials (6/16, 37\%), studies analyzing process data (5/16, 31\%), observational studies (3/16, 19\%), and qualitative studies (2/16, 13\%). The digital interventions for mental health promotion were either web based (12/16, 75\%) or mobile app based (4/16, 25\%). The engagement strategies included personalized feedback about intervention content or users' mental health status; guidance regarding content and progress through e-coaching; social forums, and interactivity with peers; content gamification; reminders; and flexibility and ease of use. These engagement strategies were deemed effective based on qualitative user feedback or responses on questionnaires or tools (4/16, 25\%), usability data (5/16, 31\%), or both (7/16, 44\%). Most studies identified personalized support in the form of e-coaching, peer support through a social platform, personalized feedback, or joint videoconference sessions as an engaging feature. Conclusions: Personalized support during the intervention, access to social support, and personalized feedback seem to promote engagement with digital interventions for mental health promotion. These findings need to be interpreted with caution because the included studies were heterogeneous, had small sample sizes, and typically did not address engagement as the primary outcome. Despite the importance of user engagement for the effectiveness of digital interventions, this field has not yet received much attention. Further research is needed on the effectiveness of different strategies required to facilitate user engagement in digital interventions for mental health promotion. ", doi="10.2196/30000", url="https://mental.jmir.org/2021/12/e30000", url="http://www.ncbi.nlm.nih.gov/pubmed/34931995" } @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/10.2196/34170, author="Schwarz, Julian and B{\"a}rk{\aa}s, Annika and Blease, Charlotte and Collins, Lorna and H{\"a}gglund, Maria and Markham, Sarah and Hochwarter, Stefan", title="Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review", journal="JMIR Ment Health", year="2021", month="Dec", day="14", volume="8", number="12", pages="e34170", keywords="electronic health record", keywords="open notes", keywords="user involvement", keywords="patient advocacy", keywords="patient portal", keywords="patient rights", keywords="collaborative health care", keywords="participation", keywords="coproduction", keywords="system transformation", keywords="health care reform", abstract="Background: Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)---often referred to as open notes---have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective: This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders' perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods: A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results: Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members' mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions: PAEHRs in MHC may strengthen user involvement, patients' autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention. ", doi="10.2196/34170", url="https://mental.jmir.org/2021/12/e34170", url="http://www.ncbi.nlm.nih.gov/pubmed/34904956" } @Article{info:doi/10.2196/17062, author="Meyer, Julien and Okuboyejo, Senanu", title="User Reviews of Depression App Features: Sentiment Analysis", journal="JMIR Form Res", year="2021", month="Dec", day="14", volume="5", number="12", pages="e17062", keywords="mHealth", keywords="depression", keywords="app reviews", keywords="natural language processing", keywords="app features", keywords="emotions", keywords="use", keywords="linguistic inquiry word count", keywords="mobile phone", abstract="Background: Mental health in general, and depression in particular, remain undertreated conditions. Mobile health (mHealth) apps offer tremendous potential to overcome the barriers to accessing mental health care and millions of depression apps have been installed and used. However, little is known about the effect of these apps on a potentially vulnerable user population and the emotional reactions that they generate, even though emotions are a key component of mental health. App reviews, spontaneously posted by the users on app stores, offer up-to-date insights into the experiences and emotions of this population and are increasingly decisive in influencing mHealth app adoption. Objective: This study aims to investigate the emotional reactions of depression app users to different app features by systematically analyzing the sentiments expressed in app reviews. Methods: We extracted 3261 user reviews of depression apps. The 61 corresponding apps were categorized by the features they offered (psychoeducation, medical assessment, therapeutic treatment, supportive resources, and entertainment). We then produced word clouds by features and analyzed the reviews using the Linguistic Inquiry Word Count 2015 (Pennebaker Conglomerates, Inc), a lexicon-based natural language analytical tool that analyzes the lexicons used and the valence of a text in 4 dimensions (authenticity, clout, analytic, and tone). We compared the language patterns associated with the different features of the underlying apps. Results: The analysis highlighted significant differences in the sentiments expressed for the different features offered. Psychoeducation apps exhibited more clout but less authenticity (ie, personal disclosure). Medical assessment apps stood out for the strong negative emotions and the relatively negative ratings that they generated. Therapeutic treatment app features generated more positive emotions, even though user feedback tended to be less authentic but more analytical (ie, more factual). Supportive resources (connecting users to physical services and people) and entertainment apps also generated fewer negative emotions and less anxiety. Conclusions: Developers should be careful in selecting the features they offer in their depression apps. Medical assessment features may be riskier as users receive potentially disturbing feedback on their condition and may react with strong negative emotions. In contrast, offering information, contacts, or even games may be safer starting points to engage people with depression at a distance. We highlight the necessity to differentiate how mHealth apps are assessed and vetted based on the features they offer. Methodologically, this study points to novel ways to investigate the impact of mHealth apps and app features on people with mental health issues. mHealth apps exist in a rapidly changing ecosystem that is driven by user satisfaction and adoption decisions. As such, user perceptions are essential and must be monitored to ensure adoption and avoid harm to a fragile population that may not benefit from traditional health care resources. ", doi="10.2196/17062", url="https://formative.jmir.org/2021/12/e17062", url="http://www.ncbi.nlm.nih.gov/pubmed/34904955" } @Article{info:doi/10.2196/31293, author="Matsumoto, Kazuki and Hamatani, Sayo and Shimizu, Eiji", title="Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review", journal="J Med Internet Res", year="2021", month="Dec", day="13", volume="23", number="12", pages="e31293", keywords="videoconference-delivered cognitive behavioral therapy", keywords="depression", keywords="anxiety", keywords="psychiatric disorders", keywords="systematic review", keywords="meta-analysis", keywords="digital health", keywords="mental health", keywords="cognitive therapy", keywords="internet-based therapy", keywords="cognition", keywords="neurodevelopment", keywords="communication technology", keywords="health technology", keywords="psychological disorders", keywords="anxiety disorder", abstract="Background: Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective: This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods: A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results: The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of ?0.49 (95\% CI --0.68 to --0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions: While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=224832 ", doi="10.2196/31293", url="https://www.jmir.org/2021/12/e31293", url="http://www.ncbi.nlm.nih.gov/pubmed/34898445" } @Article{info:doi/10.2196/30668, author="Davies, M. Sian and Jardine, Jenni and Gutridge, Kerry and Bernard, Zara and Park, Stephen and Dawson, Tom and Abel, M. Kathryn and Whelan, Pauline", title="Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e30668", keywords="digital mental health", keywords="acceptability", keywords="feasibility", keywords="child and adolescent mental health and well-being", keywords="school-based mental health care", keywords="prevention", keywords="digital assessment and monitoring", keywords="reading screening or ability", abstract="Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6\%) consented and took part; of these 34 children, all 34 (100\%) completed the baseline Lexplore assessment, and 30 (88\%) completed the follow-up. In addition, most children were classified by Lincus as regular (?1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. ", doi="10.2196/30668", url="https://formative.jmir.org/2021/12/e30668", url="http://www.ncbi.nlm.nih.gov/pubmed/34898446" } @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/10.2196/28141, 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/10.2196/32948, author="Ellis, A. Louise and Meulenbroeks, Isabelle and Churruca, Kate and Pomare, Chiara and Hatem, Sarah and Harrison, Reema and Zurynski, Yvonne and Braithwaite, Jeffrey", title="The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis", journal="JMIR Ment Health", year="2021", month="Dec", day="6", volume="8", number="12", pages="e32948", keywords="e-mental health", keywords="mental health", keywords="COVID-19", keywords="bibliometrics", keywords="health systems", abstract="Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the ``new normal.'' Objective: The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. Methods: We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. Results: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2\%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9\%), though a notable number came from middle-income countries (n=59, 16.6\%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25\% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. Conclusions: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. ", doi="10.2196/32948", url="https://mental.jmir.org/2021/12/e32948", url="http://www.ncbi.nlm.nih.gov/pubmed/34666306" } @Article{info:doi/10.2196/23659, author="Kavanagh, John David and Connolly, Jennifer and Fisher, Jane and Halford, Kim W. and Hamilton, Kyra and Hides, Leanne and Milgrom, Jeannette and Rowe, Heather and Scuffham, A. Paul and White, M. Katherine and Wittkowski, Anja and Appleton, Shelley and Sanders, Davina", title="The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Nov", day="26", volume="23", number="11", pages="e23659", keywords="perinatal", keywords="depression", keywords="prevention", keywords="men", keywords="self-guided", keywords="internet", abstract="Background: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective: This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods: The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks' gestation), using web-based registration. Most (337/388, 86.8\%) were obtained from prenatal hospital classes. Couples' randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50\% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results: Selection criteria were met by 63.9\% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6\%), tertiary educated (324/496, 65.3\%), employed full time (407/496, 82\%), and born in Australia (337/496, 67.9\%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9\% (18/248) of men, and 16.1\% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6\% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92\% ?50). Only 37.3\% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6\%) than fathers (52/248, 20.9\%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions: Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277 ", doi="10.2196/23659", url="https://www.jmir.org/2021/11/e23659", url="http://www.ncbi.nlm.nih.gov/pubmed/34842534" } @Article{info:doi/10.2196/26521, author="Luquiens, Amandine and von Hammerstein, Cora and Benyamina, Amine and Perney, Pascal", title="Burden and Help-Seeking Behaviors Linked to Problem Gambling and Gaming: Observational Quantitative and Qualitative Analysis", journal="JMIR Ment Health", year="2021", month="Nov", day="26", volume="8", number="11", pages="e26521", keywords="gambling", keywords="gaming", keywords="helpline", keywords="burden, relatives", keywords="qualitative research", abstract="Background: Models based on the uniqueness of addiction processes between behavioral addictions are highly contentious, and the inclusion of gaming disorder in the addiction nosography remains controversial. An exploratory approach could clarify a hypothesized common and subjectively identifiable process in addictive behaviors and the necessarily different expressions of the disorder due to behavior specificities, in particular the sociocultural characteristics and profiles of users. Objective: The aim of this study was to describe the nature of contacts to a help service by exploring commonality and specificities of burden and help-seeking for problem gambling or gaming. Methods: This was an observational quantitative-qualitative study. We included all contacts (ie, online questions and contacts by phone or chat when the helper completed a summary) to a helpline for gamers, gamblers, and relatives over a 7-year period. We constituted a text corpus with online questions and summaries of contacts by phone or chat. We collected basic sociodemographic data, including the device used to contact the service (phone or internet), contacting the service for oneself (``user'') or being a relative of a user and type of relative, gambling (yes/no), gaming (yes/no), and age and sex of the gambler/gamer. We describe the corpus descriptively and report the computerized qualitative analysis of online questions, chat, and summary of phone calls. We performed a descendant hierarchical analysis on the data. Results: A total of 14,564 contacts were made to the helpline, including 10,017 users and 4547 relatives. The corpus was composed of six classes: (1) gaming specificities, (2) shared psychological distress and negative emotions, (3) the procedure for being banned from gambling, (4) the provided help, (5) gambling specificities, and (6) financial problems. Conclusions: Negative emotions and shared distress linked to gambling and gaming support current scientific consensus that these behaviors can produce psychological distress in se; however, meaningful differences were observed in core symptoms of addiction between gamers and gamblers, beyond specificities related to the behavior itself: loss of control was elicited in the class corresponding to gambling specificities and not by gamers and their relatives. ", doi="10.2196/26521", url="https://mental.jmir.org/2021/11/e26521", url="http://www.ncbi.nlm.nih.gov/pubmed/34842562" } @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/10.2196/32351, author="Montgomery, M. Robert and Boucher, M. Eliane and Honomichl, D. Ryan and Powell, A. Tyler and Guyton, L. Sharelle and Bernecker, L. Samantha and Stoeckl, Elizabeth Sarah and Parks, C. Acacia", title="The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data", journal="JMIR Cardio", year="2021", month="Nov", day="19", volume="5", number="2", pages="e32351", keywords="digital mental health", keywords="digital health", keywords="mobile apps", keywords="mobile health", keywords="internet-based intervention", keywords="happiness", keywords="subjective well-being", keywords="anxiety", keywords="cardiovascular health", keywords="high blood pressure", keywords="high cholesterol", keywords="diabetes", keywords="cardiovascular disease risk", keywords="real-world data", abstract="Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks' exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. ", doi="10.2196/32351", url="https://cardio.jmir.org/2021/2/e32351", url="http://www.ncbi.nlm.nih.gov/pubmed/34806986" } @Article{info:doi/10.2196/30995, author="Barrera, Z. Alinne and Hamil, Jaime and Tandon, Darius", title="Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study", journal="JMIR Form Res", year="2021", month="Nov", day="18", volume="5", number="11", pages="e30995", keywords="perinatal mental health", keywords="postpartum depression", keywords="public health", keywords="SMS", keywords="technology", abstract="Background: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. Objective: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). Methods: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors' adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants' usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. Results: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89\%) and rated the text message content as very useful and understandable. Conclusions: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. Trial Registration: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755 ", doi="10.2196/30995", url="https://formative.jmir.org/2021/11/e30995", url="http://www.ncbi.nlm.nih.gov/pubmed/34792478" } @Article{info:doi/10.2196/29760, author="Hoeppner, B. Bettina and Siegel, R. Kaitlyn and Carlon, A. Hannah and Kahler, W. Christopher and Park, R. Elyse and Hoeppner, S. Susanne", title="A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study", journal="JMIR Form Res", year="2021", month="Nov", day="17", volume="5", number="11", pages="e29760", keywords="nondaily", keywords="smoking cessation", keywords="smartphone app", keywords="positive psychology", keywords="mHealth", keywords="happiness", keywords="mobile phone", abstract="Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74\% regarding cigarette log and 59/95, 62\% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ?84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87\%), and helped them stay positive while quitting (78/95, 82\%). Large effects were found for within-person decreases in the desire to smoke (b=?1.5, 95\% CI ?1.9 to ?1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95\% CI ?27.2 to ?14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=?0.8, 95\% CI ?1.0 to ?0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95\% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95\% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40\%, 56\%, and 56\% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. ", doi="10.2196/29760", url="https://formative.jmir.org/2021/11/e29760", url="http://www.ncbi.nlm.nih.gov/pubmed/34787577" } @Article{info:doi/10.2196/32708, author="Wood, M. Sarah and Pickel, Julia and Phillips, W. Alexis and Baber, Kari and Chuo, John and Maleki, Pegah and Faust, L. Haley and Petsis, Danielle and Apple, E. Danielle and Dowshen, Nadia and Schwartz, A. Lisa", title="Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="15", volume="4", number="4", pages="e32708", keywords="telehealth", keywords="telemedicine", keywords="adolescent", keywords="COVID-19", keywords="acceptability", keywords="feasibility", keywords="young adult", keywords="teenager", keywords="cross-sectional", keywords="patient experience", keywords="experience", keywords="efficiency", keywords="equity", keywords="survey", abstract="Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5\% (55/268) for AYA and 21.8\% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22\% vs 3/118, 2.5\%, P<.001). One-quarter (14/55) of the AYA patients and 31.7\% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. ", doi="10.2196/32708", url="https://pediatrics.jmir.org/2021/4/e32708", url="http://www.ncbi.nlm.nih.gov/pubmed/34779782" } @Article{info:doi/10.2196/26221, author="Lawler, Kate and Earley, Caroline and Timulak, Ladislav and Enrique, Angel and Richards, Derek", title="Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study", journal="JMIR Form Res", year="2021", month="Nov", day="12", volume="5", number="11", pages="e26221", keywords="depression", keywords="anxiety", keywords="iCBT", keywords="dropout", keywords="internet interventions", abstract="Background: Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient. Objective: The aim of this study is to perform a qualitative analysis of patients' experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout. Methods: A total of 15 purposively sampled participants (female: 8/15, 53\%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach. Results: The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period. Conclusions: Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated. ", doi="10.2196/26221", url="https://formative.jmir.org/2021/11/e26221", url="http://www.ncbi.nlm.nih.gov/pubmed/34766909" } @Article{info:doi/10.2196/29146, author="Chen, Wen and Boggero, Andrea and Del Puente, Giovanni and Olcese, Martina and Prestia, Davide and Jahrami, Haitham and Chalghaf, Nasr and Guelmami, Noomen and Azaiez, Fairouz and Bragazzi, Luigi Nicola", title="Googling for Suicide--Content and Quality Analysis of Suicide-Related Websites: Thematic Analysis", journal="JMIR Form Res", year="2021", month="Nov", day="11", volume="5", number="11", pages="e29146", keywords="suicide", keywords="internet", keywords="world wide web", keywords="content analysis", keywords="HONcode", keywords="mental health", keywords="webpage", keywords="health information", keywords="eHealth", abstract="Background: Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are ``virtual pathways'' facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals. Objective: The aim of this study is to characterize suicide-related webpages in the Italian language. Methods: The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term ``suicidio'' (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument Results: A total of 65 webpages were included: 12.5\% (8/64) were antisuicide and 6.3\% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2\%) and had informative content and purpose (39/64, 60.9\%). Most webpages targeted adolescents as an age group (38/64, 59.4\%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6\%), included medical/professional supervision or guidance (45/64, 70.3\%), lacked figures or pictures related to suicide (41/64, 64.1\%), and did not contain any access restraint (62/64, 96.9\%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword ``suicide.'' Conclusions: Specialized mental health professionals should try to improve their presence online by providing high-quality material. ", doi="10.2196/29146", url="https://formative.jmir.org/2021/11/e29146", url="http://www.ncbi.nlm.nih.gov/pubmed/34689118" } @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/10.2196/31944, author="Choi, Bogeum and Kim, Heejun and Huh-Yoo, Jina", title="Seeking Mental Health Support Among College Students in Video-Based Social Media: Content and Statistical Analysis of YouTube Videos", journal="JMIR Form Res", year="2021", month="Nov", day="11", volume="5", number="11", pages="e31944", keywords="mental health", keywords="college student", keywords="social media", keywords="YouTube", keywords="help-seeking", keywords="experiential knowledge", keywords="video types", keywords="content analysis", keywords="time distribution analysis", keywords="depression", keywords="anxiety", keywords="student", keywords="knowledge", keywords="stigma", keywords="strategy", keywords="engagement", abstract="Background: Mental health is a highly stigmatized disease, especially for young people. Due to its free, accessible format, college students increasingly use video-based social media for many aspects of information needs, including how-to tips, career, or health-related needs. The accessibility of video-based social media brings potential in supporting stigmatized contexts, such as college students' mental health. Understanding which kinds of videos about college students' mental health have increased viewer engagement will help build a foundation for exploring this potential. Little research has been done to identify video types systematically, how they have changed over time, and their associations on viewer engagement both short term and long term. Objective: This study aims to identify strategies for using video-based social media to combat stigmatized diseases, such as mental health, among college students. We identify who, with what perspective, purpose, and content, makes up the videos available on social media (ie, YouTube) about college students' mental health and how these factors associate with viewer engagement. We then identify effective strategies for designing video-based social media content for supporting college students' mental health. Methods: We performed inductive content analysis to identify different types of YouTube videos concerning college students' mental health (N=452) according to video attributes, including poster, perspective, and purpose. Time analysis showed how video types have changed over time. Fisher's exact test was used to examine the relationships between video attributes. The Mann-Whitney U test was used to test the association between video types and viewer engagement. Lastly, we investigated the difference in viewer engagement across time between two major types of videos (ie, individuals' storytelling and organization's informational videos). Results: Time trend analysis showed a notable increase in the number of (1) videos by individuals, (2) videos that represent students' perspectives, and (3) videos that share stories and experiential knowledge over the recent years. Fisher's exact test found all video attributes (ie, poster, perspective, and purpose) are significantly correlated with each other. In addition, the Mann-Whitney U test found that poster (individual vs organization) and purpose (storytelling vs sharing information) type has a significant association with viewer engagement (P<.001). Lastly, individuals' storytelling videos had a greater engagement in the short term and the long term. Conclusions: The study shows that YouTube videos on college students' mental health can be well differentiated by the types of posters and the purpose of the videos. Taken together, the videos where individuals share their personal stories, as well as experiential knowledge (ie, tips and advice), engaged more viewers in both the short term and long term. Individuals' videos on YouTube showed the potential to support college students' mental health in unique ways, such as providing social support, validating experience, and sharing the positive experience of help-seeking. ", doi="10.2196/31944", url="https://formative.jmir.org/2021/11/e31944", url="http://www.ncbi.nlm.nih.gov/pubmed/34762060" } @Article{info:doi/10.2196/30580, author="Suffoletto, Brian and Goldstein, Tina and Brent, David", title="A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial", journal="JMIR Form Res", year="2021", month="Nov", day="9", volume="5", number="11", pages="e30580", keywords="adolescent", keywords="depression", keywords="help seeking", keywords="text message", keywords="intervention", abstract="Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care. Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers. Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks. Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52\% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5\% (1/20) reported that it was scheduled for a future date, 10\% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15\% (3/20) reported that they were no longer interested in receiving mental health care. Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation. ", doi="10.2196/30580", url="https://formative.jmir.org/2021/11/e30580", url="http://www.ncbi.nlm.nih.gov/pubmed/34751665" } @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/10.2196/18969, author="Nwaogu, Mayowa Janet and Chan, C. Albert P. and Naslund, A. John and Hon, H. Carol K. and Belonwu, Christopher and Yang, Jackie", title="Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study", journal="JMIR Form Res", year="2021", month="Nov", day="9", volume="5", number="11", pages="e18969", keywords="mental health", keywords="construction personnel", keywords="digital technology", keywords="digital intervention", keywords="barriers", keywords="motivators", keywords="mobile phone", abstract="Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. ", doi="10.2196/18969", url="https://formative.jmir.org/2021/11/e18969", url="http://www.ncbi.nlm.nih.gov/pubmed/34751652" } @Article{info:doi/10.2196/24471, author="Chancellor, Stevie and Sumner, A. Steven and David-Ferdon, Corinne and Ahmad, Tahirah and De Choudhury, Munmun", title="Suicide Risk and Protective Factors in Online Support Forum Posts: Annotation Scheme Development and Validation Study", journal="JMIR Ment Health", year="2021", month="Nov", day="8", volume="8", number="11", pages="e24471", keywords="online communities", keywords="suicide crisis", keywords="construct validity", keywords="annotation scheme", keywords="Reddit", keywords="annotation", abstract="Background: Online communities provide support for individuals looking for help with suicidal ideation and crisis. As community data are increasingly used to devise machine learning models to infer who might be at risk, there have been limited efforts to identify both risk and protective factors in web-based posts. These annotations can enrich and augment computational assessment approaches to identify appropriate intervention points, which are useful to public health professionals and suicide prevention researchers. Objective: This qualitative study aims to develop a valid and reliable annotation scheme for evaluating risk and protective factors for suicidal ideation in posts in suicide crisis forums. Methods: We designed a valid, reliable, and clinically grounded process for identifying risk and protective markers in social media data. This scheme draws on prior work on construct validity and the social sciences of measurement. We then applied the scheme to annotate 200 posts from r/SuicideWatch---a Reddit community focused on suicide crisis. Results: We documented our results on producing an annotation scheme that is consistent with leading public health information coding schemes for suicide and advances attention to protective factors. Our study showed high internal validity, and we have presented results that indicate that our approach is consistent with findings from prior work. Conclusions: Our work formalizes a framework that incorporates construct validity into the development of annotation schemes for suicide risk on social media. This study furthers the understanding of risk and protective factors expressed in social media data. This may help public health programming to prevent suicide and computational social science research and investigations that rely on the quality of labels for downstream machine learning tasks. ", doi="10.2196/24471", url="https://mental.jmir.org/2021/11/e24471", url="http://www.ncbi.nlm.nih.gov/pubmed/34747705" } @Article{info:doi/10.2196/31789, author="Kaiser, Sabine and Martinussen, Monica and Adolfsen, Frode and Breivik, Kyrre and Kyrrestad, Henriette", title="An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="8", volume="10", number="11", pages="e31789", keywords="cyberbullying", keywords="intervention", keywords="mobile app", keywords="adolescents", keywords="NettOpp", keywords="mental health", keywords="health care", abstract="Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 ", doi="10.2196/31789", url="https://www.researchprotocols.org/2021/11/e31789", url="http://www.ncbi.nlm.nih.gov/pubmed/34747704" } @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/10.2196/27114, author="Bhattacharjee, Ananya and Haque, Taiabul S. M. and Hady, Abdul Md and Alam, Raihanul S. M. and Rabbi, Mashfiqui and Kabir, Ashad Muhammad and Ahmed, Ishtiaque Syed", title="Understanding the Social Determinants of Mental Health of Undergraduate Students in Bangladesh: Interview Study", journal="JMIR Form Res", year="2021", month="Nov", day="2", volume="5", number="11", pages="e27114", keywords="Bangladesh", keywords="global south", keywords="social determinant", keywords="students", keywords="undergraduate", keywords="religion", keywords="women", keywords="mobile phone", abstract="Background: The undergraduate student population has been actively studied in digital mental health research. However, the existing literature primarily focuses on students from high-income nations, and undergraduates from limited-income nations remain understudied. Objective: This study aims to identify the broader social determinants of mental health among undergraduate students in Bangladesh, a limited-income nation in South Asia; study the manifestation of these determinants in their day-to-day lives; and explore the feasibility of self-monitoring tools in helping them identify the specific factors or relationships that affect their mental health. Methods: We conducted a 21-day study with 38 undergraduate students from 7 universities in Bangladesh. We conducted 2 semistructured interviews: one prestudy and one poststudy. During the 21-day study, participants used an Android app to self-report and self-monitor their mood after each phone conversation. The app prompted participants to report their mood after each phone conversation and provided graphs and charts so that the participants could independently review their mood and conversation patterns. Results: Our results show that academics, family, job and economic condition, romantic relationship, and religion are the major social determinants of mental health among undergraduate students in Bangladesh. Our app helped the participants pinpoint the specific issues related to these factors, as the participants could review the pattern of their moods and emotions from past conversation history. Although our app does not provide any explicit recommendation, the participants took certain steps on their own to improve their mental health (eg, reduced the frequency of communication with certain persons). Conclusions: Although some of the factors (eg, academics) were reported in previous studies conducted in the Global North, this paper sheds light on some new issues (eg, extended family problems and religion) that are specific to the context of the Global South. Overall, the findings from this study would provide better insights for researchers to design better solutions to help the younger population from this part of the world. ", doi="10.2196/27114", url="https://formative.jmir.org/2021/11/e27114", url="http://www.ncbi.nlm.nih.gov/pubmed/34726609" } @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/10.2196/27676, author="Hechinger, Mareike and Fringer, Andr{\'e}", title="Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis", journal="JMIR Form Res", year="2021", month="Oct", day="28", volume="5", number="10", pages="e27676", keywords="nursing care", keywords="health care professionals", keywords="suicidal behavior", keywords="suicidal inclinations", keywords="suicidal ideation", keywords="inpatient", keywords="outpatient", keywords="eHealth", keywords="mHealth", keywords="mental health", keywords="suicide", keywords="stress", abstract="Background: Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care. Objective: This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development. Methods: A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived. Results: In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life. Conclusions: The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care. ", doi="10.2196/27676", url="https://formative.jmir.org/2021/10/e27676", url="http://www.ncbi.nlm.nih.gov/pubmed/34709191" } @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/10.2196/22199, author="Sora, Beatriz and Nieto, Rub{\'e}n and Montesano del Campo, Adrian and Armayones, Manuel", title="Acceptance and Use of Telepsychology From the Clients' Perspective: Questionnaire Study to Document Perceived Advantages and Barriers", journal="JMIR Ment Health", year="2021", month="Oct", day="15", volume="8", number="10", pages="e22199", keywords="telepsychology", keywords="telepsychology