@Article{info:doi/10.2196/mental.7847,
author="Robinson, Jo
and Bailey, Eleanor
and Hetrick, Sarah
and Paix, Steve
and O'Donnell, Matt
and Cox, Georgina
and Ftanou, Maria
and Skehan, Jaelea",
title="Developing Social Media-Based Suicide Prevention Messages in Partnership With Young People: Exploratory Study",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="04",
volume="4",
number="4",
pages="e40",
keywords="suicide",
keywords="suicidal ideation",
keywords="social media",
keywords="youth",
keywords="adolescents",
keywords="mass media",
abstract="Background: Social media is increasingly being used by young people for health-related issues, including communicating about suicide. Due to the concerns about causing distress or inducing suicidal thoughts or behaviors, to date young people neither have been engaged in the development of social media--based suicide prevention interventions nor have interventions focused on educating young people about safe ways to communicate about suicide online. Given the potential that social media holds to deliver messages to vast numbers of people across space and time and the fact that young people often prefer to seek help from their friends and peers, safely educating and engaging young people to develop suicide prevention messages that can be delivered via social media is an obvious next step. Objectives: The objectives of this study were to (1) provide education to a small number of secondary school students about safe ways to communicate about suicide via social media; (2) engage the same young people in the development of a suite of social media--based suicide prevention multimedia messages; (3) assess the impact of this on participants; and (4) assess the acceptability and safety of the messages developed. Methods: This study involved two phases. In phase 1, 20 participants recruited from two schools took part in an 8- to 10-week program during which they were provided with psychoeducation about mental health and suicide, including how to talk safely about suicide online, and they were then supported to design and develop their own media messages. These participants completed an evaluation questionnaire at the conclusion of the program. In phase 2, a larger group of participants (n=69), recruited via an opt-in process, viewed the media messages and completed a short questionnaire about each one. Results: Participants in phase 1 enjoyed the program and reported that they learned new skills, such as how to talk safely about suicide online, and felt more able to provide emotional support to others (16/20, 80\%). No participants reported that the program made them feel suicidal. Participants in phase 2 generally rated the media messages as safe and acceptable, although some messages were rated more highly than others. Conclusions: This study suggests that young people can be safely engaged in developing suicide prevention messages, which can be disseminated via social media. Engaging young people in this process may improve the traction that such campaigns will have with other young people. The study also suggests that educating young people regarding how to talk safely about suicide online has multiple benefits and is not associated with distress. Overall, these findings pave the way for new approaches to prevent suicide among young people. ",
doi="10.2196/mental.7847",
url="https://mental.jmir.org/2017/4/e40/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28978499"
}


@Article{info:doi/10.2196/mental.8141,
author="Lachmar, Megan E.
and Wittenborn, K. Andrea
and Bogen, W. Katherine
and McCauley, L. Heather",
title="\#MyDepressionLooksLike: Examining Public Discourse About Depression on Twitter",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="18",
volume="4",
number="4",
pages="e43",
keywords="social media",
keywords="depression",
keywords="community networks",
keywords="social stigma",
abstract="Background: Social media provides a context for billions of users to connect, express sentiments, and provide in-the-moment status updates. Because Twitter users tend to tweet emotional updates from daily life, the platform provides unique insights into experiences of mental health problems. Depression is not only one of the most prevalent health conditions but also carries a social stigma. Yet, opening up about one's depression and seeking social support may provide relief from symptoms. Objective: The aim of this study was to examine the public discourse of the trending hashtag \#MyDepressionLooksLike to look more closely at how users talk about their depressive symptoms on Twitter. Methods: We captured 3225 original content tweets for the hashtag \#MyDepressionLooksLike that circulated in May of 2016. Eliminating public service announcements, spam, and tweets with links to pictures or videos resulted in a total of 1978 tweets. Using qualitative content analysis, we coded the tweets to detect themes. Results: The content analysis revealed seven themes: dysfunctional thoughts, lifestyle challenges, social struggles, hiding behind a mask, apathy and sadness, suicidal thoughts and behaviors, and seeking relief. Conclusions: The themes revealed important information about the content of the public messages that people share about depression on Twitter. More research is needed to understand the effects of the hashtag on increasing social support for users and reducing social stigma related to depression. ",
doi="10.2196/mental.8141",
url="http://mental.jmir.org/2017/4/e43/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29046270"
}


