%0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60754 %T Promises and Pitfalls of Internet Search Data in Mental Health: Critical Review %A Loch,Alexandre Andrade %A Kotov,Roman %K privacy %K stigma %K online %K prevention %K internet %K search data %K mental health %K health care %K clinical information %K World Health Organization %K WHO %K digital health %K mental illness %K digital technologies %K social network %K mobile health %K mHealth %D 2025 %7 18.2.2025 %9 %J JMIR Ment Health %G English %X The internet is now integral to everyday life, and users’ web-based search data could be of strategic importance in mental health care. As shown by previous studies, internet searches may provide valuable insights into an individual’s mental state and could be of great value in early identification and helping in pathways to care. Internet search data can potentially provide real-time identification (eg, alert mechanisms for timely interventions). In this paper, we discuss the various problems related to the use of these data in research and clinical practice, including privacy concerns, integration with clinical information, and technical limitations. We also propose solutions to address these issues and provide possible future directions. %R 10.2196/60754 %U https://mental.jmir.org/2025/1/e60754 %U https://doi.org/10.2196/60754 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58068 %T Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study %A Gorban,Carla %A McKenna,Sarah %A Chong,Min K %A Capon,William %A Battisti,Robert %A Crowley,Alison %A Whitwell,Bradley %A Ottavio,Antonia %A Scott,Elizabeth M %A Hickie,Ian B %A Iorfino,Frank %K digital navigator %K digital coach %K clinical technology specialist %K mental health services %K shared decision-making %K lived experience %K implementation %K poor engagement %K decision-making %K mental health %K digital mental health %K digital mental health technology %D 2024 %7 6.11.2024 %9 %J JMIR Ment Health %G English %X Despite the efficacy of digital mental health technologies (DMHTs) in clinical trials, low uptake and poor engagement are common in real-world settings. Accordingly, digital technology experts or “digital navigators” are increasingly being used to enhance engagement and shared decision-making between health professionals and clients. However, this area is relatively underexplored and there is a lack of data from naturalistic settings. In this paper, we report observational findings from the implementation of a digital navigator in a multidisciplinary mental health clinic in Sydney, Australia. The digital navigator supported clients and health professionals to use a measurement-based DMHT (the Innowell platform) for improved multidimensional outcome assessment and to guide personalized decision-making. Observational data are reported from implementation logs, platform usage statistics, and response rates to digital navigator emails and phone calls. Ultimately, support from the digital navigator led to improved data collection and clearer communications about goals for using the DMHT to track client outcomes; however, this required strong partnerships between health professionals, the digital navigator, and clients. The digital navigator helped to facilitate the integration of DMHT into care, rather than providing a stand-alone service. Thus, collaborations between health professionals and digital navigators are mutually beneficial and empower clients to be more engaged in their own care. %R 10.2196/58068 %U https://mental.jmir.org/2024/1/e58068 %U https://doi.org/10.2196/58068 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e64626 %T Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors %A McAlister,Kelsey L %A Beatty,Clare C %A Smith-Caswell,Jacqueline E %A Yourell,Jacqlyn L %A Huberty,Jennifer L %K adolescent social media %K social media bans %K emotion regulation %K youth %K adolescent %K media use %K social platform %K social network %K self-regulation %K behavioral health %K mental health %K digital health %K technology %K digital literacy %D 2024 %7 4.11.2024 %9 %J JMIR Ment Health %G English %X Social media is an integral part of adolescents’ daily lives, but the significant time they invest in social media has raised concerns about the effect on their mental health. Bans and severe restrictions on social media use are quickly emerging as an attempt to regulate social media use; however, evidence supporting their effectiveness is limited. Adolescents experience several benefits from social media, including increased social connection, reduced loneliness, and a safe space for marginalized groups (eg, LGBTQ+) to interact. Rather than enforcing bans and severe restrictions, emotion regulation should be leveraged to help adolescents navigate the digital social environment. This viewpoint paper proposes a nuanced approach toward regulating adolescent social media use by (1) discontinuing the use of ineffective bans, (2) recognizing the benefits social media use can have, and (3) fostering emotion regulation skills in adolescents to encourage the development of self-regulation. %R 10.2196/64626 %U https://mental.jmir.org/2024/1/e64626 %U https://doi.org/10.2196/64626 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58493 %T Regulating AI in Mental Health: Ethics of Care Perspective %A Tavory,Tamar %+ Faculty of Law, Bar Ilan University, Ramat Gan, 5290002, Israel, 972 35318816, ttavory@gmail.com %K artificial intelligence %K ethics of care %K regulation %K legal %K relationship %K mental health %K mental healthcare %K AI %K ethic %K ethics %K ethical %K regulations %K law %K framework %K frameworks %K regulatory %K relationships %K chatbot %K chatbots %K conversational agent %K conversational agents %K European Artificial Intelligence Act %D 2024 %7 19.9.2024 %9 Viewpoint %J JMIR Ment Health %G English %X This article contends that the responsible artificial intelligence (AI) approach—which is the dominant ethics approach ruling most regulatory and ethical guidance—falls short because it overlooks the impact of AI on human relationships. Focusing only on responsible AI principles reinforces a narrow concept of accountability and responsibility of companies developing AI. This article proposes that applying the ethics of care approach to AI regulation can offer a more comprehensive regulatory and ethical framework that addresses AI’s impact on human relationships. This dual approach is essential for the effective regulation of AI in the domain of mental health care. The article delves into the emergence of the new “therapeutic” area facilitated by AI-based bots, which operate without a therapist. The article highlights the difficulties involved, mainly the absence of a defined duty of care toward users, and shows how implementing ethics of care can establish clear responsibilities for developers. It also sheds light on the potential for emotional manipulation and the risks involved. In conclusion, the article proposes a series of considerations grounded in the ethics of care for the developmental process of AI-powered therapeutic tools. %M 39298759 %R 10.2196/58493 %U https://mental.jmir.org/2024/1/e58493 %U https://doi.org/10.2196/58493 %U http://www.ncbi.nlm.nih.gov/pubmed/39298759 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58432 %T Data Integrity Issues With Web-Based Studies: An Institutional Example of a Widespread Challenge %A French,Blandine %A Babbage,Camilla %A Bird,Katherine %A Marsh,Lauren %A Pelton,Mirabel %A Patel,Shireen %A Cassidy,Sarah %A Rennick-Egglestone,Stefan %+ School of Psychology, University of Nottingham, University Park Campus, Psychology, Pharmacy, Life Sciences, East Dr, Nottingham, NG7 2RD, United Kingdom, 44 0115 748 6970, blandine.french@nottingham.ac.uk %K web-based research %K web-based studies %K qualitative studies %K surveys %K mental health %K data integrity, misrepresentation %D 2024 %7 16.9.2024 %9 Viewpoint %J JMIR Ment Health %G English %X This paper reports on the growing issues experienced when conducting web-based–based research. Nongenuine participants, repeat responders, and misrepresentation are common issues in health research posing significant challenges to data integrity. A summary of existing data on the topic and the different impacts on studies is presented. Seven case studies experienced by different teams within our institutions are then reported, primarily focused on mental health research. Finally, strategies to combat these challenges are presented, including protocol development, transparent recruitment practices, and continuous data monitoring. These strategies and challenges impact the entire research cycle and need to be considered prior to, during, and post data collection. With a lack of current clear guidelines on this topic, this report attempts to highlight considerations to be taken to minimize the impact of such challenges on researchers, studies, and wider research. Researchers conducting web-based research must put mitigating strategies in place, and reporting on mitigation efforts should be mandatory in grant applications and publications to uphold the credibility of web-based research. %R 10.2196/58432 %U https://mental.jmir.org/2024/1/e58432 %U https://doi.org/10.2196/58432 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e54781 %T The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy %A Haber,Yuval %A Levkovich,Inbar %A Hadar-Shoval,Dorit %A Elyoseph,Zohar %K psychoanalysis %K generative artificial intelligence %K psychotherapy %K large language models %K narcissism %K narcissist %K narcissistic %K perception %K perceptions %K critical thinking %K transparency %K autonomy %K mental health %K interpersonal %K LLM %K LLMs %K language model %K language models %K artificial intelligence %K generative %K AI %K ethic %K ethics %K ethical %D 2024 %7 23.5.2024 %9 %J JMIR Ment Health %G English %X This paper explores a significant shift in the field of mental health in general and psychotherapy in particular following generative artificial intelligence’s new capabilities in processing and generating humanlike language. Following Freud, this lingo-technological development is conceptualized as the “fourth narcissistic blow” that science inflicts on humanity. We argue that this narcissistic blow has a potentially dramatic influence on perceptions of human society, interrelationships, and the