advantages", keywords="telepsychology barriers", keywords="telepsychology use", keywords="telepsychology usefulness", keywords="intention to use telepsychology", abstract="Background: Telepsychology is increasingly being incorporated in clinical practice, being offered in many psychotherapy centers, especially after the impact of the pandemic. However, there seems to be a remarkable discrepancy between the offer, or interest in, and real-world uptake of e-mental health interventions among the population. A critical precondition is clients' willingness to accept and use telepsychology, although this issue has thus far been overlooked in research. Objective: The aim of this study was to examine people's acceptance and use of telepsychology by adopting an extended model of the unified theory of acceptance and use of technology (UTAUT) that integrates perceived telepsychology advantages and barriers, usefulness perceptions, behavioral intention, and telepsychology use. Methods: An online survey was conducted with a convenience sample of 514 participants. Structural equation models were computed to test a mediation model. Results: Results supported the UTAUT model to explain participants' acceptance and use of telepsychology. They showed a causal chain in which perceived telepsychology advantages and barriers were related to telepsychology use through the perceived usefulness of and intention to use telepsychology. Conclusions: Telepsychology use may be explained according to the UTAUT model when coupled with participants' perceptions of telepsychology advantages and barriers. Mental health stakeholders could consider these factors in order to increase the acceptance and use of telepsychology. ", doi="10.2196/22199", url="https://mental.jmir.org/2021/10/e22199", url="http://www.ncbi.nlm.nih.gov/pubmed/34652276" } @Article{info:doi/10.2196/32271, author="Suffoletto, Brian and Goldstein, Tina and Gotkiewicz, Dawn and Gotkiewicz, Emily and George, Brandie and Brent, David", title="Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Oct", day="14", volume="5", number="10", pages="e32271", keywords="college", keywords="mental health", keywords="self-management", keywords="digital intervention", keywords="mHealth", abstract="Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85\% female [45/52], 91\% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100\% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78\% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95\% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 ", doi="10.2196/32271", url="https://formative.jmir.org/2021/10/e32271", url="http://www.ncbi.nlm.nih.gov/pubmed/34647893" } @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/10.2196/29963, author="Hood, M. Anna and Stotesbury, Hanne and Murphy, Jennifer and K{\"o}lbel, Melanie and Slee, April and Springall, Charlie and Paradis, Matthew and Corral-Fr{\'i}as, Sara{\'i} Nadia and Reyes-Aguilar, Azalea and Cuellar Barboza, B. Alfredo and Noser, E. Amy and Gomes, Stacey and Mitchell, Monica and Watkins, M. Sharon and Butsch Kovacic, Melinda and Kirkham, J. Fenella and Crosby, E. Lori", title="Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study", journal="JMIR Ment Health", year="2021", month="Oct", day="7", volume="8", number="10", pages="e29963", keywords="COVID-19", keywords="mental health", keywords="international", keywords="mitigation strategies", keywords="deprivation", abstract="Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95\% Clopper--Pearson (exact) tests with 95\% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99\% [1326/1396] White, 72.22\% [1014/1404] female, and 20.12\% [277/1377] key or essential workers); 18.88\% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36\% (402/1282) reported a preexisting chronic medical illness, and 35.11\% (493/1404) were aged over 65; 57.72\% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89\% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics. ", doi="10.2196/29963", url="https://mental.jmir.org/2021/10/e29963", url="http://www.ncbi.nlm.nih.gov/pubmed/34357877" } @Article{info:doi/10.2196/23465, author="Kim, Taewan and Hong, Hwajung", title="Understanding University Students' Experiences, Perceptions, and Attitudes Toward Peers Displaying Mental Health--Related Problems on Social Networking Sites: Online Survey and Interview Study", journal="JMIR Ment Health", year="2021", month="Oct", day="5", volume="8", number="10", pages="e23465", keywords="mental health", keywords="social media", keywords="social support", keywords="peers", keywords="peer support", keywords="self-disclosure", abstract="Background: College students' mental health is at an all-time low. Students are increasingly disclosing their vulnerable, stigmatizing experiences on online social networking sites (SNSs). Peer support facilitated by SNSs can play a crucial role for the students in coping with mental health--related problems. Thus, it is imperative to understand how university students form perceptions, attitudes, and behaviors toward their peers who are dealing with mental health problems. Objective: This study aimed to provide a better understanding of how college students recognize, perceive, and react to signs of mental health problems in their peers on SNSs. Our ultimate goal in this study was to inform the design of SNSs that can facilitate online peer support. Methods: We conducted surveys with 226 students as well as semistructured interviews with 20 students at six universities in South Korea. Results: Of the 226 survey respondents, 150 (66.4\%) reported that they recognized signs of a mental health problem on their friends' SNS posts. However, a considerable number of respondents (62/150, 41.3\%) were reluctant to offer support, even when they had identified friends who were at risk; this reluctance was due to a lack of knowledge or confidence and their desire to maintain a distance from at-risk peers to save their identity from stigmatization and to avoid emotional contagion online. Conclusions: Drawing on these results, we provide implications that could explain the construction of students' perceptions regarding their peers' mental health problems. We also provide design proposals for SNSs to serve as platforms that facilitate just-in-time and adaptive support exchanges among peers while mitigating stigma-related concerns. ", doi="10.2196/23465", url="https://mental.jmir.org/2021/10/e23465", url="http://www.ncbi.nlm.nih.gov/pubmed/34609315" } @Article{info:doi/10.2196/30274, author="Van Herck, Maarten and Go{\"e}rtz, J. Yvonne M. and Houben-Wilke, Sarah and Machado, C. Felipe V. and Meys, Roy and Delbressine, M. Jeannet and Vaes, W. Anouk and Burtin, Chris and Posthuma, Rein and Franssen, E. Frits M. and Hajian, Bita and Vijlbrief, Herman and Spies, Yvonne and van 't Hul, J. Alex and Janssen, A. Daisy J. and Spruit, A. Martijn", title="Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups", journal="J Med Internet Res", year="2021", month="Sep", day="21", volume="23", number="9", pages="e30274", keywords="COVID-19", keywords="SARS-CoV-2", keywords="long COVID", keywords="post-COVID-19 syndrome", keywords="post-acute sequelae of COVID-19", keywords="fatigue", keywords="post-viral fatigue", keywords="pandemic", keywords="online health", keywords="mental health", keywords="online support", abstract="Background: Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective: The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods: A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength--subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ?36 points was used to qualify patients as having severe fatigue. Results: A total of 239 patients with polymerase chain reaction/computed tomography--confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8\%) were women; 142 (59.4\%) had no self-reported pre-existing comorbidities; 208 (87\%) self-reported being in good health before contracting COVID-19; and 62 (25.9\%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4\%, and n=188, 78.7\%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: --2 points, IQR --7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue --1 point, IQR --3 to 0, P<.001; median change for mental fatigue 0 points, IQR --3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2\%) and 164/239 (68.6\%) of all patients had received care from at least one medical professional and one allied health care professional, respectively. Conclusions: Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. ", doi="10.2196/30274", url="https://www.jmir.org/2021/9/e30274", url="http://www.ncbi.nlm.nih.gov/pubmed/34494964" } @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/10.2196/29845, author="Burbach, R. Frank and Stiles, M. Katie", title="Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation", journal="JMIR Form Res", year="2021", month="Sep", day="17", volume="5", number="9", pages="e29845", keywords="telehealth", keywords="young people", keywords="adolescents", keywords="online psychological therapy", keywords="online neurodevelopmental assessments", keywords="digital services", keywords="realist evaluation", keywords="multiple case study", keywords="CBT", keywords="autism", abstract="Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case--study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services. ", doi="10.2196/29845", url="https://formative.jmir.org/2021/9/e29845", url="http://www.ncbi.nlm.nih.gov/pubmed/34369382" } @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/10.2196/29318, author="Bushman, Maggie and Godishala, Shreya and Hyzer, Reese and Jerisha, Joshua and Jolliff, Anna and Kaji, Ethan and Kerr, Bradley and Mathur, Anjali and Tsao, Owen", title="Adolescent Health on Social Media and the Mentorship of Youth Investigators: Five Content Analysis Studies Conducted by Youth Investigators", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e29318", keywords="social media", keywords="anxiety", keywords="depression", keywords="self-esteem", keywords="Instagram", keywords="Reddit", keywords="Twitter", keywords="YouTube", keywords="content analysis", keywords="adolescent", doi="10.2196/29318", url="https://mental.jmir.org/2021/9/e29318", url="http://www.ncbi.nlm.nih.gov/pubmed/34524099" } @Article{info:doi/10.2196/26484, author="Evans, Yolanda and Hutchinson, Jeffrey and Ameenuddin, Nusheen", title="Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26484", keywords="pandemic", keywords="technology", keywords="media", keywords="bullying", keywords="mental health", keywords="distance learning", doi="10.2196/26484", url="https://mental.jmir.org/2021/9/e26484", url="http://www.ncbi.nlm.nih.gov/pubmed/34524094" } @Article{info:doi/10.2196/26203, author="Hwang, Juwon and Toma, L. Catalina", title="The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents' Problematic Internet Use: Moderation Analysis", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26203", keywords="problematic internet use", keywords="PIU", keywords="subjective mental well-being", keywords="perceived parental supportiveness", keywords="adolescents", keywords="well-being", keywords="young adult", keywords="internet", keywords="mental health", keywords="support", keywords="parent", keywords="engagement", keywords="social media", abstract="Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents' subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents' engagement in PIU. Objective: This paper aimed to examine the role played by adolescents' perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology \& Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4\% (2130/4592) female and 66.9\% (3370/4592) White. Findings revealed that, controlling for adolescents' demographics and social media use, higher levels of perceived parental supportiveness ($\beta$=--.285, P<.001) and higher levels of subjective mental well-being ($\beta$=--.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being ($\beta$=--.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents' mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents' mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. ", doi="10.2196/26203", url="https://mental.jmir.org/2021/9/e26203", url="http://www.ncbi.nlm.nih.gov/pubmed/34524093" } @Article{info:doi/10.2196/26176, author="Campos-Castillo, Celeste and Thomas, Jason Brian and Reyes, Felipe and Laestadius, Irina Linnea", title="Seeking Help From Trusted Adults in Response to Peers' Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26176", keywords="adolescents", keywords="confidants", keywords="ethnicity", keywords="gender", keywords="network resources", keywords="privacy", keywords="race", keywords="social media", keywords="social support", keywords="tie activation", keywords="trust", abstract="Background: Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being. Objective: This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide. Methods: We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents' request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide. Results: Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults. Conclusions: To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support. ", doi="10.2196/26176", url="https://mental.jmir.org/2021/9/e26176", url="http://www.ncbi.nlm.nih.gov/pubmed/34524088" } @Article{info:doi/10.2196/26158, author="Craig Rushing, Stephanie and Kelley, Allyson and Bull, Sheana and Stephens, David and Wrobel, Julia and Silvasstar, Joshva and Peterson, Roger and Begay, Corey and Ghost Dog, Thomas and McCray, Celena and Love Brown, Danica and Thomas, Morgan and Caughlan, Colbie and Singer, Michelle and Smith, Paige and Sumbundu, Kanku", title="Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26158", keywords="American Indian", keywords="Alaska Native", keywords="adolescent", keywords="mental health", keywords="help-seeking skills, text messaging", keywords="mHealth, behavioral intervention", keywords="Indian health", keywords="mobile phone", abstract="Background: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1\% (427/618) at 3 months to 76\% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4\% (138/616) at 3 months to 54.6\% (272/498) at 8 months. Conclusions: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 ", doi="10.2196/26158", url="https://mental.jmir.org/2021/9/e26158", url="http://www.ncbi.nlm.nih.gov/pubmed/34524092" } @Article{info:doi/10.2196/26154, author="Fadiran, Babayosimi and Lee, Jessica and Lemminger, Jared and Jolliff, Anna", title="How Our Technology Use Changed in 2020: Perspectives From Three Youths", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26154", keywords="mental health", keywords="social media", keywords="digital technology", keywords="youth", keywords="adolescent", keywords="commentary", keywords="technology", keywords="wellness", doi="10.2196/26154", url="https://mental.jmir.org/2021/9/e26154", url="http://www.ncbi.nlm.nih.gov/pubmed/34524108" } @Article{info:doi/10.2196/26134, author="Rutter, A. Lauren and Thompson, M. Holly and Howard, Jacqueline and Riley, N. Tennisha and De Jes{\'u}s-Romero, Robinson and Lorenzo-Luaces, Lorenzo", title="Social Media Use, Physical Activity, and Internalizing Symptoms in Adolescence: Cross-sectional Analysis", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26134", keywords="social media", keywords="depression", keywords="anxiety", keywords="physical activity", keywords="adolescence", keywords="mobile phone", abstract="Background: Most American adolescents have access to smartphones, and recent estimates suggest that they spend considerable time on social media compared with other physical and leisure activities. A large body of literature has established that social media use is related to poor mental health, but the complicated relationship between social media and symptoms of depression and anxiety in adolescents is yet to be fully understood. Objective: We aim to investigate the relationship between social media use and depression and anxiety symptoms in adolescents by exploring physical activity as a mediator. Methods: A Qualtrics survey manager recruited adult panel participants between February and March 2019, who indicated that they had adolescent children who spoke English. A total of 4592 adolescent-parent dyads completed the survey that took approximately 39 minutes. The survey entailed completing web-based questionnaires assessing various aspects of social media use, psychological symptoms, and psychosocial factors. The average age of the adolescent participants was 14.62 (SD 1.68; range 12-17) years, and the majority of the adolescent sample was male (2392/4592, 52.09\%). Results: Total social media use was associated with more depressive symptoms (multiple R2=0.12; F3,4480=207.1; P<.001), anxiety (multiple R2=0.09; F3,4477=145.6; P<.001), and loneliness (multiple R2=0.06; F3,4512=98.06; P<.001), controlling for age and gender. Physical activity was associated with decreased depression and anxiety symptoms after controlling for other extracurricular activities and social media use (multiple R2=0.24; F5,4290=266.0; P<.001). There were significant differences in symptoms based on gender: female adolescents reported higher rates of social media use and males reported higher rates of depression. Nonbinary and transgender adolescents had higher rates of depression, anxiety, and loneliness than the female and male adolescents in the sample. Conclusions: In a nationally representative sample of adolescents, more social media use was associated with more severe symptoms of depression, anxiety, and loneliness. Increased physical activity was associated with decreased depression and anxiety symptoms. Physical activity partially mediated the relationship between social media use and depression and anxiety. As this was a cross-sectional study, we cannot conclude that social media use causes internalizing symptoms or that physical activity leads to decreased internalizing symptoms---there may be additional confounding variables producing the relationships we observed. Physical activity may protect against the potentially harmful effect of social media on some adolescents. The effect sizes were small to medium, and the results should be interpreted with caution. Other limitations of this study include our reliance on self-reporting. Future work should examine social media use beyond how much time adolescents spend using social media and instead focus on the nature of social media activity. ", doi="10.2196/26134", url="https://mental.jmir.org/2021/9/e26134", url="http://www.ncbi.nlm.nih.gov/pubmed/34524096" } @Article{info:doi/10.2196/26029, author="Kutok, R. Emily and Dunsiger, Shira and Patena, V. John and Nugent, R. Nicole and Riese, Alison and Rosen, K. Rochelle and Ranney, L. Megan", title="A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26029", keywords="cyberbullying", keywords="adolescents", keywords="mobile application", keywords="messaging", keywords="brief interventions", keywords="social media", keywords="recruitment", keywords="mobile phone", abstract="Background: Between 15\% and 70\% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97\% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant--led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5\% (121/494) of eligible participants provided contact information; of these, 69.4\% (84/121) completed full enrollment procedures. Of the participants enrolled, 45\% (36/80) were randomized into the IMPACT intervention and 55\% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89\% (77/80) of the daily prompts were answered. The retention rate was 99\% (79/80) at 8 weeks and 96\% (77/80) at 16 weeks for all participants. Regarding acceptability, 100\% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92\% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher ($\beta$=1.17, SE 0.87, P=.02 at 8 weeks and $\beta$=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower ($\beta$=?.66, SE 0.08, P=.04 at 8 weeks and $\beta$=?.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks ($\beta$=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. ", doi="10.2196/26029", url="https://mental.jmir.org/2021/9/e26029", url="http://www.ncbi.nlm.nih.gov/pubmed/34524103" } @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/10.2196/30292, author="Flobak, Eivind and Nordby, Sektnan Emilie and Guribye, Frode and Kenter, Robin and Nordgreen, Tine and Lundervold, J. Astri", title="Designing Videos With and for Adults With ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation", journal="JMIR Ment Health", year="2021", month="Sep", day="14", volume="8", number="9", pages="e30292", keywords="participatory design", keywords="ADHD", keywords="online intervention", keywords="video", keywords="therapeutic content", keywords="stigma", keywords="attention deficit hyperactivity disorder", keywords="design", keywords="participatory", keywords="intervention", keywords="experience", keywords="mental health", abstract="Background: Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group. Objective: This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences. Methods: We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis. Results: In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change. Conclusions: A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants' experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 ", doi="10.2196/30292", url="https://mental.jmir.org/2021/9/e30292", url="http://www.ncbi.nlm.nih.gov/pubmed/34519666" } @Article{info:doi/10.2196/25294, author="Mauriello, Louis Matthew and Tantivasadakarn, Nantanick and Mora-Mendoza, Antonio Marco and Lincoln, Thierry Emmanuel and Hon, Grace and Nowruzi, Parsa and Simon, Dorien and Hansen, Luke and Goenawan, H. Nathaniel and Kim, Joshua and Gowda, Nikhil and Jurafsky, Dan and Paredes, Enrique Pablo", title="A Suite of Mobile Conversational Agents for Daily Stress Management (Popbots): Mixed Methods Exploratory Study", journal="JMIR Form Res", year="2021", month="Sep", day="14", volume="5", number="9", pages="e25294", keywords="conversational agents", keywords="virtual agent", keywords="chatbot", keywords="therapy", keywords="stress relief", keywords="stress management", keywords="mental health", keywords="stress", keywords="exploratory", keywords="support", keywords="mobile phone", abstract="Background: Approximately 60\%-80\% of the primary care visits have a psychological stress component, but only 3\% of patients receive stress management advice during these visits. Given recent advances in natural language processing, there is renewed interest in mental health chatbots. Conversational agents that can understand a user's problems and deliver advice that mitigates the effects of daily stress could be an effective public health tool. However, such systems are complex to build and costly to develop. Objective: To address these challenges, our aim is to develop and evaluate a fully automated mobile suite of shallow chatbots---we call them Popbots---that may serve as a new species of chatbots and further complement human assistance in an ecosystem of stress management support. Methods: After conducting an exploratory Wizard of Oz study (N=14) to evaluate the feasibility of a suite of multiple chatbots, we conducted a web-based study (N=47) to evaluate the implementation of our prototype. Each participant was randomly assigned to a different chatbot designed on the basis of a proven cognitive or behavioral intervention method. To measure the effectiveness of the chatbots, the participants' stress levels were determined using self-reported psychometric evaluations (eg, web-based daily surveys and Patient Health Questionnaire-4). The participants in these studies were recruited through email and enrolled on the web, and some of them participated in follow-up interviews that were conducted in person or on the web (as necessary). Results: Of the 47 participants, 31 (66\%) completed the main study. The findings suggest that the users viewed the conversations with our chatbots as helpful or at least neutral and came away with increasingly positive sentiment toward the use of chatbots for proactive stress management. Moreover, those users who used the system more often (ie, they had more than or equal to the median number of conversations) noted a decrease in depression symptoms compared with those who used the system less often based on a Wilcoxon signed-rank test (W=91.50; Z=?2.54; P=.01; r=0.47). The follow-up interviews with a subset of the participants indicated that half of the common daily stressors could be discussed with chatbots, potentially reducing the burden on human coping resources. Conclusions: Our work suggests that suites of shallow chatbots may offer benefits for both users and designers. As a result, this study's contributions include the design and evaluation of a novel suite of shallow chatbots for daily stress management, a summary of benefits and challenges associated with random delivery of multiple conversational interventions, and design guidelines and directions for future research into similar systems, including authoring chatbot systems and artificial intelligence--enabled recommendation algorithms. ", doi="10.2196/25294", url="https://formative.jmir.org/2021/9/e25294", url="http://www.ncbi.nlm.nih.gov/pubmed/34519655" } @Article{info:doi/10.2196/25168, author="Hatzioannou, Anna and Chatzittofis, Andreas and Koutroubas, Sunday Virginia and Papastavrou, Evridiki and Karanikola, Maria", title="Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="8", volume="10", number="9", pages="e25168", keywords="education", keywords="empowerment", keywords="bipolar disorders", keywords="self-management", keywords="bipolar", keywords="mental health", abstract="Background: Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide. Objective: This protocol describes the study ``Management of my Bipolarity'' (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants' knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. Methods: The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). Results: A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70\% of the visitors. Conclusions: Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. Trial Registration: ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210 International Registered Report Identifier (IRRID): DERR1-10.2196/25168 ", doi="10.2196/25168", url="https://www.researchprotocols.org/2021/9/e25168", url="http://www.ncbi.nlm.nih.gov/pubmed/34494969" } @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/10.2196/30596, author="Adanijo, Abimbola and McWilliams, Caoimhe and Wykes, Til and Jilka, Sagar", title="Investigating Mental Health Service User Opinions on Clinical Data Sharing: Qualitative Focus Group Study", journal="JMIR Ment Health", year="2021", month="Sep", day="3", volume="8", number="9", pages="e30596", keywords="clinical data", keywords="data sharing", keywords="mental health data", keywords="service users", keywords="focus groups", keywords="mental health", keywords="digital health", keywords="health records", abstract="Background: Sharing patient data can help drive scientific advances and improve patient care, but service users are concerned about how their data are used. When the National Health Service proposes to scrape general practitioner records, it is very important that we understand these concerns in some depth. Objective: This study aims to investigate views of mental health service users on acceptable data sharing to provide clear recommendations for future data sharing systems. Methods: A total of 4 focus groups with 4 member-checking groups were conducted via the internet between October 2020 and March 2021, with a total of 22 service users in the United Kingdom. Thematic analysis was used to identify the themes. Results: Six main themes, with several subthemes were identified, such as the purpose of data sharing---for profit, public good, and continuation of care; discrimination through the misattribution of physical symptoms to mental health conditions (ie, diagnostic overshadowing) alongside the discrimination of individuals or groups within society (ie, institutional discrimination); safeguarding data by preserving anonymity and confidentiality, strengthening security measures, and holding organizations accountable; data accuracy and informed consent---increasing transparency about data use and choice; and incorporating service user involvement in system governance to provide insight and increase security. Conclusions: This study extends the limited research on the views and concerns of mental health service users regarding acceptable data sharing. If adopted, the recommendations should improve the confidence of service users in sharing their data. The five recommendations include screening to ensure that data sharing benefits the public, providing service users with information about how their data are shared and what for, highlighting the existing safeguarding procedures, incorporating service user involvement, and developing tailored training for health care professionals to address issues of diagnostic overshadowing and inaccurate health records. Adopting such systems would aid in data sharing for legitimate interests that will benefit patients and the National Health Service. ", doi="10.2196/30596", url="https://mental.jmir.org/2021/9/e30596", url="http://www.ncbi.nlm.nih.gov/pubmed/34477558" } @Article{info:doi/10.2196/27713, author="Linden, Brooke", title="Cross-Canada Release of the Post-Secondary Student Stressors Index (PSSI): Protocol for a Cross-sectional, Repeated Measures Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="31", volume="10", number="8", pages="e27713", keywords="stress", keywords="mental health", keywords="health promotion", keywords="postsecondary", keywords="higher education", keywords="measurement tool", keywords="study protocol", abstract="Background: The prevalence of mental health--related problems, including stress, psychological distress, and symptoms of mental illnesses, continues to increase among Canadian postsecondary student populations. Excessive stress in this population has been linked to a number of negative academic and health outcomes. Despite attempts to improve mental health at postsecondary institutions, a persistent gap exists in the evaluation of the specific sources of stress for students within the postsecondary setting. Objective: The purpose of this paper is to report the study protocol for a cross-Canada, multisite launch of the Post-Secondary Student Stressors Index (PSSI), which will engage postsecondary institutions across the country as partners and facilitate improved measurement of the sources of student stress, in addition to contributing toward improved tailoring of upstream mental health services and support. Methods: Created in collaboration with students, the PSSI is a validated 46-item tool assessing stressors across five domains: academics, learning environment, campus culture, interpersonal, and personal stressors. The tool is designed to be applicable to students at all years, levels, and areas of study. Data will be collected longitudinally at multiple time points over the course of each academic year. Results: We recruited 15 postsecondary institutions across Canada for the first year, inviting students to participate in an online survey including questions concerning sociodemographic characteristics, stress, mental health, and resiliency. Analyses, including appropriate data visualization, will be conducted to determine the impact of specific stressors on mental health, linking responses over time to allow for the observation of changes in trends. Conclusions: The PSSI is an intuitive and evidence-informed tool that can aid postsecondary institutions in evaluating the sources of student stress on their campuses. This multisite project will make a substantial contribution to the current literature regarding postsecondary student stress and allow institutions across the country to improve the tailoring of upstream mental health services in order to directly support the unique needs of their student body. Opportunities for knowledge translation and exchange are discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/27713 ", doi="10.2196/27713", url="https://www.researchprotocols.org/2021/8/e27713", url="http://www.ncbi.nlm.nih.gov/pubmed/34463632" } @Article{info:doi/10.2196/28045, author="van Rijt, Mattheus Antonius and Hulter, Pauline and Weggelaar-Jansen, Marie Anne and Ahaus, Kees and Pluut, Bettine", title="Mental Health Care Professionals' Appraisal of Patients' Use of Web-Based Access to Their Electronic Health Record: Qualitative Study", journal="J Med Internet Res", year="2021", month="Aug", day="27", volume="23", number="8", pages="e28045", keywords="patient portals", keywords="eHealth", keywords="mental health care professionals", keywords="mental health", keywords="eMental health", keywords="mental health care", keywords="patient-accessible", keywords="electronic health records", keywords="Open Notes", keywords="normalization process theory", keywords="NPT", abstract="Background: Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient's well-being and privacy as well as the professional's own workload. Objective: This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. Methods: We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. Results: Our study provides insights into mental health care professionals' appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. Conclusions: Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals. ", doi="10.2196/28045", url="https://www.jmir.org/2021/8/e28045", url="http://www.ncbi.nlm.nih.gov/pubmed/34448705" } @Article{info:doi/10.2196/26223, author="Beames, R. Joanne and Johnston, Lara and O'Dea, Bridianne and Torok, Michelle and Christensen, Helen and Boydell, M. Katherine and Werner-Seidler, Aliza", title="Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study", journal="J Med Internet Res", year="2021", month="Aug", day="27", volume="23", number="8", pages="e26223", keywords="secondary school", keywords="depression", keywords="prevention", keywords="digital", keywords="barrier", keywords="facilitator", keywords="teacher", keywords="counselor", keywords="principal", keywords="student", abstract="Background: Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective: The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods: This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results: A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students' mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions: The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types. ", doi="10.2196/26223", url="https://www.jmir.org/2021/8/e26223", url="http://www.ncbi.nlm.nih.gov/pubmed/34448701" } @Article{info:doi/10.2196/27709, author="Yu, Jessica and Chiu, Carter and Wang, Yajuan and Dzubur, Eldin and Lu, Wei and Hoffman, Julia", title="A Machine Learning Approach to Passively Informed Prediction of Mental Health Risk in People with Diabetes: Retrospective Case-Control Analysis", journal="J Med Internet Res", year="2021", month="Aug", day="27", volume="23", number="8", pages="e27709", keywords="diabetes mellitus", keywords="mental health", keywords="risk detection", keywords="passive sensing", keywords="ecological momentary assessment", keywords="machine learning", abstract="Background: Proactive detection of mental health needs among people with diabetes mellitus could facilitate early intervention, improve overall health and quality of life, and reduce individual and societal health and economic burdens. Passive sensing and ecological momentary assessment are relatively newer methods that may be leveraged for such proactive detection. Objective: The primary aim of this study was to conceptualize, develop, and evaluate a novel machine learning approach for predicting mental health risk in people with diabetes mellitus. Methods: A retrospective study was designed to develop and evaluate a machine learning model, utilizing data collected from 142,432 individuals with diabetes enrolled in the Livongo for Diabetes program. First, participants' mental health statuses were verified using prescription and medical and pharmacy claims data. Next, four categories of passive sensing signals were extracted from the participants' behavior