@Article{info:doi/10.2196/24605,
author="Albritton, Tashuna
and Ford, Lynett Kelsey
and Elsbernd, Kira
and Santodomingo, Melodie
and Juzang, Ivan
and Weddington, Pam
and Bull, Sheana",
title="Implementing a Peer Advocate Mental Health Digital Intervention Program for Ohio Youth: Descriptive Pilot Study",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="23",
volume="8",
number="4",
pages="e24605",
keywords="mental health",
keywords="adolescent",
keywords="digital health",
keywords="suicide prevention",
keywords="social support",
keywords="youth",
abstract="Background: In the United States, millions of adolescents report poor mental health, where 1 in 5 teenagers considers suicide. Reducing stigma and fostering peer support remains critical for positive mental health interventions and programs. Increasingly, digital mental health tools have emerged with great promise, leveraging social networks. Despite the potential, limited understanding of such comprehensive programs and their implementation exist. Objective: The objective of this study investigates a piloted digital mental health training program (Be Present) for youth, specifically describing the impact on youth behavioral outcomes and user engagement and identifying high-risk youth in the early phases of prevention. Methods: Eligibility included Ohio residents (aged 14 to 22 years) to be enrolled as either a Friend or a Peer Advocate. From May 1 to June 1, 2019, participants completed the Advocate training course, taking pretest and posttest surveys. Single-arm descriptive analyses measured youth outcomes (self-efficacy, intentions, behaviors, social support, knowledge, and sources of strength) and engagement and assessed risk based on survey responses. Results: A total of 65 adolescents participated, with 54 completing both pretest and posttest surveys. The majority of participants included non-Hispanic White females. Findings illustrated a significant increase in self-report of referrals for mental health services as well as in perceptions that youth had of experiencing social support; however, no significant differences were found for measures of self-efficacy, knowledge, and sources of strength between pretest and posttest surveys. Roughly two-thirds of the participants completed all of the Advocate training modules, and we observed a gradual decline in engagement. Most respondents who received escalated high-risk response messages identified as female. Conclusions: The pilot presented promise for implementing a digital mental health program focused on peer support, specifically observing reported youth behavioral outcomes and user engagement and identifying high-risk youth. Various limitations exist given the small nonrepresentative sample and lack of control group. All findings should be considered preliminary to a larger trial and underscore the feasibility of delivering online training programs to bolster adolescent mental health. Such formative evaluation proved critical for future implementation and research, offering opportunity for substantial improvements for real-world digital mental health programs. ",
doi="10.2196/24605",
url="https://mental.jmir.org/2021/4/e24605",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890868"
}


@Article{info:doi/10.2196/20424,
author="Jonathan, K. Geneva
and Dopke, A. Cynthia
and Michaels, Tania
and Bank, Andrew
and Martin, R. Clair
and Adhikari, Krina
and Krakauer, L. Rachel
and Ryan, Chloe
and McBride, Alyssa
and Babington, Pamela
and Frauenhofer, Ella
and Silver, Jamilah
and Capra, Courtney
and Simon, Melanie
and Begale, Mark
and Mohr, C. David
and Goulding, H. Evan",
title="A Smartphone-Based Self-management Intervention for Bipolar Disorder (LiveWell): User-Centered Development Approach",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="12",
volume="8",
number="4",
pages="e20424",
keywords="behavioral intervention technology",
keywords="mHealth",
keywords="bipolar disorder",
keywords="depression",
keywords="illness management",
keywords="smartphone",
keywords="behavior change",
keywords="early warning signs",
keywords="self-management",
keywords="qualitative",
abstract="Background: Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. Objective: This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. Methods: Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. Results: The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40\%), followed by cognitive (25\%), mood (15\%), physical (10\%), and motivational (7\%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. Conclusions: User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development. ",
doi="10.2196/20424",
url="https://mental.jmir.org/2021/4/e20424",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843607"
}