self. We should, accordingly, expect dramatic changes in perceptions of the therapeutic act following the emergence of what we term the artificial third in the field of psychotherapy. The introduction of an artificial third marks a critical juncture, prompting us to ask the following important core questions that address two basic elements of critical thinking, namely, transparency and autonomy: (1) What is this new artificial presence in therapy relationships? (2) How does it reshape our perception of ourselves and our interpersonal dynamics? and (3) What remains of the irreplaceable human elements at the core of therapy? Given the ethical implications that arise from these questions, this paper proposes that the artificial third can be a valuable asset when applied with insight and ethical consideration, enhancing but not replacing the human touch in therapy. %R 10.2196/54781 %U https://mental.jmir.org/2024/1/e54781 %U https://doi.org/10.2196/54781 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e48441 %T The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth %A Ridout,Brad %A Forsyth,Rowena %A Amon,Krestina L %A Navarro,Pablo %A Campbell,Andrew J %K mental health %K internet %K digital health %K telecounselling %K social networking %K telehealth %K telemedicine %K counseling %K counselling %K digital health %K service %K services %K healthcare delivery %K youth %K model %D 2024 %7 22.3.2024 %9 %J JMIR Ment Health %G English %X Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians. %R 10.2196/48441 %U https://mental.jmir.org/2024/1/e48441 %U https://doi.org/10.2196/48441 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49936 %T The Potential Influence of AI on Population Mental Health %A Ettman,Catherine K %A Galea,Sandro %+ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, United States, 1 410 516 8000, cettman1@jhu.edu %K mental health %K artificial intelligence %K AI %K policy %K policies %K population health %K population %K ChatGPT %K generative %K tools %K digital mental health %D 2023 %7 16.11.2023 %9 Viewpoint %J JMIR Ment Health %G English %X The integration of artificial intelligence (AI) into everyday life has galvanized a global conversation on the possibilities and perils of AI on human health. In particular, there is a growing need to anticipate and address the potential impact of widely accessible, enhanced, and conversational AI on mental health. We propose 3 considerations to frame how AI may influence population mental health: through the advancement of mental health care; by altering social and economic contexts; and through the policies that shape the adoption, use, and potential abuse of AI-enhanced tools. %M 37971803 %R 10.2196/49936 %U https://mental.jmir.org/2023/1/e49936 %U https://doi.org/10.2196/49936 %U http://www.ncbi.nlm.nih.gov/pubmed/37971803 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44679 %T Health Economic Evaluation of Cognitive Control Training for Depression: Key Considerations %A Nève de Mévergnies,Constance %A Verhaeghe,Nick %A Koster,Ernst H W %A Baeken,Chris %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 9 264 64 74, kristof.hoorelbeke@Ugent.be %K health economic evaluation %K cost utility %K cognitive control training %K CCT %K depression recurrence %K health policies %D 2023 %7 18.8.2023 %9 Viewpoint %J JMIR Ment Health %G English %X Depression is a serious and burdensome psychiatric illness that contributes heavily to health expenditures. These costs are partly related to the observation that depression is often not limited to a single episode but can recur or follow a chronic pathway. In terms of risk factors, it is acknowledged that cognitive impairments play a crucial role in vulnerability to depression. Within this context, cognitive control training (CCT) has shown its effectiveness in reducing the risk for recurrence of depression. CCT is low cost intensive and can be provided as a web-based intervention, which makes it easy to disseminate. Despite increasing interest in the field, studies examining the cost-effectiveness of CCT in the context of depression are largely missing. Health economic evaluation (HEE) allows to inform decision makers with evidence-based insights about how to spend limited available (financial) resources in the most efficient way. HEE studies constitute a crucial step in the implementation of a new intervention in clinical practice. Approaching preventive measures for depression such as CCT from an HEE perspective is informative to health policy, fostering optimal use of health expenditures. The aim of this paper was to inform and guide researchers during the phase of designing HEE studies in the context of CCT for depression. A clear view of CCT’s cost-effectiveness is paramount for its clinical implementation. %M 37594847 %R 10.2196/44679 %U https://mental.jmir.org/2023/1/e44679 %U https://doi.org/10.2196/44679 %U http://www.ncbi.nlm.nih.gov/pubmed/37594847 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e38920 %T Reintroducing the Effortless Assessment Research System (EARS) %A Lind,Monika N %A Kahn,Lauren E %A Crowley,Ryann %A Reed,Wyatt %A Wicks,Geordie %A Allen,Nicholas B %+ Center for Digital Mental Health, University of Oregon, Straub Hall, Eugene, OR, 97403, United States, 1 541 346 4075, nallen3@uoregon.edu %K mobile sensing %K passive sensing %K personal sensing %K digital phenotyping %K ecological momentary assessment %K digital mental health %D 2023 %7 26.4.2023 %9 Viewpoint %J JMIR Ment Health %G English %X This paper reintroduces the Effortless Assessment Research System (EARS), 4 years and 10,000 participants after its initial launch. EARS is a mobile sensing tool that affords researchers the opportunity to collect naturalistic, behavioral data via participants’ naturalistic smartphone use. The first section of the paper highlights improvements made to EARS via a tour of EARS’s capabilities—the most important of which is the expansion of EARS to the iOS operating system. Other improvements include better keyboard integration for the collection of typed text; full control of survey design and administration for research teams; and the addition of a researcher-facing EARS dashboard, which facilitates survey design, the enrollment of participants, and the tracking of participants. The second section of the paper goes behind the scenes to describe 3 challenges faced by the EARS developers—remote participant enrollment and tracking, keeping EARS running in the background, and continuous attention and effort toward data protection—and how those challenges shaped the design of the app. %M 37099361 %R 10.2196/38920 %U https://mental.jmir.org/2023/1/e38920 %U https://doi.org/10.2196/38920 %U http://www.ncbi.nlm.nih.gov/pubmed/37099361 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44601 %T Assessing Diversity and Inclusivity is the Next Frontier in Mental Health Recovery Narrative Research and Practice %A Kotera,Yasuhiro %A Rennick-Egglestone,Stefan %A Ng,Fiona %A Llewellyn-Beardsley,Joy %A Ali,Yasmin %A Newby,Chris %A Fox,Caroline %A Slade,Emily %A Bradstreet,Simon %A Harrison,Julian %A Franklin,Donna %A Todowede,Olamide %A Slade,Mike %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 01158231294, yasuhiro.kotera@nottingham.ac.uk %K recovery narrative %K web-based mental health interventions %K inclusivity %K diversity %K collective action %K curation %K mental health %K digital health %K telemedicine %K clinical practice %K narrative research %K demographic %D 2023 %7 17.4.2023 %9 Viewpoint %J JMIR Ment Health %G English %X Demand for digital health interventions is increasing in many countries. The use of recorded mental health recovery narratives in digital health interventions is becoming more widespread in clinical practice. Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, including struggles and successes over time. Helpful impacts of recorded mental health recovery narratives include connectedness with the narrative and validation of experiences. Possible harms include feeling disconnected and excluded from others. Diverse narrative collections from many types of narrators and describing multiple ways to recover are important to maximize the opportunity for service users to benefit through connection and to minimize the likelihood of harm. Mental health clinicians need to know whether narrative collections are sufficiently diverse to recommend to service users. However, no method exists for assessing the diversity and inclusivity of existing or new narrative collections. We argue that assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice. This is important, but methodologically and ethically complex. In this viewpoint, we propose and evaluate one diversity and two inclusivity assessment methods. The diversity assessment method involves use of the Simpson Diversity Index. The two inclusivity assessment methods are based on comparator demographic rates and arbitrary thresholds, respectively. These methods were applied to four narrative collections as a case study. Refinements are needed regarding a narrative assessment tool in terms of its practicality and cultural adaptation. %M 37067882 %R 10.2196/44601 %U https://mental.jmir.org/2023/1/e44601 %U https://doi.org/10.2196/44601 %U http://www.ncbi.nlm.nih.gov/pubmed/37067882 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40429 %T Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals %A Westheimer,Jessa Lin %A Moukaddam,Nidal %A Lindsay,Jan A %A Sabharwal,Ashutosh %A Najafi,Bijan %A Iacobelli,Peter A %A Boland,Robert J %A Patriquin,Michelle A %+ Research Department, The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, United States, 1 832 738 8300, jwestheimer@menninger.edu %K digital transformation %K user-centered design %K innovation %K implementation science %K user acceptability %K wearables %K mental health %K implementation %K technology implementation %D 2023 %7 6.4.2023 %9 Viewpoint %J JMIR Ment Health %G English %X Digital transformation is the adoption of digital technologies by an entity in an effort to increase operational efficiency. In mental health care, digital transformation entails technology implementation to improve the quality of care and mental health outcomes. Most psychiatric hospitals rely heavily on “high-touch” interventions or those that require in-person, face-to-face interaction with the patient. Those that