in the program, including demographics and glucometer, coaching, and event data. Data sets were then assembled to create participant-period instances, and descriptive analyses were conducted to understand the correlation between mental health status and passive sensing signals. Passive sensing signals were then entered into the model to train and test its performance. The model was evaluated based on seven measures: sensitivity, specificity, precision, area under the curve, F1 score, accuracy, and confusion matrix. SHapley Additive exPlanations (SHAP) values were computed to determine the importance of individual signals. Results: In the training (and validation) and three subsequent test sets, the model achieved a confidence score greater than 0.5 for sensitivity, specificity, area under the curve, and accuracy. Signals identified as important by SHAP values included demographics such as race and gender, participant's emotional state during blood glucose checks, time of day of blood glucose checks, blood glucose values, and interaction with the Livongo mobile app and web platform. Conclusions: Results of this study demonstrate the utility of a passively informed mental health risk algorithm and invite further exploration to identify additional signals and determine when and where such algorithms should be deployed. ", doi="10.2196/27709", url="https://www.jmir.org/2021/8/e27709", url="http://www.ncbi.nlm.nih.gov/pubmed/34448707" } @Article{info:doi/10.2196/30098, author="Lau, Nancy and Colt, F. Susannah and Waldbaum, Shayna and O'Daffer, Alison and Fladeboe, Kaitlyn and Yi-Frazier, P. Joyce and McCauley, Elizabeth and Rosenberg, R. Abby", title="Telemental Health For Youth With Chronic Illnesses: Systematic Review", journal="JMIR Ment Health", year="2021", month="Aug", day="27", volume="8", number="8", pages="e30098", keywords="telehealth care", keywords="mental health", keywords="psychosocial issues", keywords="psychiatry", keywords="psychology", keywords="child", keywords="chronic disease", abstract="Background: Children, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap. Objective: In this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ?25 years with chronic illnesses. Methods: PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ?25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals. Results: We screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis. Conclusions: The state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic. ", doi="10.2196/30098", url="https://mental.jmir.org/2021/8/e30098", url="http://www.ncbi.nlm.nih.gov/pubmed/34448724" } @Article{info:doi/10.2196/14004, author="Ribanszki, Robert and Saez Fonseca, Andres Jose and Barnby, Matthew Joseph and Jano, Kimberly and Osmani, Fatima and Almasi, Soma and Tsakanikos, Elias", title="Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study", journal="JMIR Form Res", year="2021", month="Aug", day="27", volume="5", number="8", pages="e14004", keywords="qualitative", keywords="adolescents", keywords="mental health", keywords="digital smartphone app", keywords="digital mental health", keywords="mobile phone", abstract="Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. ", doi="10.2196/14004", url="https://formative.jmir.org/2021/8/e14004", url="http://www.ncbi.nlm.nih.gov/pubmed/34128814" } @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/10.2196/32475, author="Morant, Nicola and Chilman, Natasha and Lloyd-Evans, Brynmor and Wackett, Jane and Johnson, Sonia", title="Acceptability of Using Social Media Content in Mental Health Research: A Reflection. Comment on ``Twitter Users' Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis''", journal="JMIR Ment Health", year="2021", month="Aug", day="17", volume="8", number="8", pages="e32475", keywords="Twitter", keywords="social media", keywords="qualitative", keywords="crisis resolution team", keywords="home treatment team", keywords="mental health", keywords="acute care", keywords="severe mental illness", doi="10.2196/32475", url="https://mental.jmir.org/2021/8/e32475", url="http://www.ncbi.nlm.nih.gov/pubmed/34402799" } @Article{info:doi/10.2196/24393, author="McCall, Terika and Ali, Osama Muhammad and Yu, Fei and Fontelo, Paul and Khairat, Saif", title="Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study", journal="JMIR Form Res", year="2021", month="Aug", day="17", volume="5", number="8", pages="e24393", keywords="African Americans", keywords="women", keywords="mental health", keywords="anxiety", keywords="depression", keywords="telemedicine", keywords="mHealth", keywords="mobile applications", keywords="digital health", keywords="user-centered design", keywords="mobile phone", abstract="Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants' visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants' acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. ", doi="10.2196/24393", url="https://formative.jmir.org/2021/8/e24393", url="http://www.ncbi.nlm.nih.gov/pubmed/34133313" } @Article{info:doi/10.2196/23360, author="Ashrafi, Agaah and Tabatabaee, Maryam and Sharifi, Vandad", title="Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study", journal="JMIR Form Res", year="2021", month="Aug", day="17", volume="5", number="8", pages="e23360", keywords="bipolar disorder", keywords="psychoeducation", keywords="web-based intervention", keywords="feasibility", keywords="acceptability", abstract="Background: Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients. Objective: This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran. Methods: A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention. Results: We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51\%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics. Conclusions: This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level. ", doi="10.2196/23360", url="https://formative.jmir.org/2021/8/e23360", url="http://www.ncbi.nlm.nih.gov/pubmed/34402794" } @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/10.2196/29671, author="Venville, Annie and O'Connor, Sarah and Roeschlein, Hannah and Ennals, Priscilla and McLoughlan, Grace and Thomas, Neil", title="Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study", journal="JMIR Ment Health", year="2021", month="Aug", day="12", volume="8", number="8", pages="e29671", keywords="telehealth", keywords="mental health", keywords="psychosocial support", keywords="COVID-19", keywords="service user", keywords="workers", keywords="qualitative", keywords="e-mental health", keywords="support", keywords="telemedicine", keywords="intervention", keywords="user experience", abstract="Background: During the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed. Objective: We focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic. Methods: This study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics. Results: Service users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60\%), by videoconferencing (6/20, 30\%), and by both telephone and videoconferencing (2/20, 10\%). Of note, 55\% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30\% (6/20) preferred to receive a mixture of in-person and telehealth, and 15\% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth. Conclusions: Overall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood. ", doi="10.2196/29671", url="https://mental.jmir.org/2021/8/e29671", url="http://www.ncbi.nlm.nih.gov/pubmed/34182461" } @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/10.2196/31588, author="Pine, Russell and Mbinta, James and Te Morenga, Lisa and Fleming, Theresa", title="A Casual Video Game With Psychological Well-being Concepts for Young Adolescents: Protocol for an Acceptability and Feasibility Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="12", volume="10", number="8", pages="e31588", keywords="digital mental health tools", keywords="casual video games", keywords="young people", abstract="Background: Many face-to-face and digital therapeutic supports are designed for adolescents experiencing high levels of psychological distress. However, promoting psychological well-being among adolescents is often neglected despite significant short-term and long-term benefits. Objective: This research has 3 main objectives: (1) to assess the acceptability of Match Emoji, a casual video game with psychological well-being concepts among 13-15-year-old students in a New Zealand secondary school; (2) to identify the feasibility of the research process; and (3) to explore the preliminary well-being and therapeutic potential of Match Emoji. Methods: Approximately 40 participants aged 13-15 years from a local secondary college in Wellington, New Zealand, will be invited to download and play Match Emoji 3-4 times a week for 5-15 minutes over a 2-week period. Participants will complete 4 assessments at baseline, postintervention, and 3 weeks later to assess psychological well-being and therapeutic changes. Statistical analysis will be used to synthesize data from interviews and triangulated with assessment changes and game analytics. This synthesis will help to assess the acceptability and feasibility of the Match Emoji. Results: The key outputs from the project will include the acceptability, feasibility, and therapeutic potential of Match Emoji. It is anticipated that participants will have finished playing the recommended game play regimen by August 2021 with analysis of results completed by October 2021. Conclusions: Data from the study are expected to inform future research on Match Emoji including a randomized controlled trial and further adjustments to the design and development of the game. International Registered Report Identifier (IRRID): PRR1-10.2196/31588 ", doi="10.2196/31588", url="https://www.researchprotocols.org/2021/8/e31588", url="http://www.ncbi.nlm.nih.gov/pubmed/34387558" } @Article{info:doi/10.2196/29368, author="Schueller, M. Stephen and Neary, Martha and Lai, Jocelyn and Epstein, A. Daniel", title="Understanding People's Use of and Perspectives on Mood-Tracking Apps: Interview Study", journal="JMIR Ment Health", year="2021", month="Aug", day="11", volume="8", number="8", pages="e29368", keywords="mental health", keywords="mobile apps", keywords="mHealth", keywords="emotions", keywords="affect", keywords="self-tracking", abstract="Background: Supporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them. Objective: To address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts. Methods: We interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short. Results: Users of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood. Conclusions: Although people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations. ", doi="10.2196/29368", url="https://mental.jmir.org/2021/8/e29368", url="http://www.ncbi.nlm.nih.gov/pubmed/34383678" } @Article{info:doi/10.2196/17971, author="Oxholm, Christina and Christensen, Soendergaard Anne-Marie and Christiansen, Regina and Wiil, Kock Uffe and Nielsen, S{\o}gaard Anette", title="Attitudes of Patients and Health Professionals Regarding Screening Algorithms: Qualitative Study", journal="JMIR Form Res", year="2021", month="Aug", day="9", volume="5", number="8", pages="e17971", keywords="screening", keywords="algorithms", keywords="alcohol", keywords="qualitative study", keywords="attitudes", keywords="opinions", keywords="patients", keywords="health professionals", abstract="Background: As a preamble to an attempt to develop a tool that can aid health professionals at hospitals in identifying whether the patient may have an alcohol abuse problem, this study investigates opinions and attitudes among both health professionals and patients about using patient data from electronic health records (EHRs) in an algorithm screening for alcohol problems. Objective: The aim of this study was to investigate the attitudes and opinions of patients and health professionals at hospitals regarding the use of previously collected data in developing and implementing an algorithmic helping tool in EHR for screening inexpedient alcohol habits; in addition, the study aims to analyze how patients would feel about asking and being asked about alcohol by staff, based on a notification in the EHR from such a tool. Methods: Using semistructured interviews, we interviewed 9 health professionals and 5 patients to explore their opinions and attitudes about an algorithm-based helping tool and about asking and being asked about alcohol usage when being given a reminder from this type of tool. The data were analyzed using an ad hoc method consistent with a close reading and meaning condensing. Results: The health professionals were both positive and negative about a helping tool grounded in algorithms. They were optimistic about the potential of such a tool to save some time by providing a quick overview if it was easy to use but, on the negative side, noted that this type of helping tool might take away the professionals' instinct. The patients were overall positive about the helping tool, stating that they would find this tool beneficial for preventive care. Some of the patients expressed concerns that the information provided by the tool could be misused. Conclusions: When developing and implementing an algorithmic helping tool, the following aspects should be considered: (1) making the helping tool as transparent in its recommendations as possible, avoiding black boxing, and ensuring room for professional discretion in clinical decision making; and (2) including and taking into account the attitudes and opinions of patients and health professionals in the design and development process of such an algorithmic helping tool. ", doi="10.2196/17971", url="https://formative.jmir.org/2021/8/e17971", url="http://www.ncbi.nlm.nih.gov/pubmed/34383666" } @Article{info:doi/10.2196/28360, author="Mata-Greve, Felicia and Johnson, Morgan and Pullmann, D. Michael and Friedman, C. Emily and Griffith Fillipo, Isabell and Comtois, A. Katherine and Arean, Patricia", title="Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study", journal="JMIR Ment Health", year="2021", month="Aug", day="5", volume="8", number="8", pages="e28360", keywords="digital health", keywords="COVID-19", keywords="essential worker", keywords="unemployed", keywords="usability", keywords="user burden", keywords="mental health", keywords="e-mental health", keywords="survey", keywords="distress", abstract="Background: COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. Objective: The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. Methods: A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. Results: The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8\%) reported clinically significant emotional distress. Only 14.2\% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6\%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=--3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=--3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0\%), information or education (1254/1987, 63.1\%), distraction tools (1170/1987, 58.9\%), symptom tracking for mood and sleep (1160/1987, 58.4\%), link to mental health resources (1140/1987, 57.4\%), and positive psychology (1131/1986, 56.9\%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9\%). Conclusions: Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons. ", doi="10.2196/28360", url="https://mental.jmir.org/2021/8/e28360", url="http://www.ncbi.nlm.nih.gov/pubmed/34081592" } @Article{info:doi/10.2196/27436, author="Damerau, Mirjam and Teufel, Martin and Musche, Venja and Dinse, Hannah and Schweda, Adam and Beckord, Jil and Steinbach, Jasmin and Schmidt, Kira and Skoda, Eva-Maria and B{\"a}uerle, Alexander", title="Determining Acceptance of e-Mental Health Interventions in Digital Psychodiabetology Using a Quantitative Web-Based Survey: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="Jul", day="30", volume="5", number="7", pages="e27436", keywords="e-mental health", keywords="acceptance", keywords="UTAUT", keywords="mental health", keywords="diabetes", keywords="e-mental health intervention", keywords="psychodiabetology", abstract="Background: Diabetes is a very common chronic disease that exerts massive physiological and psychological burdens on patients. The digitalization of mental health care has generated effective e-mental health approaches, which offer an indubitable practical value for patient treatment. However, before implementing and optimizing e-mental health tools, their acceptance and underlying barriers and resources should be first determined for developing and establishing effective patient-oriented interventions. Objective: This study aims to assess the acceptance of e-mental health interventions among patients with diabetes and explore its underlying barriers and resources. Methods: A cross-sectional study was conducted in Germany from April 9, 2020, to June 15, 2020, through a web-based survey for which patients were recruited via web-based diabetes channels. The eligibility requirements were adult age (18 years or older), a good command of the German language, internet access, and a diagnosis of diabetes. Acceptance was measured using a modified questionnaire, which was based on the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) and assessed health-related internet use, acceptance of e-mental health interventions, and its barriers and resources. Mental health was measured using validated and established instruments, namely the Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-2, and Distress Thermometer. In addition, sociodemographic and medical data regarding diabetes were collected. Results: Of the 340 participants who started the survey, 261 (76.8\%) completed it and the final sample comprised 258 participants with complete data sets. The acceptance of e-mental health interventions in patients with diabetes was overall moderate (mean 3.02, SD 1.14). Gender and having a mental disorder had a significant influence on acceptance (P<.001). In an extended UTAUT regression model (UTAUT predictors plus sociodemographics and mental health variables), distress ($\beta$=.11; P=.03) as well as the UTAUT predictors performance expectancy ($\beta$=.50; P<.001), effort expectancy ($\beta$=.15; P=.001), and social influence ($\beta$=.28; P<.001) significantly predicted acceptance. The comparison between an extended UTAUT regression model (13 predictors) and the UTAUT-only regression model (performance expectancy, effort expectancy, social influence) revealed no significant difference in explained variance (F10,244=1.567; P=.12). Conclusions: This study supports the viability of the UTAUT model and its predictors in assessing the acceptance of e-mental health interventions among patients with diabetes. Three UTAUT predictors reached a notable amount of explained variance of 75\% in the acceptance, indicating that it is a very useful and efficient method for measuring e-mental health intervention acceptance in patients with diabetes. Owing to the close link between acceptance and use, acceptance-facilitating interventions focusing on these three UTAUT predictors should be fostered to bring forward the highly needed establishment of effective e-mental health interventions in psychodiabetology. ", doi="10.2196/27436", url="https://formative.jmir.org/2021/7/e27436", url="http://www.ncbi.nlm.nih.gov/pubmed/34328429" } @Article{info:doi/10.2196/26187, author="Mazziotti, Raffaele and Rutigliano, Grazia", title="Tele--Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction", journal="JMIR Ment Health", year="2021", month="Jul", day="29", volume="8", number="7", pages="e26187", keywords="telepsychiatry", keywords="telepsychology", keywords="e-mental health", keywords="document clustering", keywords="survey", keywords="COVID-19", keywords="access to care", keywords="patient satisfaction", keywords="mental health", keywords="tele--mental health", keywords="review", keywords="telemedicine", keywords="satisfaction", keywords="access", abstract="Background: The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele--mental health was rapidly implemented to deliver health care services. Objective: The aims of this study were (1) to present state-of-the-art tele--mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele--mental health. Methods: Document clustering was applied to map research topics within tele--mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele--mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. Results: Evidence on tele--mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele--mental health delivery of care. However, respondents held skeptical views about tele--mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele--mental health as they are with face-to-face interventions (Hedges g=?0.001, 95\% CI ?0.116 to 0.114, P=.98, Q=43.83, I2=36\%, P=.03) if technology-related issues were minimized. Conclusions: Mental health services equipped with tele--mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations. ", doi="10.2196/26187", url="https://mental.jmir.org/2021/7/e26187", url="http://www.ncbi.nlm.nih.gov/pubmed/34114956" } @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/10.2196/30845, author="Alavi, Nazanin and Stephenson, Callum and Omrani, Mohsen and Gerritsen, Cory and Martin, S. Michael and Knyahnytskyi, Alex and Zhu, Yiran and Kumar, Anchan and Jagayat, Jasleen and Shirazi, Amirhossein and Moghimi, Elnaz and Patel, Charmy and Knyahnytska, Yuliya and Simpson, F. Alexander I. and Zaheer, Juveria and Andersen, Judith and Munshi, Alpna and Groll, Dianne", title="Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Jul", day="22", volume="10", number="7", pages="e30845", keywords="mental health", keywords="correctional workers", keywords="public safety personnel", keywords="depression", keywords="anxiety", keywords="psychotherapy", keywords="cognitive behavioral therapy", keywords="online", keywords="internet", keywords="treatment", abstract="Background: Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. Objective: This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers' mental health problems. Methods: This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. Results: The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. Conclusions: If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. Trial Registration: ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974 International Registered Report Identifier (IRRID): DERR1-10.2196/30845 ", doi="10.2196/30845", url="https://www.researchprotocols.org/2021/7/e30845", url="http://www.ncbi.nlm.nih.gov/pubmed/34088656" } @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/10.2196/20969, author="Bhattacharya, Arpita and Nagar, Ria and Jenness, Jessica and Munson, A. Sean and Kientz, A. Julie", title="Designing Asynchronous Remote Support for Behavioral Activation in Teenagers With Depression: Formative Study", journal="JMIR Form Res", year="2021", month="Jul", day="13", volume="5", number="7", pages="e20969", keywords="teens", keywords="mental health", keywords="behavioral activation", keywords="asynchronous remote communities", abstract="Background: Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based on behavioral activation (BA) help teens understand the relationship between mood and activity, help them practice goal-directed behaviors to improve mood, and may be particularly well-suited to delivery via internet-based platforms. Objective: This study aims to understand the needs and challenges that teens and mental health clinicians face in depression management and involve them in the design process of a remote intervention that uses asynchronous remote communities. Our goal is to understand the benefits and challenges of adapting BA to an internet-based platform that supports the asynchronous remote community approach as a delivery tool for teen depression management. Methods: We enrolled mental health clinicians (n=10) and teens (n=8) in separate, private, internet-based groups on Slack (Slack Technologies Inc). They participated in 20-minute design activities for 10 weeks and were then invited to interviews about their experiences in the study. Results: Both teen and clinician participants wanted internet-based support for BA as a supplement to in-person therapy. Although participants perceived the asynchronous format as conducive to supporting accessible care, teens and clinicians raised concerns about safety, privacy, and the moderating of the internet-based group. Design decisions that address these concerns need to be balanced with the potential benefits of learning coping skills, increasing access to mental health care, and promoting asynchronous human connection to support teens. Conclusions: We discuss considerations for balancing tensions in privacy and safety while designing and selecting internet-based platforms to support remote care and integrating evidence-based support when designing digital technologies for the treatment of teens with depression. ", doi="10.2196/20969", url="https://formative.jmir.org/2021/7/e20969", url="http://www.ncbi.nlm.nih.gov/pubmed/34255665" } @Article{info:doi/10.2196/24512, author="Vornholt, Piper and De Choudhury, Munmun", title="Understanding the Role of Social Media--Based Mental Health Support Among College Students: Survey and Semistructured Interviews", journal="JMIR Ment Health", year="2021", month="Jul", day="12", volume="8", number="7", pages="e24512", keywords="college mental health", keywords="social media", keywords="social support", keywords="mobile phone", abstract="Background: Mental illness is a growing concern within many college campuses. Limited access to therapy resources, along with the fear of stigma, often prevents students from seeking help. Introducing supportive interventions, coping strategies, and mitigation programs might decrease the negative effects of mental illness among college students. Objective: Many college students find social support for a variety of needs through social media platforms. With the pervasive adoption of social media sites in college populations, in this study, we examine whether and how these platforms may help meet college students' mental health needs. Methods: We first conducted a survey among 101 students, followed by semistructured interviews (n=11), of a large public university in the southeast region of the United States to understand whether, to what extent, and how students appropriate social media platforms to suit their struggle with mental health concerns. The interviews were intended to provide comprehensive information on students' attitudes and their perceived benefits and limitations of social media as platforms for mental health support. Results: Our survey revealed that a large number of participating students (71/101, 70.3\%) had recently experienced some form of stress, anxiety, or other mental health challenges related to college life. Half of them (52/101, 51.5\%) also reported having appropriated some social media platforms for self-disclosure or help, indicating the pervasiveness of this practice. Through our interviews, we obtained deeper insights into these initial observations. We identified specific academic, personal, and social life stressors; motivations behind social media use for mental health needs; and specific platform affordances that helped or hindered this use. Conclusions: Students recognized the benefits of social media in helping connect with peers on campus and promoting informal and candid disclosures. However, they argued against complete anonymity in platforms for mental health help and advocated the need for privacy and boundary regulation mechanisms in social media platforms supporting this use. Our findings bear implications for informing campus counseling efforts and in designing social media--based mental health support tools for college students. ", doi="10.2196/24512", url="https://mental.jmir.org/2021/7/e24512", url="http://www.ncbi.nlm.nih.gov/pubmed/34255701" } @Article{info:doi/10.2196/28526, author="Ben-Zeev, Dror and Meller, Suzanne and Snyder, Jaime and Attah, A. Dzifa and Albright, Liam and Le, Hoa and Asafo, M. Seth and Collins, Y. Pamela and Ofori-Atta, Angela", title="A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study", journal="JMIR Ment Health", year="2021", month="Jul", day="2", volume="8", number="7", pages="e28526", keywords="mobile phone", keywords="low- and middle-income country", keywords="schizophrenia", keywords="bipolar disorder", abstract="Background: The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. Objective: The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. Results: A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67\%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable. Conclusions: This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses. ", doi="10.2196/28526", url="https://mental.jmir.org/2021/7/e28526", url="http://www.ncbi.nlm.nih.gov/pubmed/34255712" } @Article{info:doi/10.2196/25742, author="Chilman, Natasha and Morant, Nicola and Lloyd-Evans, Brynmor and Wackett, Jane and Johnson, Sonia", title="Twitter Users' Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis", journal="JMIR Ment Health", year="2021", month="Jun", day="29", volume="8", number="6", pages="e25742", keywords="Twitter", keywords="social media", keywords="qualitative", keywords="crisis resolution team", keywords="home treatment team", keywords="mental health", keywords="acute care", keywords="severe mental illness", abstract="Background: Analyzing Twitter posts enables rapid access to how issues and experiences are socially shared and constructed among communities of health service users and providers, in ways that traditional qualitative methods may not. Objective: To enrich the understanding of mental health crisis care in the United Kingdom, this study explores views on crisis resolution teams (CRTs) expressed on Twitter. We aim to identify the similarities and differences among views expressed on Twitter compared with interviews and focus groups. Methods: We used Twitter's advanced search function to retrieve public tweets on CRTs. A thematic analysis was conducted on 500 randomly selected tweets. The principles of refutational synthesis were applied to compare themes with those identified in a multicenter qualitative interview study. Results: The most popular hashtag identified was \#CrisisTeamFail, where posts were principally related to poor quality of care and access, particularly for people given a personality disorder diagnosis. Posts about CRTs giving unhelpful self-management advice were common, as were tweets about resource strains on mental health services. This was not identified in the research interviews. Although each source yielded unique themes, there were some overlaps with themes identified via interviews and focus groups, including the importance of rapid access to care. Views expressed on Twitter were generally more critical than those obtained via face-to-face methods. Conclusions: Traditional qualitative studies may underrepresent the views of more critical stakeholders by collecting data from participants accessed via mental health services. Research on social media content can complement traditional or face-to-face methods and ensure that a broad spectrum of viewpoints can inform service development and policy. ", doi="10.2196/25742", url="https://mental.jmir.org/2021/6/e25742", url="http://www.ncbi.nlm.nih.gov/pubmed/34185017" } @Article{info:doi/10.2196/29561, author="Cislo, Christine and Clingan, Caroline and Gilley, Kristen and Rozwadowski, Michelle and Gainsburg, Izzy and Bradley, Christina and Barabas, Jenny and Sandford, Erin and Olesnavich, Mary and Tyler, Jonathan and Mayer, Caleb and DeMoss, Matthew and Flora, Christopher and Forger, B. Daniel and Cunningham, Lee Julia and Tewari, Muneesh and Choi, Won Sung", title="Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study", journal="JMIR Res Protoc", year="2021", month="Jun", day="24", volume="10", number="6", pages="e29561", keywords="college students", keywords="COVID-19", keywords="global pandemic", keywords="mental health", keywords="mHealth", keywords="pandemic", keywords="risk monitoring", keywords="wearable sensors", keywords="well-being", abstract="Background: The COVID-19 pandemic has significantly impacted lives and greatly affected the mental health and public safety of an already vulnerable population---college students. Social distancing and isolation measures have presented challenges to students' mental health. mHealth apps and wearable sensors may help monitor students at risk of COVID-19 and support their mental well-being. Objective: This study aimed to monitor students at risk of COVID-19 by using a wearable sensor and a smartphone-based survey. Methods: We conducted a prospective study on undergraduate and graduate students at a public university in the Midwest United States. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal smartphone devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints: at baseline, 1 month later, 2 months later, 3 months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. Results: This study enrolled 2158 college students between September 2020 and January 2021. Subjects are currently being followed-up for 1 academic year. Data collection and analysis are currently underway. Conclusions: This study examined student health and well-being during the COVID-19 pandemic and assessed the feasibility of using a wearable sensor and a survey in a college student population, which may inform the role of our mHealth tools in assessing student health and well-being. Finally, using data derived from a wearable sensor, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data toward the development of a model for the early prediction and detection of COVID-19. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): DERR1-10.2196/29561 ", doi="10.2196/29561", url="https://www.researchprotocols.org/2021/6/e29561/" } @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/10.2196/27475, author="Fulford, Daniel and Gard, E. David and Mueser, T. Kim and Mote, Jasmine and Gill, Kathryn and Leung, Lawrence and Mow, Jessica", title="Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App", journal="JMIR Ment Health", year="2021", month="Jun", day="15", volume="8", number="6", pages="e27475", keywords="schizophrenia", keywords="psychosis", keywords="social functioning", keywords="social skills", keywords="motivation", keywords="mHealth", keywords="smartphone", keywords="mobile phone", abstract="Background: People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients' hands. Objective: We aim to develop a smartphone app---called Motivation and Skills Support---to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial. Methods: In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention. Results: The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort. Conclusions: The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed. Trial Registration: ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219 ", doi="10.2196/27475", url="https://mental.jmir.org/2021/6/e27475", url="http://www.ncbi.nlm.nih.gov/pubmed/34128812" } @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/10.2196/20128, author="Fritz, Jessica and Stochl, Jan and Kievit, A. Rogier and van Harmelen, Anne-Laura and Wilkinson, O. Paul", title="Tracking Stress, Mental Health, and Resilience Factors in Medical Students Before, During, and After a Stress-Inducing Exam Period: Protocol and Proof-of-Principle Analyses for the RESIST Cohort Study", journal="JMIR Form Res", year="2021", month="Jun", day="8", volume="5", number="6", pages="e20128", keywords="exam stress", keywords="perceived stress", keywords="mental distress", keywords="student mental health", keywords="mental health resilience", keywords="protective factors", keywords="resilience factors", abstract="Background: Knowledge of mental distress and resilience factors over the time span from before to after a stressor is important to be able to leverage the most promising resilience factors and promote mental health at the right time. To shed light on this topic, we designed the RESIST (Resilience Study) study, in which we assessed medical students before, during, and after their yearly exam period. Exam time is generally a period of notable stress among medical students, and it has been suggested that exam time triggers mental distress. Objective: In this paper, we aim to describe the study protocol and to examine whether the exam period indeed induces higher perceived stress and mental distress. We also aim to explore whether perceived stress and mental distress coevolve in response to exams. Methods: RESIST is a cohort study in which exam stress functions as a within-subject natural stress manipulation. In this paper, we outline the sample (N=451), procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors, and adversity), and ethical considerations. Moreover, we conducted a series of latent growth models and bivariate latent change score models to analyze perceived stress and mental distress changes over the 3 time points. Results: We found that perceived stress and mental distress increased from the time before the exams to the exam period and decreased after the exams to a lower level than before the exams. Our findings further suggest that higher mental distress before exams increased the risk of developing more perceived stress during exams. Higher perceived stress during exams, in turn, increased the risk of experiencing a less successful (or quick) recovery of mental distress after exams. Conclusions: As expected, the exam period caused a temporary increase in perceived stress and mental distress. Therefore, the RESIST study lends itself well to exploring resilience factors in response to naturally occurring exam stress. Such knowledge will eventually help researchers to find out which resilience factors lend themselves best as prevention targets and which lend themselves best as treatment targets for the mitigation of mental health problems that are triggered or accelerated by natural exam stress. The findings from the RESIST study may therefore inform student support services, mental health services, and resilience theory. ", doi="10.2196/20128", url="https://formative.jmir.org/2021/6/e20128", url="http://www.ncbi.nlm.nih.gov/pubmed/34100761" } @Article{info:doi/10.2196/28055, author="Heyen, Marie Janna and Weigl, No{\'e} and M{\"u}ller, Mario and M{\"u}ller, Stefan and Eberle, Urs and Manoliu, Andrei and Vetter, Stefan and Brown, D. Adam and Berger, Thomas and Kleim, Birgit", title="Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders", journal="JMIR Form Res", year="2021", month="Jun", day="7", volume="5", number="6", pages="e28055", keywords="anxiety", keywords="COVID-19", keywords="electronic mental health", keywords="feasibility", keywords="first responder", keywords="mental health", keywords="mindfulness", keywords="resilience", keywords="self-efficacy", keywords="sleep quality", keywords="stress", keywords="training", abstract="Background: Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. Objective: This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. Methods: We developed COVID-19--specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19--related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. Results: In total, 52 of 702 (7\%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. ", doi="10.2196/28055", url="https://formative.jmir.org/2021/6/e28055", url="http://www.ncbi.nlm.nih.gov/pubmed/33999835" } @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/10.2196/29427, author="Opara, Ijeoma and R Leonard, Noelle and Thorpe, Daneele and Kershaw, Trace", title="Understanding Neighborhoods' Impact on Youth Substance Use and Mental Health Outcomes in Paterson, New Jersey: Protocol for a Community-Based Participatory Research Study", journal="JMIR Res Protoc", year="2021", month="May", day="28", volume="10", number="5", pages="e29427", keywords="protocol", keywords="substance use", keywords="mental health", keywords="venue-based sampling", keywords="community", abstract="Background: Substance use among youth is a major public health concern. Of note, substance use among youth is increasing in prevalence, and the incidence of substance use at earlier ages is rising. Given the long-term consequences of early substance use, it is important to identify factors that increase youth vulnerability to drug use, as they may be important targets for future interventions. Objective: This study aims to use innovative methods, such as venue-based sampling, to recruit youth who are disconnected from school and use community-based participatory research to gain a better understanding of the prevalence of substance use and important correlates among youth aged between 13 and 21 years in Paterson, New Jersey, a low-income, urban community. The study will use a convergent, mixed methods design involving multiple data collection components and the analysis of a ministrative data source, designed with the strengths of complex intervention frameworks in mind. The overall aims of the study are to identify the prevalence of substance use among youth who are engaged in school and not engaged in school; to understand important antecedents and correlates of substance use; and to use this information to inform social, environmental, and culturally appropriate interventions to address substance use and its correlates among youths in a lower-resourced urban community. Methods: This study will use both qualitative and quantitative methods to address important questions. Specifically, semistructured interviews using focus group and interview methodologies will be used to assess youths' lived experiences and will account for specific details that quantitative methods may not be able to attain. In addition, quantitative methods will be used to examine direct and multilevel associations between neighborhood factors and youth substance use and mental health outcomes. Results: A previous analysis from a substance use initiative in Paterson, New Jersey found that youth who use substances such as marijuana and alcohol are more likely to have higher rates of depression and anxiety. On the basis of the research questions, this study will examine the association between neighborhood characteristics, substance use, and mental health symptoms among youth in Paterson by using quantitative and qualitative methods and will use these findings to inform the adaptation of a community- and evidence-based substance use prevention intervention for these youths. Conclusions: The findings of this study will provide an important contribution to understanding the role of socioecological factors in predicting substance use and mental health outcomes among youth in a lower-resourced, urban community. Furthermore, these findings will serve as evidence for the development of a culturally informed, community-based prevention program to address substance use disparities for youth, including those who are truant in Paterson, New Jersey. International Registered Report Identifier (IRRID): PRR1-10.2196/29427 ", doi="10.2196/29427", url="https://www.researchprotocols.org/2021/5/e29427", url="http://www.ncbi.nlm.nih.gov/pubmed/34047712" } @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/10.2196/24417, author="Slade, Mike and Rennick-Egglestone, Stefan and Llewellyn-Beardsley, Joy and Yeo, Caroline and Roe, James and Bailey, Sylvia and Smith, Andrew Roger and Booth, Susie and Harrison, Julian and Bhogal, Adaresh and Penas Mor{\'a}n, Patricia and Hui, Ada and Quadri, Dania and Robinson, Clare and Smuk, Melanie and Farkas, Marianne and Davidson, Larry and van der Krieke, Lian and Slade, Emily and Bond, Carmel and Nicholson, Joe and Grundy, Andrew and Charles, Ashleigh and Hare-Duke, Laurie and Pollock, Kristian and Ng, Fiona", title="Recorded Mental Health Recovery Narratives as a Resource for People Affected by Mental Health Problems: Development of the Narrative Experiences Online (NEON) Intervention", journal="JMIR Form Res", year="2021", month="May", day="27", volume="5", number="5", pages="e24417", keywords="narratives", keywords="storytelling", keywords="intervention development", keywords="mental health", keywords="online intervention", keywords="patient involvement", keywords="narrative medicine", keywords="internet", keywords="recovery", keywords="mobile phone", abstract="Background: The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs). Objective: This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs. Methods: Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made. Results: KI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8\% (105/330) of narrative accesses. Conclusions: RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health. ", doi="10.2196/24417", url="https://formative.jmir.org/2021/5/e24417", url="http://www.ncbi.nlm.nih.gov/pubmed/34042595" } @Article{info:doi/10.2196/24566, author="Bowling, B. April and Slavet, James and Hendrick, Chelsea and Beyl, Robbie and Nauta, Phillip and Augustyn, Marilyn and Mbamalu, Mediatrix and Curtin, Carol and Bandini, Linda and Must, Aviva and Staiano, E. Amanda", title="The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study", journal="JMIR Form Res", year="2021", month="May", day="14", volume="5", number="5", pages="e24566", keywords="exercise", keywords="diet", keywords="sleep", keywords="mental health", keywords="children", keywords="adolescent", keywords="health promotion", keywords="telehealth", keywords="exergaming", abstract="Background: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. Objective: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. Methods: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. Results: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83\%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67\%) reported intention to continue, and 8 (89\%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (?58.8 min; P=.04) but not for the intervention group (?5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. Conclusions: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. Trial Registration: ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415. ", doi="10.2196/24566", url="https://formative.jmir.org/2021/5/e24566", url="http://www.ncbi.nlm.nih.gov/pubmed/33988508" } @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/10.2196/25047, author="Al Azdi, Zunayed and Islam, Khaleda and Khan, Amir Muhammad and Khan, Nida and Ejaz, Amna and Khan, Ahmar Muhammad and Warraitch, Azza and Jahan, Ishrat and Huque, Rumana", title="Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="May", day="4", volume="10", number="5", pages="e25047", keywords="mental health", keywords="refugee health", keywords="early childhood development", keywords="Rohingya", keywords="Bangladesh", keywords="community health care", keywords="community health worker", abstract="Background: Thousands of Rohingya refugee mothers at the world's largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. Objective: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers' mental health status. Methods: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox's Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention's acceptability and feasibility. Results: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. Conclusions: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention's sustainability. Trial Registration: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553 International Registered Report Identifier (IRRID): DERR1-10.2196/25047 ", doi="10.2196/25047", url="https://www.researchprotocols.org/2021/5/e25047", url="http://www.ncbi.nlm.nih.gov/pubmed/33944793" } @Article{info:doi/10.2196/27308, author="Alavi, Nazanin and Stephenson, Callum and Rivera, Margo", title="Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial", journal="JMIR Ment Health", year="2021", month="Apr", day="30", volume="8", number="4", pages="e27308", keywords="borderline personality disorder", keywords="treatment", keywords="psychotherapy", keywords="dialectical behavioral therapy", keywords="barriers to treatment", keywords="mental health", keywords="online", keywords="internet", keywords="electronic", abstract="Background: Borderline personality disorder is a debilitating and prevalent mental health disorder, with often inaccessible treatment options. Electronically delivered dialectical behavioral therapy could be an efficacious and more accessible intervention. Objective: We aimed to evaluate the efficacy of electronic delivery of dialectical behavioral therapy in the treatment of individuals with symptoms of borderline personality disorder. Methods: Study participants diagnosed with borderline personality disorder were offered either an email-based or in-person group format dialectical behavioral therapy skill-building program. During each session, participants were provided with both the material and feedback regarding their previous week's homework. Electronically delivered dialectical behavioral therapy protocol and content were designed to mirror in-person content. Participants were assessed using the Self-Assessment Questionnaire (SAQ) and Difficulties in Emotion Regulation Scale (DERS). Results: There were significant increases in SAQ scores from pre- to posttreatment in the electronic delivery group (F1,92=69.32, P<.001) and in-person group (F1,92=60.97, P<.001). There were no significant differences observed between the groups at pre- and posttreatment for SAQ scores (F1,92=.05, P=.83). There were significant decreases in DERS scores observed between pre- and posttreatment in the electronic delivery group (F1,91=30.15, P<.001) and the in-person group (F1,91=58.18, P<.001). There were no significant differences observed between the groups for DERS scores pre- and posttreatment (F1,91=.24, P=.63). There was no significant difference in treatment efficacy observed between the 2 treatment arms (P<.001). Conclusions: Despite the proven efficacy of in-person dialectical behavioral therapy in the treatment of borderline personality disorder, there are barriers to receiving this treatment. With the prevalence of internet access continuing to rise globally, delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care. Trial Registration: ClinicalTrials.gov NCT04493580; https://clinicaltrials.gov/ct2/show/NCT04493580 ", doi="10.2196/27308", url="https://mental.jmir.org/2021/4/e27308", url="http://www.ncbi.nlm.nih.gov/pubmed/33835936" } @Article{info:doi/10.2196/25097, author="Jha, Prakash Indra and Awasthi, Raghav and Kumar, Ajit and Kumar, Vibhor and Sethi, Tavpritesh", title="Learning the Mental Health Impact of COVID-19 in the United States With Explainable Artificial Intelligence: Observational Study", journal="JMIR Ment Health", year="2021", month="Apr", day="20", volume="8", number="4", pages="e25097", keywords="COVID-19", keywords="mental health", keywords="Bayesian network", keywords="machine learning", keywords="artificial intelligence", keywords="disorder", keywords="susceptibility", keywords="well-being", keywords="explainable artificial intelligence", abstract="Background: The COVID-19 pandemic has affected the health, economic, and social fabric of many nations worldwide. Identification of individual-level susceptibility factors may help people in identifying and managing their emotional, psychological, and social well-being. Objective: This study is focused on learning a ranked list of factors that could indicate a predisposition to a mental disorder during the COVID-19 pandemic. Methods: In this study, we have used a survey of 17,764 adults in the United States from different age groups, genders, and socioeconomic statuses. Through initial statistical analysis and Bayesian network inference, we have identified key factors affecting mental health during the COVID-19 pandemic. Integrating Bayesian networks with classical machine learning approaches led to effective modeling of the level of mental health prevalence. Results: Overall, females were more stressed than males, and people in the age group 18-29 years were more vulnerable to anxiety than other age groups. Using the Bayesian network model, we found that people with a chronic mental illness were more prone to mental disorders during the COVID-19 pandemic. The new realities of working from home; homeschooling; and lack of communication with family, friends, and neighbors induces mental pressure. Financial assistance from social security helps in reducing mental stress during the COVID-19--generated economic crises. Finally, using supervised machine learning models, we predicted the most mentally vulnerable people with {\textasciitilde}80\% accuracy. Conclusions: Multiple factors such as social isolation, digital communication, and working and schooling from home were identified as factors of mental illness during the COVID-19 pandemic. Regular in-person communication with friends and family, a healthy social life, and social security were key factors, and taking care of people with a history of mental disease appears to be even more important during this time. ", doi="10.2196/25097", url="https://mental.jmir.org/2021/4/e25097", url="http://www.ncbi.nlm.nih.gov/pubmed/33877051" } @Article{info:doi/10.2196/25545, author="Boucher, M. Eliane and Ward, E. Haley and Stafford, L. Julia and Parks, C. Acacia", title="Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Apr", day="19", volume="10", number="4", pages="e25545", keywords="digital intervention", keywords="adolescents", keywords="stress management", keywords="mental health", keywords="mobile phone", abstract="Background: Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress. Objective: The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination. Methods: This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions. Results: Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021. Conclusions: Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally. Trial Registration: ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888 International Registered Report Identifier (IRRID): PRR1-10.2196/25545 ", doi="10.2196/25545", url="https://www.researchprotocols.org/2021/4/e25545", url="http://www.ncbi.nlm.nih.gov/pubmed/33871377" } @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/10.2196/26268, author="Tokg{\"o}z, Pinar and Hrynyschyn, Robert and Hafner, Jessica and Sch{\"o}nfeld, Simone and Dockweiler, Christoph", title="Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review", journal="JMIR Ment Health", year="2021", month="Apr", day="16", volume="8", number="4", pages="e26268", keywords="digital health", keywords="depression", keywords="scoping review", keywords="health care", abstract="Background: Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. Objective: The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. Methods: A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. Results: In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. Conclusions: Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic. ", doi="10.2196/26268", url="https://mental.jmir.org/2021/4/e26268", url="http://www.ncbi.nlm.nih.gov/pubmed/33861201" } @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/10.2196/25358, author="Renfrew, Elise Melanie and Morton, Peter Darren and Northcote, Maria and Morton, Kyle Jason and Hinze, Scott Jason and Przybylko, Geraldine", title="Participant Perceptions of Facilitators and Barriers to Adherence in a Digital Mental Health Intervention for a Nonclinical Cohort: Content Analysis", journal="J Med Internet Res", year="2021", month="Apr", day="14", volume="23", number="4", pages="e25358", keywords="web-based mental health", keywords="health promotion", keywords="eHealth", keywords="adherence", keywords="participant perceptions", keywords="mobile phone", abstract="Background: Digital mental health promotion interventions (MHPIs) present a scalable opportunity to attenuate the risk of mental health distress among nonclinical cohorts. However, adherence is frequently suboptimal, and little is known about participants' perspectives concerning facilitators and barriers to adherence in community-based settings. Objective: This study aimed to examine participants' perceptions of facilitators and barriers to adherence in a web- and mobile app--based MHPI for a nonclinical cohort. Methods: This qualitative study used inductive, reflexive thematic analysis to explore free-text responses in a postintervention evaluation of a 10-week digital MHPI. The intervention was administered using a web and mobile app from September to December 2018. Participants (N=320) were Australian and New Zealand members of a faith-based organization who self-selected into the study, owned a mobile phone with messaging capability, had an email address and internet access, were fluent in English, provided informed consent, and gave permission for their data to be used for research. The postintervention questionnaire elicited participants' perceptions of facilitators and barriers to adherence during the intervention period. Results: Key factors that facilitated adherence were engaging content, time availability and management, ease of accessibility, easy or enjoyable practical challenges, high perceived value, and personal motivation to complete the intervention. The primary perceived barrier to adherence was the participants' lack of time. Other barriers included completing and recording practical activities, length of video content, technical difficulties, and a combination of personal factors. Conclusions: Time scarcity was the foremost issue for the nonclinical cohort engaged in this digital MHPI. Program developers should streamline digital interventions to minimize the time investment for participants. This may include condensed content, optimization of intuitive web and app design, simplified recording of activities, and greater participant autonomy in choosing optional features. Nonetheless, participants identified a multiplicity of other interindividual factors that facilitated or inhibited adherence. ", doi="10.2196/25358", url="https://www.jmir.org/2021/4/e25358", url="http://www.ncbi.nlm.nih.gov/pubmed/33851925" } @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/10.2196/26214, author="Rodriguez-Jimenez, Roberto and Corripio, Iluminada and Campos, Ricardo and P{\'a}ramo, Mario and Franco-Martin, Manuel and Segura, Estefan{\'i}a and Gonz{\'a}lez, Sergio and Mart{\'i}nez-Raga, Jos{\'e}", title="Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study", journal="JMIR Res Protoc", year="2021", month="Apr", day="7", volume="10", number="4", pages="e26214", keywords="acute inpatient psychiatric units", keywords="organization", keywords="resources", keywords="scorecard", keywords="Spain", abstract="Background: As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems. Objective: The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs. Methods: A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices. Results: The questionnaire was completed by 60.0\% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units. Conclusions: This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries. International Registered Report Identifier (IRRID): RR1-10.2196/26214 ", doi="10.2196/26214", url="https://www.researchprotocols.org/2021/4/e26214", url="http://www.ncbi.nlm.nih.gov/pubmed/33729167" } @Article{info:doi/10.2196/26562, author="Tatar, Ovidiu and Abdel-Baki, Amal and Tra, Christophe and Mongeau-P{\'e}russe, Violaine and Arruda, Nelson and Kaur, Navdeep and Landry, Vivianne and Coronado-Montoya, Stephanie and Jutras-Aswad, Didier", title="Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives", journal="JMIR Form Res", year="2021", month="Apr", day="5", volume="5", number="4", pages="e26562", keywords="psychology", keywords="intervention", keywords="cannabis misuse", keywords="cannabis use disorder", keywords="young adult", keywords="clinician", keywords="psychosis", keywords="schizophrenia", keywords="dual diagnosis", keywords="qualitative", keywords="acceptability", keywords="technology-based", keywords="telemedicine", keywords="mHealth", keywords="digital health", keywords="eHealth", keywords="application", keywords="smartphone", keywords="mobile phone", abstract="Background: The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective: The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods: A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Qu{\'e}bec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results: Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions: This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis. ", doi="10.2196/26562", url="https://formative.jmir.org/2021/4/e26562", url="http://www.ncbi.nlm.nih.gov/pubmed/33818397" } @Article{info:doi/10.2196/23447, author="Wong, W. Howard and Lo, Brian and Shi, Jenny and Hollenberg, Elisa and Abi-Jaoude, Alexxa and Johnson, Andrew and Chaim, Gloria and Cleverley, Kristin and Henderson, Joanna and Levinson, Andrea and Robb, Janine and Voineskos, Aristotle and Wiljer, David", title="Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience", journal="JMIR Ment Health", year="2021", month="Apr", day="2", volume="8", number="4", pages="e23447", keywords="transition-aged youth", keywords="qualitative study", keywords="user experience", keywords="help-seeking", keywords="mental health", keywords="postsecondary", keywords="mobile apps", keywords="adolescent", abstract="Background: There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students. Objective: This study focuses on understanding postsecondary students' attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience. Methods: Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants' overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts. Results: User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time. Conclusions: Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 ", doi="10.2196/23447", url="https://mental.jmir.org/2021/4/e23447", url="http://www.ncbi.nlm.nih.gov/pubmed/33797395" } @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/10.2196/23365, author="Rauschenberg, Christian and Schick, Anita and Hirjak, Dusan and Seidler, Andreas and Paetzold, Isabell and Apfelbacher, Christian and Riedel-Heller, G. Steffi and Reininghaus, Ulrich", title="Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review", journal="J Med Internet Res", year="2021", month="Mar", day="10", volume="23", number="3", pages="e23365", keywords="COVID-19", keywords="mHealth", keywords="eHealth", keywords="telemedicine", keywords="prevention", keywords="mental health promotion", keywords="intervention", keywords="digital mental health", keywords="digital intervention", keywords="public mental health", abstract="Background: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs. ", doi="10.2196/23365", url="https://www.jmir.org/2021/3/e23365", url="http://www.ncbi.nlm.nih.gov/pubmed/33606657" } @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/10.2196/18172, author="Alqahtani, Felwah and Winn, Andrea and Orji, Rita", title="Co-Designing a Mobile App to Improve Mental Health and Well-Being: Focus Group Study", journal="JMIR Form Res", year="2021", month="Feb", day="26", volume="5", number="2", pages="e18172", keywords="mental health", keywords="mobile app", keywords="focus groups", keywords="design recommendation", keywords="mobile phone", abstract="Background: Recent advances in mobile technology have created opportunities to develop mobile apps to aid and assist people in achieving various health and wellness goals. Mental health apps hold significant potential to assist people affected by various mental health issues at any time they may need it, considering the ubiquitous nature of mobile phones. However, there is a need for research to explore and understand end users' perceptions, needs, and concerns with respect to such technologies. Objective: The aim of this paper is to explore the opinions, perceptions, preferences, and experiences of people who have experienced some form of mental health issues based on self-diagnosis to inform the design of a next-generation mental health app that would be substantially more engaging and effective than the currently available apps to improve mental health and well-being. Methods: We conducted six focus group sessions with people who had experienced mental health issues based on self-diagnosis (average age 26.7 years, SD 23.63; 16/32, 50\% male; 16/32, 50\% female). We asked participants about their experiences with mental health issues and their viewpoints regarding two existing mental health apps (the Happify app and the Self-Help Anxiety Management app). Finally, participants were engaged in a design session where they each sketched a design for their ideal mental health and well-being mobile app. Results: Our findings revealed that participants used strategies to deal with their mental health issues: doing something to distract themselves from their current negative mood, using relaxation exercises and methods to relieve symptoms, interacting with others to share their issues, looking for an external source to solve their problems, and motivating themselves by repeating motivational sentences to support themselves or by following inspirational people. Moreover, regarding the design of mental health apps, participants identified that general design characteristics; personalization of the app, including tracking and feedback, live support, and social community; and providing motivational content and relaxation exercises are the most important features that users want in a mental health app. In contrast, games, relaxation audio, the Google map function, personal assistance to provide suggestions, goal setting, and privacy preservation were surprisingly the least requested features. Conclusions: Understanding end users' needs and concerns about mental health apps will inform the future design of mental health apps that are useful to and used by many people. ", doi="10.2196/18172", url="https://formative.jmir.org/2021/2/e18172", url="http://www.ncbi.nlm.nih.gov/pubmed/33635281" } @Article{info:doi/10.2196/25870, author="Parker, L. Belinda and Chakouch, Cassandra and Subotic-Kerry, Mirjana and Batterham, J. Philip and Mackinnon, Andrew and Newby, M. Jill and Whitton, E. Alexis and McGoldrick, Janey and Cockayne, Nicole and O'Dea, Bridianne", title="The Building Educators' Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Feb", day="24", volume="10", number="2", pages="e25870", keywords="mental health training", keywords="schools", keywords="teachers", keywords="educators", keywords="mental health", keywords="student mental health", keywords="secondary school", abstract="Background: In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators' Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed. Objective: The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators' confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators' frequency of providing help to students and improving their mental health knowledge and reducing educators' psychological distress and stigma toward students with mental health issues. Methods: The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment. Results: Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021. Conclusions: This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students' mental health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208 International Registered Report Identifier (IRRID): DERR1-10.2196/25870 ", doi="10.2196/25870", url="https://www.researchprotocols.org/2021/2/e25870", url="http://www.ncbi.nlm.nih.gov/pubmed/33625374" } @Article{info:doi/10.2196/22705, author="Yu, Yanqiu and She, Rui and Luo, Sitong and Xin, Meiqi and Li, Lijuan and Wang, Suhua and Ma, Le and Tao, Fangbiao and Zhang, Jianxin and Zhao, Junfeng and Li, Liping and Hu, Dongsheng and Zhang, Guohua and Gu, Jing and Lin, Danhua and Wang, Hongmei and Cai, Yong and Wang, Zhaofen and You, Hua and Hu, Guoqing and Lau, Tak-Fai Joseph", title="Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study", journal="JMIR Ment Health", year="2021", month="Feb", day="22", volume="8", number="2", pages="e22705", keywords="COVID-19", keywords="depression", keywords="mental distress", keywords="psychological responses", keywords="mediation", keywords="China", keywords="online survey", abstract="Background: The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. Objective: This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. Methods: A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. Results: Of the 23,863 participants, 47.1\% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1\% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0\%-79.5\%). Conclusions: Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic. ", doi="10.2196/22705", url="https://mental.jmir.org/2021/2/e22705", url="http://www.ncbi.nlm.nih.gov/pubmed/33616541" } @Article{info:doi/10.2196/21432, author="Egilsson, Erlendur and Bjarnason, Ragnar and Njardvik, Urdur", title="Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Feb", day="17", volume="5", number="2", pages="e21432", keywords="mHealth", keywords="intervention", keywords="adolescent", keywords="attrition", keywords="self-efficacy", keywords="mental health", keywords="physical activity", keywords="young adult", keywords="behavior", abstract="Background: The majority of adolescents own smartphones, although only 8\% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention's usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted $\alpha$ levels through Bonferroni corrections were used to assess main outcome effects. Results: The attrition from initiation of the intervention to 6-week follow up was 35\%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22\% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61\% in the intervention group but dropped by 26.21\% among controls. Self-efficacy levels increased by 8.23\% in the invention arm compared to a 3.03\% decrease in the control group. Conclusions: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants' self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. ", doi="10.2196/21432", url="http://formative.jmir.org/2021/2/e21432/", url="http://www.ncbi.nlm.nih.gov/pubmed/33481750" } @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/10.2196/23200, author="Krijnen-de Bruin, Esther and Geerlings, A. Jasmijn and Muntingh, DT Anna and Scholten, D. Willemijn and Maarsingh, R. Otto and van Straten, Annemieke and Batelaan, M. Neeltje and van Meijel, Berno", title="Evaluation of a Blended Relapse Prevention Program for Anxiety and Depression in General Practice: Qualitative Study", journal="JMIR Form Res", year="2021", month="Feb", day="16", volume="5", number="2", pages="e23200", keywords="relapse prevention", keywords="anxiety disorder", keywords="depressive disorder", keywords="eHealth", keywords="general practice", keywords="qualitative research", abstract="Background: Existing studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions. Objective: This study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice. Methods: Semistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis. Results: Participants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative. Conclusions: The implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2034-6 ", doi="10.2196/23200", url="http://formative.jmir.org/2021/2/e23200/", url="http://www.ncbi.nlm.nih.gov/pubmed/33591277" } @Article{info:doi/10.2196/24162, author="Wang, Qian and Song, Bo and Di, Jiangli and Yang, Xue and Wu, Anise and Lau, Joseph and Xin, Meiqi and Wang, Linhong and Mo, Kit-Han Phoenix", title="Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study", journal="JMIR Ment Health", year="2021", month="Feb", day="11", volume="8", number="2", pages="e24162", keywords="pregnant women", keywords="COVID-19", keywords="depression", keywords="anxiety", keywords="help-seeking", keywords="mental health services", keywords="social support", keywords="trust", keywords="intention", keywords="mental health", keywords="pregnancy", keywords="survey", abstract="Background: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. Objective: We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. Methods: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ?10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ?5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. Results: More than half (3292/6248, 52.7\%) of the participants reported that they did not need mental health services. Furthermore, 