@Article{info:doi/10.2196/mental.8571,
author="Heilemann, V. MarySue
and Soderlund, D. Patricia
and Kehoe, Priscilla
and Brecht, Mary-Lynn",
title="A Transmedia Storytelling Intervention With Interactive Elements to Benefit Latinas' Mental Health: Feasibility, Acceptability, and Efficacy",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="19",
volume="4",
number="4",
pages="e47",
keywords="depression",
keywords="anxiety",
keywords="transmedia",
keywords="Internet",
keywords="mental health",
keywords="mood disorders",
keywords="smartphone",
abstract="Background: Latinos report higher rates of depression and anxiety than US whites but are less likely to receive care. Transmedia storytelling interventions accessible on the Internet via smartphones, tablets, and computers hold promise for reducing reluctance to explore or get help for symptoms because they are private, convenient, and can reach large numbers of people, including Latinas with mental health needs. Objective: The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mental health transmedia intervention for Latinas with elevated symptoms of depression, anxiety, or both. Methods: A total of 28 symptomatic English-speaking Latina women aged 21 to 48 years participated in a 6-week study using a within-group design. All aspects of the study were completed via telephone or Internet. Participants used their personal devices to engage the Web-based transmedia intervention (in English) that included story-based videos, a data-informed psychotherapeutic video, an interactive video sequence, and a blog written from the point of view of one of the characters with links to mental health resources. Perceived confidence to get help and perceived importance for seeking immediate help were both measured using single-item questions. Participants completed surveys at baseline (via telephone) and 1 and 6 weeks after media engagement that measured various factors, including depression (Patient Health Questionnaire; PHQ-9 and PHQ-8) and anxiety (Generalized Anxiety Disorder scale; GAD-7). A telephone interview was conducted within 72 hours of media engagement. Action taken or intentions to get help (single-item question) and talking about the videos with others (single-item question) were measured 1 and 6 weeks after media engagement. Repeated measures analysis of variance was used to assess change in depression (PHQ-8) and anxiety (GAD-7) before transmedia engagement and 1 and 6 weeks after. Spearman correlations evaluated the association of confidence and importance of getting help with action taken, anxiety, and depression. Results: All 28 Latinas (English speakers) who engaged with the transmedia remained in the 6-week study. Within 1 week of transmedia engagement, 39\% of women took action to get help, and 82\% discussed the media with others. Symptoms of depression (F2,54=9.0, P<.001) and anxiety (F2,54=18.7, P<.001) significantly reduced across time. Higher levels of confidence were significantly associated with actions taken at 1 (P=.005) and 6 weeks (P=.04), and higher levels of importance were significantly associated with actions taken at 1 (P=.009) and 6 weeks (P=.003). Higher levels of confidence were associated with lower levels of depression (P=.04) and anxiety (P=.01) at 6 weeks. Conclusions: Preliminary findings indicate a culturally tailored mental health transmedia intervention is a feasible approach that holds promise for engaging large numbers of symptomatic English-speaking Latina women to begin the process of seeking help, as well as decreasing symptoms of anxiety and depression. ",
doi="10.2196/mental.8571",
url="http://mental.jmir.org/2017/4/e47/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29051135"
}


@Article{info:doi/10.2196/mental.6888,
author="Kingston, Dawn
and Biringer, Anne
and Veldhuyzen van Zanten, Sander
and Giallo, Rebecca
and McDonald, Sarah
and MacQueen, Glenda
and Vermeyden, Lydia
and Austin, Marie-Paule",
title="Pregnant Women's Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="20",
volume="4",
number="4",
pages="e42",
keywords="pregnancy",
keywords="mental health",
keywords="screening",
keywords="prenatal care",
keywords="computers",
abstract="Background: Pregnant women's perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. Objective: The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women's perceptions of risk and benefit of disclosure. Methods: Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women's perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. Results: Of the 675 eligible women approached, 636 (94.2\%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1\% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. Conclusions: Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women's vulnerability throughout the screening process with strategies such as addressing women's concerns, explaining the rationale for screening, and discussing how results will be used. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at?http://www.webcitation.org/6tRKtGC4M) ",
doi="10.2196/mental.6888",
url="http://mental.jmir.org/2017/4/e42/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29054833"
}


@Article{info:doi/10.2196/mental.8180,
author="Muldoon, L. Abigail
and Kuhns, M. Lisa
and Supple, Julie
and Jacobson, C. Kristen
and Garofalo, Robert",
title="A Web-Based Study of Dog Ownership and Depression Among People Living With HIV",
journal="JMIR Ment Health",
year="2017",
month="Nov",
day="08",
volume="4",
number="4",
pages="e53",
keywords="HIV",
keywords="depression",
keywords="pet-human bonding",
abstract="Background: People living with human immunodeficiency virus (PLHIV) are approximately twice as likely to be depressed compared with HIV-negative individuals. Depression is consistently associated with low antiretroviral therapy (ART) adherence, an important step within the HIV care continuum related to HIV disease progression and overall health. One factor that may have positive psychosocial benefits and promote ART adherence is dog ownership. Research indicates that dog ownership is associated with lower depression, and initial evidence suggests its positive impact on psychosocial outcomes for PLHIV. Objective: The aim of our study was to expand the existing research by examining the relationship between current dog ownership and depression for a sample of PLHIV while controlling for demographic characteristics and other potential confounders. Methods: Participants aged 18 years or older and who self-reported an HIV diagnosis were recruited via social media into When Dogs Heal, a cross-sectional Web-based survey to collect data among adult PLHIV. The research visit was conducted via a Web-based survey, and there was no in-person interaction with the participant. Primary outcome measures included demographic questions (age, race, ethnicity, gender, and sexual orientation), pet ownership (type of pet owned and current dog ownership), depression (Center for Epidemiologic Studies Depression Scale, 10 items), and resilience (Resilience Research Centre Adult Resilience Measure, 28 items). Results: A total of 252 participants were enrolled into the study in January 2016, with a final analytic sample of 199 participants. Mean age was 49 years, 86.4\% (172/199) of participants were male, and 80.4\% (160/199) were white. Current dog ownership was prevalent among the sample (68.3\%, 136/199). Bivariate analysis indicated that there was no significant relationship between depression and demographic characteristics (age, race, ethnicity, gender, and sexual orientation), with P>.05. The multivariate logistic regression, including age, race, ethnicity, gender, resilience, and current dog ownership, was significant, with P<.001. Of the 6 predictor variables, only 2 were statistically significant: dog ownership and resilience. Noncurrent dog owners had 3 times higher odds of depression in comparison with current dog owners: odds ratio 3.01; 95\% CI 1.54-6.21. Conclusions: Growing evidence suggests that dog ownership reduces the likelihood of depression and, therefore, may confer long-term health benefits on PLHIV. Future studies should explore whether dog-specific interventions are a feasible and efficacious intervention to improve outcomes among PLHIV. ",
doi="10.2196/mental.8180",
url="http://mental.jmir.org/2017/4/e53/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29117933"
}


