%0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e67418 %T Game Design, Effectiveness, and Implementation of Serious Games Promoting Aspects of Mental Health Literacy Among Children and Adolescents: Systematic Review %A Zeiler,Michael %A Vögl,Sandra %A Prinz,Ursula %A Werner,Nino %A Wagner,Gudrun %A Karwautz,Andreas %A Zeller,Natalie %A Ackermann,Lorenz %A Waldherr,Karin %+ Medical University of Vienna, Department for Child and Adolescent Psychiatry, Waehringer Guertel 18-20, Vienna, 1090, Austria, 43 14040021270, michael.zeiler@meduniwien.ac.at %K serious games %K gamification %K mental health literacy %K game design %K children %K adolescents %K systematic review %K artificial intelligence %D 2025 %7 5.5.2025 %9 Review %J JMIR Ment Health %G English %X Background: The effects of traditional health-promoting and preventive interventions in mental health and mental health literacy are often attenuated by low adherence and user engagement. Gamified approaches such as serious games (SGs) may be useful to reach and engage youth for mental health prevention and promotion. Objective: This study aims to systematically review the literature on SGs designed to promote aspects of mental health literacy among adolescents aged 10 to 14 years, focusing on game design characteristics and the evaluation of user engagement, as well as efficacy, effectiveness, and implementation-related factors. Methods: We searched PubMed, Scopus, and PsycINFO for original studies, intervention development studies, and study protocols that described the development, characteristics, and evaluation of SG interventions promoting aspects of mental health literacy among adolescents aged 10 to 14 years. We included SGs developed for both universal and selected prevention. Using the co.LAB framework, which considers aspects of learning design, game mechanics, and game design, we coded the design elements of the SGs described in the studies. We coded the characteristics of the evaluation studies; indicators of efficacy, effectiveness, and user engagement; and factors potentially fostering or hindering the reach, efficacy and effectiveness, organizational adoption, implementation, and maintenance of the SGs. Results: We retrieved 1454 records through database searches and other sources. Of these, 36 (2.48%) studies describing 17 distinct SGs were included in the review. Most of the SGs (14/17, 82%) were targeted to a universal population of youth, with learning objectives mainly focusing on how to obtain and maintain good mental health and on enhancing help-seeking efficacy. All SGs were single-player games, and many (7/17, 41%) were embedded within a wider pedagogical scenario. Diverse game mechanics and game elements (eg, minigames and quizzes) were used to foster user engagement. Most of the SGs (12/17, 71%) featured an overarching storyline resembling real-world scenarios, fictional scenarios, or a combination of both. The evaluation studies provided evidence for the short-term efficacy and effectiveness of SGs in improving aspects of mental health literacy as well as their feasibility. However, the evidence was mostly based on small samples, and user adherence was sometimes low. Conclusions: The results of this review may inform the future development and implementation of SGs for adolescents. Intervention co-design, the involvement of facilitators (eg, teachers), and the use of diverse game mechanics and customization to meet the needs of diverse users are examples of elements that may promote intervention success. Although there is promising evidence for the efficacy and effectiveness of SGs for promoting mental health literacy in youth, there is a need for more rigorously planned studies, including randomized controlled trials and real-world evaluations, that involve follow-up measures and the assessment of in-game performance alongside self-reports. %M 40324175 %R 10.2196/67418 %U https://mental.jmir.org/2025/1/e67418 %U https://doi.org/10.2196/67418 %U http://www.ncbi.nlm.nih.gov/pubmed/40324175 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68544 %T Exploring Engagement With and Effectiveness of Digital Mental Health Interventions in Young People of Different Ethnicities: Systematic Review %A Bakhti,Rinad %A Daler,Harmani %A Ogunro,Hephzibah %A Hope,Steven %A Hargreaves,Dougal %A Nicholls,Dasha %+ Department of Brain Sciences, Division of Psychiatry, Imperial College London, Du Cane Road, London, W12 0NN, United Kingdom, 44 020 7594 1069, r.bakhti@imperial.ac.uk %K digital mental health interventions %K young people %K ethnicity %K engagement %K effectiveness %K artificial intelligence %K AI %D 2025 %7 7.4.2025 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of mental health difficulties among young people has risen in recent years, with 75% of mental disorders emerging before the age of 24 years. The identification and treatment of mental health issues earlier in life improves later-life outcomes. The COVID-19 pandemic spurred the growth of digital mental health interventions (DMHIs), which offer accessible support. However, young people of different ethnicities face barriers