are exploring digital mental health care interventions, particularly for outpatient care, often copiously commit to the “high-tech” model, losing the crucial human element. The process of digital transformation, especially within acute psychiatric treatment settings, is in its infancy. Existing implementation models outline the development of patient-facing treatment interventions within the primary care system; however, to our knowledge, there is no proposed or established model for implementing a new provider-facing ministration tool within an acute inpatient psychiatric setting. Solving the complex challenges within mental health care demands that new mental health technology is developed in concert with a use protocol by and for the inpatient mental health professional (IMHP; the end user), allowing the “high-touch” to inform the “high-tech” and vice versa. Therefore, in this viewpoint article, we propose the Technology Implementation for Mental-Health End-Users framework, which outlines the process for developing a prototype of an IMHP-facing digital intervention tool in parallel with a protocol for the IMHP end user to deliver the intervention. By balancing the design of the digital mental health care intervention tool with IMHP end user resource development, we can significantly improve mental health outcomes and pioneer digital transformation nationwide. %M 37023415 %R 10.2196/40429 %U https://mental.jmir.org/2023/1/e40429 %U https://doi.org/10.2196/40429 %U http://www.ncbi.nlm.nih.gov/pubmed/37023415 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41855 %T From Social Network to Peer Support Network: Opportunities to Explore Mechanisms of Online Peer Support for Mental Health %A Rayland,Amy %A Andrews,Jacob %+ National Institute for Health and Care Research Mindtech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1157484 218, jacob.andrews@nottingham.ac.uk %K peer-to-peer support %K Facebook %K social networking sites %K mental health %K moderation %D 2023 %7 28.2.2023 %9 Viewpoint %J JMIR Ment Health %G English %X An increasing number of psychological interventions are shifting to online modes of delivery. One such intervention is peer-to-peer support, which in this context may provide internet users living with mental health disorders an opportunity to connect with and support others living with similar conditions. This paper presents a call for further research into how platforms such as Facebook could be used as channels for peer support and the mechanisms that may underlie their effectiveness. We discuss the background of peer support, how it has transitioned online, and consider theories and models that may have relevance. We also consider the importance of moderation within online peer support and the development of specific social network–based online interventions. We conclude that for social network sites to be used as peer-to-peer support interventions, more research is needed to understand their effectiveness, the role of moderation in these communities, and the mechanisms that produce the benefits experienced by users. %M 36853738 %R 10.2196/41855 %U https://mental.jmir.org/2023/1/e41855 %U https://doi.org/10.2196/41855 %U http://www.ncbi.nlm.nih.gov/pubmed/36853738 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e38346 %T Young People’s Trust in Cocreated Web-Based Resources to Promote Mental Health Literacy: Focus Group Study %A Ito-Jaeger,Sachiyo %A Perez Vallejos,Elvira %A Logathasan,Saruka %A Curran,Thomas %A Crawford,Paul %+ Faculty of Medicine and Health Sciences, University of Nottingham, Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1158231294, sachiyo.ito-jaeger@nottingham.ac.uk %K trust %K mental health %K web %K young people %K cocreation %K mental health literacy %K qualitative study %K thematic analysis %K trustworthy %K digital mental health %K internet %K digital health %K mobile phone %D 2023 %7 9.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is a pressing need to create resources to promote mental health literacy among young people. Digital media is one of the methods that can be used to successfully promote mental health literacy. Although digital mental health resources are generally favorably perceived by young people, one of the essential factors in whether they choose to use these interventions is trust. Objective: The objective of this study was to explore young people’s trust-related concerns about and recommendations for the cocreated mental health website “What’s Up With Everyone” by using TrustScapes. Our aim was to use the findings to improve the trustworthiness of the website and to inform future creators of web-based mental health resources. Methods: In total, 30 young people (mean age 19, SD 1.509; range 17-21 years) participated in TrustScapes focus groups. Thematic analysis was carried out to analyze both the TrustScapes worksheets and audio transcripts. Results: Qualitative analysis revealed that the mental health website contains elements perceived to be both trustworthy and untrustworthy by young people. The relatable and high-quality design, which was achieved by cocreating the website with a team of design professionals and young people, was considered to increase trust. Creators’ credibility also positively affected trust, but the logos and other information about the creators were recommended to be more salient for users. Suggestions were made to update the privacy policy and cookie settings and include communication functions on the platform to improve the trustworthiness of the website. Conclusions: Factors perceived to be trustworthy included the website's relatable, high-quality design and creators’ credibility, whereas those perceived to be untrustworthy included the privacy policy and cookie settings. The findings highlighted the significance of collaborating with end users and industrial partners and the importance of making the trust-enabling factors salient for users. We hope that these findings will inform future creators of web-based mental health resources to make these resources as trustworthy and effective as possible. %M 36622752 %R 10.2196/38346 %U https://mental.jmir.org/2023/1/e38346 %U https://doi.org/10.2196/38346 %U http://www.ncbi.nlm.nih.gov/pubmed/36622752 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e39047 %T Use of an Ingestible, Sensor-Based Digital Adherence System to Strengthen the Therapeutic Relationship in Serious Mental Illness %A Richey,Anabel G %A Kovacs,Ildiko %A Browne,Sara %+ Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, La jolla, CA, 92037, United States, 1 858 822 6563, shbrowne@health.ucsd.edu %K patient-physician relationship %K ingestible sensor %K mental health %K serious mental illness %K antipsychotic %K medication adherence %K digital adherence %K therapy %K digital intervention %K digital mental health %D 2022 %7 2.12.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Serious mental illness is a chronic condition that requires long-term pharmacological treatment. Adherence to oral antipsychotic medication has specific nuances that affects patients and physicians alike. For patients with serious mental illness, nonadherence increases their risk of hospitalization and relapse. Nonadherence is a formidable barrier for physicians in accurately assessing medication efficacy and helping patients achieve their fullest potential. A digital adherence system approved by the Food and Drug Administration can provide near–real time aripiprazole ingestion information. The system records ingestions through an embedded ingestible sensor in oral aripiprazole, which sends a transient local signal to a patch worn on the patient’s torso that is then stored on a paired smartphone app. With patient permission, these data can be viewed remotely by their physician, along with a patient’s mood, activity, and time spent resting. Such data are able to do the following: reveal broad patterns of medication adherence behavior to the patient as well as their physician; help physicians and patients understand and create more realistic expectations for adherence; promote discussion of treatment options; and minimize therapeutic appointment time devoted to determining actual adherence, thereby maximizing the time available to address each patient’s distinctive reasons for their adherence pattern. Crucially, extra time created during appointments can be used to strengthen the therapeutic relationship, which may translate into both improvements in adherence and patient attitude toward their medication. Future investigations are needed to examine how this technology impacts the development of training and best practice guidelines for its use. Otherwise, the potential benefits of this technology may be lost, or worse, inadequate and inappropriate use may harm the therapeutic relationship. %M 36459392 %R 10.2196/39047 %U https://mental.jmir.org/2022/12/e39047 %U https://doi.org/10.2196/39047 %U http://www.ncbi.nlm.nih.gov/pubmed/36459392 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e41014 %T Ethical Implications of the Use of Language Analysis Technologies for the Diagnosis and Prediction of Psychiatric Disorders %A Loch,Alexandre Andrade %A Lopes-Rocha,Ana Caroline %A Ara,Anderson %A Gondim,João Medrado %A Cecchi,Guillermo A %A Corcoran,Cheryl Mary %A Mota,Natália Bezerra %A Argolo,Felipe C %+ Institute of Psychiatry, University of Sao Paulo, R. Dr. Ovidio Pires de Campos 785, 4 andar sala 4N60, Sao Paulo, 05403010, Brazil, 55 11996201213, alexandre.loch@usp.br %K at-risk mental state %K psychosis %K clinical high risk %K digital phenotyping %K machine learning %K artificial intelligence %K natural language processing %D 2022 %7 1.11.