@Article{info:doi/10.2196/mental.8492,
author="Yap, BH Marie
and Lawrence, A. Katherine
and Rapee, M. Ronald
and Cardamone-Breen, C. Mairead
and Green, Jacqueline
and Jorm, F. Anthony",
title="Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety",
journal="JMIR Ment Health",
year="2017",
month="Dec",
day="19",
volume="4",
number="4",
pages="e59",
keywords="family",
keywords="tailored",
keywords="internet",
keywords="mental health",
keywords="preventive health services",
doi="10.2196/mental.8492",
url="http://mental.jmir.org/2017/4/e59/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258974"
}


@Article{info:doi/10.2196/mental.8086,
author="Frith, Emily
and Loprinzi, Paul",
title="Can Facebook Reduce Perceived Anxiety Among College Students? Randomized Controlled Exercise Trial Using the Transtheoretical Model of Behavior Change",
journal="JMIR Ment Health",
year="2017",
month="Dec",
day="08",
volume="4",
number="4",
pages="e50",
keywords="mental health",
keywords="physical activity behavior change",
keywords="social media",
abstract="Background: Recent studies suggest social media may be an attractive strategy to promote mental health and wellness. There remains a need to examine the utility for individually tailored wellness messages posted to social media sites such as Facebook to facilitate positive psychological outcomes. Objective: Our aim was to extend the growing body of evidence supporting the potential for social media to enhance mental health. We evaluated the influence of an 8-week social media intervention on anxiety in college students and examined the impact of dynamic (active) versus static (passive) Facebook content on physical activity behaviors. Methods: Participants in the static group (n=21) accessed a Facebook page featuring 96 statuses. Statuses were intended to engage cognitive processes followed by behavioral processes of change per the transtheoretical model of behavior change. Content posted on the static Facebook page was identical to the dynamic page; however, the static group viewed all 96 statuses on the first day of the study, while the dynamic group received only 1 to 2 of these status updates per day throughout the intervention. Anxiety was measured using the Overall Anxiety Severity and Impairment Scale (OASIS). Time spent engaging in physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Results: The OASIS change score for the dynamic Facebook group was statistically significant (P=.003), whereas the change score for the static group was not (P=.48). A statistically significant group-by-time interaction was observed (P=.03). The total IPAQ group-by-time interaction was not statistically significant (P=.06). Conclusions: We observed a decrease in anxiety and increase in total physical activity for the dynamic group only. Dynamic social networking sites, featuring regularly updated content, may be more advantageous than websites that retain static content over time. Trial Registration: ClinicalTrials.gov NCT03363737; https://clinicaltrials.gov/ct2/show/NCT03363737 (Archived by WebCite at http://www.webcitation.org/6vXzNbOWJ) ",
doi="10.2196/mental.8086",
url="http://mental.jmir.org/2017/4/e50/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29222077"
}


@Article{info:doi/10.2196/mental.6802,
author="Tonn, Peter
and Reuter, Christin Silja
and Kuchler, Isabelle
and Reinke, Britta
and Hinkelmann, Lena
and St{\"o}ckigt, Saskia
and Siemoneit, Hanna
and Schulze, Nina",
title="Development of a Questionnaire to Measure the Attitudes of Laypeople, Physicians, and Psychotherapists Toward Telemedicine in Mental Health",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="03",
volume="4",
number="4",
pages="e39",
keywords="screening",
keywords="questionnaire",
keywords="e-mental health",
keywords="remote consultation",
keywords="attitude to computers",
keywords="physician expectations",
keywords="telemedicine",
keywords="online-intervention",
abstract="Background: In the field of psychiatry and psychotherapy, there are now a growing number of Web-based interventions, mobile phone apps, or treatments that are available via remote transmission screen worldwide. Many of these interventions have been shown to be effective in studies but still find little use in everyday therapeutic work. However, it is important that attitude and expectation toward this treatment are generally examined, because these factors have an important effect on the efficacy of the treatment. To measure the general attitude of the users and prescribers toward telemedicine, which may include, for instance, Web-based interventions or interventions through mobile phone apps, there are a small number of extensive tests. The results of studies based on small groups of patients have been published too, but there is no useful short screening tool to give an insight into the general population's attitude. We have developed a screening instrument that examines such attitude through a few graded questions. Objective: This study aimed to explore the Attitude toward Telemedicine in Psychiatry and Psychotherapy (ATiPP) and to evaluate the results of general population and some subgroups. Methods: In a three-step process, the questionnaire, which is available in three versions (laypeople, physicians, and psychologists), was developed. Afterwards, it was evaluated by four groups: population-representative laypeople, outpatients in different faculties, physicians, and psychotherapists. Results: The results were evaluated from a total of 1554 questionnaires. The sample population included 1000 laypeople, 455 outpatients, 62 physicians, and 37 psychotherapists. The reliability of all three versions of the questionnaire seemed good, as indicated by the Cronbach alpha values of .849 (the laypeople group), .80 (the outpatients' group), .827 (the physicians' group), and .855 (the psychotherapists' group). Conclusions: The ATiPP was found to be useful and reliable for measuring the attitudes toward the Web-based interventions in psychiatry and psychotherapy and should be used in different studies in this field in the future to evaluate and reflect the attitude of the participants. ",
doi="10.2196/mental.6802",
url="https://mental.jmir.org/2017/4/e39/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28974485"
}