@Article{info:doi/10.2196/25050,
author="Owoyemi, Praise
and Salcone, Sarah
and King, Christopher
and Kim, Julie Heejung
and Ressler, James Kerry
and Vahia, Vihang Ipsit",
title="Measuring and Quantifying Collateral Information in Psychiatry: Development and Preliminary Validation of the McLean Collateral Information and Clinical Actionability Scale",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="14",
volume="8",
number="4",
pages="e25050",
keywords="electronic media",
keywords="psychotherapy",
keywords="text message",
keywords="electronic mail",
keywords="collateral information",
keywords="telecommunication",
keywords="communications media",
keywords="digital",
abstract="Background: The review of collateral information is an essential component of patient care. Although this is standard practice, minimal research has been done to quantify collateral information collection and to understand how collateral information translates to clinical decision making. To address this, we developed and piloted a novel measure (the McLean Collateral Information and Clinical Actionability Scale [M-CICAS]) to evaluate the types and number of collateral sources viewed and the resulting actions made in a psychiatric setting. Objective: This study aims to test the feasibility of the M-CICAS, validate this measure against clinician notes via medical records, and evaluate whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. Methods: For the M-CICAS, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision making between the clinician and patient. To determine feasibility and preliminary validity, we piloted this measure among clinicians providing psychotherapy at McLean Hospital. These clinicians (n=7) completed the M-CICAS after individual clinical sessions with 89 distinct patient encounters. Scales were completed by clinicians only once for each patient during routine follow-up visits. After clinicians completed these scales, researchers conducted chart reviews by completing the M-CICAS using only the clinician's corresponding note from that session. For the analyses, we generated summary scores for the number of collateral sources and clinical actions for each encounter. We examined Pearson correlation coefficients to assess interrater reliability between clinicians and chart reviewers, and simple univariate regression modeling followed by multilevel mixed effects regression modeling to test the relationship between collateral information accessed and clinical actions taken. Results: The study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98; P<.001) and actions taken (r=0.97; P<.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r=0.24, P=.02 and r=0.25, P=.02, respectively). Univariate regression modeling with a two-tailed test demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS ($\beta$=.27; t87=2.47; P=.02). The multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences ($\beta$=.23; t57=2.13; P=.04). Conclusions: This pilot study established the feasibility and preliminary validity of the M-CICAS in assessing collateral sources and clinical decision making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session. ",
doi="10.2196/25050",
url="https://mental.jmir.org/2021/4/e25050",
url="http://www.ncbi.nlm.nih.gov/pubmed/33851928"
}


@Article{info:doi/10.2196/24482,
author="Armstrong, C. Courtney
and Odukoya, J. Erica
and Sundaramurthy, Keerthi
and Darrow, M. Sabrina",
title="Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="22",
volume="8",
number="4",
pages="e24482",
keywords="qualitative",
keywords="mHealth",
keywords="mobile phone",
keywords="behavior monitoring",
keywords="youth",
abstract="Background: Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. Objective: The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. Methods: Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. Results: During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. Conclusions: Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers. ",
doi="10.2196/24482",
url="https://mental.jmir.org/2021/4/e24482",
url="http://www.ncbi.nlm.nih.gov/pubmed/33885364"
}


@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/10.2196/25847,
author="Lehtimaki, Susanna
and Martic, Jana
and Wahl, Brian
and Foster, T. Katherine
and Schwalbe, Nina",
title="Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="29",
volume="8",
number="4",
pages="e25847",
keywords="digital health",
keywords="adolescent health",
keywords="young people",
keywords="mental health",
keywords="digital technologies",
abstract="Background: An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective: This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods: We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results: In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions: Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-{\`a}-vis the type of service provided, target population, and the current standard of care. ",
doi="10.2196/25847",
url="https://mental.jmir.org/2021/4/e25847",
url="http://www.ncbi.nlm.nih.gov/pubmed/33913817"
}


@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/10.2196/23447,
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/10.2196/25731,
author="Hur, Ji-Won
and Shin, Hyemin
and Jung, Dooyoung
and Lee, Heon-Jeong
and Lee, Sungkil
and Kim, J. Gerard
and Cho, Chung-Yean
and Choi, Seungmoon
and Lee, Seung-Moo
and Cho, Chul-Hyun",
title="Virtual Reality--Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="14",
volume="8",
number="4",
pages="e25731",
keywords="virtual reality",
keywords="VR",
keywords="social anxiety",
keywords="social phobia",
keywords="exposure therapy",
keywords="fMRI",
keywords="unctional magnetic resonance imaging",
abstract="Background: Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. Objective: We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. Methods: We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality--based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. Results: Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality--based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. Conclusions: These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation. ",
doi="10.2196/25731",
url="https://mental.jmir.org/2021/4/e25731",
url="http://www.ncbi.nlm.nih.gov/pubmed/33851931"
}