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Recent developments in artificial intelligence technologies have come to a point where machine learning algorithms can infer mental status based on someone’s photos and texts posted on social media. More than that, these algorithms are able to predict, with a reasonable degree of accuracy, future mental illness. They potentially represent an important advance in mental health care for preventive and early diagnosis initiatives, and for aiding professionals in the follow-up and prognosis of their patients. However, important issues call for major caution in the use of such technologies, namely, privacy and the stigma related to mental disorders. In this paper, we discuss the bioethical implications of using such technologies to diagnose and predict future mental illness, given the current scenario of swiftly growing technologies that analyze human language and the online availability of personal information given by social media. We also suggest future directions to be taken to minimize the misuse of such important technologies. %M 36318266 %R 10.2196/41014 %U https://mental.jmir.org/2022/11/e41014 %U https://doi.org/10.2196/41014 %U http://www.ncbi.nlm.nih.gov/pubmed/36318266 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e40410 %T The Best Predictor of the Future—the Metaverse, Mental Health, and Lessons Learned From Current Technologies %A Benrimoh,David %A Chheda,Forum D %A Margolese,Howard C %+ Department of Psychiatry, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada, 1 5144637813, david.benrimoh@mail.mcgill.ca %K metaverse %K mental health %K social media %K virtual reality %K VR %K digital experience %K human interaction %K mental health risk %K teleworking %K assisted therapy %K teletherapy %K benefits %K safety %K mental health problems %K data security %K privacy %K protection %K user safety %K safety regulations %K mobile phone %D 2022 %7 28.10.2022 %9 Viewpoint %J JMIR Ment Health %G English %X The metaverse—a virtual world accessed via virtual reality technology—has been heralded as the next key digital experience. It is meant to provide the next evolution of human interaction after social media and telework. However, in the context of the growing awareness of the risks to mental health posed by current social media technologies, there is a great deal of uncertainty as to the potential effects of this new technology on mental health. This uncertainty is compounded by a lack of clarity regarding what form the metaverse will ultimately take and how widespread its application will be. Despite this, given the nascent state of the metaverse, there is an opportunity to plan the research and regulatory approaches needed to understand it and promote its positive effects while protecting vulnerable groups. In this viewpoint, we examine the following three current technologies whose functions comprise a portion of what the metaverse seeks to accomplish: teleworking, virtual reality, and social media. We attempted to understand in what ways the metaverse may have similar benefits and pitfalls to these technologies but also how it may fundamentally differ from them. These differences suggest potential research questions to be addressed in future work. We found that current technologies have enabled tools such as virtual reality–assisted therapy, avatar therapy, and teletherapy, which have had positive effects on mental health care, and that the metaverse may provide meaningful improvements to these tools. However, given its similarities to social media and its expansion upon the social media experience, the metaverse raises some of the same concerns that we have with social media, such as the possible exacerbation of certain mental health problems. These concerns led us to consider questions such as how the users will be protected and what regulatory mechanisms will be put in place to ensure user safety. Although clear answers to these questions are challenging in this early phase of metaverse research, in this viewpoint, we use the context provided by comparator technologies to provide recommendations to maximize the potential benefits and limit the putative harms of the metaverse. We hope that this paper encourages discussions among researchers and policy makers. %M 36306155 %R 10.2196/40410 %U https://mental.jmir.org/2022/10/e40410 %U https://doi.org/10.2196/40410 %U http://www.ncbi.nlm.nih.gov/pubmed/36306155 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e18539 %T Psychiatry on Twitter: Content Analysis of the Use of Psychiatric Terms in French %A Delanys,Sarah %A Benamara,Farah %A Moriceau,Véronique %A Olivier,François %A Mothe,Josiane %+ Fédération Régionale de Recherche en Psychiatrie et santé mentale d’Occitanie, 134 route d'Espagne, Toulouse, 31000, France, 33 5 61 43 78 52, s.delanys@ch-montauban.fr %K social media analysis %K psychiatric term use %K social stigma %K Twitter %K social media %K mental health %D 2022 %7 14.2.2022 %9 Viewpoint %J JMIR Form Res %G English %X Background: With the advent of digital technology and specifically user-generated contents in social media, new ways emerged for studying possible stigma of people in relation with mental health. Several pieces of work studied the discourse conveyed about psychiatric pathologies on Twitter considering mostly tweets in English and a limited number of psychiatric disorders terms. This paper proposes the first study to analyze the use of a wide range of psychiatric terms in tweets in French. Objective: Our aim is to study how generic, nosographic, and therapeutic psychiatric terms are used on Twitter in French. More specifically, our study has 3 complementary goals: (1) to analyze the types of psychiatric word use (medical, misuse, or irrelevant), (2) to analyze the polarity conveyed in the tweets that use these terms (positive, negative, or neural), and (3) to compare the frequency of these terms to those observed in related work (mainly in English). Methods: Our study was conducted on a corpus of tweets in French posted from January 1, 2016, to December 31, 2018, and collected using dedicated keywords. The corpus was manually annotated by clinical psychiatrists following a multilayer annotation scheme that includes the type of word use and the opinion orientation of the tweet. A qualitative analysis was performed to measure the reliability of the produced manual annotation, and then a quantitative analysis was performed considering mainly term frequency in each layer and exploring the interactions between them. Results: One of the first results is a resource as an annotated dataset. The initial dataset is composed of 22,579 tweets in French containing at least one of the selected psychiatric terms. From this set, experts in psychiatry randomly annotated 3040 tweets that corresponded to the resource resulting from our work. The second result is the analysis of the annotations showing that terms are misused in 45.33% (1378/3040) of the tweets and that their associated polarity is negative in 86.21% (1188/1378) of the cases. When considering the 3 types of term use, 52.14% (1585/3040) of the tweets are associated with a negative polarity. Misused terms related to psychotic disorders (721/1300, 55.46%) were more frequent to those related to depression (15/280, 5.4%). Conclusions: Some psychiatric terms are misused in the corpora we studied, which is consistent with the results reported in related work in other languages. Thanks to the great diversity of studied terms, this work highlighted a disparity in the representations and ways of using psychiatric terms. Moreover, our study is important to help psychiatrists to be aware of the term use in new communication media such as social networks that are widely used. This study has the huge advantage to be reproducible thanks to the framework and guidelines we produced so that the study could be renewed in order to analyze the evolution of term usage. While the newly build dataset is a valuable resource for other analytical studies, it could also serve to train machine learning algorithms to automatically identify stigma in social media. %M 35156925 %R 10.2196/18539 %U https://formative.jmir.org/2022/2/e18539 %U https://doi.org/10.2196/18539 %U http://www.ncbi.nlm.nih.gov/pubmed/35156925 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30838 %T Attentional Harms and Digital Inequalities %A Hartford,Anna %A Stein,Dan J %+ Brain-Behaviour Unit, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, 7935, South Africa, 27 214042174, annahartford@gmail.com %K digital inequalities %K attentional harms %K excessive internet use %K persuasive technologies %K internet ethics %K attention economies %D 2022 %7 11.2.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Recent years have seen growing public concern about the effects of persuasive digital technologies on public mental health and well-being. As the draws on our attention reach such staggering scales and as our ability to focus our attention on our own considered ends erodes ever further, the need to understand and articulate what is at stake has become pressing. In this ethical viewpoint, we explore the concept of attentional harms and emphasize their potential seriousness. We further argue that the acknowledgment of these harms has relevance for evolving debates on digital inequalities. An underdiscussed aspect of web-based inequality concerns the persuasions, and even the manipulations, that help to generate sustained attentional loss. These inequalities are poised to grow, and as they do, so will concerns about justice with regard to the psychological and self-regulatory burdens of web-based participation for different internet users. In line with calls for multidimensional approaches to digital inequalities, it is important to recognize these potential harms as well as to empower internet users against them even while expanding high-quality access. %M 35147504 %R 10.2196/30838 %U https://mental.jmir.org/2022/2/e30838 %U https://doi.org/10.2196/30838 %U http://www.ncbi.nlm.nih.gov/pubmed/35147504 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e32430 %T A Novel Peer-to-Peer Coaching Program to Support Digital Mental Health: Design and Implementation %A Rosenberg,Benjamin M %A Kodish,Tamar %A Cohen,Zachary D %A Gong-Guy,Elizabeth %A Craske,Michelle G %+ Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, 95030, United States, 1 4083068603, benrosenberg@g.ucla.edu %K peer support %K digital mental health %K university students %K college students %K training and supervision %K scalable psychological interventions %D 2022 %7 26.1.