@Article{info:doi/10.2196/mental.8139,
author="Shen, Chen
and Wang, Ping Man
and Chu, TW Joanna
and Wan, Alice
and Viswanath, Kasisomayajula
and Chan, Chee Sophia Siu
and Lam, Hing Tai",
title="Sharing Family Life Information Through Video Calls and Other Information and Communication Technologies and the Association With Family Well-Being: Population-Based Survey",
journal="JMIR Ment Health",
year="2017",
month="Nov",
day="23",
volume="4",
number="4",
pages="e57",
keywords="mobile phone, video call, Chinese",
abstract="Background: The use of information and communication technologies (ICTs) for information sharing among family members is increasing dramatically. However, little is known about the associated factors and the influence on family well-being. Objective: The authors investigated the pattern and social determinants of family life information sharing with family and the associations of different methods of sharing with perceived family health, happiness, and harmony (3Hs) in Hong Kong, where mobile phone ownership and Internet access are among the most prevalent, easiest, and fastest in the world. Methods: A territory-wide population-based telephone survey was conducted from January to August 2016 on different methods of family life information (ie, information related to family communication, relationships with family members, emotion and stress management) sharing with family members, including face-to-face, phone, instant messaging (IM), social media sites, video calls, and email. Family well-being was assessed by three single items on perceived family health, happiness, and harmony, with higher scores indicating better family well-being. Adjusted prevalence ratios were used to assess the associations of sociodemographic factors with family life information sharing, and adjusted beta coefficients for family well-being. Results: Of 2017 respondents, face-to-face was the most common method to share family life information (74.45\%, 1502/2017), followed by IM (40.86\%, 824/2017), phone (28.10\%, 567/2017), social media sites (11.91\%, 240/2017), video calls (5.89\%, 119/2017), and email (5.48\%, 111/2017). Younger age and higher education were associated with the use of any (at least one) method, face-to-face, IM, and social media sites for sharing family life information (all P for trend <.01). Higher education was most strongly associated with the use of video calls (adjusted prevalence ratio=5.61, 95\% CI 2.29-13.74). Higher household income was significantly associated with the use of any method, face-to-face, and IM (all P for trend <.05). Sharing family life information was associated with a higher level of perceived family well-being (beta=0.56, 95\% CI 0.37-0.75), especially by face-to-face (beta=0.62, 95\% CI 0.45-0.80) and video calls (beta=0.34, 95\% CI 0.04-0.65). The combination of face-to-face and video calls was most strongly associated with a higher level of perceived family well-being (beta=0.81, 95\% CI 0.45-1.16). Conclusions: The differential use of ICTs to share family life information was observed. The prevalence of video calls was low, but associated with much better family well-being. The results need to be confirmed by prospective and intervention studies to promote the use of video calls to communicate and share information with family, particularly in disadvantaged groups. ",
doi="10.2196/mental.8139",
url="http://mental.jmir.org/2017/4/e57/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29170145"
}


@Article{info:doi/10.2196/mental.7262,
author="Crookston, T. Benjamin
and West, H. Joshua
and Hall, Cougar P.
and Dahle, Martinez Kaitana
and Heaton, L. Thomas
and Beck, N. Robin
and Muralidharan, Chandni",
title="Mental and Emotional Self-Help Technology Apps: Cross-Sectional Study of Theory, Technology, and Mental Health Behaviors",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="17",
volume="4",
number="4",
pages="e45",
keywords="mental health",
keywords="decision theory",
keywords="mobile applications",
abstract="Background: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health--related behavior change have not been thoroughly examined. Objective: The objective of this study was to examine the association between theoretical behavior change mechanisms and use of mental and emotional self-help apps and whether the use of such apps is associated with mental health behaviors. Methods: This study utilized a cross-sectional survey of 150 users of mental or emotional health apps in the past 6 months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement, and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior after controlling for potentially confounding variables. Results: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. Engagement (P<.001) was positively associated with the reported changes in theory items, whereas perceived behavior change was positively associated with theory (P<.001), engagement (P=.004), frequency of use of apps (P=.01), and income (P=.049). Conclusions: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. This increase in perceptions, beliefs, and attitudes surrounding their mental and emotional health was considerably associated with perceived change in behavior. There was a positive association between the level of engagement with the app and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field. ",
doi="10.2196/mental.7262",
url="http://mental.jmir.org/2017/4/e45/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29042340"
}