to DMHIs, such as socioeconomic disadvantage and cultural stigma. Objective: This review aimed to summarize and evaluate the engagement with and effectiveness of DMHIs among young people of different ethnicities. Methods: A systematic search was conducted in MEDLINE, Embase, and PsycINFO for studies published between January 2019 and May 2024, with an update in September 2024. The inclusion criteria were participants aged <25 years using DMHIs from various ethnic backgrounds. Three reviewers independently screened and selected the studies. Data on engagement (eg, use and uptake) and effectiveness (eg, clinical outcomes and symptom improvement) were extracted and synthesized to compare findings. Studies were assessed for quality using the Mixed Methods Appraisal Tool. Results: The final search yielded 67 studies, of which 7 (10%) met inclusion criteria. There were 1853 participants across the 7 studies, all from high-income countries. Participants were predominantly aged 12 to 25 years, with representation of diverse ethnic identities, including Black, Asian, Hispanic, mixed race, and Aboriginal individuals. Engagement outcomes varied, with culturally relatable, low-cost interventions showing higher retention and user satisfaction. Linguistic barriers and country of origin impeded the effectiveness of some interventions, while near-peer mentorship, coproduction, and tailored content improved the effectiveness of DMHIs. While initial results are promising, small sample sizes, heterogeneity in outcome assessments, and a paucity of longitudinal data impeded robust comparisons and generalizability. Conclusions: DMHIs show potential as engaging and effective mental health promotional tools for young people of different ethnicities, especially when coproduced and culturally relatable. Initial data suggest that interventions facilitating near-peer mentoring, linguistic adaptation, low cost, and cultural relatability have improved engagement and effectiveness. Future research should focus on developing a consensus definition of DMHIs, exploring DMHIs in children aged <12 years, and conducting detailed qualitative and quantitative research on use factors and treatment efficacy of DMHIs for young people of different ethnicities. Trial Registration: PROSPERO CRD42024544364; https://tinyurl.com/yk5jt8yk %M 40194267 %R 10.2196/68544 %U https://www.jmir.org/2025/1/e68544 %U https://doi.org/10.2196/68544 %U http://www.ncbi.nlm.nih.gov/pubmed/40194267 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e69120 %T Effects of Sound Interventions on the Mental Stress Response in Adults: Scoping Review %A Saskovets,Marina %A Saponkova,Irina %A Liang,Zilu %+ Faculty of Engineering, Kyoto University of Advanced Science, 18 Yamanouchi Gotanda-cho, Ukyo-ku, Kyoto, Kyoto, 615-8577, Japan, 81 9049473689, saskovets.m@gmail.com %K mental stress %K anxiety %K sound therapy %K music therapy %K psychoacoustics %K expressive sounds %K stress reduction %K stress management %K stress relief %K stress markers %K relaxation %K personalized therapy %K PRISMA %D 2025 %7 24.3.2025 %9 Review %J JMIR Ment Health %G English %X Background: This scoping review examines the effects of various sound interventions, including music, natural sounds, and speech, on the stress response in adults. Objective: The review aims to identify key therapeutic factors, including sound type, individual listener characteristics, and environmental influences. It also synthesizes evidence on physiological responses to sound interventions and highlights current research gaps. Methods: We conducted a comprehensive search using databases such as PubMed, Web of Science, Scopus, and PsycINFO, focusing on studies from 1990 to 2024. Eligible studies included randomized controlled trials, clinical trials, and laboratory experiments that measured stress through physiological markers (eg, heart rate variability and cortisol) and self-reports. A total of 34 studies were included, and thematic analysis was conducted to identify recurring themes in the findings. Results: The findings suggest that music, especially classical and self-selected pieces, effectively reduces physiological stress markers, including cortisol levels, heart rate variability, and blood pressure. Nonmusical sounds, such as nature sounds and calming voices, also demonstrate potential for stress relief, although research in this area remains limited. While most sound interventions showed positive effects, some studies reported adverse effects, indicating that sound can both alleviate and induce stress. The outcomes were substantially affected by contextual factors such as personal preferences, delivery methods, cultural context, and emphasizing the importance of personalized interventions. Conclusions: Sound interventions offer promising, noninvasive methods for stress reduction. This review suggests that future research should address gaps in the study of nonmusical sound interventions and further investigate the neural mechanisms underlying stress responses to sound. International Registered Report Identifier (IRRID): RR2-10.2196/54030 %M 40127440 %R 10.2196/69120 %U https://mental.jmir.org/2025/1/e69120 %U https://doi.org/10.2196/69120 %U http://www.ncbi.nlm.nih.gov/pubmed/40127440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56975 %T Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis %A Brinsley,Jacinta %A O'Connor,Edward J %A Singh,Ben %A McKeon,Grace %A Curtis,Rachel %A Ferguson,Ty %A Gosse,Georgia %A Willems,Iris %A Marent,Pieter-Jan %A Szeto,Kimberley %A Firth,Joseph %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, 108 North Terrace, Adelaide, 5000, Australia, 61 8 8302 6558, jacinta.brinsley@unisa.edu.au %K depression %K anxiety %K stress %K well-being %K mental health %K lifestyle intervention %K physical activity %K sleep %K diet %K digital health %K mobile phone %D 2025 %7 20.3.2025 %9 Review %J J Med Internet Res %G English %X Background: There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior. Objective: The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes. Methods: A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics. Results: Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] −0.37; P<.001), a small effect on anxiety (SMD −0.29; P<.001) and stress (SMD −0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted. Conclusions: Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity. Trial Registration: PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908 %M 40112295 %R 10.2196/56975 %U https://www.jmir.org/2025/1/e56975 %U https://doi.org/10.2196/56975 %U http://www.ncbi.nlm.nih.gov/pubmed/40112295 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e59869 %T Problematic Digital Technology Use Measures in Children Aged 0 to 6 Years: Scoping Review %A Selak,Špela %A Horvat,Janja %A Žmavc,Mark %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubjana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K scoping review %K measures %K problematic digital technology use %K children %K early childhood %K mobile phone %D 2025 %7 18.3.2025 %9 Review %J JMIR Ment Health %G English %X Background: In the interest of accurately assessing the effects of digital technology use in early childhood, researchers and experts have emphasized the need to conceptualize and measure children’s digital technology use beyond screen time. Researchers have argued that many patterns of early digital technology use could be problematic, resulting in the emerging need to list and examine their measures. Objective: We aimed to review existing empirical literature that is using measures for problematic digital technology use in preschool children with the end goal of identifying a set of reliable and valid measures, predicting negative outcomes for children’s health, development, or well-being. Methods: We conducted a scoping review across the Web of Science, PubMed, and Google Scholar databases to identify peer-reviewed publications that were published from January 2012 to December 2023, were written in the English language, described an empirical study, and included a measure of problematic digital technology use beyond exposure (ie, screen time) in children aged 0 to 6 years. Results: The search yielded 95 empirical studies, in which 18 composite measures of problematic use and 23 measures of specific problematic use aspects were found. Existing composite measures conceptualize problematic use as either a group of risky behaviors or as a group of symptoms of a presumed underlying disorder, with the latter being more common. Looking at their conceptual background and psychometric properties, existing composite measures fall short of reliably assessing all the crucial aspects of problematic digital technology use in early childhood. Therefore, the benefits and shortcomings of single-aspect problematic digital technology use measures are evaluated and discussed. Conclusions: On the basis of current research, early exposure to digital technologies, device use before sleep, and solitary device use represent measures that have been consistently associated with negative outcomes for children. In addition, potential measures of problematic use include device use during meals, device use for emotional regulation, device multitasking, and technoference, warranting further research. Public health benefits of defining problematic digital technology use as a group of risky behaviors rather than a group of addiction symptoms are discussed. %M 40100254 %R 10.2196/59869 %U https://mental.jmir.org/2025/1/e59869 %U https://doi.org/10.2196/59869 %U http://www.ncbi.nlm.nih.gov/pubmed/40100254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69621 %T Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review %A Zhong,Chuhan %A Luo,Xian %A Tan,Miaoqin %A Chi,Jing %A Guo,Bingqian %A Tang,Jianyao %A Guo,Zihan %A Deng,Shisi %A Zhang,Yujie %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 18818860076, yanniwuSMU@126.com %K digital health care services %K mental health care %K oncology %K digital delivery modality %K umbrella review %K PRISMA %D 2025 %7 21.