28.3\% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19\% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19--related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services. Conclusions: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers. ", doi="10.2196/24162", url="http://mental.jmir.org/2021/2/e24162/", url="http://www.ncbi.nlm.nih.gov/pubmed/33570500" } @Article{info:doi/10.2196/21737, author="Hemmings, R. Nicola and Kawadler, M. Jamie and Whatmough, Rachel and Ponzo, Sonia and Rossi, Alessio and Morelli, Davide and Bird, Geoffrey and Plans, David", title="Development and Feasibility of a Digital Acceptance and Commitment Therapy--Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study", journal="JMIR Form Res", year="2021", month="Feb", day="9", volume="5", number="2", pages="e21737", keywords="anxiety", keywords="depression", keywords="acceptance and commitment therapy", keywords="person-based approach", keywords="mHealth", keywords="mental health", keywords="digital", keywords="remote", keywords="smartphone", keywords="mobile phone", abstract="Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77\%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for?AAQ-II and?WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. ", doi="10.2196/21737", url="https://formative.jmir.org/2021/2/e21737", url="http://www.ncbi.nlm.nih.gov/pubmed/33560232" } @Article{info:doi/10.2196/21207, author="Bur, Thomas Oliver and Krieger, Tobias and Moritz, Steffen and Klein, Philipp Jan and Berger, Thomas", title="Optimizing the Context of Support to Improve Outcomes of Internet-Based Self-help in Individuals With Depressive Symptoms: Protocol for a Randomized Factorial Trial", journal="JMIR Res Protoc", year="2021", month="Feb", day="2", volume="10", number="2", pages="e21207", keywords="depression", keywords="self-help", keywords="adherence", keywords="internet-based intervention", keywords="factorial design", keywords="problem-solving therapy", keywords="online", keywords="mental health", keywords="multiphase optimization strategy", keywords="digital health", abstract="Background: Internet-based self-help interventions for individuals with depressive symptoms, in which the main component is often a web-based self-help program, have been shown to be efficacious in many controlled trials. However, there are also trials on self-help programs showing no significant effect when delivered in routine care, and some studies report high dropout and low adherence rates. Research suggests that these findings do not emerge primarily due to the specific content of a self-help program. It seems more important how a program is embedded in the context of human and automated support before and during the use of a self-help program. Objective: This study aims to better understand the effects of 4 supportive contextual factors on outcomes of and adherence to a web-based self-help program for depressive symptoms. In a factorial experiment, 2 of 4 supportive factors, for which there is evidence for their role on outcomes and adherence, are realized during the intervention---personal guidance and automated email reminders. The other 2 factors are realized before the intervention---a diagnostic interview and a preintervention module aimed at increasing the motivation to use the program with motivational interviewing techniques. Methods: The study is a full factorial randomized trial. Adults with mild to moderate depressive symptoms (Patient Health Questionnaire--9 score: 5-14) are recruited from the community through the internet and conventional media. All participants receive access to a web-based self-help program based on problem-solving therapy. They are randomized across 4 experimental factors, each reflecting the presence versus absence of a supportive factor (guidance, automated reminders, diagnostic interview, preintervention module) resulting in a 16-condition balanced factorial design. The primary outcome is depressive symptoms at 10 weeks post assessment. Secondary outcomes include adherence to the program, anxiety, stress, health-related quality of life, possible negative effects, and treatment satisfaction. Potential moderators and mediators (eg, treatment expectancy, problem-solving skills, working alliance with the study team) will also be investigated. Results: Ethical approval was received on January 20, 2020. The study was initiated in February 2020, and 240 participants have been enrolled in the study as of November 1, 2020. Recruitment for a total of 255 participants is ongoing. Data collection is expected to be completed by May 2021. Conclusions: A better understanding of relevant supportive factors in the dissemination of web-based interventions is necessary to improve outcomes of and adherence to web-based self-help programs. This study may inform health care systems and guide decisions to optimize the implementation context of web-based self-help programs for depressive symptoms. Trial Registration: ClinicalTrials.gov NCT04318236; https://clinicaltrials.gov/ct2/show/NCT04318236 International Registered Report Identifier (IRRID): DERR1-10.2196/21207 ", doi="10.2196/21207", url="http://www.researchprotocols.org/2021/2/e21207/", url="http://www.ncbi.nlm.nih.gov/pubmed/33528377" } @Article{info:doi/10.2196/23126, author="Wu, Xiaoyan and Tao, Shuman and Zhang, Yi and Li, Shiyue and Ma, Le and Yu, Yizhen and Sun, Guilong and Li, Tingting and Tao, Fangbiao", title="Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study", journal="J Med Internet Res", year="2021", month="Jan", day="29", volume="23", number="1", pages="e23126", keywords="COVID-19 pandemic", keywords="college students", keywords="mental health problems", keywords="geographic location", abstract="Background: Since the COVID-19 outbreak was first reported, considerable attention has been drawn to mental health problems among college students. Objective: We aimed to estimate the prevalence of anxiety and depressive symptoms among college students in different geographical areas of China during the early stage of the COVID-19 outbreak. Methods: A nationwide cross-sectional survey was conducted among Chinese college students of 16 provinces or municipalities from February 4 to 12, 2020. A web-based survey was adopted to collect information from these college students, including demographics, perceived risk of infection, attitudes toward the epidemic and its control, and mental health status. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale, and depressive symptoms were assessed using the Patient Health Questionnaire. Chi-square test was used to compare the percentage of perceived risk of infection and attitude toward COVID-19 among college students in different geographic locations. Binary logistic models were used to identify associations between geographic locations and mental health problems after controlling for covariates. Results: A total of 11,787 participants were analyzed in this study (response rate: 79.7\%). The prevalence of anxiety and depressive symptoms among college students was 17.8\% (95\% CI 17.1\%-18.5\%) and 25.9\% (95\% CI 25.1\%-26.7\%), respectively. After controlling for covariates, current residence area in Wuhan city was found to have a positive association with anxiety symptoms (odds ratio [OR] 1.37, 95\% CI 1.11-1.68) and depressive symptoms (OR 1.32, 95\% CI 1.09-1.59). Similarly, college location in Wuhan city was found to have a positive association with anxiety symptoms (OR 1.20, 95\% CI 1.07-1.35) and depressive symptoms (OR 1.22, 95\% CI 1.10-1.36). History of residence in or travel to Wuhan city in the past month was also positively associated with anxiety symptoms (OR 1.62, 95\% CI 1.46-1.80) and depressive symptoms (OR 1.48, 95\% CI 1.35-1.63). Furthermore, the perceived risk of COVID-19 was higher among students whose college location and current residence area were in Wuhan city, and it was positively associated with anxiety and depressive symptoms. Conclusions: During the COVID-19 pandemic, mental health problems among Chinese college students were widespread and geographically diverse. Our study results provide further insight for policymakers to develop targeted intervention strategies. ", doi="10.2196/23126", url="http://www.jmir.org/2021/1/e23126/", url="http://www.ncbi.nlm.nih.gov/pubmed/33439853" } @Article{info:doi/10.2196/14781, author="Stanyon, Miriam and Streater, Amy and Coleston-Shields, Maria Donna and Yates, Jennifer and Challis, David and Dening, Tom and Hoe, Juanita and Lloyd-Evans, Brynmor and Mitchell, Shirley and Moniz-Cook, Esme and Poland, Fiona and Prothero, David and Orrell, Martin", title="Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="27", volume="10", number="1", pages="e14781", keywords="dementia", keywords="caregivers", keywords="crisis", keywords="mental health", keywords="home management", abstract="Background: Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams. Objective: The aim of this study is to develop a ``best practice model'' for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a ``best practice model.'' Methods: Participants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit. Results: Data were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice. Conclusions: This is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers. International Registered Report Identifier (IRRID): RR1-10.2196/14781 ", doi="10.2196/14781", url="http://www.researchprotocols.org/2021/1/e14781/", url="http://www.ncbi.nlm.nih.gov/pubmed/33502333" } @Article{info:doi/10.2196/24736, author="Kidd, Sean and McKenzie, Kwame and Wang, Wei and Agrawal, Sacha and Voineskos, Aristotle", title="Examining a Digital Health Approach for Advancing Schizophrenia Illness Self-Management and Provider Engagement: Protocol for a Feasibility Trial", journal="JMIR Res Protoc", year="2021", month="Jan", day="25", volume="10", number="1", pages="e24736", keywords="schizophrenia", keywords="psychosis", keywords="digital health", keywords="mobile health", keywords="smartphone", abstract="Background: In schizophrenia spectrum populations, adherence to treatment is poor, community-based supports are limited, and efforts to foster illness self-management have had limited success. These challenges contribute to frequent, lengthy, and costly hospital readmissions and poor functional outcomes. Digital health strategies, in turn, hold considerable promise in the effort to address these problems. Objective: This feasibility trial will examine a digital health platform called App4Independence (A4i), which was designed to enhance illness self-management and treatment engagement for individuals with schizophrenia. Methods: Feasibility metrics in this single-blind, randomized trial include study recruitment and retention, rate of technology use, safety, and utility in clinical interactions. Other outcome metrics include symptomatology, treatment adherence, patient-provider alliance, and quality of life. In this trial, 160 study participants with schizophrenia spectrum diagnoses will be randomized to either treatment or control conditions, with pretest-posttest outcomes measured over a 6-month period. Results: This study was funded by the Canadian Institutes of Health Research in January 2020 and received Institutional Review Board approval on August 13, 2020. This study plans to begin recruiting in January 2021 and will be completed within 3 years. Data collection is projected to begin in January 2021. Conclusions: This research will provide critical information for the development of this new technology in the larger effort to address a key problem in the schizophrenia field---how to leverage technology to enhance illness self-management and care engagement in resource-limited service contexts. International Registered Report Identifier (IRRID): PRR1-10.2196/24736 ", doi="10.2196/24736", url="http://www.researchprotocols.org/2021/1/e24736/", url="http://www.ncbi.nlm.nih.gov/pubmed/33492235" } @Article{info:doi/10.2196/16508, author="MacDougall, Sarah and Jerrott, Susan and Clark, Sharon and Campbell, Anne Leslie and Murphy, Andrea and Wozney, Lori", title="Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review", journal="JMIR Ment Health", year="2021", month="Jan", day="8", volume="8", number="1", pages="e16508", keywords="adolescent", keywords="mental health", keywords="eHealth", keywords="text messaging", keywords="SMS", keywords="information science", keywords="cell phone", keywords="implementation", keywords="review", abstract="Background: The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective: The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging--based interventions for mental health and addiction services among adolescents. Methods: A scoping review was conducted according to Levac's adaptation of Arksey and O'Malley's methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications. Results: We screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65\% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported. Conclusions: The use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone--based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required. ", doi="10.2196/16508", url="https://mental.jmir.org/2021/1/e16508", url="http://www.ncbi.nlm.nih.gov/pubmed/33416504" } @Article{info:doi/10.2196/18934, author="Lackie, E. Madison and Parrilla, S. Julia and Lavery, M. Brynn and Kennedy, L. Andrea and Ryan, Deirdre and Shulman, Barbara and Brotto, A. Lori", title="Digital Health Needs of Women With Postpartum Depression: Focus Group Study", journal="J Med Internet Res", year="2021", month="Jan", day="6", volume="23", number="1", pages="e18934", keywords="postpartum depression", keywords="perinatal mental health", keywords="eHealth", keywords="women's health", keywords="reproductive health", keywords="maternal health", keywords="qualitative research", keywords="focus groups", keywords="user-centered design", keywords="knowledge translation", keywords="self-management", abstract="Background: Although approximately 10\% of new mothers in Canada develop postpartum depression (PPD), they face many barriers when accessing care. eHealth offers a unique opportunity to provide psychosocial skills and support to new mothers; however, patient populations are not consistently engaged in eHealth development processes. Thus, the diversity of women's backgrounds and needs are often not reflected in existing tools. Objective: This study aims to engage women from a variety of backgrounds and locations around British Columbia (BC) who have previously experienced PPD to determine the unmet psychoeducational needs of women with PPD and how a web-enabled platform used to deliver psychosocial skills and education to assist in the management of PPD could fulfill those needs. Methods: Focus groups were conducted in 7 cities across BC with a total of 31 women (mean age 34.5 years, SD 4.9), with each group ranging from 2-7 participants. Focus groups were cofacilitated by the study coordinator and a local service provider in each community using a semistructured guide to discuss participants' needs, ideas, and opinions as they relate to the use of technology in PPD management. Transcripts were approached inductively using thematic analysis to identify themes and qualitative description to frame what was observed in the data. Results: A total of 5 themes were identified: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. Each theme identified a need (eg, combatting stigma) and a way to address that need using a web-enabled intervention (eg, providing validation). At the intersection of these themes was the overarching value of promoting agency for women experiencing PPD. Conclusions: Ultimately, new mothers require accessible mental health care that promotes their agency in mental health care decision making. Our participants believed that a web-enabled intervention could help meet this need. These data will be used to guide the design of such an intervention, with the eventual implementation of this resource as a first-line management option for PPD. ", doi="10.2196/18934", url="https://www.jmir.org/2021/1/e18934", url="http://www.ncbi.nlm.nih.gov/pubmed/33404506" } @Article{info:doi/10.2196/24245, author="Kip, Hanneke and Wentzel, Jobke and Kelders, M. Saskia", title="Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health", journal="JMIR Ment Health", year="2020", month="Nov", day="13", volume="7", number="11", pages="e24245", keywords="eHealth", keywords="blended care", keywords="implementation science", keywords="participatory development", keywords="forensic psychiatry", keywords="mobile phone", abstract="Background: Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. Objective: The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting---forensic mental health care---by means of participatory development with therapists. Methods: The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. Results: In phase 1, it became clear that the therapists' main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. Conclusions: The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed. ", doi="10.2196/24245", url="http://mental.jmir.org/2020/11/e24245/", url="http://www.ncbi.nlm.nih.gov/pubmed/33185559" } @Article{info:doi/10.2196/21145, author="Michel, Toni and Tachtler, Franziska and Slovak, Petr and Fitzpatrick, Geraldine", title="Young People's Attitude Toward Positive Psychology Interventions: Thematic Analysis", journal="JMIR Hum Factors", year="2020", month="Nov", day="9", volume="7", number="4", pages="e21145", keywords="adolescent", keywords="mental health", keywords="health resources", abstract="Background: Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. Objective: The aim of this study is to explore young people's attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. Methods: We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. Results: Some interventions were conflicting with young people's values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. Conclusions: Values, context, strengths, and other personal factors are entangled with young people's attitudes toward digital instantiations of PPI principles. ", doi="10.2196/21145", url="http://humanfactors.jmir.org/2020/4/e21145/", url="http://www.ncbi.nlm.nih.gov/pubmed/33164908" } @Article{info:doi/10.2196/22528, author="Gulliver, Amelia and Calear, L. Alison and Sunderland, Matthew and Kay-Lambkin, Frances and Farrer, M. Louise and Banfield, Michelle and Batterham, J. Philip", title="Consumer-Guided Development of an Engagement-Facilitation Intervention for Increasing Uptake and Adherence for Self-Guided Web-Based Mental Health Programs: Focus Groups and Online Evaluation Survey", journal="JMIR Form Res", year="2020", month="Oct", day="29", volume="4", number="10", pages="e22528", keywords="mental health", keywords="internet", keywords="anxiety", keywords="depression", keywords="technology", keywords="treatment adherence and compliance", abstract="Background: Self-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs. Objective: This study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e--mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs. Methods: A total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e--mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods. Results: Participants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program's content or effectiveness and data security, and normalization of using e--mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence. Conclusions: EFIs have the potential to improve community uptake of e--mental health programs. They should focus on providing information on the content and effectiveness of e--mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness. ", doi="10.2196/22528", url="http://formative.jmir.org/2020/10/e22528/", url="http://www.ncbi.nlm.nih.gov/pubmed/33118939" } @Article{info:doi/10.2196/18514, author="Stunden, Chelsea and Zasada, Julie and VanHeerwaarden, Nicole and Hollenberg, Elisa and Abi-Jaoud{\'e}, Alexxa and Chaim, Gloria and Cleverley, Kristin and Henderson, Joanna and Johnson, Andrew and Levinson, Andrea and Lo, Brian and Robb, Janine and Shi, Jenny and Voineskos, Aristotle and Wiljer, David", title="Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study", journal="J Med Internet Res", year="2020", month="Oct", day="5", volume="22", number="10", pages="e18514", keywords="mental health", keywords="students", keywords="adolescent", keywords="substance abuse", keywords="eHealth", keywords="mHealth", keywords="mobile apps", keywords="help-seeking behavior", keywords="social stigma", keywords="social support", abstract="Background: Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help. Objective: The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada. Methods: A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes. Results: Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help. Conclusions: Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth. ", doi="10.2196/18514", url="https://www.jmir.org/2020/10/e18514", url="http://www.ncbi.nlm.nih.gov/pubmed/33016882" } @Article{info:doi/10.2196/19198, author="Serhal, Eva and Kirvan, Anne and Sanches, Marcos and Crawford, Allison", title="Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains", journal="J Med Internet Res", year="2020", month="Sep", day="29", volume="22", number="9", pages="e19198", keywords="telemedicine", keywords="psychiatry", keywords="mental health", keywords="patient satisfaction", keywords="quality of health care", abstract="Background: Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. Objective: This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. Methods: The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. Results: The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. Conclusions: By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens. ", doi="10.2196/19198", url="http://www.jmir.org/2020/9/e19198/", url="http://www.ncbi.nlm.nih.gov/pubmed/32755896" } @Article{info:doi/10.2196/19168, author="Nwoke, Nmanma Chinenye and Okpalauwaekwe, Udoka and Bwala, Hauwa", title="Mental Health Professional Consultations and the Prevalence of Mood and Anxiety Disorders Among Immigrants: Multilevel Analysis of the Canadian Community Health Survey", journal="JMIR Ment Health", year="2020", month="Sep", day="16", volume="7", number="9", pages="e19168", keywords="immigrants", keywords="immigrant mental health", keywords="mental health consultations", keywords="mood disorders", keywords="anxiety disorders", keywords="mental health visits", keywords="Canadian Community Health Survey", abstract="Background: There is a significant body of evidence on the link between migration and mental health stressors. However, there has been very little research on the use of mental health services by immigrants in Canada. The prevalence of mental health professional consultations among immigrants, as well as its correlations, are not well understood and remain largely unknown. Objective: This study aims to examine how specialist mental health visits (to a psychiatrist) differ from general mental health visits (to a family doctor or general practitioner) from immigrants, when compared to visits from those born in Canada, in a nationally representative sample of Canadian adults. This study also examines which group---immigrant or Canadian-born---suffers more from depression or anxiety, 2 of the more common mental health conditions. Methods: We used data from the Canadian Community Health Survey (CCHS) between the years 2015 and 2016. The outcome variables included consultation with any mental health professional, consultation with a specialist (psychiatrist), and the prevalence of mood and anxiety disorders. The independent variable was immigrant status. Other variables of interest were adjusted for in the analyses. Multilevel regression models were developed, and all analyses were performed with Stata IC statistical software (version 13.0, StataCorp). Results: The prevalence of mood and anxiety disorders was significantly lower among immigrants compared with individuals born in Canada; the prevalence of mood disorders was 5.24\% (389,164/7,422,773) for immigrants vs. 9.15\% (2,001,829/21,885,625) for individuals born in Canada, and the prevalence of anxiety disorders was 4.47\% (330,937/7,410,437) for immigrants vs. 9.51\% (2,083,155/21,898,839) for individuals born in Canada. It is expected that individuals with a lower prevalence of mood or anxiety disorders would use mental health services less frequently. However, results show that immigrants, while less likely to consult with any mental health professional (OR=0.80, 95\% CI 0.72-0.88, P<.001), were more likely to consult with a psychiatrist (OR=1.24, 95\% CI 1.04-1.48, P=.02) for their mental health visits when compared to individuals born in Canada. Conclusions: The results of this study reveal an unusual discord between the likelihood of mental health professional consultations with any mental health professional and mental health visits with psychiatrists among immigrants compared to nonimmigrants in Canada. Mental health initiatives need to be cognizant of the differences in the associated characteristics of consultations for immigrants to better tailor mental health services to be responsive to the unique needs of immigrant populations in Canada. ", doi="10.2196/19168", url="http://mental.jmir.org/2020/9/e19168/", url="http://www.ncbi.nlm.nih.gov/pubmed/32801115" } @Article{info:doi/10.2196/21607, author="Atherly, Adam and Van Den Broek-Altenburg, Eline and Hart, Victoria and Gleason, Kelsey and Carney, Jan", title="Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis", journal="JMIR Public Health Surveill", year="2020", month="Sep", day="14", volume="6", number="3", pages="e21607", keywords="COVID-19", keywords="telemedicine", keywords="deferred care", keywords="mental health", keywords="alternative", keywords="health effect", keywords="viability", abstract="Background: The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. Objective: This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. Methods: We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. Results: Deferred care was widespread---48\% (n=812) of respondents deferred care---but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2\% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. Conclusions: Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services. ", doi="10.2196/21607", url="http://publichealth.jmir.org/2020/3/e21607/", url="http://www.ncbi.nlm.nih.gov/pubmed/32833661" } @Article{info:doi/10.2196/19031, author="Raphiphatthana, Buaphrao and Maulana, Herdiyan and Howarth, Timothy and Gardner, Karen and Nagel, Tricia", title="Digital Mental Health Resources for Asylum Seekers, Refugees, and Immigrants: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2020", month="Aug", day="24", volume="9", number="8", pages="e19031", keywords="eHealth", keywords="migrant", keywords="refugee", keywords="scoping review", keywords="immigrant", abstract="Background: Asylum seekers, refugees, and immigrants experience a number of risk factors for mental health problems. However, in comparison to the host population, these populations are less likely to use mental health services. Digital mental health approaches have been shown to be effective in improving well-being for the general population. Thus, they may provide an effective and culturally appropriate strategy to bridge the treatment gap for these populations vulnerable to mental health risks. Objective: This paper aims to provide the background and rationale for conducting a scoping review on digital mental health resources for asylum seekers, refugees, and immigrants. It also provides an outline of the methods and analyses, which will be used to answer the following questions. What are the available digital mental health resources for asylum seekers, refugees, and immigrants? Are they effective, feasible, appropriate, and accepted by the population? What are the knowledge gaps in the field? Methods: The scoping review methodology will follow 5 phases: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results. Searches will be conducted in the following databases: EBSCOhost databases (CINAHL Plus with Full Text, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, and APA PsycInfo), PubMed, and Scopus. Additionally, OpenGrey, Mednar, and Eldis will be searched for gray literature. All primary studies and gray literature in English concerning the use of information and communication technology to deliver services addressing mental health issues for asylum seekers, refugees, and immigrants will be included. Results: This scoping review will provide an overview of the available digital mental health resources for asylum seekers, refugees, and immigrants and describe the implementation outcomes of feasibility, acceptability, and appropriateness of such approaches for those populations. Potential gaps in the field will also be identified. Conclusions: As of February 2020, there were no scoping reviews, which assessed the effectiveness, feasibility, acceptability, and appropriateness of the available digital mental health resources for asylum seekers, refugees, and immigrants. This review will provide an extensive coverage on a promising and innovative intervention for such populations. It will give insight into the range of approaches, their effectiveness, and progress in their implementation. It will also provide valuable information for health practitioners, policy makers, and researchers working with the population. International Registered Report Identifier (IRRID): PRR1-10.2196/19031 ", doi="10.2196/19031", url="http://www.researchprotocols.org/2020/8/e19031/", url="http://www.ncbi.nlm.nih.gov/pubmed/32831185" } @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/10.2196/18347, author="Holtz, E. Bree and McCarroll, M. Alexis and Mitchell, M. Katharine", title="Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study", journal="JMIR Form Res", year="2020", month="Aug", day="7", volume="4", number="8", pages="e18347", keywords="mental health", keywords="mobile phone", keywords="mHealth", abstract="Background: Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students. Objective: This qualitative study aims to better understand college students' perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM). Methods: A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator's guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students' perceptions and attitudes toward MySSP. Results: The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence. Conclusions: The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students. ", doi="10.2196/18347", url="https://formative.jmir.org/2020/8/e18347", url="http://www.ncbi.nlm.nih.gov/pubmed/32667892" } @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/10.2196/16961, 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="Perceived Effectiveness and Motivations for the Use of Web-Based Mental Health Programs: Qualitative Study", journal="J Med Internet Res", year="2020", month="Jul", day="31", volume="22", number="7", pages="e16961", keywords="prevention", keywords="mental health", keywords="depression", keywords="cognitive behavioral therapy", keywords="motivators", keywords="perceived effectiveness", keywords="internet-based intervention", keywords="interview", abstract="Background: The prevalence of depression is high and has been stable despite increased treatment, research, and dissemination. People encounter barriers to seeking traditional mental health services, which could be mitigated by using web-based prevention methods. Objective: This study aims to understand what people at high risk for depression perceive as effective aspects of web-based mental health programs and what motivates people at high risk for depression to use web-based mental health programs. Methods: We conducted an inductive content analysis using telephone interview data from 77 participants at high risk for depression who were recruited from 2 randomized controlled trials (RCTs). Participants from the first RCT were working men who had been randomly assigned to 1 of the following 3 groups: control group, who had access to general depression information from a website called BroMatters; intervention group 1, who had access to the BroMatters website along with the associated BroHealth web-based mental health program; and intervention group 2, who had access to the BroMatters website, the BroHealth web-based mental health program, and telephone sessions with a life coach. Participants from the second RCT were men and women who had been assigned to the intervention group, who received access to the HardHat web-based mental health program, or the control group, who only received access to the HardHat web-based mental health program following completion of the RCT. Participants for this inductive content analysis study were recruited from the intervention groups in both RCTs. Two groups of participants (n=41 and n=20) were recruited from the BroHealth RCT, and a third group comprised 16 participants that were recruited from the HardHat RCT. Results: We generated four categories regarding the perceived effectiveness of web-based programs and five categories related to what motivates the use of web-based programs. Participants identified awareness, program medium and functionality, program content, and coaches as categories related to the effectiveness of the programs. Categories of motivators to use web-based programs included providing reminders or incentives, promotion of the programs, providing appropriate medium and functionality, appropriate content, and perceived need. The final category related to motivators reflects perceptions of participants who were either unsure about what motivates them or believed that there is no way to motivate use. Conclusions: Conflicting evidence was obtained regarding the perceived effectiveness of aspects of the content and functionality of web-based programs. In general, web-based mental health programs were perceived to help increase mental health awareness, especially when it includes live access to a coach. However, the results also revealed that it is difficult to motivate people to begin using web-based mental health programs. Strategies that may motivate the use of such programs include perceived personal need, effective promotion, providing incentives and reminders, and improving functionality. ", doi="10.2196/16961", url="http://www.jmir.org/2020/7/e16961/", url="http://www.ncbi.nlm.nih.gov/pubmed/32735216" } @Article{info:doi/10.2196/19008, author="Aref-Adib, Golnar and Landy, Gabriella and Eskinazi, Michelle and Sommerlad, Andrew and Morant, Nicola and Johnson, Sonia and Graham, Richard and Osborn, David and Pitman, Alexandra", title="Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees' Experiences, Views, and Understanding", journal="JMIR Ment Health", year="2020", month="Jul", day="29", volume="7", number="7", pages="e19008", keywords="risk assessment", keywords="internet", keywords="suicide", keywords="self-injurious behavior", keywords="mental health", keywords="psychiatrists", keywords="mixed methods", keywords="mobile phone", abstract="Background: The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective: This study aimed to explore psychiatry trainees' experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods: We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees' conference to investigate how they routinely assess patients' internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees' understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results: The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2\%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4\%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77\% vs 40/91, 44\%;P=.02). However, 67.3\% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90\% vs 54/82, 66\%; P=.03), prosuicide websites (20/21, 95\% vs 57/81, 70\%; P=.01), and online sexual behavior (17/21, 81\% vs 44/81, 54\%; P=.02). Although 84.1\% (95/113) of the participants reported using a proforma to record general risk assessment, only 5\% (5/95) of these participants prompted an assessment of internet use. Only 9.7\% (11/113) of the trainees had received digital risk training, and 73.5\% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions: Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment. ", doi="10.2196/19008", url="http://mental.jmir.org/2020/7/e19008/", url="http://www.ncbi.nlm.nih.gov/pubmed/32726288" } @Article{info:doi/10.2196/18990, author="Valentine, Lee