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present an avenue for increasing the reach of mental health services. These interventions often rely on paraprofessionals, or coaches, to support the treatment. Although existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between the scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention for undergraduate students within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts. %M 35080504 %R 10.2196/32430 %U https://mental.jmir.org/2022/1/e32430 %U https://doi.org/10.2196/32430 %U http://www.ncbi.nlm.nih.gov/pubmed/35080504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32422 %T Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study %A Sutherland,Stephanie %A Jeong,Dahn %A Cheng,Michael %A St-Jean,Mireille %A Jalali,Alireza %+ Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada, 1 6135625800, ajalali@uottawa.ca %K mental health %K Canada %K qualitative research %K caregiver %K family physician %K mentorship %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers’ willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. Objective: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. Methods: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. Results: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician’s office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son’s or daughter’s mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. Conclusions: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other’s perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives. %M 34994704 %R 10.2196/32422 %U https://formative.jmir.org/2022/1/e32422 %U https://doi.org/10.2196/32422 %U http://www.ncbi.nlm.nih.gov/pubmed/34994704 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30915 %T Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility %A Kiekens,Glenn %A Robinson,Kealagh %A Tatnell,Ruth %A Kirtley,Olivia J %+ Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Tiensestraat 102, Leuven, 3720, Belgium, 32 16372852, glenn.kiekens@kuleuven.be %K real-time monitoring %K nonsuicidal self-injury %K NSSI %K experience sampling %K ecological momentary assessment %K digital psychiatry %D 2021 %7 19.11.2021 %9 Viewpoint %J JMIR Ment Health %G English %X Although nonsuicidal self-injury (NSSI)—deliberate damaging of body tissue without suicidal intent—is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research. %M 34807835 %R 10.2196/30915 %U https://mental.jmir.org/2021/11/e30915 %U https://doi.org/10.2196/30915 %U http://www.ncbi.nlm.nih.gov/pubmed/34807835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27507 %T Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K digital implementation %K digital mental health %K digital psychiatry %K digital technology %K viewpoint %D 2021 %7 13.10.2021 %9 Viewpoint %J J Med Internet Res %G English %X Digital mental health technologies such as mobile health (mHealth) tools can offer innovative ways to help develop and facilitate mental health care provision, with the COVID-19 pandemic acting as a pivot point for digital health implementation. This viewpoint offers an overview of the opportunities and challenges mHealth innovators must navigate to create an integrated digital ecosystem for mental health care moving forward. Opportunities exist for innovators to develop tools that can collect a vast range of active and passive patient and transdiagnostic symptom data. Moving away from a symptom-count approach to a transdiagnostic view of psychopathology has the potential to facilitate early and accurate diagnosis, and can further enable personalized treatment strategies. However, the uptake of these technologies critically depends on the perceived relevance and engagement of end users. To this end, behavior theories and codesigning approaches offer opportunities to identify behavioral drivers and address barriers to uptake, while ensuring that products meet users’ needs and preferences. The agenda for innovators should also include building strong evidence-based cases for digital mental health, moving away from a one-size-fits-all well-being approach to embrace the development of comprehensive digital diagnostics and validated digital tools. In particular, innovators have the opportunity to make their clinical evaluations more insightful by assessing effectiveness and feasibility in the intended context of use. Finally, innovators should adhere to standardized evaluation frameworks introduced by regulators and health care providers, as this can facilitate transparency and guide health care professionals toward clinically safe and effective technologies. By laying these foundations, digital services can become integrated into clinical practice, thus facilitating deeper technology-enabled changes. %M 34643537 %R 10.2196/27507 %U https://www.jmir.org/2021/10/e27507 %U https://doi.org/10.2196/27507 %U http://www.ncbi.nlm.nih.gov/pubmed/34643537 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26484 %T Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning %A Evans,Yolanda %A Hutchinson,Jeffrey %A Ameenuddin,Nusheen %+ Division of Community Pediatric and Adolescent Medicine, Department of Pediatrics, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, United States, 1 5072842511, ameenuddin.nusheen@mayo.edu %K pandemic %K technology %K media %K bullying %K mental health %K distance learning %D 2021 %7 15.9.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The transition to web-based learning during the COVID-19 pandemic has highlighted the need to consider the benefits of and the risks associated with web-based technology for education, media use, and access to resources. Prior to the pandemic, children and adolescents had in-person access to peers; social relationships; educators; health care providers; and, in some cases, mental health resources and medical care in schools and community settings. Due to the introduction of universal masking and physical distancing guidelines to prevent the spread of COVID-19 in early 2020, methods for accessing these resources have shifted dramatically, as people now rely on web-based platforms to access such resources. This viewpoint will explore equity in access to technology for web-based learning, mental health (with a focus on students of color), and the challenge of cultivating meaningful relationships on web-based platforms. Challenges and possible solutions will be offered. %M 34524094 %R 10.2196/26484 %U https://mental.jmir.org/2021/9/e26484 %U https://doi.org/10.2196/26484 %U http://www.ncbi.nlm.nih.gov/pubmed/34524094 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28555 %T Advancing Health Equity in Digital Mental Health: Lessons From Medical Anthropology for Global Mental Health %A Kozelka,Ellen Elizabeth %A Jenkins,Janis H %A Carpenter-Song,Elizabeth %+ Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 (858) 534 4145, ekozelka@ucsd.edu %K qualitative methods %K digital health %K mental health %K health equity %D 2021 %7 16.8.2021 %9 Viewpoint %J JMIR Ment Health %G English %X Digital health engenders the opportunity to create new effective mental health care models—from substance use recovery to suicide prevention. Anthropological methodologies offer a unique opportunity for the field of global mental health to examine and incorporate contextual mental health needs through attention to the lived experience of illness; engagement with communities; and knowledge of context, structures, and systems. Attending to these diverse mental health needs and conditions as well as the limitations of digital health will allow global mental health researchers, practitioners, and patients to collaboratively create new models for care in the service of equitable, accessible recovery. %M 34398788 %R 10.2196/28555 %U https://mental.jmir.org/2021/8/e28555 %U https://doi.org/10.2196/28555 %U http://www.ncbi.nlm.nih.gov/pubmed/34398788 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e29314 %T COVID-19 and Open Notes: A New Method to Enhance Patient Safety and Trust %A Blease,Charlotte %A Salmi,Liz %A Hägglund,Maria %A Wachenheim,Deborah %A DesRoches,Catherine %+ Division of General Medicine, Beth Israel Deaconess Medical Center, 133 Brookline Avenue, HVMA Second Floor Annex, Boston, MA, 02215, United States, 1 6173201281, cblease@bidmc.harvard.edu %K COVID-19 %K patient portals %K electronic health records %K patient safety %K patient-centered care %D 2021 %7 21.6.2021 %9 Viewpoint %J JMIR Ment Health %G English %X From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic. %M 34081603 %R 10.2196/29314 %U https://mental.jmir.org/2021/6/e29314 %U https://doi.org/10.2196/29314 %U http://www.ncbi.nlm.nih.gov/pubmed/34081603 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e26811 %T Digital Mental Health Challenges and the Horizon Ahead for Solutions %A Balcombe,Luke %A De Leo,Diego %+ Australian Institute for Suicide Research and Prevention, Griffith University, Messines Ridge Rd, Brisbane, 4122, Australia, 61 0447505709, lukebalcombe@gmail.com %K challenges %K COVID-19 %K digital mental health implementation %K explainable artificial intelligence %K hybrid model of care %K human-computer interaction %K resilience %K technology %D 2021 %7 29.3.2021 %9 Commentary %J JMIR Ment Health %G English %X The demand outstripping supply of mental health resources during the COVID-19 pandemic presents opportunities for digital technology tools to fill this new gap and, in the process, demonstrate capabilities to increase their effectiveness and efficiency. However, technology-enabled services have faced challenges in being sustainably implemented despite showing promising outcomes in efficacy trials since the early 2000s. The ongoing failure of these implementations has been addressed in reconceptualized models and frameworks, along with various efforts to branch out among disparate developers and clinical researchers to provide them with a key for furthering evaluative research. However, the limitations of traditional research methods in dealing with the complexities of mental health care warrant a diversified approach. The crux of the challenges of digital mental health implementation is the efficacy and evaluation of existing studies. Web-based interventions are increasingly used during the pandemic, allowing for affordable access to psychological therapies. However, a lagging infrastructure and skill base has limited the application of digital solutions in mental health care. Methodologies need to be converged owing to the rapid development of digital technologies that have outpaced the evaluation of rigorous digital mental health interventions and strategies to prevent mental illness. The functions and implications of human-computer interaction require a better understanding to overcome engagement barriers, especially with predictive technologies. Explainable