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs. Objective: This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer. Methods: Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool. Results: In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer. Conclusions: Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice. Trial Registration: PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9 %M 39984165 %R 10.2196/69621 %U https://www.jmir.org/2025/1/e69621 %U https://doi.org/10.2196/69621 %U http://www.ncbi.nlm.nih.gov/pubmed/39984165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59656 %T Interventions for Digital Addiction: Umbrella Review of Meta-Analyses %A Lu,Peng %A Qiu,Jiamin %A Huang,Shiqi %A Wang,Xinman %A Han,Shasha %A Zhu,Sui %A Ning,Youjing %A Zeng,Fang-fang %A Yuan,Yuan %+ Department of Chinese International Education, Chinese Language and Culture College, Huaqiao University, No 8 Jiageng Road, Xiamen, 361021, China, 86 6068002, yuanyuan361021@163.com %K digital addiction %K interventions %K umbrella reviews %K systematic review %K internet addiction %K loneliness %K quality of life %K well-being %K internet %K psychological %K pharmacological treatment %K cognitive behavioral therapy %D 2025 %7 11.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions. Objective: This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses. Methods: An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty. Results: A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95% CI, 0.311 to 2.206), and IA scores (SMD –2.097, 95% CI –2.814 to –1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95% CI 0.269 to 2.322) and reducing IA levels (SMD –1.417, 95% CI –1.836 to –0.997). Exercise intervention reduced IA scores (SMD –2.322, 95% CI –3.212 to –1.431), depression scores (SMD –1.421, 95% CI –2.046 to –797), and interpersonal sensitivity scores (SMD –1.433, 95% CI –2.239 to –0.627). Conclusions: The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence. Trial Registration: PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display_record.php?RecordID=528173 %M 39933164 %R 10.2196/59656 %U https://www.jmir.org/2025/1/e59656 %U https://doi.org/10.2196/59656 %U http://www.ncbi.nlm.nih.gov/pubmed/39933164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58434 %T Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review %A Kearns,Amanda %A Moorhead,Anne %A Mulvenna,Maurice %A Bond,Raymond %+ Life and Health Sciences, Institute for Nursing and Health Research, Ulster University, 2-24 York Street, Belfast, BT15 1AP, United Kingdom, 44 7706848477, kearns-a7@ulster.ac.uk %K digital communication %K digital technology %K digital transformation %K health professional %K mental health %K obesity %K complex needs %K artificial intelligence %K AI %K PRISMA %D 2025 %7 10.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication. Methods: A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs’ use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: “What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?” Results: In total, 8 studies—featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email—met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P≥.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals’ complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs. %M 39928923 %R 10.2196/58434 %U https://www.jmir.org/2025/1/e58434 %U https://doi.org/10.2196/58434 %U http://www.ncbi.nlm.nih.gov/pubmed/39928923 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e69294 %T Does the Digital Therapeutic Alliance Exist? Integrative Review %A Malouin-Lachance,Amylie %A Capolupo,Julien %A Laplante,Chloé %A Hudon,Alexandre %K psychotherapy %K mental health %K psychiatry %K artificial intelligence %K therapeutic alliance %K digital interventions %K chatbot %K psychology %D 2025 %7 7.2.2025 %9 %J JMIR Ment Health %G English %X Background: Mental health disorders significantly impact global populations, prompting the rise of digital mental health interventions, such as artificial intelligence (AI)-powered chatbots, to address gaps in access to care. This review explores the potential for a “digital therapeutic alliance (DTA),” emphasizing empathy, engagement, and alignment with traditional therapeutic principles to enhance user outcomes. Objective: The primary objective of this review was to identify key concepts underlying the DTA in AI-driven psychotherapeutic interventions for mental health. The secondary objective was to propose an initial definition of the DTA based on these identified concepts. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for scoping reviews and Tavares de Souza’s integrative review methodology were followed, encompassing systematic literature searches in Medline, Web of Science, PsycNet, and Google Scholar. Data from eligible studies were extracted and analyzed using Horvath et al’s conceptual framework on a therapeutic alliance, focusing on goal alignment, task agreement, and the therapeutic bond, with quality assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Results: A total of 28 studies were identified from an initial pool of 1294 articles after excluding duplicates and ineligible studies. These studies informed the development of a conceptual framework for a DTA, encompassing key elements such as goal alignment, task agreement, therapeutic bond, user engagement, and the facilitators and barriers affecting therapeutic outcomes. The interventions primarily focused on AI-powered chatbots, digital psychotherapy, and other digital tools. Conclusions: The findings of this integrative review provide a foundational framework for the concept of a DTA and report its potential to replicate key therapeutic mechanisms such as empathy, trust, and collaboration in AI-driven psychotherapeutic tools. While the DTA shows promise in enhancing accessibility and engagement in mental health care, further research and innovation are needed to address challenges such as personalization, ethical concerns, and long-term impact. %R 10.2196/69294 %U https://mental.jmir.org/2025/1/e69294 %U https://doi.org/10.2196/69294 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e67785 %T Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews %A Cameron,Gillian %A Mulvenna,Maurice %A Ennis,Edel %A O'Neill,Siobhan %A Bond,Raymond %A Cameron,David %A Bunting,Alex %+ School of Computing, Ulster University, 2-24 York Street, Belfast, BT15 1AP, United Kingdom, 44 7753 430736, cameron-g2@ulster.ac.uk %K digital interventions for mental health %K workplace wellbeing %K stress %K anxiety %K depression %K burnout %K CBT %K umbrella review %K digital mental health %K evaluation %K psychological %K databases %K Pubmed %K Web of Science %K Medline %K Cochrane Library %K PRISMA %D 2025 %7 24.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: There is potential for digital mental health interventions to provide affordable, efficient, and scalable support to individuals. Digital interventions, including cognitive behavioral therapy, stress management, and mindfulness programs, have shown promise when applied in workplace settings. Objective: The aim of this study is to conduct an umbrella review of systematic reviews in order to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Methods: A systematic search was conducted to identify systematic reviews relating to digital interventions for the workplace, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The review protocol was registered in the Open Science Framework. The following databases were searched: PubMed, Web of Science, MEDLINE, PsycINFO, and Cochrane Library. Data were extracted using a predefined extraction table. To assess the methodological quality of a study, the AMSTAR-2 tool was used to critically appraise systematic reviews of health care interventions. Results: The literature search resulted in 11,875 records, which was reduced to 14 full-text systematic literature reviews with the use of Covidence to remove duplicates and screen titles and abstracts. The 14 included reviews were published between 2014 and 2023, comprising 9 systematic reviews and 5 systematic reviews and meta-analyses. AMSTAR-2 was used to complete a quality assessment of the reviews, and the results were critically low for 7 literature reviews and low for the other 7 literature reviews. The most common types of digital intervention studied were cognitive behavioral therapy, mindfulness/meditation, and stress management followed by other self-help interventions. Effectiveness of digital interventions was found for many mental health symptoms and conditions in employee populations, such as stress, anxiety, depression, burnout, and psychological well-being. Factors such as type of technology, guidance, recruitment, tailoring, and demographics were found to impact effectiveness. Conclusions: This umbrella review aimed to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Despite the low quality of the reviews, best practice guidelines can be derived from factors that impact the effectiveness of digital interventions in the workplace. Trial Registration: OSF Registries osf.io/rc6ds; https://doi.org/10.17605/OSF.IO/RC6DS %M 39854722 %R 10.2196/67785 %U https://mental.jmir.org/2025/1/e67785 %U https://doi.org/10.2196/67785 %U http://www.ncbi.nlm.nih.gov/pubmed/39854722 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e65246 %T Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis %A Eisner,Emily %A Faulkner,Sophie %A Allan,Stephanie %A Ball,Hannah %A Di Basilio,Daniela %A Nicholas,Jennifer %A Priyam,Aansha %A Wilson,Paul %A Zhang,Xiaolong %A Bucci,Sandra %+ Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL, United Kingdom, 44 1613066000, emily.eisner@manchester.ac.uk %K psychosis %K bipolar %K schizophrenia %K smartphone %K digital %K wearable %K mobile phone %K PRISMA %D 2025 %7 20.