and McEnery, Carla and Bell, Imogen and O'Sullivan, Shaunagh and Pryor, Ingrid and Gleeson, John and Bendall, Sarah and Alvarez-Jimenez, Mario", title="Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study", journal="JMIR Ment Health", year="2020", month="Jul", day="28", volume="7", number="7", pages="e18990", keywords="Blended Treatment", keywords="Psychotic Disorders", keywords="Digital Intervention", keywords="Adolescent", keywords="Young Adults", keywords="mHealth", abstract="Background: A small number of studies have found that digital mental health interventions can be feasible and acceptable for young people experiencing first-episode psychosis; however, little research has examined how they might be blended with face-to-face approaches in order to enhance care. Blended treatment refers to the integration of digital and face-to-face mental health care. It has the potential to capitalize on the evidence-based features of both individual modalities, while also exceeding the sum of its parts. This integration could bridge the online--offline treatment divide and better reflect the interconnected, and often complementary, ways young people navigate their everyday digital and physical lives. Objective: This study aimed to gain young people's perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment. Methods: This qualitative study was underpinned by an end-user development framework and was based on semistructured interviews with 10 participants aged 19 to 28 (mean 23.4, SD 2.62). A thematic analysis was used to analyze the data. Results: Three superordinate themes emerged relating to young people's perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment: (1) blended features, (2) cautions, and (3) therapeutic alliance. Conclusions: We found that young people were very enthusiastic about the prospect of blended models of mental health care, in so far as it was used to enhance their experience of traditional face-to-face treatment but not to replace it overall. Aspects of blended treatment that could enhance clinical care were readily identified by young people as increasing accessibility, continuity, and consolidation; accessing posttherapy support; strengthening the relationship between young person and clinician; and tracking personal data that could be used to better inform clinical decision making. Future research is needed to investigate the efficacy of blended models of care by evaluating its impact on the therapeutic alliance, clinical and social outcomes, cost-effectiveness, and engagement. ", doi="10.2196/18990", url="http://mental.jmir.org/2020/7/e18990/", url="http://www.ncbi.nlm.nih.gov/pubmed/32720904" } @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/10.2196/21718, author="Balcombe, Luke and De Leo, Diego", title="An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19", journal="JMIR Ment Health", year="2020", month="Jul", day="22", volume="7", number="7", pages="e21718", keywords="digital mental health", keywords="mental well-being online assessments", keywords="machine learning", keywords="automation", keywords="COVID-19", keywords="well-being services", doi="10.2196/21718", url="https://mental.jmir.org/2020/7/e21718", url="http://www.ncbi.nlm.nih.gov/pubmed/32668402" } @Article{info:doi/10.2196/17224, author="Rivas, Ryan and Shahbazi, Moloud and Garett, Renee and Hristidis, Vagelis and Young, Sean", title="Mental Health--Related Behaviors and Discussions Among Young Adults: Analysis and Classification", journal="J Med Internet Res", year="2020", month="May", day="29", volume="22", number="5", pages="e17224", keywords="social media", keywords="data analysis", keywords="supervised machine learning", keywords="universities", keywords="students", abstract="Background: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. Objective: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. Methods: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. Results: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. Conclusions: Our results show that messages containing data about students' mental health--related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support. ", doi="10.2196/17224", url="http://www.jmir.org/2020/5/e17224/", url="http://www.ncbi.nlm.nih.gov/pubmed/32469317" } @Article{info:doi/10.2196/15817, author="Niu, Zhaomeng and Willoughby, Fitts Jessica and Mei, Jing and Li, Shaochun and Hu, Pengwei", title="A Cross-Cultural Comparison of an Extended Planned Risk Information Seeking Model on Mental Health Among College Students: Cross-Sectional Study", journal="J Med Internet Res", year="2020", month="May", day="11", volume="22", number="5", pages="e15817", keywords="information seeking behavior", keywords="mental health", keywords="cross-cultural comparison", abstract="Background: Approximately 42.5 million adults have been affected by mental illness in the United States in 2013, and 173 million people have been affected by a diagnosable psychiatric disorder in China. An increasing number of people tend to seek health information on the Web, and it is important to understand the factors associated with individuals' mental health information seeking. Identifying factors associated with mental health information seeking may influence the disease progression of potential patients. The planned risk information seeking model (PRISM) was developed in 2010 by integrating multiple information seeking models including the theory of planned behavior. Few studies have replicated PRISM outside the United States and no previous study has examined mental health as a personal risk in different cultures. Objective: This study aimed to test the planned risk information seeking model (PRISM) in China and the United States with a chronic disease, mental illness, and two additional factors, ie, media use and cultural identity, among college students. Methods: Data were collected in both countries using the same online survey through a survey management program (Qualtrics). In China, college instructors distributed the survey link among university students, and it was also posted on a leading social media site called Sina Weibo. In the United States, the data were collected in a college-wide survey pool in a large Northwestern university. Results: The final sample size was 235 for the Chinese sample and 241 for the US sample. Media use was significantly associated with mental health information--seeking intentions in the Chinese sample (P<.001), and cultural identity was significantly associated with intentions in both samples (China: P=.02; United States: P<.001). The extended PRISM had a better model fit than the original PRISM. Conclusions: Cultural identity and media use should be considered when evaluating the process of mental health information seeking or when designing interventions to address mental health information seeking. ", doi="10.2196/15817", url="http://www.jmir.org/2020/5/e15817/", url="http://www.ncbi.nlm.nih.gov/pubmed/32441654" } @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/10.2196/15962, author="Park, Young Sun and Andalibi, Nazanin and Zou, Yikai and Ambulkar, Siddhant and Huh-Yoo, Jina", title="Understanding Students' Mental Well-Being Challenges on a University Campus: Interview Study", journal="JMIR Form Res", year="2020", month="Mar", day="5", volume="4", number="3", pages="e15962", keywords="emerging adults", keywords="university students", keywords="life events", keywords="mental wellbeing", keywords="mental wellness", keywords="mental health", keywords="social support", abstract="Background: Research shows that emerging adults face numerous stressors as they transition from adolescence to adulthood. This paper investigates university students' lived experiences of maintaining mental well-being during major life events and challenges associated with this transitional period. As we continue to design health technology to support students' mental health needs, it is imperative to understand the fundamental needs and issues particular to this phase of their life to effectively engage and lower the barriers to seeking help. Objective: This study first aimed to understand how university students currently seek and receive support to maintain their mental well-being while going through frequent life events during this period of emerging adulthood. The study then aimed to provide design requirements for how social and technical systems should support the students' mental well-being maintenance practice. Methods: Semistructured interviews with 19 students, including graduate and undergraduate students, were conducted at a large university in the Midwest in the United States. Results: This study's findings identified three key needs: students (1) need to receive help that aligns with the perceived severity of the problem caused by a life event, (2) have to continuously rebuild relationships with support givers because of frequent life events, and (3) negotiate tensions between the need to disclose and the stigma associated with disclosure. The study also identified three key factors related to maintaining mental well-being: time, audience, and disclosure. Conclusions: On the basis of this study's empirical findings, we discuss how and when help should be delivered through technology to better address university students' needs for maintaining their mental well-being, and we argue for reconceptualizing seeking and receiving help as a colearning process. ", doi="10.2196/15962", url="http://formative.jmir.org/2020/3/e15962/", url="http://www.ncbi.nlm.nih.gov/pubmed/32134393" } @Article{info:doi/10.2196/14095, author="Chung, Kyungmi and Cho, Young Hee and Kim, Ran Young and Jhung, Kyungun and Koo, Seon Hwa and Park, Young Jin", title="Medical Help-Seeking Strategies for Perinatal Women With Obstetric and Mental Health Problems and Changes in Medical Decision Making Based on Online Health Information: Path Analysis", journal="J Med Internet Res", year="2020", month="Mar", day="4", volume="22", number="3", pages="e14095", keywords="perinatal care", keywords="obstetrics", keywords="mental health", keywords="information seeking behavior", keywords="help-seeking behavior", keywords="self efficacy", keywords="health literacy", keywords="consultation", keywords="decision making", keywords="internet", abstract="Background: Previous studies have revealed that most pregnant women rarely discuss informal information found on the internet with health professionals and have frequently expressed concerns for medical experts' reactions to the online information they shared, as well as the lack of time to consult the medical experts in general. To date, little information is available on the effect of individual differences in utilizing medical help-seeking strategies on their medical decisions during the perinatal period. Objective: The objectives of this study were (1) to determine associations among perinatal women's medical help-seeking strategies, changes in medical decision making, and online health information utilization with a focus on the mediating effect of self-efficacy in perinatal health literacy on the intent to consult health professionals, and (2) to clarify these associations in perinatal women with two different medical problems: obstetric and mental health. Methods: A total of 164 perinatal women aged 24 to 47 years (mean 34.64, SD 3.80) repeatedly completed the Problem Solving in Medicine and Online Health Information Utilization questionnaires to examine the moderating effect of two types of medical problems on their decision-making processes. To validate the hypothesized relationships in the proposed conceptual model encompassing obstetric and mental health problem-solving models, path analyses were performed. Results: This study found that some perinatal women, who use an online informal medical help-seeking (OIMH) strategy, would be more likely to change their medical decisions based only on internet-based information without consulting health professionals (P<.001), compared to other women using different medical help-seeking strategies. Particularly, this concern is significantly prevalent when encountering obstetric problems during the perinatal period (obstetric problem-solving: P<.001; mental health problem-solving: P=.02). Furthermore, perinatal women with mental health issues using the OIMH strategy showed a significant difference in intent to consult health professionals based on online health information when the medical problem they had to solve was different (obstetric problem-solving: P=.94; mental health problem-solving: P=.003). Conclusions: Despite the positive mediating effects of perinatal women's enhanced health literacy on the intent to discuss personal medical issues with health professionals based on online health information, the strategy used is of fundamental importance for understanding their help-seeking and decision-making processes during the perinatal period. Beyond a short consultation to steer patients quickly and authoritatively towards an obstetric doctor's choice of action, it is recommended in this study that obstetricians attempt to provide their patients with needed context for the information found online. To fully explain this information with an open mind, they should actively develop or support information and communications technology (ICT)-based health information services. ", doi="10.2196/14095", url="https://www.jmir.org/2020/3/e14095", url="http://www.ncbi.nlm.nih.gov/pubmed/32130139" } @Article{info:doi/10.2196/14698, author="Hadjistavropoulos, D. Heather and Gullickson, M. Kirsten and Adrian-Taylor, Shelley and Wilhelms, Andrew and Sundstr{\"o}m, Christopher and Nugent, Marcie", title="Stakeholder Perceptions of Internet-Delivered Cognitive Behavior Therapy as a Treatment Option for Alcohol Misuse: Qualitative Analysis", journal="JMIR Ment Health", year="2020", month="Mar", day="3", volume="7", number="3", pages="e14698", keywords="internet intervention", keywords="cognitive behavioral therapy", keywords="alcohol consumption", keywords="stakeholder participation", keywords="qualitative research", keywords="implementation science", abstract="Background: Internet-delivered cognitive behavior therapy (ICBT) has been found to be effective for treating alcohol misuse in research trials, but it is not available as part of routine care in Canada. Recent recommendations in the literature highlight the importance of integrating perspectives from both patient and health care stakeholders when ICBT is being implemented in routine practice settings. Objective: This study aimed to gain an understanding of how ICBT is perceived as a treatment option for alcohol misuse by interviewing diverse stakeholders. Specifically, the objectives were to (1) learn about the perceived advantages and disadvantages of ICBT for alcohol misuse and (2) elicit recommendations to inform implementation efforts in routine practice. Methods: A total of 30 participants representing six stakeholder groups (ie, patients, family members, academic experts, frontline managers, service providers, and health care decision makers) participated in semistructured interviews. To be included in the study, stakeholders had to reside in Saskatchewan, Canada, and have personal or professional experience with alcohol misuse. Interviews were transcribed verbatim, anonymized, and analyzed using thematic analysis. Results: Stakeholders identified numerous advantages of ICBT for alcohol misuse (eg, accessibility, convenience, privacy, relevance to technology-based culture, and fit with stepped care) and several disadvantages (eg, lack of internet access and technological literacy, isolation, less accountability, and unfamiliarity with ICBT). Stakeholders also provided valuable insight into factors to consider when implementing ICBT for alcohol misuse in routine practice. In terms of intervention design, stakeholders recommended a 6- to 8-week guided program that uses Web-based advertising, point-of-sale marketing, and large-scale captive audiences to recruit participants. With regard to treatment content, stakeholders recommended that the program focus on harm reduction rather than abstinence; be evidence based; appeal to the diverse residents of Saskatchewan; and use language that is simple, encouraging, and nonjudgmental. Finally, in terms of population characteristics, stakeholders felt that several features of the alcohol misuse population, such as psychiatric comorbidity, readiness for change, and stigma, should be considered when developing an ICBT program for alcohol misuse. Conclusions: Stakeholders' insights will help maximize the acceptability, appropriateness, and adoption of ICBT for alcohol misuse and in turn contribute to implementation success. The methodology and findings from this study could be of benefit to others who are seeking to implement ICBT in routine practice. ", doi="10.2196/14698", url="https://mental.jmir.org/2020/3/e14698", url="http://www.ncbi.nlm.nih.gov/pubmed/32130151" } @Article{info:doi/10.2196/15564, author="Navarro, Pablo and Sheffield, Jeanie and Edirippulige, Sisira and Bambling, Matthew", title="Exploring Mental Health Professionals' Perspectives of Text-Based Online Counseling Effectiveness With Young People: Mixed Methods Pilot Study", journal="JMIR Ment Health", year="2020", month="Jan", day="29", volume="7", number="1", pages="e15564", keywords="mental health", keywords="child health", keywords="adolescent health", keywords="distance counseling", keywords="mHealth", keywords="applied psychology", keywords="psychological processes", abstract="Background: Population-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups. Objective: This pilot study aimed to explore and confirm e-mental health professional's perspectives about various domains and themes related to young service users' (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities. Methods: Participants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness. Results: A total of 4 domains and various subthemes were confirmed and identified to be related to YSUs' characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors). Conclusions: Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor's interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation. ", doi="10.2196/15564", url="https://mental.jmir.org/2020/1/e15564", url="http://www.ncbi.nlm.nih.gov/pubmed/32012097" } @Article{info:doi/10.2196/15373, author="Apolin{\'a}rio-Hagen, Jennifer and Hennemann, Severin and Fritsche, Lara and Dr{\"u}ge, Marie and Breil, Bernhard", title="Determinant Factors of Public Acceptance of Stress Management Apps: Survey Study", journal="JMIR Ment Health", year="2019", month="Nov", day="7", volume="6", number="11", pages="e15373", keywords="mental health", keywords="eHealth", keywords="mHealth", keywords="attitude to computers", keywords="acceptability of health care", keywords="stress, psychological", keywords="mobile apps", abstract="Background: Chronic stress is a major public health concern. Mobile health (mHealth) apps can help promote coping skills in daily life and prevent stress-related issues. However, little is known about the determinant factors of public acceptance of stress management in relation to preferences for psychological services. Objective: The aim of this survey study was to (1) assess determinant factors of public acceptance (behavioral use intention) of stress management apps based on an adapted and extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and (2) explore preferences for mHealth apps compared with other mental health services. Methods: Using convenience sampling, participants completed a multiscale 54-item Web-based survey. Based on significant correlations with acceptance, hierarchical stepwise regression analysis was performed within three blocks: (1) background and stress-related control variables, (2) beliefs and attitudes toward using mHealth, and (3) the core UTAUT determinants. The preference for mHealth apps in comparison with nine other mental health services (operationalized as readiness to use) was analyzed using paired t tests. Results: Of 141 participants, nearly half (69/141, 48.9\%) indicated prior mHealth use. Acceptance of stress coping apps was moderate (mean 3.10, SD 1.03, range 1-5). Hierarchical stepwise regression including four of 11 variables (R2=.62; P=.01, f2=1.63) identified positive attitudes toward using mHealth for stress coping (beta=0.69, P<.001, 46\% R2 increase above block 1, f2=0.85), skepticism/perceived risks (beta=?0.14, P=.01, f2=0.16), and stress symptoms (beta=0.12, P=.03, f2=0.14) as significant predictors of acceptance. UTAUT determinants added no predictive contribution beyond attitudes (all P>.05, R2 increase of 1\%), whereas post hoc analysis showed significant R2 increases of attitudes and skepticism/perceived risks beyond UTAUT determinants (all P<.001, R2 increase of 13\%). The readiness to use apps was equivalent to or significantly higher than most service types, but lower than information websites. Conclusions: Attitudes may be at least as predictive for the acceptance of stress management apps as for more elaborated outcome beliefs. Efforts aimed at improving the public adoption of mHealth could put more emphasis on the pleasant aspects of app use, address misconceptions, offer stress screening tools on health websites, and increase options to try high-quality apps. ", doi="10.2196/15373", url="https://mental.jmir.org/2019/11/e15373", url="http://www.ncbi.nlm.nih.gov/pubmed/31697243" } @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/10.2196/14385, author="Garrido, Sandra and Cheers, Daniel and Boydell, Katherine and Nguyen, Vinh Quang and Schubert, Emery and Dunne, Laura and Meade, Tanya", title="Young People's Response to Six Smartphone Apps for Anxiety and Depression: Focus Group Study", journal="JMIR Ment Health", year="2019", month="Oct", day="2", volume="6", number="10", pages="e14385", keywords="depression", keywords="adolescent", keywords="smartphone", keywords="mobile phone", keywords="mental health", abstract="Background: Suicide is one of the most frequent causes of death in young people worldwide. Depression lies at the root of this issue, a condition that has a significant negative impact on the lives of those who experience it and on society more generally. However, 80\% of affected young people do not obtain professional help for depression and other mental health issues. Therefore, a key challenge is to find innovative and appealing ways to engage young people in learning to manage their mental health. Research suggests that young people prefer to access anonymous Web-based programs rather than get face-to-face help, which has led to the development of numerous smartphone apps. However, the evidence indicates that not all of these apps are effective in engaging the interest of young people who are most in need of help. Objective: The study aimed to investigate young people's response to six currently available smartphone apps for mental health and to identify features that young people like and dislike in such apps. Methods: Focus groups were conducted with 23 young people aged 13 to 25 years in which they viewed and used six smartphone apps for mental health. A general inductive approach following a realist paradigm guided data analysis. Results: The results revealed that young people value autonomy and the opportunity to personalize experiences with these apps above other things. Finding a balance between simplicity and informativeness is also an important factor. Conclusions: App developers need to consider using participant-design frameworks to ensure that smartphone apps are providing what young people want in a mental health app. Solutions to the need for personalization and increasing user engagement are also crucially needed. ", doi="10.2196/14385", url="https://mental.jmir.org/2019/10/e14385", url="http://www.ncbi.nlm.nih.gov/pubmed/31579023" } @Article{info:doi/10.2196/13662, author="LaMonica, M. Haley and Davenport, A. Tracey and Burns, Jane and Cross, Shane and Hodson, Stephanie and Veitch, Jennifer and Hickie, B. Ian", title="Technology-Enabled Mental Health Service Reform for Open Arms -- Veterans and Families Counselling: Participatory Design Study", journal="JMIR Form Res", year="2019", month="Sep", day="19", volume="3", number="3", pages="e13662", keywords="veterans", keywords="mental health", keywords="technology", keywords="community-based participatory research", keywords="health care reform", keywords="stakeholder participation", abstract="Background: The impact of mental ill-health on every aspect of the lives of a large number of Australian Defence Force (ADF) personnel, their partners, and their families is widely recognized. Recent Senate inquiries have highlighted gaps in service delivery as well as the need for service reform to ensure appropriate care options for individuals who are currently engaged with mental health and support services as well as for those who, for a variety of reasons, have not sought help. To that end, successive Australian governments generally and the Department of Veterans' Affairs specifically have prioritized veteran-centric reform. Open Arms is an Australia-wide service that provides counseling and support to current and former ADF personnel, and their family members, for mental health conditions. Objective: The aim of this study was to develop and configure a prototypic Web-based platform for Open Arms -- Veterans \& Families Counselling (formerly Veterans and Veterans Families Counselling Service) with the Open Arms community to enhance the quality of mental health services provided by Open Arms. Methods: The study aimed to recruit up to 100 people from the Open Arms community (current and former ADF personnel and their families, health professionals, service managers, and administrators) in regions of New South Wales, including Sydney, Canberra, Maitland, Singleton, and Port Stephens. Participants were invited to participate in 4-hour participatory design workshops. A variety of methods were used within the workshops, including prompted discussion, review of working prototypes, creation of descriptive artifacts, and group-based development of user journeys. Results: Seven participatory design workshops were held, including a total of 49 participants. Participants highlighted that the prototype has the potential to (1) provide the opportunity for greater and better-informed personal choice in relation to options for care based on the level of need and personal preferences; (2) ensure transparency in care by providing the individual with access to all of their personal health information; and (3) improve collaborative care and care continuity by allowing information to be shared securely with current and future providers. Conclusions: Our findings highlight the value of actively engaging stakeholders in participatory design processes for the development and configuration of new technologies. ", doi="10.2196/13662", url="http://formative.jmir.org/2019/3/e13662/", url="http://www.ncbi.nlm.nih.gov/pubmed/31538937" } @Article{info:doi/10.2196/13524, author="Pretorius, Claudette and Chambers, Derek and Cowan, Benjamin and Coyle, David", title="Young People Seeking Help Online for Mental Health: Cross-Sectional Survey Study", journal="JMIR Ment Health", year="2019", month="Aug", day="26", volume="6", number="8", pages="e13524", keywords="mental health", keywords="eHealth", keywords="mHealth", keywords="Internet", keywords="help-seeking behavior", keywords="health literacy", keywords="young adults", keywords="survey and questionnaires", abstract="Background: Young people are particularly vulnerable to experiencing mental health difficulties, but very few seek treatment or help during this time. Online help-seeking may offer an additional domain where young people can seek aid for mental health difficulties, yet our current understanding of how young people seek help online is limited. Objective: This was an exploratory study which aimed to investigate the online help-seeking behaviors and preferences of young people. Methods: This study made use of an anonymous online survey. Young people aged 18-25, living in Ireland, were recruited through social media ads on Twitter and Facebook and participated in the survey. Results: A total of 1308 respondents completed the survey. Many of the respondents (80.66\%; 1055/1308) indicated that they would use their mobile phone to look online for help for a personal or emotional concern. When looking for help online, 82.57\% (1080/1308) of participants made use of an Internet search, while 57.03\% (746/1308) made use of a health website. When asked about their satisfaction with these resources, 36.94\% (399/1080) indicated that they were satisfied or very satisfied with an Internet search while 49.33\% (368/746) indicated that they were satisfied or very satisfied with a health website. When asked about credibility, health websites were found to be the most trustworthy, with 39.45\% (516/1308) indicating that they found them to be trustworthy or very trustworthy. Most of the respondents (82.95\%; 1085/1308) indicated that a health service logo was an important indicator of credibility, as was an endorsement by schools and colleges (54.97\%; 719/1308). Important facilitators of online help-seeking included the anonymity and confidentiality offered by the Internet, with 80\% (1046/1308) of the sample indicating that it influenced their decision a lot or quite a lot. A noted barrier was being uncertain whether information on an online resource was reliable, with 55.96\% (732/1308) of the respondents indicating that this influenced their decision a lot or quite a lot. Conclusions: Findings from this survey suggest that young people are engaging with web-based mental health resources to assist them with their mental health concerns. However, levels of satisfaction with the available resources vary. Young people are engaging in strategies to assign credibility to web-based resources, however, uncertainty around their reliability is a significant barrier to online help-seeking. ", doi="10.2196/13524", url="http://mental.jmir.org/2019/8/e13524/", url="http://www.ncbi.nlm.nih.gov/pubmed/31452519" } @Article{info:doi/10.2196/13152, author="Navarro, Pablo and Bambling, Matthew and Sheffield, Jeanie and Edirippulige, Sisira", title="Exploring Young People's Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study", journal="JMIR Ment Health", year="2019", month="Jul", day="03", volume="6", number="7", pages="e13152", keywords="mental health", keywords="child health", keywords="adolescent health", keywords="distance counseling", keywords="mhealth", keywords="applied psychology", keywords="psychological processes", abstract="Background: Young people aged 10-24 years are at the highest risk for mental health problems and are the least likely to seek professional treatment. Owing to this population's high consumption of internet content, electronic mental (e-mental) health services have increased globally, with an aim to address barriers to treatment. Many of these services use text-based online counseling (TBOC), which shows promising results in supporting young people but also greater variance in outcomes compared with adult comparators. Objective: This pilot study qualitatively explored the characteristics of users aged 15-25 years accessing TBOC services, their motivations for access, and their perceptions about factors believed to influence the effectiveness of these modalities. Methods: E-surveys were administered naturalistically to 100 young service users aged 15-25 years who accessed webchat and email counseling services via an Australian e-mental health service. Thematic analysis of qualitative themes and quantitative descriptive and proportional data presented in electronic surveys were examined across the areas of user characteristics, motivations for selecting TBOC modalities, and their perceptions of TBOC effectiveness. Results: Participants were predominately female high school students of Caucasian or European descent from middle socioeconomic status, living with their parents in major cities. Four domains and various themes and subthemes were related to participants' reasons for accessing TBOC and perceptions of its effectiveness: user characteristics (ie, physical and mental health syndrome and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), factors perceived to increase effectiveness (ie, general therapeutic benefits, positive modality and service factors, and persisting with counseling to increase benefit), and factors perceived to decrease effectiveness (ie, negative modality and service factors, and persisting with counseling despite benefit). Conclusions: Participants were motivated to use TBOC to increase their sense of safety in response to negative perceptions of their social skills and the response of the online counsellor to their presenting problem. By using TBOC services, they also sought to improve their access to mental health services that better met their expectations. Factors that increased effectiveness of TBOC were the counsellor's interpersonal skills, use of text-based communication, and persisting with beneficial counseling sessions. Factors that reduced TBOC effectiveness were poor timeliness in response to service requests, experiencing no change in their presenting problem, not knowing what postcounseling action to take, and persisting with ineffective counseling sessions. ", doi="10.2196/13152", url="https://mental.jmir.org/2019/7/e13152/", url="http://www.ncbi.nlm.nih.gov/pubmed/31271149" } @Article{info:doi/10.2196/12848, author="Kerner, Berit and Crisanti, S. Annette and DeShaw, L. Jason and Ho, G. Janika-Marie and Jordan, Kimmie and Krall, L. Ronald and Kuntz, J. Matt and Mazurie, J. Aur{\'e}lien and Nestsiarovich, Anastasiya and Perkins, J. Douglas and Schroeter, L. Quentin and Smith, N. Alicia and Tohen, Mauricio and Volesky, Emma and Zhu, Yiliang and Lambert, G. Christophe", title="Preferences of Information Dissemination on Treatment for Bipolar Disorder: Patient-Centered Focus Group Study", journal="JMIR Ment Health", year="2019", month="Jun", day="25", volume="6", number="6", pages="e12848", keywords="internet", keywords="information seeking", keywords="psychiatry", keywords="bipolar disorder", keywords="patient-physician relationship", keywords="decision-making", keywords="patient education", keywords="therapeutics", abstract="Background: Patient education has taken center stage in successfully shared decision making between patients and health care providers. However, little is known about how patients with bipolar disorder typically obtain information on their illness and the treatment options available to them. Objective: This study aimed to obtain the perspectives of patients with bipolar disorder and their family members on the preferred and most effectively used information channels on bipolar disorder and the available treatment options. Methods: We conducted nine focus groups in Montana, New Mexico, and California, in which we surveyed 84 individuals including patients with bipolar disorder and family members of patients with bipolar disorder. The participants were recruited using National Alliance on Mental Illness mailing lists and websites. Written verbatim responses to semistructured questionnaires were analyzed using summative content analysis based on grounded theory. Two annotators coded and analyzed the data on the sentence or phrase level to create themes. Relationships between demographics and information channel were also examined using the Chi-square and Fisher exact tests. Results: The focus group participants mentioned a broad range of information channels that were successfully used in the past and could be recommended for future information dissemination. The majority of participants used providers (74\%) and internet-based resources (75\%) as their main information sources. There was no association between internet use and basic demographics such as age or geographical region of the focus groups. Patients considered time constraints and the fast pace in which an overwhelming amount of information is often presented by the provider as major barriers to successful provider-patient interactions. If Web-based channels were used, the participants