artificial intelligence is being incorporated into digital mental health implementation to obtain positive and responsible outcomes. Investment in digital platforms and associated apps for real-time screening, tracking, and treatment offer the promise of cost-effectiveness in vulnerable populations. Although machine learning has been limited by study conduct and reporting methods, the increasing use of unstructured data has strengthened its potential. Early evidence suggests that the advantages outweigh the disadvantages of incrementing such technology. The limitations of an evidence-based approach require better integration of decision support tools to guide policymakers with digital mental health implementation. There is a complex range of issues with effectiveness, equity, access, and ethics (eg, privacy, confidentiality, fairness, transparency, reproducibility, and accountability), which warrant resolution. Evidence-informed policies, development of eminent digital products and services, and skills to use and maintain these solutions are required. Studies need to focus on developing digital platforms with explainable artificial intelligence–based apps to enhance resilience and guide the treatment decisions of mental health practitioners. Investments in digital mental health should ensure their safety and workability. End users should encourage the use of innovative methods to encourage developers to effectively evaluate their products and services and to render them a worthwhile investment. Technology-enabled services in a hybrid model of care are most likely to be effective (eg, specialists using these services among vulnerable, at-risk populations but not severe cases of mental ill health). %M 33779570 %R 10.2196/26811 %U https://mental.jmir.org/2021/3/e26811 %U https://doi.org/10.2196/26811 %U http://www.ncbi.nlm.nih.gov/pubmed/33779570 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25456 %T It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups %A Friis-Healy,Elsa A %A Nagy,Gabriela A %A Kollins,Scott H %+ Department of Psychiatry and Behavioral Services, Duke University School of Medicine, 2608 Erwin Road, Durham, NC, 27705, United States, 1 919 681 0014, eaf23@duke.edu %K digital health %K app %K public mental health %K health disparities %K COVID-19 %K pandemic %K mental health %K disparity %K behavior %D 2021 %7 26.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The behavioral health toll of the COVID-19 pandemic and systemic racism has directed increased attention to the potential of digital health as a way of improving access to and quality of behavioral health care. However, as the pandemic continues to widen health disparities in racially and ethnically minoritized groups, concerns arise around an increased reliance on digital health technologies exacerbating the digital divide and reinforcing rather than mitigating systemic health inequities in communities of color. As funding for digital mental health continues to surge, we offer five key recommendations on how the field can “REACT” to ensure the development of approaches that increase health equity by increasing real-world evidence, educating consumers and providers, utilizing adaptive interventions to optimize care, creating for diverse populations, and building trust. Recommendations highlight the need to take a strengths-based view when designing for racially and ethnically diverse populations and embracing the potential of digital approaches to address complex challenges. %M 33406050 %R 10.2196/25456 %U http://mental.jmir.org/2021/1/e25456/ %U https://doi.org/10.2196/25456 %U http://www.ncbi.nlm.nih.gov/pubmed/33406050 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e21895 %T The Digital Therapeutic Alliance and Human-Computer Interaction %A D'Alfonso,Simon %A Lederman,Reeva %A Bucci,Sandra %A Berry,Katherine %+ School of Computing and Information Systems, University of Melbourne, Doug McDonell Building, Parkville, 3010, Australia, 61 3 9035 5511, dalfonso@unimelb.edu.au %K therapeutic alliance %K digital mental health %K affective computing %K persuasive computing %K positive computing %K mobile phone %K mHealth %D 2020 %7 29.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps. %M 33372897 %R 10.2196/21895 %U http://mental.jmir.org/2020/12/e21895/ %U https://doi.org/10.2196/21895 %U http://www.ncbi.nlm.nih.gov/pubmed/33372897 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e23776 %T Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities %A Martinez-Martin,Nicole %A Dasgupta,Ishan %A Carter,Adrian %A Chandler,Jennifer A %A Kellmeyer,Philipp %A Kreitmair,Karola %A Weiss,Anthony %A Cabrera,Laura Y %+ Department of Pediatrics, Center for Biomedical Ethics, School of Medicine, Stanford University, 1215 Welch Road, Modular A, Stanford, CA, 94305, United States, 1 6507235760, nicolemz@stanford.edu %K ethics %K digital mental health %K neuroethics %K mental health %K COVID-19 %K crisis %K opportunity %K implementation %K online tool %K telehealth %D 2020 %7 22.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X Social distancing measures due to the COVID-19 pandemic have accelerated the adoption and implementation of digital mental health tools. Psychiatry and therapy sessions are being conducted via videoconferencing platforms, and the use of digital mental health tools for monitoring and treatment has grown. This rapid shift to telehealth during the pandemic has given added urgency to the ethical challenges presented by digital mental health tools. Regulatory standards have been relaxed to allow this shift to socially distanced mental health care. It is imperative to ensure that the implementation of digital mental health tools, especially in the context of this crisis, is guided by ethical principles and abides by professional codes of conduct. This paper examines key areas for an ethical path forward in this digital mental health revolution: privacy and data protection, safety and accountability, and access and fairness. %M 33156811 %R 10.2196/23776 %U https://mental.jmir.org/2020/12/e23776 %U https://doi.org/10.2196/23776 %U http://www.ncbi.nlm.nih.gov/pubmed/33156811 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e23596 %T Direct-to-Consumer Genetic Ancestry Testing in Clinical Encounters: Perspectives From Psychotherapy Cases %A Rubanovich,Caryn Kseniya %A Zhang,Wendy %A Bloss,Cinnamon S %+ Division of Health Policy, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 (858) 534 9595, cbloss@ucsd.edu %K direct-to-consumer %K genetic ancestry testing %K therapeutic alliance %K psychotherapy %D 2020 %7 26.11.2020 %9 Viewpoint %J JMIR Ment Health %G English %X Despite the fact that direct-to-consumer (DTC) genetic ancestry testing (GAT) has been available for two decades, there is a lack of evidence-based guidance for clinicians who may work with patients who raise the topic of DTC-GAT. Although DTC-GAT accounts for the majority of the DTC genetic testing marketplace, it has received less attention than health-related testing from scientific and clinical communities. Importantly, however, from our personal experience, patients have been raising the topic of DTC-GAT in clinical encounters, including psychotherapy sessions. In this viewpoint, we present two cases of patients seen by two of the authors to raise awareness of this issue. We describe the implications of DTC-GAT for patients and clinicians, offer recommendations, and suggest future directions. %M 33242016 %R 10.2196/23596 %U http://mental.jmir.org/2020/11/e23596/ %U https://doi.org/10.2196/23596 %U http://www.ncbi.nlm.nih.gov/pubmed/33242016 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e19600 %T Therapist-Supported Online Interventions for Children and Young People With Tic Disorders: Lessons Learned From a Randomized Controlled Trial and Considerations for Future Practice %A Chamberlain,Liam R %A Hall,Charlotte L %A Andrén,Per %A Davies,E Bethan %A Kilgariff,Joseph %A Kouzoupi,Natalia %A Murphy,Tara %A Hollis,Chris %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 8230258, Chris.Hollis@nottingham.ac.uk %K Tourette syndrome %K tic disorders %K internet-based cognitive behavioral therapy (iCBT) %K remote therapy %K therapist support %D 2020 %7 23.10.2020 %9 Viewpoint %J JMIR Ment Health %G English %X In recent years, research into internet-based cognitive behavioral therapy (iCBT) has suggested that therapist-guided digital interventions have greater engagement, adherence, and effectiveness than self-directed digital therapies. While research has focused on the effectiveness of, and adherence to, these interventions, less attention has been paid to their implementation in practice and what aspects of the therapist role support success. An understanding of the key factors related to the therapist role and intervention delivery is required if these iCBTs are to be applied in routine clinical care and outcomes optimized. In light of the coronavirus disease 2019 (COVID-19) pandemic, there is greater emphasis on allowing patients access to remote therapies. We report the experiences and reflections of 4 therapists and their 2 supervisors in delivering an online, therapist-supported intervention in a randomized controlled trial for children and young people with tic disorders (the Online Remote Behavioural Intervention for Tics [ORBIT] trial). Themes discussed include the importance of training, supervision, creating support documents/manuals, and record keeping. Alongside this are communication strategies used by therapists to encourage patient adherence and treatment effectiveness. These include rapport building, treatment personalization, and suggestions for overcoming non-engagement. These reflections offer important considerations for the delivery of iCBTs as well as implications associated with the implementation of these interventions in existing services and future research studies. We share thoughts on where iCBTs may sit in a stepped care model, how services may deal with comorbid conditions, and the potential role of iCBTs in collecting clinical data. %M 33095180 %R 10.2196/19600 %U http://mental.jmir.org/2020/10/e19600/ %U https://doi.org/10.2196/19600 %U http://www.ncbi.nlm.nih.gov/pubmed/33095180 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e18472 %T Digital Mental Health: The Answer to the Global Mental Health Crisis? %A Rudd,Brittany N %A