@Article{info:doi/10.2196/24522,
author="Nestsiarovich, Anastasiya
and Kumar, Praveen
and Lauve, Raymond Nicolas
and Hurwitz, G. Nathaniel
and Mazurie, J. Aur{\'e}lien
and Cannon, C. Daniel
and Zhu, Yiliang
and Nelson, James Stuart
and Crisanti, S. Annette
and Kerner, Berit
and Tohen, Mauricio
and Perkins, J. Douglas
and Lambert, Gerard Christophe",
title="Using Machine Learning Imputed Outcomes to Assess Drug-Dependent Risk of Self-Harm in Patients with Bipolar Disorder: A Comparative Effectiveness Study",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="21",
volume="8",
number="4",
pages="e24522",
keywords="bipolar",
keywords="mood",
keywords="mania",
keywords="depression",
keywords="pharmacotherapy",
keywords="self-harm",
keywords="suicide",
keywords="machine learning",
keywords="psychotherapy",
abstract="Background: Incomplete suicidality coding in administrative claims data is a known obstacle for observational studies. With most of the negative outcomes missing from the data, it is challenging to assess the evidence on treatment strategies for the prevention of self-harm in bipolar disorder (BD), including pharmacotherapy and psychotherapy. There are conflicting data from studies on the drug-dependent risk of self-harm, and there is major uncertainty regarding the preventive effect of monotherapy and drug combinations. Objective: The aim of this study was to compare all commonly used BD pharmacotherapies, as well as psychotherapy for the risk of self-harm, in a large population of commercially insured individuals, using self-harm imputation to overcome the known limitations of this outcome being underrecorded within US electronic health care records. Methods: The IBM MarketScan administrative claims database was used to compare self-harm risk in patients with BD following 65 drug regimens and drug-free periods. Probable but uncoded self-harm events were imputed via machine learning, with different probability thresholds examined in a sensitivity analysis. Comparators included lithium, mood-stabilizing anticonvulsants (MSAs), second-generation antipsychotics (SGAs), first-generation antipsychotics (FGAs), and five classes of antidepressants. Cox regression models with time-varying covariates were built for individual treatment regimens and for any pharmacotherapy with or without psychosocial interventions (``psychotherapy''). Results: Among 529,359 patients, 1.66\% (n=8813 events) had imputed and/or coded self-harm following the exposure of interest. A higher self-harm risk was observed during adolescence. After multiple testing adjustment (P?.012), the following six regimens had higher risk of self-harm than lithium: tri/tetracyclic antidepressants + SGA, FGA + MSA, FGA, serotonin-norepinephrine reuptake inhibitor (SNRI) + SGA, lithium + MSA, and lithium + SGA (hazard ratios [HRs] 1.44-2.29), and the following nine had lower risk: lamotrigine, valproate, risperidone, aripiprazole, SNRI, selective serotonin reuptake inhibitor (SSRI), ``no drug,'' bupropion, and bupropion + SSRI (HRs 0.28-0.74). Psychotherapy alone (without medication) had a lower self-harm risk than no treatment (HR 0.56, 95\% CI 0.52-0.60; P=8.76{\texttimes}10-58). The sensitivity analysis showed that the direction of drug-outcome associations did not change as a function of the self-harm probability threshold. Conclusions: Our data support evidence on the effectiveness of antidepressants, MSAs, and psychotherapy for self-harm prevention in BD. Trial Registration: ClinicalTrials.gov NCT02893371; https://clinicaltrials.gov/ct2/show/NCT02893371 ",
doi="10.2196/24522",
url="https://mental.jmir.org/2021/4/e24522",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688834"
}


@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/10.2196/28479,
author="Green, Jennifer
and Huberty, Jennifer
and Puzia, Megan
and Stecher, Chad",
title="The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19--Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="13",
volume="8",
number="4",
pages="e28479",
keywords="coronavirus",
keywords="health behavior",
keywords="mindfulness meditation",
keywords="mHealth",
keywords="COVID-19",
keywords="mental health",
abstract="Background: The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people's mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19. Objective: The objectives of this study were to (1) examine the regional differences in mental health and COVID-19--related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19--related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19--related worry, attention to news, and stress. Methods: A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19--related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19--related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19--related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects. Results: The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19--related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001). Conclusions: Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic. ",
doi="10.2196/28479",
url="https://mental.jmir.org/2021/4/e28479",
url="http://www.ncbi.nlm.nih.gov/pubmed/33788698"
}


@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"
}