@Article{info:doi/10.2196/mental.8311,
author="Berry, Natalie
and Bucci, Sandra
and Lobban, Fiona",
title="Use of the Internet and Mobile Phones for Self-Management of Severe Mental Health Problems: Qualitative Study of Staff Views",
journal="JMIR Ment Health",
year="2017",
month="Nov",
day="01",
volume="4",
number="4",
pages="e52",
keywords="psychosis",
keywords="bipolar disorder",
keywords="mHealth",
keywords="eHealth",
keywords="clinicians",
keywords="mobile phone",
keywords="Internet",
keywords="intervention",
abstract="Background: Researchers are currently investigating the feasibility, acceptability, and efficacy of digital health interventions for people who experience severe mental health problems such as psychosis and bipolar disorder. Although the acceptability of digital health interventions for severe mental health problems appears to be relatively high and some people report successfully using the Internet and mobile phones to manage their mental health, the attitudes of mental health care staff toward such approaches have yet to be considered. Objective: The aim of this study was to explore mental health care staff experiences of clients with severe mental health problems engaging with the Internet and mobile phones to self-manage their mental health and their views toward these behaviors. The study also sought to examine the opinions expressed by mental health care staff toward digital health interventions for severe mental health problems to identify potential facilitators and barriers to implementation. Methods: Four focus groups were conducted with 20 staff working in mental health care services in the North West of the England using a topic guide. Focus groups involved 12 staff working in secondary care psychological services (7 participants in focus group 1 and 5 participants in focus group 4), 4 staff working in a rehabilitation unit (focus group 2), and 4 staff working in a community mental health team (focus group 3). Focus groups were transcribed verbatim, and transcripts were analyzed thematically to identify key themes that emerged from the data. Results: Four overarching themes, two with associated subthemes, were identified: (1) staff have conflicting views about the pros and cons of using Web-based resources and digital health interventions to manage mental health; (2) digital health interventions could increase access to mental health support options for severe mental health problems but may perpetuate the digital divide; (3) digital health interventions' impact on staff roles and responsibilities; and (4) digital health interventions should be used to enhance, not replace, face-to-face support. Conclusions: This study is the first, to our knowledge, to qualitatively explore the experiences and attitudes of mental health care staff toward individuals with severe mental health problems using the Internet, mobile phones, and digital health interventions to self-manage their mental health. Understanding the positive and negative experiences and views shared by staff toward both current and potential digital health intervention use has enabled the identification of several considerations for implementation. Additionally, the findings suggest mental health care staff need clear guidance and training in relation to their responsibilities in recommending reputable and secure websites, forums, and digital health interventions and in how to manage professional boundaries on the Internet. Overall, the study highlights that digital health interventions could be well received by staff working in mental health services but importantly, such management options must be presented to frontline staff as an avenue to enhance care and extend choice, rather than as a method to reduce costs. ",
doi="10.2196/mental.8311",
url="http://mental.jmir.org/2017/4/e52/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29092809"
}


@Article{info:doi/10.2196/mental.7500,
author="Larsen, Erik Mark
and Shand, Fiona
and Morley, Kirsten
and Batterham, J. Philip
and Petrie, Katherine
and Reda, Bill
and Berrouiguet, Sofian
and Haber, S. Paul
and Carter, Gregory
and Christensen, Helen",
title="A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT)",
journal="JMIR Ment Health",
year="2017",
month="Dec",
day="13",
volume="4",
number="4",
pages="e56",
keywords="suicide, attempted",
keywords="emergency service, hospital",
keywords="continuity of patient care",
keywords="text messaging",
keywords="Internet",
abstract="Background: Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated. Objective: The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system. Methods: To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group. Results: Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption. Conclusions: The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway. ",
doi="10.2196/mental.7500",
url="http://mental.jmir.org/2017/4/e56/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29237584"
}


@Article{info:doi/10.2196/mental.7889,
author="Zwerenz, R{\"u}diger
and Becker, Jan
and Johansson, Robert
and Frederick, J. Ronald
and Andersson, Gerhard
and Beutel, E. Manfred",
title="Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="16",
volume="4",
number="4",
pages="e41",
keywords="psychoanalytic psychotherapy",
keywords="emotion-focused therapy",
keywords="inpatients",
keywords="aftercare",
keywords="Internet",
keywords="clinical trial",
abstract="Background: Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions. Objective: The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders. Methods: A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT). Results: Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84\%, 58/69), anxiety (68\%, 47/69), personality disorder (38\%, 26/69), and depersonalization-derealization disorder (22\%, 15/69). A majority of the patients (86\%, 36/42) logged into the program, of which 86\% (31/36) completed the first unit. Satisfaction with the units mastered was rated as good (52\%, 16/31) and very good (26\%, 9/31). However, there was a steady decline of participation over the course of the program; only 36\% of the participants (13/36) participated throughout the trial completing at least 50\% of the sessions. According to the ITT analysis, participants improved statistically significantly and with moderate effect sizes (Cohen d) compared with the WLCG regarding depression (d=0.60), quality of life (d=0.53), and emotional competence (d=0.49). Effects were considerably stronger for the completers with respect to depression (d=1.33), quality of life (d=0.83), emotional competence (d=0.68), and general anxiety (d=0.62). Conclusions: Although overall program satisfaction and benefit of the program were favorable with respect to the indicators of emotional disorders, the rate of completion was low. Our findings point to the need to target the intervention more specifically to the needs and capabilities of participants and to the context of the intervention. Trial Registration: Clinicaltrials.gov NCT02671929; https://clinicaltrials.gov/ct2/show/NCT02671929 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb) ",
doi="10.2196/mental.7889",
url="http://mental.jmir.org/2017/4/e41/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29038094"
}