Beidas,Rinad S %+ Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 1747 West Roosevelt Road, Office 218, Chicago, IL, 60608, United States, 1 (312) 996 7723, bnrudd@uic.edu %K public mental health %K universal mental health prevention %K digital implementation support %D 2020 %7 2.6.2020 %9 Editorial %J JMIR Ment Health %G English %X Digital mental health interventions are often touted as the solution to the global mental health crisis. However, moving mental health care from the hands of professionals and into digital apps may further isolate individuals who need human connection the most. In this commentary, we argue that people, our society’s greatest resource, are as ubiquitous as technology. Thus, we argue that research focused on using technology to support all people in delivering mental health prevention and intervention deserves greater attention in the coming decade. %M 32484445 %R 10.2196/18472 %U https://mental.jmir.org/2020/6/e18472 %U https://doi.org/10.2196/18472 %U http://www.ncbi.nlm.nih.gov/pubmed/32484445 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e18848 %T Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow %A Torous,John %A Jän Myrick,Keris %A Rauseo-Ricupero,Natali %A Firth,Joseph %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Rabb 2, 330 Brookline Ave, Boston, MA, 02215, United States, 1 61766700, jtorous@bidmc.harvard.edu %K digital health %K emergency response %K telehealth %K apps %D 2020 %7 26.3.2020 %9 Editorial %J JMIR Ment Health %G English %X As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must “flatten the curve” of spread of the virus, we argue that now is the time to “accelerate and bend the curve” on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further. %M 32213476 %R 10.2196/18848 %U http://mental.jmir.org/2020/3/e18848/ %U https://doi.org/10.2196/18848 %U http://www.ncbi.nlm.nih.gov/pubmed/32213476 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e14581 %T E-Clinical High Risk for Psychosis: Viewpoint on Potential of Digital Innovations for Preventive Psychiatry %A Reilly,Thomas %A Mechelli,Andrea %A McGuire,Philip %A Fusar-Poli,Paolo %A Uhlhaas,Peter J %+ Institute of Neuroscience and Psychology, University of Glasgow, 62 Hillhead Street, Glasgow, United Kingdom, 44 0141 330 8763, peter.uhlhaas@glasgow.ac.uk %K psychotic disorders %K schizophrenia %K prognosis %K treatment %K clinical high risk %K digital %K e-health %K internet %K smartphone %K mobile phone %D 2019 %7 3.10.2019 %9 Viewpoint %J JMIR Ment Health %G English %X E-mental health is an emerging area of research that has the potential to overcome some of the current barriers to progress in working with people at clinical high risk for psychosis (CHR-P). This article provides an overview of how e-mental health could be used in the detection, prediction, and treatment in the CHR-P population. Specifically, we evaluate e-detection, e-prediction, and e-therapeutics for this clinical population. E-mental health holds great promise to improve current management of CHR-P individuals. %M 31584006 %R 10.2196/14581 %U https://mental.jmir.org/2019/10/e14581 %U https://doi.org/10.2196/14581 %U http://www.ncbi.nlm.nih.gov/pubmed/31584006 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11402 %T Telehealth Services for Children With Autism Spectrum Disorders in Rural Areas of the Kingdom of Saudi Arabia: Overview and Recommendations %A Alkhalifah,Shahad %A Aldhalaan,Hesham %+ Centre for Autism Research, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia, 966 14647272 ext 70723, shahad.alkh@gmail.com %K autism spectrum disorders %K intervention %K Saudi Arabia %K telehealth %D 2018 %7 15.11.2018 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Autism spectrum disorders (ASD) are the most-prevalent neurodevelopmental disorders. However, each child diagnosed with ASD presents with a unique range of behavioral and communication problems and issues with social skills. Many studies have highlighted the importance of early interventions for children with ASD to improve their skills and provide their families with the necessary support. However, in the Kingdom of Saudi Arabia (KSA), the earliest that a child with ASD in the major cities receives an intervention is at the age of 4 years, owing to limited services and a lack of awareness of the importance and benefits of early interventions. Families who live in rural areas of KSA arguably have a greater need for these services, as they have to travel to cities such as Riyadh for help. The use of telehealth services may be effective for ASD intervention among children living in rural areas, since such services use technology to provide consultations, interventions, diagnosis, training, and education. Research indicates that telehealth services are as valuable as traditional face-to-face treatment, allow families to obtain support from their homes, and help them improve their quality of life. This review will discuss the application of telehealth services to support families in rural areas of KSA who are dealing with issues of ASD, considering the cultural and religious contexts. In addition, it will examine ways in which technology can be employed to suit KSA’s culture and needs. %M 31518306 %R 10.2196/11402 %U http://pediatrics.jmir.org/2018/2/e11402/ %U https://doi.org/10.2196/11402 %U http://www.ncbi.nlm.nih.gov/pubmed/31518306 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10334 %T The Effortless Assessment of Risk States (EARS) Tool: An Interpersonal Approach to Mobile Sensing %A Lind,Monika N %A Byrne,Michelle L %A Wicks,Geordie %A Smidt,Alec M %A Allen,Nicholas B %+ Center for Digital Mental Health, Department of Psychology, University of Oregon, 1227 University Street, Eugene, OR, 97403, United States, 1 541 346 4075, nallen3@uoregon.edu %K passive mobile sensing %K personal sensing %K mobile sensing %K mental health %K risk assessment %K crisis prevention %K individual big data %K telemedicine %K mobile apps %K cell phone %K depression %D 2018 %7 28.08.2018 %9 Viewpoint %J JMIR Ment Health %G English %X Background: To predict and prevent mental health crises, we must develop new approaches that can provide a dramatic advance in the effectiveness, timeliness, and scalability of our interventions. However, current methods of predicting mental health crises (eg, clinical monitoring, screening) usually fail on most, if not all, of these criteria. Luckily for us, 77% of Americans carry with them an unprecedented opportunity to detect risk states and provide precise life-saving interventions. Smartphones present an opportunity to empower individuals to leverage the data they generate through their normal phone use to predict and prevent mental health crises. Objective: To facilitate the collection of high-quality, passive mobile sensing data, we built the Effortless Assessment of Risk States (EARS) tool to enable the generation of predictive machine learning algorithms to solve previously intractable problems and identify risk states before they become crises. Methods: The EARS tool captures multiple indices of a person’s social and affective behavior via their naturalistic use of a smartphone. Although other mobile data collection tools exist, the EARS tool places a unique emphasis on capturing the content as well as the form of social communication on the phone. Signals collected include facial expressions, acoustic vocal quality, natural language use, physical activity, music choice, and geographical location. Critically, the EARS tool collects these data passively, with almost no burden on the user. We programmed the EARS tool in Java for the Android mobile platform. In building the EARS tool, we concentrated on two main considerations: (1) privacy and encryption and (2) phone use impact. Results: In a pilot study (N=24), participants tolerated the EARS tool well, reporting minimal burden. None of the participants who completed the study reported needing to use the provided battery packs. Current testing on a range of phones indicated that the tool consumed approximately 15% of the battery over a 16-hour period. Installation of the EARS tool caused minimal change in the user interface and user experience. Once installation is completed, the only difference the user notices is the custom keyboard. Conclusions: The EARS tool offers an innovative approach to passive mobile sensing by emphasizing the centrality of a person’s social life to their well-being. We built the EARS tool to power cutting-edge research, with the ultimate goal of leveraging individual big data to empower people and enhance mental health. %M 30154072 %R 10.2196/10334 %U http://mental.jmir.org/2018/3/e10334/ %U https://doi.org/10.2196/10334 %U http://www.ncbi.nlm.nih.gov/pubmed/30154072 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e33 %T Ethical Issues in Addressing Social Media Posts About Suicidal Intentions During an Online Study Among Youth: Case Study %A Young,Sean D %A Garett,Renee %+ University of California Institute for Prediction Technology, Department of Family Medicine, University of California, Los Angeles, Suite 1800, 10880 Wilshire Blvd, Los Angeles, CA,, United States, 1 310 794 8530, sdyoung@mednet.ucla.edu %K suicide %K social media %K undergraduates %D 2018 %7 03.05.2018 %9 Case Study %J JMIR Ment Health %G English %X Due to the popularity of social media, researchers are increasingly conducting studies that monitor and analyze people’s health-related social media conversations. Because social media users can post about any topic at any time, no known best ethical practices exist as to whether and how to monitor participants’ posts for safety-related issues that might be unrelated to the study, such as expressions of suicidal intentions. This is a case study during a social media-based study on sleep and activity among freshman undergraduate students, where we by chance noticed that a student was using social media to express suicidal intentions. Although we connected the student to student psychological services in order to receive treatment, we encountered a number of barriers that initially prevented this from occurring, such as institutional review board and regulatory practices related to lack of experience with these newer types of studies. We discuss the implications of this experience for future research. %M 29724707 %R 10.2196/mental.8971 %U http://mental.jmir.org/2018/2/e33/ %U https://doi.org/10.2196/mental.8971 %U http://www.ncbi.nlm.nih.gov/pubmed/29724707 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e32 %T Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent %A Martinez-Martin,Nicole %A Kreitmair,Karola %+ Stanford Center for Biomedical Ethics, 1215 Welch Road, Stanford, CA, 94305, United States, 1 650 723 5760, nicolemz@stanford.edu %K ethics %K ethical issues %K mental health %K technology %K telemedicine %K mHealth %K psychotherapy %D 2018 %7 23.04.2018 %9 Viewpoint %J JMIR Ment Health %G English %X This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer. %M 29685865 %R 10.2196/mental.9423 %U http://mental.jmir.org/2018/2/e32/ %U https://doi.org/10.2196/mental.9423 %U http://www.ncbi.nlm.nih.gov/pubmed/29685865 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e114 %T Phone-Based Interventions in Adolescent Psychiatry: A Perspective and Proof of Concept Pilot Study With a Focus on Depression and Autism %A Chen,Robert Yuzen %A Feltes,Jordan Robert %A Tzeng,William Shun %A Lu,Zoe Yunzhu %A Pan,Michael %A Zhao,Nan %A Talkin,Rebecca %A Javaherian,Kavon %A Glowinski,Anne %A Ross,Will %+ Washington University School of Medicine, Farrell Learning and Teaching Center, 660 S Euclid Avenue, St. Louis, MO, 63110, United States, 1 425 753 4101, robert.chen@wustl.edu %K telemedicine %K depression %K autistic disorder %K mobile applications %K text messaging %K child %K mental health %D 2017 %7 16.06.2017 %9 Viewpoint %J JMIR Res Protoc %G English %X Background: Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed. Objective: The aim of this paper was to explore the utility of text message interventions in adolescent psychiatry and describe a user feedback-driven iterative design process for text message systems. Methods: We developed automated text message interventions using a platform for both depression (EpxDepression) and autism spectrum disorder (ASD; EpxAutism) and conducted 2 pilot studies for each intervention (N=3 and N=6, respectively). The interventions were prescribed by and accessible to the patients’ healthcare providers. EpxDepression and EpxAutism utilized an automated system to triage patients into 1 of 3 risk categories based on their text responses and alerted providers directly via phone and an online interface when patients met provider-specified risk criteria. Rapid text-based feedback from participants and interviews with providers allowed for quick iterative cycles to improve interventions. Results: Patients using EpxDepression had high weekly response rates (100% over 2 to 4 months), but exhibited message fatigue with daily prompts with mean (SD) overall response rates of 66.3% (21.6%) and 64.7% (8.2%) for mood and sleep questionnaires, respectively. In contrast, parents using EpxAutism displayed both high weekly and overall response rates (100% and 85%, respectively, over 1 to 4 months) that did not decay significantly with time. Monthly participant feedback surveys for EpxDepression (7 surveys) and EpxAutism (18 surveys) preliminarily indicated that for both interventions, daily messages constituted the “perfect amount” of contact and that EpxAutism, but not EpxDepression, improved patient communication with providers. Notably, EpxDepression detected thoughts of self-harm in patients before their case managers or caregivers were aware of such ideation. Conclusions: Text-message interventions in adolescent psychiatry can provide a cost-effective and engaging method to track symptoms, behavior, and ideation over time. Following the collection of pilot data and feedback from providers and patients, larger studies are already underway to validate the clinical utility of EpxDepression and EpxAutism. Trial Registration: Clinicaltrials.gov NCT03002311; https://clinicaltrials.gov/ct2/show/NCT03002311 (Archived by WebCite at http://www.webcitation.org/6qQtlCIS0) %M 28623183 %R 10.2196/resprot.7245 %U http://www.researchprotocols.org/2017/6/e114/ %U https://doi.org/10.2196/resprot.7245 %U http://www.ncbi.nlm.nih.gov/pubmed/28623183 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e20 %T Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps %A Tang,Wei %A Kreindler,David %+ Division of Youth Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, Room FG-17, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 416 480 5225, david.kreindler@sunnybrook.ca %K cognitive behavioral therapy %K homework compliance %K mobile apps %D 2017 %7 08.06.2017 %9 Viewpoint %J JMIR Ment Health %G English %X Cognitive behavioral therapy (CBT) is one of the most effective psychotherapy modalities used to treat depression and anxiety disorders. Homework is an integral component of CBT, but homework compliance in CBT remains problematic in real-life practice. The popularization of the mobile phone with app capabilities (smartphone) presents a unique opportunity to enhance CBT homework compliance; however, there are no guidelines for designing mobile phone apps created for this purpose. Existing literature suggests 6 essential features of an optimal mobile app for maximizing CBT homework compliance: (1) therapy congruency, (2) fostering learning, (3) guiding therapy, (4) connection building, (5) emphasis on completion, and (6) population specificity. We expect that a well-designed mobile app incorporating these features should result in improved homework compliance and better outcomes for its users. %M 28596145 %R 10.2196/mental.5283 %U http://mental.jmir.org/2017/2/e20/ %U https://doi.org/10.2196/mental.5283 %U http://www.ncbi.nlm.nih.gov/pubmed/28596145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e153 %T Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment %A Mohr,David C %A Lyon,Aaron R %A Lattie,Emily G %A Reddy,Madhu %A Schueller,Stephen M %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 3125031403, d-mohr@northwestern.edu %K eHealth %K mHealth %K methodology %D 2017 %7 10.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients. %M 28490417 %R 10.2196/jmir.7725 %U http://www.jmir.org/2017/5/e153/ %U https://doi.org/10.2196/jmir.7725 %U http://www.ncbi.nlm.nih.gov/pubmed/28490417 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e9 %T Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care %A Wentzel,Jobke %A van der Vaart,Rosalie %A Bohlmeijer,Ernst T %A van Gemert-Pijnen,Julia E W C %+ Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522NB, Netherlands, 31 534896050, j.vangemert-pijnen@utwente.nl %K blended care %K Internet-delivered cognitive behavior therapy %K mental health care %K online %K shared decision making %D 2016 %7 09.02.2016 %9 Viewpoint %J JMIR Mental Health %G English %X Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of “blend” works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The “Fit for Blended Care” instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) “blends” of online and face-to-face therapy becomes within reach. %M 26860537 %R 10.2196/mental.4534 %U http://mental.jmir.org/2016/1/e9/ %U https://doi.org/10.2196/mental.4534 %U http://www.ncbi.nlm.nih.gov/pubmed/26860537 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e5 %T Heuristic Evaluation of Ehealth Interventions: Establishing Standards That Relate to the Therapeutic Process Perspective %A Baumel,Amit %A Muench,Fred %+ The Feinstein Institute for Medical Research, Department of Psychiatry, North Shore–LIJ Health System, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 7184708267, amitbaumel@gmail.com %K eHealth %K mHealth %K digital health %K mobile health %K heuristics %K evaluation %K principles %K therapeutic process %D 2016 %7 13.01.2016 %9 Viewpoint %J JMIR Mental Health %G English %X In recent years, the number of available eHealth interventions aimed at treating behavioral and mental health challenges has been growing. From the perspective of health care providers, there is a need for eHealth interventions to be evaluated prior to clinical trials and for the limited resources allocated to empirical research to be invested in the most promising products. Following a literature review, a gap was found in the availability of eHealth interventions evaluation principles related to the patient experience of the therapeutic process. This paper introduces principles and concepts for the evaluation of eHealth interventions developed as a first step in a process to outline general evaluation guidelines that relate to the clinical context from health care providers’ perspective. Our approach was to conduct a review of literature that relates to the examination of eHealth interventions. We identified the literature that was most relevant to our study and used it to define guidelines that relate to the clinical context. We then compiled a list of heuristics we found to be useful for the evaluation of eHealth intervention products’ suitability for empirical examination. Four heuristics were identified with respect to the therapeutic process: (1) the product’s ease of use (ie, usability), (2) the eHealth intervention’s compatibility with the clinical setting, (3) the presence of tools that make it easier for the user to engage in therapeutic activities, and (4) the provision of a feasible therapeutic pathway to growth. We then used this set of heuristics to conduct a detailed examination of MyFitnessPal. This line of work could help to set the bar higher for product developers and to inform health care providers about preferred eHealth intervention designs. %M 26764209 %R 10.2196/mental.4563 %U http://mental.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/mental.4563 %U http://www.ncbi.nlm.nih.gov/pubmed/26764209 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e15 %T Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study %A Maercker,Andreas %A Bachem,Rahel C %A Lorenz,Louisa %A Moser,Christian T %A Berger,Thomas %+ Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Institute of Psychology, Binzmühlestrasse 14/17, Zurich, 8050, Switzerland, 41 44 635 7310, maercker@psychologie.uzh.ch %K adjustment disorders %K intervention %K e-mental health %K unguided self-help %K depression %D 2015 %7 08.05.2015 %9 Viewpoint %J JMIR Mental Health %G English %X Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders. %M 26543920 %R 10.2196/mental.4157 %U http://mental.jmir.org/2015/2/e15/ %U https://doi.org/10.2196/mental.4157 %U http://www.ncbi.nlm.nih.gov/pubmed/26543920