perceived information obtained through Web-based channels as more helpful than information received in the provider's office (P<.05). Conclusions: Web-based resources are increasingly used by patients with bipolar disorder and their family members to educate themselves about the disease and its treatment. Although provider-patient interactions are frequently perceived to be burdened with time constraints, Web-based information sources are considered reliable and helpful. Future research should explore how high-quality websites could be used to empower patients and improve provider-patient interactions with the goal of enhancing shared decision making between patients and providers. ", doi="10.2196/12848", url="http://mental.jmir.org/2019/6/e12848/", url="http://www.ncbi.nlm.nih.gov/pubmed/31237566" } @Article{info:doi/10.2196/13230, author="Toscos, Tammy and Coupe, Amanda and Flanagan, Mindy and Drouin, Michelle and Carpenter, Maria and Reining, Lauren and Roebuck, Amelia and Mirro, J. Michael", title="Teens Using Screens for Help: Impact of Suicidal Ideation, Anxiety, and Depression Levels on Youth Preferences for Telemental Health Resources", journal="JMIR Ment Health", year="2019", month="Jun", day="21", volume="6", number="6", pages="e13230", keywords="adolescent", keywords="students", keywords="telemedicine", keywords="mental health", keywords="suicidal ideation", keywords="depression", keywords="anxiety", keywords="health resources", keywords="online social networking", keywords="mental health services", keywords="help-seeking behavior", abstract="Background: High rates of mental illness, stress, and suicidality among teens constitute a major public health concern in the United States. However, treatment rates remain low, partially because of barriers that could be mitigated with tech-based telemental health (TMH) resources, separate from or in addition to traditional care. Objective: This study aimed to analyze TMH resource usage by high school students to establish current user characteristics and provide a framework for future development. Methods: A total of 2789 students were surveyed regarding demographics, recent anxiety and depression symptoms, suicidality, and stress; people with whom they could openly and honestly discuss stress or problems, and prior TMH use. Logistic regression models and a general linear model were used to test relationships between variables. Results: Overall, 30.58\% (853/2789) and 22.91\% (639/2789) of students reported moderate to severe anxiety and depression symptoms, respectively, in the past 2 weeks; 16.24\% (414/2550) had seriously considered suicide in the past year, consistent with national averages. Meanwhile, 16.03\% (447/2789) of students had previously used at least 1 of 4 types of TMH resources (ie, self-help, anonymous chat, online counselor, or crisis text line). Teens reporting depression symptoms, higher stress, or suicidality were less likely to talk to a parent about stress or problems and more likely to tell no one. Suicidality was related to the use of all 4 types of TMH resources. Depression symptoms were related to the use of anonymous chat and crisis text line, and those with higher stress were more likely to have used an online counselor. Those reporting anxiety symptoms were less likely to have no one to talk to and more likely to have used a self-help resource. Conclusions: Youth struggling with mental health symptoms, some of whom lack real-life confidants, are using existing TMH support, with resource preferences related to symptoms. Future research should consider these preferences and assist in the creation of specialized, evidence-based TMH resources. ", doi="10.2196/13230", url="http://mental.jmir.org/2019/6/e13230/", url="http://www.ncbi.nlm.nih.gov/pubmed/31228179" } @Article{info:doi/10.2196/11167, author="Chiauzzi, Emil and Drahos, Jennifer and Sarkey, Sara and Curran, Christopher and Wang, Victor and Tomori, Dapo", title="Patient Perspective of Cognitive Symptoms in Major Depressive Disorder: Retrospective Database and Prospective Survey Analyses", journal="J Participat Med", year="2019", month="May", day="16", volume="11", number="2", pages="e11167", keywords="cognition", keywords="cognitive function", keywords="depression", keywords="major depressive disorder", keywords="patient-centered care", keywords="patient preference", keywords="relapse", keywords="remission", keywords="symptoms", abstract="Background: Major depressive disorder (MDD) is a common and burdensome condition. The clinical understanding of MDD is shaped by current research, which lacks insight into the patient perspective. Objective: This two-part study aimed to generate data from PatientsLikeMe, an online patient network, on the perception of cognitive symptoms and their prioritization in MDD. Methods: A retrospective data analysis (study 1) was used to analyze data from the PatientsLikeMe community with self-reported MDD. Information on patient demographics, comorbidities, self-rated severity of MDD, treatment effectiveness, and specific symptoms of MDD was analyzed. A prospective electronic survey (study 2) was emailed to longstanding and recently active members of the PatientsLikeMe MDD community. Study 1 analysis informed the objectives of the study 2 survey, which were to determine symptom perception and prioritization, cognitive symptoms of MDD, residual symptoms, and medication effectiveness. Results: In study 1 (N=17,166), cognitive symptoms were frequently reported, including ``severe'' difficulty in concentrating (28\%). Difficulty in concentrating was reported even among patients with no/mild depression (80\%) and those who considered their treatment successful (17\%). In study 2 (N=2525), 23\% (118/508) of patients cited cognitive symptoms as a treatment priority. Cognitive symptoms correlated with depression severity, including difficulty in making decisions, concentrating, and thinking clearly (rs=0.32, 0.36, and 0.34, respectively). Cognitive symptoms interfered with meaningful relationships and daily life tasks and had a profound impact on patients' ability to work and recover from depression. Conclusions: Patients acknowledge that cognitive dysfunction in MDD limits their ability to recover fully and return to a normal level of social and occupational functioning. Further clinical understanding and characterization of MDD for symptom prioritization and relapse risk due to residual cognitive impairment are required to help patients return to normal cognitive function and aid their overall recovery. ", doi="10.2196/11167", url="https://jopm.jmir.org/2019/2/e11167/" } @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/10.2196/12169, author="Rickwood, Debra and Wallace, Alison and Kennedy, Vanessa and O'Sullivan, Shaunagh and Telford, Nic and Leicester, Steven", title="Young People's Satisfaction With the Online Mental Health Service eheadspace: Development and Implementation of a Service Satisfaction Measure", journal="JMIR Ment Health", year="2019", month="Apr", day="17", volume="6", number="4", pages="e12169", keywords="mental health", keywords="adolescent", keywords="telemedicine", keywords="counseling", keywords="internet", keywords="satisfaction", keywords="feedback", keywords="telehealth", keywords="young people", abstract="Background: Online youth mental health services are an expanding approach to meeting service need and can be used as the first step in a stepped-care approach. However, limited evidence exists regarding satisfaction with online services, and there is no standardized service satisfaction measure. Objective: This study implemented an online youth mental health service satisfaction questionnaire within eheadspace, an online youth mental health service. The aims were to test the questionnaire's psychometric properties and identify current levels of satisfaction among service users, as well as to identify client and service contact characteristics that affect satisfaction. Methods: Data were collected from 2280 eheadspace clients via an online questionnaire advertised and accessed through the eheadspace service platform between September 2016 and February 2018. Client and service contact characteristics, potential outcomes, and session and service feedback data were collected. Results: The service satisfaction questionnaire demonstrated high internal consistency for the overall satisfaction scale (alpha=.95) and its three subscales: session satisfaction, potential outcomes, and service satisfaction. A three-factor model was the best fit to the data, although including a higher order unidimensional construct of overall satisfaction was also a reasonable fit. Overall, young people were very satisfied with eheadspace (mean 3.60, SD 0.83). Service characteristics, but not client characteristics, were significantly associated with satisfaction. Young people were more satisfied with eheadspace when they had greater engagement as evident through receiving esupport rather than briefer service provision, having a longer session and greater interaction with the clinician, and not previously attending a face-to-face headspace center. Conclusions: The online youth mental health service satisfaction questionnaire developed for and implemented in eheadspace showed good psychometric properties. The measure is brief, has good internal consistency, and has a clear factor structure. The measure could be adapted for use in other online youth mental health services. The young people using eheadspace and completing the feedback survey were highly satisfied. Greater engagement with the online service was shown to be associated with greater satisfaction. No specific client demographic groups were shown to be more or less satisfied. ", doi="10.2196/12169", url="http://mental.jmir.org/2019/4/e12169/", url="http://www.ncbi.nlm.nih.gov/pubmed/30994470" } @Article{info:doi/10.2196/11084, author="Smith-Merry, Jennifer and Goggin, Gerard and Campbell, Andrew and McKenzie, Kirsty and Ridout, Brad and Baylosis, Cherry", title="Social Connection and Online Engagement: Insights From Interviews With Users of a Mental Health Online Forum", journal="JMIR Ment Health", year="2019", month="Mar", day="26", volume="6", number="3", pages="e11084", keywords="internet", keywords="mental health", keywords="social stigma", keywords="self-help groups", keywords="qualitative research", keywords="mental health recovery", keywords="mental disorders", abstract="Background: Over the past 2 decades, online forums for mental health support have emerged as an important tool for improving mental health and well-being. There has been important research that analyzes the content of forum posts, studies on how and why individuals engage with forums, and how extensively forums are used. However, we still lack insights into key questions on how they are experienced from the perspective of their users, especially those in rural and remote settings. Objective: The aim of our study was to investigate the dynamics, benefits, and challenges of a generalized peer-to-peer mental health online forum from a user perspective; in particular, to better explore and understand user perspectives on connection, engagement, and support offered in such forums; information and advice they gained; and what issues they encountered. We studied experiences of the forums from the perspective of both people with lived experience of mental illness and people who care for people with mental illness. Methods: To understand the experience of forum users, we devised a qualitative study utilizing semistructured interviews with 17 participants (12 women and 5 men). Data were transcribed, and a thematic analysis was undertaken. Results: The study identified 3 key themes: participants experienced considerable social and geographical isolation, which the forums helped to address; participants sought out the forums to find a social connection that was lacking in their everyday lives; and participants used the forums to both find and provide information and practical advice. Conclusions: The study suggests that online peer support provides a critical, ongoing role in providing social connection for people with a lived experience of mental ill-health and their carers, especially for those living in rural and remote areas. Forums may offer a way for individuals to develop their own understanding of recovery through reflecting on the recovery experiences and peer support shown by others and individuals enacting peer support themselves. Key to the success of this online forum was the availability of appropriate moderation, professional support, and advice. ", doi="10.2196/11084", url="http://mental.jmir.org/2019/3/e11084/", url="http://www.ncbi.nlm.nih.gov/pubmed/30912760" } @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/10.2196/12255, author="Noel, A. Valerie and Acquilano, C. Stephanie and Carpenter-Song, Elizabeth and Drake, E. Robert", title="Use of Mobile and Computer Devices to Support Recovery in People With Serious Mental Illness: Survey Study", journal="JMIR Ment Health", year="2019", month="Feb", day="20", volume="6", number="2", pages="e12255", keywords="app", keywords="mental health", keywords="mHealth", keywords="mobile phone", keywords="serious mental illness", abstract="Background: Mental health recovery refers to an individual's experience of gaining a sense of personal control, striving towards one's life goals, and meeting one's needs. Although people with serious mental illness own and use electronic devices for general purposes, knowledge of their current use and interest in future use for supporting mental health recovery remains limited. Objective: This study aimed to identify smartphone, tablet, and computer apps that mental health service recipients use and want to use to support their recovery. Methods: In this pilot study, we surveyed a convenience sample of 63 mental health service recipients with serious mental illness. The survey assessed current use and interest in mobile and computer devices to support recovery. Results: Listening to music (60\%), accessing the internet (59\%), calling (59\%), and texting (54\%) people were the top functions currently used by participants on their device to support their recovery. Participants expressed interest in learning how to use apps for anxiety/stress management (45\%), mood management (45\%), monitoring mental health symptoms (43\%), cognitive behavioral therapy (40\%), sleep (38\%), and dialectical behavior therapy (38\%) to support their recovery. Conclusions: Mental health service recipients currently use general functions such as listening to music and calling friends to support recovery. Nevertheless, they reported interest in trying more specific illness-management apps. ", doi="10.2196/12255", url="http://mental.jmir.org/2019/2/e12255/", url="http://www.ncbi.nlm.nih.gov/pubmed/30785401" } @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/10.2196/11696, author="Greer, Ben and Robotham, Dan and Simblett, Sara and Curtis, Hannah and Griffiths, Helena and Wykes, Til", title="Digital Exclusion Among Mental Health Service Users: Qualitative Investigation", journal="J Med Internet Res", year="2019", month="Jan", day="09", volume="21", number="1", pages="e11696", keywords="digital exclusion", keywords="digital divide", keywords="digital inequality", keywords="technology", keywords="eHealth", keywords="mental health", keywords="social exclusion", keywords="mobile phone", abstract="Background: Access to internet-enabled technology and Web-based services has grown exponentially in recent decades. This growth potentially excludes some communities and individuals with mental health difficulties, who face a heightened risk of digital exclusion. However, it is unclear what factors may contribute to digital exclusion in this population. Objective: To explore in detail the problems of digital exclusion in mental health service users and potential facilitators to overcome them. Methods: We conducted semistructured interviews with 20 mental health service users who were deemed digitally excluded. We recruited the participants from a large secondary mental health provider in South London, United Kingdom. We employed thematic analysis to identify themes and subthemes relating to historical and extant reasons for digital exclusion and methods of overcoming it. Results: There were three major themes that appeared to maintain digital exclusion: a perceived lack of knowledge, being unable to access the necessary technology and services owing to personal circumstances, and the barriers presented by mental health difficulties. Specific facilitators for overcoming digital exclusion included intrinsic motivation and a personalized learning format that reflects the individual's unique needs and preferences. Conclusions: Multiple factors contribute to digital exclusion among mental health service users, including material deprivation and mental health difficulties. This means that efforts to overcome digital exclusion must address the multiple deprivations individuals may face in the offline world in addition to their individual mental health needs. Additional facilitators include fostering an intrinsic motivation to overcome digital exclusion and providing a personalized learning format tailored to the individual's knowledge gaps and preferred learning style. ", doi="10.2196/11696", url="http://www.jmir.org/2019/1/e11696/", url="http://www.ncbi.nlm.nih.gov/pubmed/30626564" } @Article{info:doi/10.2196/10067, author="Babbage, Camilla and Jackson, Margaret Georgina and Nixon, Elena", title="Desired Features of a Digital Technology Tool for Self-Management of Well-Being in a Nonclinical Sample of Young People: Qualitative Study", journal="JMIR Ment Health", year="2018", month="Dec", day="18", volume="5", number="4", pages="e10067", keywords="adolescence", keywords="young people", keywords="well-being", keywords="self-management", keywords="digital technology", keywords="E-health", keywords="coping strategies", keywords="mental health, help-seeking", keywords="qualitative", abstract="Background: Adaptive coping behaviors can improve well-being for young people experiencing life stressors, while maladaptive coping can increase vulnerability to mental health problems in youth and into adulthood. Young people could potentially benefit from the use of digital technology tools to enhance their coping skills and overcome barriers in help-seeking behaviors. However, little is known about the desired digital technology use for self-management of well-being among young people in the general population. Objective: This is a small, qualitative study aimed at exploring what young people desire from digital technology tools for the self-management of their well-being. Methods: Young people aged 12-18 years were recruited from the general community to take part in semistructured interviews. Recorded data from the interviews were transcribed and analyzed using inductive thematic analysis. Results: In total, 14 participants were recruited and completed the study, with a mean age of 14.6 years (female n=3). None of the participants reported using any digital tools specifically designed to manage well-being. However, as indicated through the emerged themes, young people used digital technology to reduce their stress levels and manage their mood, mainly through games, music, and videos. Overall, identified themes showed that young people were keen on using such tools and desired certain facets and features of an ideal tool for self-management of well-being. Themes related to these facets indicated what young people felt a tool should do to improve well-being, including being immersed in a stress-free environment, being uplifting, and that such a tool would direct them to resources based on their needs. The feature-based themes suggested that young people wanted the tool to be flexible and enable engagement with others while also being sensitive to privacy. Conclusions: The young people interviewed in this study did not report engaging with digital technology specialized to improving well-being but instead used media already accessed in their daily lives in order to self-manage their psychological states. As a result, the variety of coping strategies reported and digital tools used was limited to the resources that were already being used for recreational and social purposes. These findings contribute to the scarce research into young people's preferred use of digital technology tools for the self-management of their well-being. However, this was a small-scale study and the current participant sample is not representative of the general youth population. Therefore, the results are only tentative and warrant further investigation. ", doi="10.2196/10067", url="http://mental.jmir.org/2018/4/e10067/", url="http://www.ncbi.nlm.nih.gov/pubmed/30563820" } @Article{info:doi/10.2196/10007, author="Doherty, Kevin and Barry, Marguerite and Marcano-Belisario, Jos{\'e} and Arnaud, B{\'e}renger and Morrison, Cecily and Car, Josip and Doherty, Gavin", title="A Mobile App for the Self-Report of Psychological Well-Being During Pregnancy (BrightSelf): Qualitative Design Study", journal="JMIR Ment Health", year="2018", month="Nov", day="27", volume="5", number="4", pages="e10007", keywords="engagement", keywords="mental health", keywords="mHealth", keywords="midwifery", keywords="perinatal depression", keywords="pregnancy", keywords="self-report", keywords="well-being", keywords="mobile phone", abstract="Background: Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15\% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50\% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening. Objective: The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy. Methods: This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis. Results: The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement. Conclusions: This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies. ", doi="10.2196/10007", url="http://mental.jmir.org/2018/4/e10007/", url="http://www.ncbi.nlm.nih.gov/pubmed/30482742" } @Article{info:doi/10.2196/10652, author="Carpenter-Song, Elizabeth and Noel, A. Valerie and Acquilano, C. Stephanie and Drake, E. Robert", title="Real-World Technology Use Among People With Mental Illnesses: Qualitative Study", journal="JMIR Ment Health", year="2018", month="Nov", day="23", volume="5", number="4", pages="e10652", keywords="qualitative research", keywords="technology", keywords="mental health", keywords="mobile phone", abstract="Background: There is growing interest in using technology-based tools to support mental health recovery. Yet, despite evidence suggesting widespread access to technology among people with mental illnesses, interest in using technology to support mental health, and effectiveness of technology-based tools developed by researchers, such tools have not been widely adopted within mental health settings. Little is currently known about how mental health consumers are using technology to address mental health needs in real-world settings outside of controlled research studies. Objective: This qualitative study examined current practices and orientations toward technology among consumers in 3 mental health settings in the United States. Methods: Ethnographic observations and semistructured interviews were conducted. Observations focused on if and how technology was salient within the setting and documented relevant behaviors, interactions, and dialogue in fieldnotes. Ethnographic data informed the development of a semistructured interview that inquired into technology use and interest among consumers (n=15) in a community mental health setting. Fieldnotes and interview transcripts were reviewed and coded by multiple researchers. Key concepts and patterns identified were refined by the research team to develop the main findings. Results: Ownership of technology, although common, was not ubiquitous and was varied across the sites. Participants had varying levels of awareness regarding the key capabilities of modern technologies. Participants used technology for many purposes, but there was limited evidence of technology use to support mental health. Technology-based tools specific to mental health were not routinely used, although some participants found widely available mobile apps to be helpful in recovery. Conclusions: Qualitative findings suggest that many, but not all, clients will be interested in using technology to support mental health needs. The variability in type and quality of technology owned by participants suggests the need to design for a range of functionality in the development of mental health tools. Findings also suggest thinking broadly about using existing platforms and widely available tools to support consumers in mental health recovery. ", doi="10.2196/10652", url="http://mental.jmir.org/2018/4/e10652/", url="http://www.ncbi.nlm.nih.gov/pubmed/30470681" } @Article{info:doi/10.2196/11350, author="Abel, A. Erica and Shimada, L. Stephanie and Wang, Karen and Ramsey, Christine and Skanderson, Melissa and Erdos, Joseph and Godleski, Linda and Houston, K. Thomas and Brandt, A. Cynthia", title="Dual Use of a Patient Portal and Clinical Video Telehealth by Veterans with Mental Health Diagnoses: Retrospective, Cross-Sectional Analysis", journal="J Med Internet Res", year="2018", month="Nov", day="07", volume="20", number="11", pages="e11350", keywords="mental health", keywords="patient portals", keywords="telemedicine", keywords="telehealth", keywords="eHealth", keywords="United States Department of Veterans Affairs", abstract="Background: Access to mental health care is challenging. The Veterans Health Administration (VHA) has been addressing these challenges through technological innovations including the implementation of Clinical Video Telehealth, two-way interactive and synchronous videoconferencing between a provider and a patient, and an electronic patient portal and personal health record, My HealtheVet. Objective: This study aimed to describe early adoption and use of My HealtheVet and Clinical Video Telehealth among VHA users with mental health diagnoses. Methods: We conducted a retrospective, cross-sectional analysis of early My HealtheVet adoption and Clinical Video Telehealth engagement among veterans with one or more mental health diagnoses who were VHA users from 2007 to 2012. We categorized veterans into four electronic health (eHealth) technology use groups: My HealtheVet only, Clinical Video Telehealth only, dual users who used both, and nonusers of either. We examined demographic characteristics and mental health diagnoses by group. We explored My HealtheVet feature use among My HealtheVet adopters. We then explored predictors of My HealtheVet adoption, Clinical Video Telehealth engagement, and dual use using multivariate logistic regression. Results: Among 2.17 million veterans with one or more mental health diagnoses, 1.51\% (32,723/2,171,325) were dual users, and 71.72\% (1,557,218/2,171,325) were nonusers of both My HealtheVet and Clinical Video Telehealth. African American and Latino patients were significantly less likely to engage in Clinical Video Telehealth or use My HealtheVet compared with white patients. Low-income patients who met the criteria for free care were significantly less likely to be My HealtheVet or dual users than those who did not. The odds of Clinical Video Telehealth engagement and dual use decreased with increasing age. Women were more likely than men to be My HealtheVet or dual users but less likely than men to be Clinical Video Telehealth users. Patients with schizophrenia or schizoaffective disorder were significantly less likely to be My HealtheVet or dual users than those with other mental health diagnoses (odds ratio, OR 0.50, CI 0.47-0.53 and OR 0.75, CI 0.69-0.80, respectively). Dual users were younger (53.08 years, SD 13.7, vs 60.11 years, SD 15.83), more likely to be white, and less likely to be low-income than the overall cohort. Although rural patients had 17\% lower odds of My HealtheVet adoption compared with urban patients (OR 0.83, 95\% CI 0.80-0.87), they were substantially more likely than their urban counterparts to engage in Clinical Video Telehealth and dual use (OR 2.45, 95\% CI 1.95-3.09 for Clinical Video Telehealth and OR 2.11, 95\% CI 1.81-2.47 for dual use). Conclusions: During this study (2007-2012), use of these technologies was low, leaving much potential for growth. There were sociodemographic disparities in access to My HealtheVet and Clinical Video Telehealth and in dual use of these technologies. There was also variation based on types of mental health diagnosis. More research is needed to ensure that these and other patient-facing eHealth technologies are accessible and effectively used by all vulnerable patients. ", doi="10.2196/11350", url="http://www.jmir.org/2018/11/e11350/", url="http://www.ncbi.nlm.nih.gov/pubmed/30404771" } @Article{info:doi/10.2196/10091, author="Bucci, Sandra and Morris, Rohan and Berry, Katherine and Berry, Natalie and Haddock, Gillian and Barrowclough, Christine and Lewis, Sh{\^o}n and Edge, Dawn", title="Early Psychosis Service User Views on Digital Technology: Qualitative Analysis", journal="JMIR Ment Health", year="2018", month="Oct", day="31", volume="5", number="4", pages="e10091", keywords="qualitative", keywords="psychosis", keywords="framework analysis", keywords="digital health", keywords="mHealth", keywords="mobile phone", abstract="Background: Digital technology has the potential to improve outcomes for people with psychosis. However, to date, research has largely ignored service user views on digital health interventions (DHIs). Objective: The objective of our study was to explore early psychosis service users' subjective views on DHIs. Methods: Framework analysis was undertaken with data obtained from 21 semistructured interviews with people registered with early intervention for psychosis services. Robust measures were used to develop a stable framework, including member checking, triangulation, independent verification of themes, and consensus meetings. Results: The following 4 themes were established a priori: acceptability of technology in psychosis and mental health; technology increasing access to and augmenting mental health support; barriers to adopting DHIs; and concerns about management of data protection, privacy, risk, and security of information. The following 2 themes were generated a posteriori: blending DHIs with face-to-face treatment and empowerment, control, and choice. DHIs were also viewed as potentially destigmatizing, overcoming barriers faced in traditional service settings, facilitating communication, and empowering service users to take active control of their health care. Conclusions: In the first study of its kind, early psychosis service users' were largely positive about the potential use of DHIs supporting and managing mental health. Overall, service users felt that DHIs were a progressive, modern, and relevant platform for health care delivery. Concerns were expressed around privacy and data security and practical barriers inherent within DHIs, all of which require further attention. Future research should explore whether findings transfer to other service user groups, other technology delivery formats, and across a range of treatment modalities. ", doi="10.2196/10091", url="http://mental.jmir.org/2018/4/e10091/", url="http://www.ncbi.nlm.nih.gov/pubmed/30381280" } @Article{info:doi/10.2196/10032, author="Payton, Cobb Fay and Yarger, Kvasny Lynette and Pinter, Thomas Anthony", title="Text Mining Mental Health Reports for Issues Impacting Today's College Students: Qualitative Study", journal="JMIR Ment Health", year="2018", month="Oct", day="23", volume="5", number="4", pages="e10032", keywords="text mining", keywords="mental health", keywords="college students", keywords="information and communication technologies", abstract="Background: A growing number of college students are experiencing personal circumstances or encountering situations that feel overwhelming and negatively affect their academic studies and other aspects of life on campus. To meet this growing demand for counseling services, US colleges and universities are offering a growing variety of mental health services that provide support and services to students in distress. Objective: In this study, we explore mental health issues impacting college students using a corpus of news articles, foundation reports, and media stories. Mental health concerns within this population have been on the rise. Uncovering the most salient themes articulated in current news and literature reports can better enable higher education institutions to provide health services to its students. Methods: We used SAS Text Miner to analyze 165 references that were published from 2010 to 2015 and focused on mental health among college students. Key clusters were identified to reveal the themes that were most significant to the topic. Results: The final cluster analysis yielded six themes in students' mental health experiences in higher education (ie, age, race, crime, student services, aftermath, victim). Two themes, increasing demand for student services provided by campus counseling centers (113/165, 68.5\%) and the increased mental health risks faced by racial and ethnic minorities (30/165, 18.2\%), dominated the discourse. Conclusions: Higher education institutions are actively engaged in extending mental health services and offering targeted outreach to students of color. Cluster analysis identified that institutions are devoting more and innovative resources in response to the growing number students who experience mental health concerns. However, there is a need to focus on proactive approaches to mitigate the causes of mental health and the aftermath of a negative experience, particularly violence and sexual assault. Such strategies can potentially influence how students navigate their health information seeking and how information and communication technologies, including mobile apps, can partially address the needs of college students. ", doi="10.2196/10032", url="http://mental.jmir.org/2018/4/e10032/", url="http://www.ncbi.nlm.nih.gov/pubmed/30355565" } @Article{info:doi/10.2196/10973, author="Eichenberg, Christiane and Schott, Markus and Sawyer, Adam and Aumayr, Georg and Pl{\"o}{\ss}nig, Manuela", title="Feasibility and Conceptualization of an e-Mental Health Treatment for Depression in Older Adults: Mixed-Methods Study", journal="JMIR Aging", year="2018", month="Oct", day="23", volume="1", number="2", pages="e10973", keywords="depression", keywords="online therapy", keywords="e-mental health", abstract="Background: Depression is one of the most common mental disorders in older adults. Unfortunately, it often goes unrecognized in the older population. Objective: The aim of this study was to identify how Web-based apps can recognize and help treat depression in older adults. Methods: Focus groups were conducted with mental health care experts. A Web-based survey of 56 older adults suffering from depression was conducted. Qualitative interviews were conducted with 2 individuals. Results: Results of the focus groups highlighted that there is a need for a collaborative care platform for depression in old age. Findings from the Web-based study showed that younger participants (aged 50 to 64 years) used electronic media more often than older participants (aged 65 years and older). The interviews pointed in a comparable direction. Conclusions: Overall, an e-mental (electronic mental) health treatment for depression in older adults would be well accepted. Web-based care platforms should be developed, evaluated, and in case of evidence for their effectiveness, integrated into the everyday clinic. ", doi="10.2196/10973", url="http://aging.jmir.org/2018/2/e10973/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518235" } @Article{info:doi/10.2196/10748, author="Connolly, L. Samantha and Miller, J. Christopher and Koenig, J. Christopher and Zamora, A. Kara and Wright, B. Patricia and Stanley, L. Regina and Pyne, M. Jeffrey", title="Veterans' Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences", journal="JMIR Mhealth Uhealth", year="2018", month="Aug", day="22", volume="6", number="8", pages="e10748", keywords="smartphone apps", keywords="mobile phone", keywords="mhealth", keywords="mental health", keywords="qualitative