@Article{info:doi/10.2196/mental.6707,
author="Paul, Louise Christine
and Cox, Elizabeth Martine
and Small, Julie Hannah
and Boyes, W. Allison
and O'Brien, Lorna
and Rose, Karina Shiho
and Baker, L. Amanda
and Henskens, A. Frans
and Kirkwood, Naomi Hannah
and Roach, M. Della",
title="Techniques for Improving Communication of Emotional Content in Text-Only Web-Based Therapeutic Communications: Systematic Review",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="24",
volume="4",
number="4",
pages="e46",
keywords="nonverbal communication",
keywords="Internet",
keywords="computer-assisted therapy",
abstract="Background: Web-based typed exchanges are increasingly used by professionals to provide emotional support to patients. Although some empirical evidence exists to suggest that various strategies may be used to convey emotion during Web-based text communication, there has been no critical review of these data in patients with chronic conditions. Objectives: The objective of this review was to identify the techniques used to convey emotion in written or typed Web-based communication and assess the empirical evidence regarding impact on communication and psychological outcomes. Methods: An electronic search of databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library was conducted to identify literature published from 1990 to 2016. Searches were also conducted using Google Scholar, manual searching of reference lists of identified papers and manual searching of tables of contents for selected relevant journals. Data extraction and coding were completed by 2 reviewers (10.00\% [573/5731] of screened papers, at abstract/title screening stage; 10.0\% of screened [69/694] papers, at full-text screening stage). Publications were assessed against the eligibility criteria and excluded if they were duplicates, were not published in English, were published before 1990, referenced animal or nonhuman subjects, did not describe original research, were not journal papers, or did not empirically test the effect of one or more nonverbal communication techniques (for eg, smileys, emoticons, emotional bracketing, voice accentuation, trailers [ellipsis], and pseudowords) as part of Web-based or typed communication on communication-related variables, including message interpretation, social presence, the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes, including depression, anxiety, and distress. Results: A total of 6902 unique publications were identified. Of these, six publications met the eligibility criteria and were included in a narrative synthesis. All six studies addressed the effect of smileys or emoticons on participant responses, message interpretation, or social presence of the writer. None of these studies specifically targeted chronic conditions. It was found that emoticons were more effective in influencing the emotional impact of a message than no cue and that smileys and emoticons were able to convey a limited amount of emotion. No studies addressed other techniques for conveying emotion in written communication. No studies addressed the effects of any techniques on the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes (depression, anxiety, or distress). Conclusions: There is a need for greater empirical attention to the effects of the various proposed techniques for conveying emotion in Web-based typed communications to inform health service providers regarding best-practice communication skills in this setting. ",
doi="10.2196/mental.6707",
url="http://mental.jmir.org/2017/4/e46/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29066426"
}


@Article{info:doi/10.2196/mental.8168,
author="Easton, Katherine
and Diggle, Jacob
and Ruethi-Davis, Mabel
and Holmes, Megan
and Byron-Parker, Darian
and Nuttall, Jessica
and Blackmore, Chris",
title="Qualitative Exploration of the Potential for Adverse Events When Using an Online Peer Support Network for Mental Health: Cross-Sectional Survey",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="30",
volume="4",
number="4",
pages="e49",
keywords="digital technology",
keywords="mental health",
keywords="online peer support",
keywords="adverse events",
keywords="online survey",
abstract="Background: Online peer support networks are a growing area of mental health support for offering social connection, identity, and support. However, it has been reported that not all individuals have a positive experience on such networks. The potential for adverse events within a moderated online peer support network is a new area of research exploration. Objective: The objective of the study was to determine if use of an online moderated peer networks leads to adverse events for users. Methods: Four biannual online surveys (October 2014 to March 2016) were conducted by a large national UK mental health charity, with users of their online peer support network exploring personal safety, moderation, experiences on the site, and how the site could be improved. Data were analyzed using thematic analysis by 2 independent researchers using a priori themes: negative experiences of moderation, social exclusion, contagion, negative interactions with other users, online relationships, co-rumination and collusion, and other. Results: In total, 2353 survey responses were logged with 197 (8.37\%) documenting an adverse event of negative experience. A dominant theme of negative experiences of moderation emerged (73/197, 37.1\%) with evidence of social exclusion (50/197, 25.4\%). Reading user posts was shown to be a cause of worry and distress for a few users, and analysis highlighted several instances of depressogenic and emotional contagion as well as some limited evidence of behavioral contagion (46/197, 23.4\%). Very limited evidence of co-rumination (1/197, 0.5\%) and no evidence of collusion were identified. Conclusions: Evidence of adverse events was identified at low levels in the sample of respondents, although we have no comparison data to indicate if levels are low compared with comparable platforms. Not all users of online peer support networks find them wholly beneficial. Research must explore what works for whom. The next stage of service development should consider which users may be likely to receive no benefit, or even deteriorate, as a result of using the service. ",
doi="10.2196/mental.8168",
url="http://mental.jmir.org/2017/4/e49/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29084710"
}


@Article{info:doi/10.2196/mental.8491,
author="Strand, Monica
and Gammon, Deede
and Eng, Sofie Lillian
and Ruland, Cornelia",
title="Exploring Working Relationships in Mental Health Care via an E-Recovery Portal: Qualitative Study on the Experiences of Service Users and Health Providers",
journal="JMIR Ment Health",
year="2017",
month="Nov",
day="14",
volume="4",
number="4",
pages="e54",
keywords="eHealth",
keywords="recovery",
keywords="mental health",
keywords="psychiatry",
keywords="user involvement",
keywords="empowerment",
keywords="working relationship",
keywords="secure email",
keywords="e-recovery",
keywords="participatory research",
abstract="Background: The quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood. Objective: The aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal. Methods: In this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user--generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed. Results: The thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users' and health providers' expectations for portal use were not aligned, and the consequences of not addressing these difficulties. Illustrative subthemes are initiative and responsibility, waiting for the other, feeling overwhelmed, and clarifications and agreements. Conclusions: The degree to which dyads benefited from using the e-recovery portal appeared to be mainly associated with the degree to which the dyads' relations were open and flexible before the portal was introduced. For those who experienced frustrations, the portal may have both exposed and added to suboptimal working relationships. Use of the goal module appeared to strengthen the person-centered nature of collaboration. A key question is how health providers balance between enabling service users' greater control over their care, without relinquishing responsibility for the quality of the working relationship, also when using an e-recovery portal. Implications for implementation are discussed. ",
doi="10.2196/mental.8491",
url="http://mental.jmir.org/2017/4/e54/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29138127"
}


@Article{info:doi/10.2196/mental.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.7704,
author="Cooper, Zafra
and Doll, Helen
and Bailey-Straebler, Suzanne
and Bohn, Kristin
and de Vries, Dian
and Murphy, Rebecca
and O'Connor, E. Marianne
and Fairburn, G. Christopher",
title="Assessing Therapist Competence: Development of a Performance-Based Measure and Its Comparison With a Web-Based Measure",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="31",
volume="4",
number="4",
pages="e51",
keywords="therapist competence",
keywords="Web-based knowledge assessment",
keywords="skill assessment",
keywords="therapist training outcome",
keywords="scalable assessment",
keywords="eating disorders",
keywords="cognitive-behavioral treatment",
abstract="Background: Recent research interest in how best to train therapists to deliver psychological treatments has highlighted the need for rigorous, but scalable, means of measuring therapist competence. There are at least two components involved in assessing therapist competence: the assessment of their knowledge of the treatment concerned, including how and when to use its strategies and procedures, and an evaluation of their ability to apply such knowledge skillfully in practice. While the assessment of therapists' knowledge has the potential to be completed efficiently on the Web, the assessment of skill has generally involved a labor-intensive process carried out by clinicians, and as such, may not be suitable for assessing training outcome in certain circumstances. Objectives: The aims of this study were to develop and evaluate a role-play--based measure of skill suitable for assessing training outcome and to compare its performance with a highly scalable Web-based measure of applied knowledge. Methods: Using enhanced cognitive behavioral therapy (CBT-E) for eating disorders as an exemplar, clinical scenarios for role-play assessment were developed and piloted together with a rating scheme for assessing trainee therapists' performance. These scenarios were evaluated by examining the performance of 93 therapists from different professional backgrounds and at different levels of training in implementing CBT-E. These therapists also completed a previously developed Web-based measure of applied knowledge, and the ability of the Web-based measure to efficiently predict competence on the role-play measure was investigated. Results: The role-play measure assessed performance at implementing a range of CBT-E procedures. The majority of the therapists rated their performance as moderately or closely resembling their usual clinical performance. Trained raters were able to achieve good-to-excellent reliability for averaged competence, with intraclass correlation coefficients ranging from .653 to 909. The measure was also sensitive to change, with scores being significantly higher after training than before as might be expected (mean difference 0.758, P<.001) even when taking account of repeated data (mean difference 0.667, P<.001). The major shortcoming of the role-play measure was that it required considerable time and resources. This shortcoming is inherent in the method. Given this, of most interest for assessing training outcome, scores on the Web-based measure efficiently predicted therapist competence, as judged by the role-play measure (with the Web-based measure having a positive predictive value of 77\% and specificity of 78\%). Conclusions: The results of this study suggest that while it was feasible and acceptable to assess performance using the newly developed role-play measure, the highly scalable Web-based measure could be used in certain circumstances as a substitute for the more labor-intensive, and hence, more costly role-play method. ",
doi="10.2196/mental.7704",
url="http://mental.jmir.org/2017/4/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29089289"
}


@Article{info:doi/10.2196/mental.7797,
author="Abbe, Adeline
and Falissard, Bruno",
title="Stopping Antidepressants and Anxiolytics as Major Concerns Reported in Online Health Communities: A Text Mining Approach",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="23",
volume="4",
number="4",
pages="e48",
keywords="social media",
keywords="antidepressant",
keywords="anxiolytic",
keywords="text mining",
keywords="data mining",
abstract="Background: Internet is a particularly dynamic way to quickly capture the perceptions of a population in real time. Complementary to traditional face-to-face communication, online social networks help patients to improve self-esteem and self-help. Objective: The aim of this study was to use text mining on material from an online forum exploring patients' concerns about treatment (antidepressants and anxiolytics). Methods: Concerns about treatment were collected from discussion titles in patients' online community related to antidepressants and anxiolytics. To examine the content of these titles automatically, we used text mining methods, such as word frequency in a document-term matrix and co-occurrence of words using a network analysis. It was thus possible to identify topics discussed on the forum. Results: The forum included 2415 discussions on antidepressants and anxiolytics over a period of 3 years. After a preprocessing step, the text mining algorithm identified the 99 most frequently occurring words in titles, among which were escitalopram, withdrawal, antidepressant, venlafaxine, paroxetine, and effect. Patients' concerns were related to antidepressant withdrawal, the need to share experience about symptoms, effects, and questions on weight gain with some drugs. Conclusions: Patients' expression on the Internet is a potential additional resource in addressing patients' concerns about treatment. Patient profiles are close to that of patients treated in psychiatry. ",
doi="10.2196/mental.7797",
url="http://mental.jmir.org/2017/4/e48/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29061554"
}