analysis", keywords="rurality", keywords="age", keywords="veterans", keywords="depression", keywords="anxiety disorders", keywords="posttraumatic stress disorder", keywords="PTSD", keywords="alcohol abuse", abstract="Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans' attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective: The objective of our study was to examine veterans' attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods: We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results: Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans' attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (?50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions: Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology. ", doi="10.2196/10748", url="http://mhealth.jmir.org/2018/8/e10748/", url="http://www.ncbi.nlm.nih.gov/pubmed/30135050" } @Article{info:doi/10.2196/mental.9950, author="Bonet, Lucia and Ll{\'a}cer, Blanca and Hernandez-Viadel, Miguel and Arce, David and Blanquer, Ignacio and Ca{\~n}ete, Carlos and Escart{\'i}, Maria and Gonz{\'a}lez-Pinto, M. Ana and Sanju{\'a}n, Julio", title="Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire", journal="JMIR Ment Health", year="2018", month="Jul", day="25", volume="5", number="3", pages="e51", keywords="eHealth", keywords="internet", keywords="mobile phone", keywords="viability", keywords="acceptability", keywords="psychosis", keywords="schizophrenia", abstract="Background: Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. Objective: The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. Methods: We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients' interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). Results: In this study, 84.8\% (89/105) of the patients had access to the internet and 88.6\% (93/105) owned an electronic internet device. In total, 71.3\% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2\% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). Conclusions: The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7\% (23/80) of the studied patients rejected the use of internet interventions and 38.2\% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments. ", doi="10.2196/mental.9950", url="http://mental.jmir.org/2018/3/e51/", url="http://www.ncbi.nlm.nih.gov/pubmed/30045835" } @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/10.2196/10141, author="Schueller, M. Stephen and Neary, Martha and O'Loughlin, Kristen and Adkins, C. Elizabeth", title="Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study", journal="J Med Internet Res", year="2018", month="Jun", day="11", volume="20", number="6", pages="e10141", keywords="mHealth", keywords="mental health", keywords="mobile apps", keywords="consumer preference", keywords="focus groups", abstract="Background: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. Objective: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. Methods: Participants were recruited from Northwestern University's Center for Behavioral Intervention Technologies' research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. Results: Survey participants commonly found health apps through social media (45.1\%, 366/811), personal searches (42.7\%, 346/811), or word of mouth (36.9\%, 299/811), as opposed to professional sources such as medical providers (24.6\%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. Conclusions: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people's adoption and use of such technologies. Our findings indicated that a number of factors---ease of use, aesthetics, and individual experience---drove adoption and use and highlighted areas of focus for app developers and disseminators. ", doi="10.2196/10141", url="http://www.jmir.org/2018/6/e10141/", url="http://www.ncbi.nlm.nih.gov/pubmed/29891468" } @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/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/games.8609, author="Vervaeke, Jasmien and Van Looy, Jan and Hoorelbeke, Kristof and Baeken, Chris and Koster, HW Ernst", title="Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis", journal="JMIR Serious Games", year="2018", month="Apr", day="05", volume="6", number="2", pages="e6", keywords="depression", keywords="cognitive dysfunction", keywords="cognitive remediation", keywords="relapse prevention", keywords="qualitative research", keywords="secondary prevention", abstract="Background: The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. Objective: The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. Methods: We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. Results: Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. Conclusions: The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression. ", doi="10.2196/games.8609", url="http://games.jmir.org/2018/2/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/29622525" } @Article{info:doi/10.2196/mental.8891, author="Champion, Elizabeth Katrina and Chapman, Cath and Newton, Clare Nicola and Brierley, Mary-Ellen and Stapinski, Lexine and Kay-Lambkin, Frances and Nagle, Jack and Teesson, Maree", title="A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice", journal="JMIR Ment Health", year="2018", month="Mar", day="20", volume="5", number="1", pages="e21", keywords="methamphetamine", keywords="substance-related disorders", keywords="internet", keywords="preventive psychiatry", keywords="health education", abstract="Background: The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. Objective: This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Methods: Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit's acceptability, relevance, and appeal. Results: Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were ``to get information for myself'' (185/451, 41.0\%) and ``to find out how to help a friend or a family member'' (136/451, 30.2\%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a ``low prevalence of use, yet high impact'' message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93\% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07\% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. Conclusions: The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities. ", doi="10.2196/mental.8891", url="http://mental.jmir.org/2018/1/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/29559427" } @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/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.9146, author="Carolan, Stephany and de Visser, O. Richard", title="Employees' Perspectives on the Facilitators and Barriers to Engaging With Digital Mental Health Interventions in the Workplace: Qualitative Study", journal="JMIR Ment Health", year="2018", month="Jan", day="19", volume="5", number="1", pages="e8", keywords="anxiety", keywords="depression", keywords="eHealth", keywords="Internet", keywords="mental health", keywords="mHealth", keywords="occupational", keywords="online", keywords="stress", keywords="workplace", abstract="Background: Prevalence rates of work-related stress, depression, and anxiety are high, resulting in reduced productivity and increased absenteeism. There is evidence that these conditions can be successfully treated in the workplace, but take-up of psychological treatments among workers is low. Digital mental health interventions delivered in the workplace may be one way to address this imbalance, but although there is evidence that digital mental health is effective at treating stress, depression, and anxiety in the workplace, uptake of and engagement with these interventions remains a concern. Additionally, there is little research on the appropriateness of the workplace for delivering these interventions or on what the facilitators and barriers to engagement with digital mental health interventions in an occupational setting might be. Objective: The aim of this research was to get a better understanding of the facilitators and barriers to engaging with digital mental health interventions in the workplace. Methods: Semistructured interviews were held with 18 participants who had access to an occupational digital mental health intervention as part of a randomized controlled trial. The interviews were transcribed, and thematic analysis was used to develop an understanding of the data. Results: Digital mental health interventions were described by interviewees as convenient, flexible, and anonymous; these attributes were seen as being both facilitators and barriers to engagement in a workplace setting. Convenience and flexibility could increase the opportunities to engage with digital mental health, but in a workplace setting they could also result in difficulty in prioritizing time and ensuring a temporal and spatial separation between work and therapy. The anonymity of the Internet could encourage use, but that benefit may be lost for people who work in open-plan offices. Other facilitators to engagement included interactive and interesting content and design features such as progress trackers and reminders to log in. The main barrier to engagement was the lack of time. The perfect digital mental health intervention was described as a website that combined a short interactive course that was accessed alongside time-unlimited information and advice that was regularly updated and could be dipped in and out of. Participants also wanted access to e-coaching support. Conclusions: Occupational digital mental health interventions may have an important role in delivering health care support to employees. Although the advantages of digital mental health interventions are clear, they do not always fully translate to interventions delivered in an occupational setting and further work is required to identify ways of minimizing potential barriers to access and engagement. Trial Registration: ClinicalTrials.gov: NCT02729987; https://clinicaltrials.gov/ct2/show/NCT02729987?term=NCT02729987\& rank=1 (Archived at WebCite at http://www.webcitation.org/6wZJge9rt) ", doi="10.2196/mental.9146", url="http://mental.jmir.org/2018/1/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/29351900" } @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.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.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.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/jmir.7130, author="Gesser-Edelsburg, Anat and Shalayeva, Svetlana", title="Internet as a Source of Long-Term and Real-Time Professional, Psychological, and Nutritional Treatment: A Qualitative Case Study Among Former Israeli Soviet Union Immigrants", journal="J Med Internet Res", year="2017", month="Feb", day="03", volume="19", number="2", pages="e33", keywords="long-term care", keywords="real-time systems", keywords="online systems, health psychology", keywords="nutrition therapy", keywords="qualitative research", keywords="former Soviet Union immigrants", abstract="Background: The Internet is considered to be an effective source of health information and consultation for immigrants. Nutritional interventions for immigrants have become increasingly common over the past few decades. However, each population of immigrants has specific needs. Understanding the factors influencing the success of nutrition programs among immigrants requires an examination of their attitudes and perceptions, as well as their cultural values. Objective: The purpose of this study was to examine perceptions of the Internet as a tool for long-term and ``real-time'' professional, psychological, and nutritional treatment for immigrants from the former Soviet Union who immigrated to Israel (IIFSU) from 1990 to 2012. Methods: A sample of nutrition forum users (n=18) was interviewed and comments of 80 users were analyzed qualitatively in accordance with the grounded theory principles. Results: The results show that IIFSU perceive the Internet as a platform for long-term and ``real-time'' dietary treatment and not just as an informative tool. IIFSU report benefits of online psychological support with professional dietary treatment. They attribute importance to cultural customization, which helps reduce barriers to intervention. Conclusions: In light of the results, when formulating nutritional programs, it is essential to have a specific understanding of immigrants' cultural characteristics and their patterns of Internet use concerning dietary care. ", doi="10.2196/jmir.7130", url="http://www.jmir.org/2017/2/e33/", url="http://www.ncbi.nlm.nih.gov/pubmed/28159729" } @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/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.5966, author="Fulford, Hamish and McSwiggan, Linda and Kroll, Thilo and MacGillivray, Stephen", title="Exploring the Use of Information and Communication Technology by People With Mood Disorder: A Systematic Review and Metasynthesis", journal="JMIR Ment Health", year="2016", month="Jul", day="01", volume="3", number="3", pages="e30", keywords="information and communication technology", keywords="ICTs", keywords="mood disorder", keywords="metasynthesis", keywords="self-management", abstract="Background: There is a growing body of evidence relating to how information and communication technology (ICT) can be used to support people with physical health conditions. Less is known regarding mental health, and in particular, mood disorder. Objective: To conduct a metasynthesis of all qualitative studies exploring the use of ICTs by people with mood disorder. Methods: Searches were run in eight electronic databases using a systematic search strategy. Qualitative and mixed-method studies published in English between 2007 and 2014 were included. Thematic synthesis was used to interpret and synthesis the results of the included studies. Results: Thirty-four studies were included in the synthesis. The methodological design of the studies was qualitative or mixed-methods. A global assessment of study quality identified 22 studies as strong and 12 weak with most having a typology of findings either at topical or thematic survey levels of data transformation. A typology of ICT use by people with mood disorder was created as a result of synthesis. Conclusions: The systematic review and metasynthesis clearly identified a gap in the research literature as no studies were identified, which specifically researched how people with mood disorder use mobile ICT. Further qualitative research is recommended to understand the meaning this type of technology holds for people. Such research might provide valuable information on how people use mobile technology in their lives in general and also, more specifically, how they are being used to help with their mood disorders. ", doi="10.2196/mental.5966", url="http://mental.jmir.org/2016/3/e30/", url="http://www.ncbi.nlm.nih.gov/pubmed/27370327" } @Article{info:doi/10.2196/mental.5324, author="Wallin, Karolina Emma Emmett and Mattsson, Susanne and Olsson, Gustaf Erik Martin", title="The Preference for Internet-Based Psychological Interventions by Individuals Without Past or Current Use of Mental Health Treatment Delivered Online: A Survey Study With Mixed-Methods Analysis", journal="JMIR Ment Health", year="2016", month="Jun", day="14", volume="3", number="2", pages="e25", keywords="patient acceptance of health care", keywords="patient preference", keywords="patient satisfaction", keywords="Internet-based cognitive behavioral therapy", keywords="chronic disease", keywords="mental health care", keywords="eHealth", keywords="implementation", keywords="qualitative research", abstract="Background: The use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified. Objective: The aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions. Methods: Two convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods. Results: The preference for Internet-based psychological interventions was low in both Sample 1 (6.5\%) and Sample 2 (2.6\%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95\% CI 1.18-6.75) and Sample 2 (OR 3.52, 95\% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95\% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished communication between therapist and client, fear of negative side effects, requirements of computer literacy, and concerns about confidentiality. Conclusions: Internet-based interventions were reported as the preferred choice by a minority of participants. The results suggest that Internet-based interventions have specific advantages that may facilitate help-seeking among some individuals and some disadvantages that may restrict its use. Initiatives to increase treatment acceptability may benefit from addressing the advantages and disadvantages reported in this study. ", doi="10.2196/mental.5324", url="http://mental.jmir.org/2016/2/e25/", url="http://www.ncbi.nlm.nih.gov/pubmed/27302200" } @Article{info:doi/10.2196/jmir.5442, author="Bernard, Renaldo and Sabariego, Carla and Cieza, Alarcos", title="Barriers and Facilitation Measures Related to People With Mental Disorders When Using the Web: A Systematic Review", journal="J Med Internet Res", year="2016", month="Jun", day="09", volume="18", number="6", pages="e157", keywords="World Wide Web", keywords="mental disorders", keywords="systematic review", keywords="accessibility", keywords="interaction design", keywords="Web-based interaction", abstract="Background: Mental disorders (MDs) affect almost 1 in 4 adults at some point during their lifetime, and coupled with substance use disorders are the fifth leading cause of disability adjusted life years worldwide. People with these disorders often use the Web as an informational resource, platform for convenient self-directed treatment, and a means for many other kinds of support. However, some features of the Web can potentially erect barriers for this group that limit their access to these benefits, and there is a lack of research looking into this eventuality. Therefore, it is important to identify gaps in knowledge about ``what'' barriers exist and ``how'' they could be addressed so that this knowledge can inform Web professionals who aim to ensure the Web is inclusive to this population. Objective: The objective of this study was to provide an overview of existing evidence regarding the barriers people with mental disorders experience when using the Web and the facilitation measures used to address such barriers. Methods: This study involved a systematic review of studies that have considered the difficulties people with mental disorders experience when using digital technologies. Digital technologies were included because knowledge about any barriers here would likely be also applicable to the Web. A synthesis was performed by categorizing data according to the 4 foundational principles of Web accessibility as proposed by the World Wide Web Consortium, which forms the necessary basis for anyone to gain adequate access to the Web. Facilitation measures recommended by studies were later summarized into a set of minimal recommendations. Results: A total of 16 publications were included in this review, comprising 13 studies and 3 international guidelines. Findings suggest that people with mental disorders experience barriers that limit how they perceive, understand, and operate websites. Identified facilitation measures target these barriers in addition to ensuring that Web content can be reliably interpreted by a wide range of user applications. Conclusions: People with mental disorders encounter barriers on the Web, and attempts have been made to remove or reduce these barriers. As forewarned by experts in the area, only a few studies investigating this issue were found. More rigorous research is needed to be exhaustive and to have a larger impact on improving the Web for people with mental disorders. ", doi="10.2196/jmir.5442", url="http://www.jmir.org/2016/6/e157/", url="http://www.ncbi.nlm.nih.gov/pubmed/27282115" } @Article{info:doi/10.2196/jmir.5685, author="Wang, JianLi and Lam, W. Raymond and Ho, Kendall and Attridge, Mark and Lashewicz, M. Bonnie and Patten, B. Scott and Marchand, Alain and Aiken, Alice and Schmitz, Norbert and Gundu, Sarika and Rewari, Nitika and Hodgins, David and Bulloch, Andrew and Merali, Zul", title="Preferred Features of E-Mental Health Programs for Prevention of Major Depression in Male Workers: Results From a Canadian National Survey", journal="J Med Internet Res", year="2016", month="Jun", day="06", volume="18", number="6", pages="e132", keywords="depression", keywords="Internet", keywords="prevention", keywords="e-mental health programs", keywords="design features", keywords="men", abstract="Background: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs. Objectives: The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE). Methods: A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE. Results: High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4\% vs 75.0\%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: ``information about improving sleep hygiene'' (61.3\%), ``practice and exercise to help reduce symptoms of stress and depression'' (59.5\%), and ``having access to quality information and resources about work stress issues'' (57.8\%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE. Conclusion: E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's preferences and perceived barriers to enhance the acceptability of this approach. ", doi="10.2196/jmir.5685", url="http://www.jmir.org/2016/6/e132/", url="http://www.ncbi.nlm.nih.gov/pubmed/27267782" } @Article{info:doi/10.2196/humanfactors.4765, author="Chan, KY Jade and Farrer, M. Louise and Gulliver, Amelia and Bennett, Kylie and Griffiths, M. Kathleen", title="University Students' Views on the Perceived Benefits and Drawbacks of Seeking Help for Mental Health Problems on the Internet: A Qualitative Study", journal="JMIR Human Factors", year="2016", month="Jan", day="19", volume="3", number="1", pages="e3", keywords="online", keywords="mental health", keywords="help seeking", keywords="university", keywords="students", keywords="qualitative", abstract="Background: University students experience high levels of mental health problems yet very few seek professional help. Web-based mental health interventions may be useful for the university student population. However, there are few published qualitative studies that have examined the perceived benefits and drawbacks of seeking help for mental health problems on the Internet from the perspective of university students. Objective: To investigate the attitudes of university students on mental health help-seeking on the Internet. Methods: A total of 19 university students aged 19-24 years participated in 1 of 4 focus groups to examine their views toward help-seeking for mental health problems on the Internet. Results: Perceived concerns about Web-based help-seeking included privacy and confidentiality, difficulty communicating on the Internet, and the quality of Web-based resources. Potential benefits included anonymity/avoidance of stigma, and accessibility. Participants reported mixed views regarding the ability of people with similar mental health issues to interact on the Internet. Conclusions: These factors should be considered in the development of Web-based mental health resources to increase acceptability and engagement from university students. ", doi="10.2196/humanfactors.4765", url="http://humanfactors.jmir.org/2016/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/27026140" } @Article{info:doi/10.2196/mental.4356, author="Crisp, A. Dimity and Griffiths, M. Kathleen", title="Reducing Depression Through an Online Intervention: Benefits From a User Perspective", journal="JMIR Mental Health", year="2016", month="Jan", day="08", volume="3", number="1", pages="e4", keywords="Internet interventions", keywords="depression", abstract="Background: Internet interventions are increasingly being recognized as effective in the treatment and prevention of mental health conditions; however, the usefulness of such programs from the perspective of the participants is often not reported. Objective: This study explores the experiences of participants of a 12-week randomized controlled trial of an automated self-help training program (e-couch), with and without an Internet support group, targeting depression. Methods: The study comprised a community sample of 298 participants who completed an online survey both prior to and on completion of an intervention for preventing or reducing depressive symptoms. Results: Overall, participants reported a high level of confidence in the ability of an online intervention to improve a person's understanding of depression. However, confidence that a website could help people learn skills for preventing depression was lower. Benefits reported by participants engaged in the intervention included increased knowledge regarding depression and its treatment, reduced depressive symptoms, increased work productivity, and improved ability to cope with everyday stress. A minority of participants reported concerns or problems resulting from participation in the interventions. Conclusions: The findings provide consumer support for the effectiveness of this online intervention. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 65657330;http://www.isrctn.com/ISRCTN65657330 (Archived by WebCite at http://www.webcitation.org/6cwH8xwF0) ", doi="10.2196/mental.4356", url="http://mental.jmir.org/2016/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/26747378" } @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/cancer.4631, author="K{\"o}hle, Nadine and Drossaert, HC Constance and Oosterik, Suzan and Schreurs, MG Karlein and Hagedoorn, Mari{\"e}t and van Uden-Kraan, F. Cornelia and Verdonck-de Leeuw, M. Irma and Bohlmeijer, T. Ernst", title="Needs and Preferences of Partners of Cancer Patients Regarding a Web-Based Psychological Intervention: A Qualitative Study", journal="JMIR Cancer", year="2015", month="Dec", day="29", volume="1", number="2", pages="e13", keywords="cancer", keywords="oncology", keywords="partner", keywords="needs", keywords="web-based interventions", keywords="interventions", abstract="Background: Evidence-based, easily accessible, supportive interventions for partners of cancer patients are limited, despite the fact that they often suffer from diminished emotional, social, physical, and relational functioning. To develop a new intervention that will fit their demands, it is important to consult potential users. Objective: To examine partners' interest in a Web-based psychological intervention and to identify their needs and wishes regarding such an intervention. Methods: Semistructured interviews were conducted with 16 partners of cancer patients, who varied in terms of age, gender, education, employment, type, and stage of disease. Partners were asked (1) whether they would use a psychological Web-based intervention and which preconditions (maximum time, structure, participate alone or with their partner) it should meet; (2) which functionalities (information, peer support, online psychological counseling) the intervention should contain; and (3) which topics (eg, taking care of oneself) should be addressed. Data were coded by 2 coders independently. Results: The need for a Web-based intervention varied. Arguments for being interested in a Web-based intervention included the need for acknowledgement; the need for someone they could talk to; and the need for information, tips, and support. Based on their experiences as a partner of a cancer patient, participants would prefer an intervention that is not too time-consuming (about 1-2 hours a week) and which is based on a ``step-by-step'' approach, meaning that the content of the intervention should match the stage of their partner's disease. Also, they would prefer a positive approach, which means that the intervention should be a source of hope and energy. Most participants stated that they would prefer to participate without their ill spouse, because they do not want to burden their partners with their own problems. An intervention should contain information and optional peer support. Participants' opinions about online psychological counseling in the intervention were divided. Arguments for online psychological counseling were that a professional could check on them and they were able to ask questions. Arguments against online counseling were that partners were not in need for guidance or they had enough support from usual care. Topics with the highest priority were ``coping with feelings and emotions,'' ``should I or shouldn't I spare my partner?,'' ``communicating with each other,'' ``asking for help and refusing help,'' and ``moving on with life after cancer treatment.'' Furthermore, participants suggested additional topics of ``dare to enjoy'' and ``acceptance of the patient's disease.'' Conclusions: A Web-based intervention can be a valuable addition to existing support initiatives for partners of cancer patients. This study provides important information about the content and form of such an intervention. Flexibility and a positive approach seem to be the most important features. ", doi="10.2196/cancer.4631", url="http://cancer.jmir.org/2015/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410157" } @Article{info:doi/10.2196/jmir.4817, author="Woolderink, Marla and Bindels, APM Jill and Evers, MAA Silvia and Paulus, TG Aggie and van Asselt, DI Antoinette and van Schayck, CP Onno", title="An Online Health Prevention Intervention for Youth with Addicted or Mentally Ill Parents: Experiences and Perspectives of Participants and Providers from a Randomized Controlled Trial", journal="J Med Internet Res", year="2015", month="Dec", day="02", volume="17", number="12", pages="e274", keywords="online-delivered course", keywords="process assessment", keywords="qualitative research", keywords="mental health", keywords="prevention", keywords="adolescents", abstract="Background: Mental illnesses affect many people around the world, either directly or indirectly. Families of persons suffering from mental illness or addiction suffer too, especially their children. In the Netherlands, 864,000 parents meet the diagnostic criteria for a mental illness or addiction. Evidence shows that offspring of mentally ill or addicted parents are at risk for developing mental disorders or illnesses themselves. The Kopstoring course is an online 8-week group course with supervision by 2 trained psychologists or social workers, aimed to prevent behavioral and psychological problems for children (aged 16 to 25 years) of parents with mental health problems or addictions. The course addresses themes such as roles in the family and mastery skills. An online randomized controlled trial (RCT) was conducted to assess the effectiveness of the Kopstoring course. Objective: The aim was to gain knowledge about expectations, experiences, and perspectives of participants and providers of the online Kopstoring course. Methods: A process evaluation was performed to evaluate the online delivery of Kopstoring and the experiences and perspectives of participants and providers of Kopstoring. Interviews were performed with members from both groups. Participants were drawn from a sample from the Kopstoring RCT. Results: Thirteen participants and 4 providers were interviewed. Five main themes emerged from these interviews: background, the requirements for the intervention, experience with the intervention, technical aspects, and research aspects. Overall, participants and providers found the intervention to be valuable because it was online; therefore, protecting their anonymity was considered a key component. Most barriers existed in the technical sphere. Additional barriers existed with conducting the RCT, namely gathering informed consent and gathering parental consent in the case of minors. Conclusions: This study provides valuable insight into participants' and providers' experiences and expectations with the online preventive intervention Kopstoring. It also sheds light on the process of the online provision of Kopstoring and the accompanying RCT. The findings of this study may partly explain dropout rates when delivering online interventions. The change in the (financial) structure of the youth mental health care system in the Netherlands has financial implications for the delivery of prevention programs for youth. Lastly, there are few RCTs that assess the effectiveness and cost-effectiveness of online prevention programs in the field of (youth) mental health care and not many process evaluations of these programs exist. This hampers a good comparison between online interventions and the expectations and experiences of the participants and providers. Trial Registration: Nederlands Trial Register: NTR1982; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1982 (Archived by WebCite? at http://www.webcitation.org/6d8xYDQbB) ", doi="10.2196/jmir.4817", url="http://www.jmir.org/2015/12/e274/", url="http://www.ncbi.nlm.nih.gov/pubmed/26633244" } @Article{info:doi/10.2196/mental.4400, author="Lal, Shalini and Dell'Elce, Jennifer and Tucci, Natasha and Fuhrer, Rebecca and Tamblyn, Robyn and Malla, Ashok", title="Preferences of Young Adults With First-Episode Psychosis for Receiving Specialized Mental Health Services Using Technology: A Survey Study", journal="JMIR Mental Health", year="2015", month="May", day="20", volume="2", number="2", pages="e18", keywords="eHealth", keywords="health services accessibility", keywords="medical informatics", keywords="mHealth", keywords="patient engagement", keywords="telemedicine", abstract="Background: Despite the potential and interest of using technology for delivering specialized psychiatric services to young adults, surprisingly limited attention has been paid to systematically assess their perspectives in this regard. For example, limited knowledge exists on the extent to which young people receiving specialized services for a first-episode psychosis (FEP) are receptive to using new technologies as part of mental health care, and to which types of technology-enabled mental health interventions they are amenable to. Objective: The purpose of this study is to assess the interest of young adults with FEP in using technology to receive mental health information, services, and supports. Methods: This study uses a cross-sectional, descriptive survey design. A convenience sample of 67 participants between the ages of 18 and 35 were recruited from two specialized early intervention programs for psychosis. Interviewer-administered surveys were conducted between December 2013 and October 2014. Descriptive statistics are reported. Results: Among the 67 respondents who completed the survey, the majority (85\%, 57/67) agreed or strongly agreed with YouTube as a platform for mental health-related services and supports. The top five technology-enabled services that participants were amenable to were (1) information on medication (96\%, 64/67); (2) information on education, career, and employment (93\%, 62/67); (3) decision-making tools pertaining to treatment and recovery (93\%, 62/67); (4) reminders for appointments via text messaging (93\%, 62/67); and (5) information about mental health, psychosis, and recovery in general (91\%, 61/67). The top self-reported barriers to seeking mental health information online were lack of knowledge on how to perform an Internet search (31\%, 21/67) and the way information is presented online (27\%, 18/67). Two thirds (67\%; 45/67) reported being comfortable in online settings, and almost half (48\%; 32/67) reported a preference for mixed formats when viewing mental health information online (eg, text, video, visual graphics). Conclusions: Young people diagnosed with FEP express interest in using the Internet, social media, and mobile technologies for receiving mental health-related services. Increasing the awareness of young people in relation to various forms of technology-enabled mental health care warrants further attention. A consideration for future research is to obtain more in-depth knowledge on young people's perspectives, which can help improve the design, development, and implementation of integrated technological health innovations within the delivery of specialized mental health care. ", doi="10.2196/mental.4400", url="http://mental.jmir.org/2015/2/e18/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543922" } @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.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" }