@Article{info:doi/10.2196/mental.7497,
author="Axelsson, Erland
and Linds{\"a}ter, Elin
and Lj{\'o}tsson, Brj{\'a}nn
and Andersson, Erik
and Hedman-Lagerl{\"o}f, Erik",
title="The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials",
journal="JMIR Ment Health",
year="2017",
month="Dec",
day="08",
volume="4",
number="4",
pages="e58",
keywords="disability",
keywords="Internet",
keywords="psychometrics",
keywords="questionnaire",
keywords="validity",
keywords="WHODAS",
abstract="Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widespread measure of disability and functional impairment, which is bundled with the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for use in psychiatry. Administering psychometric scales via the Internet is an effective way to reach respondents and allow for convenient handling of data. Objective: The aim was to study the psychometric properties of the 12-item self-report WHODAS 2.0 when administered online to individuals with anxiety and stress disorders. The WHODAS 2.0 was hypothesized to exhibit high internal consistency and be unidimensional. We also expected the WHODAS 2.0 to show high 2-week test-retest reliability, convergent validity (correlations approximately .50 to .90 with other self-report measures of functional impairment), that it would differentiate between patients with and without exhaustion disorder, and that it would respond to change in primary symptom domain. Methods: We administered the 12-item self-report WHODAS 2.0 online to patients with anxiety and stress disorders (N=160) enrolled in clinical trials of cognitive behavior therapy, and analyzed psychometric properties within a classical test theory framework. Scores were compared with well-established symptom and disability measures, and sensitivity to change was studied from pretreatment to posttreatment assessment. Results: The 12-item self-report WHODAS 2.0 showed high internal consistency (Cronbach alpha=.83-.92), high 2-week test-retest reliability (intraclass correlation coefficient=.83), adequate construct validity, and was sensitive to change. We found preliminary evidence for a three-factorial structure, but one strong factor accounted for a clear majority of the variance. Conclusions: We conclude that the 12-item self-report WHODAS 2.0 is a psychometrically sound instrument when administered online to individuals with anxiety and stress disorders, but that it is probably fruitful to also report the three subfactors to facilitate comparisons between studies. Trial Registration: Clinicaltrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317 (Archived by WebCite at http://www.webcitation.org/6vQEdYAem); Clinicaltrials.gov NCT02314065; https://clinicaltrials.gov/ct2/show/NCT02314065 (Archived by WebCite at http://www.webcitation.org/6vQEjlUU8) ",
doi="10.2196/mental.7497",
url="http://mental.jmir.org/2017/4/e58/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29222080"
}


@Article{info:doi/10.2196/mental.8084,
author="Coulson, S. Neil
and Bullock, Emma
and Rodham, Karen",
title="Exploring the Therapeutic Affordances of Self-Harm Online Support Communities: An Online Survey of Members",
journal="JMIR Ment Health",
year="2017",
month="Oct",
day="13",
volume="4",
number="4",
pages="e44",
keywords="self-harm",
keywords="social network",
keywords="social support",
keywords="qualitative research",
keywords="online support group",
abstract="Background: A growing number of online communities have been established to support those who self-harm. However, little is known about the therapeutic affordances arising from engagement with these communities and resulting outcomes. Objective: The aim of this study was to explore the presence of therapeutic affordances as reported by members of self-harm online support communities. Methods: In total, 94 respondents (aged 13-63 years, mean=23.5 years; 94\% female) completed an online survey exploring their experiences of engaging with a self-harm online support community. Respondents varied in terms of how long they had been accessing an online community, with 22\% (21/94) accessing less than 1 year, 39\% (37/94) 1 to 2 years, 14\% (13/94) 2 to 3 years, and 24.5\% (23/94) more than 3 years. Responses were analyzed using deductive thematic analysis. Results: The results of our analysis describe each of the five therapeutic affordances that were present in the data, namely (1) connection, the ability to make contact with others who self-harm for the purposes of mutual support and in so doing reduce feelings of loneliness and isolation; (2) adaptation, that is, how use of online support varies in relation to the personal circumstances of the individual user; (3) exploration, that is, the ability to learn about self-harm and learn about strategies to reduce or stop self-harming behavior; (4) narration, that is, the ability to share experiences, as well as read about the experiences of others; and (5) self-presentation, that is, how and what users present about themselves to others in the online community. Conclusions: Our findings suggest that engagement with self-harm online support communities may confer a range of therapeutic benefits for some users, which may serve to minimize the psychosocial burden of self-harm and promote positive coping strategies. In addition, the online nature of the support available may be helpful to those who are unable to access face-to-face support. ",
doi="10.2196/mental.8084",
url="http://mental.jmir.org/2017/4/e44/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29030324"
}