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. Objective: This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings. Methods: A systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder. The Consolidated Framework for Implementation Research was used to synthesize data on barriers and facilitators, following a best-fit framework synthesis approach. Results: The review included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; qualitative interviews; and usability, cohort, and case studies. Samples included people with schizophrenia spectrum psychosis (98/150, 65.3% of studies), bipolar disorder (62/150, 41.3% of studies), and clinicians (26/150, 17.3% of studies). Key facilitators were a strong recognition of DMHIs’ relative advantages, a clear link between intervention focus and specific patient needs, a simple, low-effort digital interface, human-supported delivery, and device provision where needed. Although staff thought patients would lose, damage, or sell devices, reviewed studies found only 11% device loss. Barriers included intervention complexity, perceived risks, user motivation, discomfort with self-reflection, digital poverty, symptoms of psychosis, poor compatibility with existing clinical workflows, staff and patient fears that DMHIs would replace traditional face-to-face care, infrastructure limitations, and limited financial support for delivery. Conclusions: Identified barriers and facilitators highlight key considerations for DMHI development and implementation. As to broader implications, sustainable business models are needed to ensure that evidence-based DMHIs are maintained and deployed. Trial Registration: PROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871 %M 39832352 %R 10.2196/65246 %U https://mental.jmir.org/2025/1/e65246 %U https://doi.org/10.2196/65246 %U http://www.ncbi.nlm.nih.gov/pubmed/39832352 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e59740 %T Scrutinizing the Gateway Relationship Between Gaming and Gambling Disorder: Scoping Review With a Focus on the Southeast Asian Region %A Siste,Kristiana %A King,Daniel L %A Hanafi,Enjeline %A Sen,Lee Thung %A Adrian,Adrian %A Murtani,Belinda Julivia %K behavioral addiction %K convergence %K gateway effect %K gambling advertisement %K gamblification %K monetized gaming %D 2025 %7 15.1.2025 %9 %J JMIR Serious Games %G English %X Background: The gaming and gambling overlap has intensified with new evidence emerging. However, the relationship between gaming and gambling in the digital space is still inconclusive, especially in resource-limited Asian countries. Objective: This study aims to review available evidence on the possible interaction and focuses specifically on the gateway interaction between gambling and gaming. Additionally, this review delves into the state of evidence from the Southeast Asian region, providing an in-depth analysis of this underexplored area. Methods: We performed a scoping review by sifting through the publications in five databases. We focused on the gateway interaction and provided a possible pathway model, while two other convergence relationships were provided for comparison. Results: The scoping review identified a total of 289 publications, with the majority being empirical (n=181), although only 12 studies used longitudinal designs. A significant proportion of the publications (n=152) concentrated on the correlation or comorbidity between gaming and gambling. Most of the evidence has originated from Global North countries, with very limited research emerging from Southeast Asia (n=8). The most commonly studied gambling-like element in video games was loot boxes (n=105). Other elements investigated included esports betting, skin betting, token wagering, gambling advertisements, and gambling-like features. Several longitudinal studies have highlighted the risk of the gateway effect associated with gamblification involvement. However, emerging evidence suggests more nuanced underlying mechanisms that drive the transition from gaming to gambling. Conclusions: Overall, there is early evidence of linkage between gambling and gaming, through shared structural and biopsychosocial characteristics. This association possibly extends beyond disparate comorbidity, as such engagement in one activity might influence the risk of partaking in the other behavior. The field requires further longitudinal data to determine the directionality and significant precipitating factors of the gateway effect, particularly evidence from Asia. %R 10.2196/59740 %U https://games.jmir.org/2025/1/e59740 %U https://doi.org/10.2196/59740 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e65143 %T Utility of Consumer-Grade Wearable Devices for Inferring Physical and Mental Health Outcomes in Severe Mental Illness: Systematic Review %A Hassan,Lamiece %A Milton,Alyssa %A Sawyer,Chelsea %A Casson,Alexander J %A Torous,John %A Davies,Alan %A Ruiz-Yu,Bernalyn %A Firth,Joseph %+ School for Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613066000, lamiece.hassan@manchester.ac.uk %K wearable %K mental health %K severe mental illness %K SMI %K schizophrenia %K psychosis %K bipolar disorder %K digital phenotyping %K physical health %K remote monitoring %K mobile health %K telehealth %K sleep %K psychiatry %K smartphone %D 2025 %7 7.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: Digital wearable devices, worn on or close to the body, have potential for passively detecting mental and physical health symptoms among people with severe mental illness (SMI); however, the roles of consumer-grade devices are not well understood. Objective: This study aims to examine the utility of data from consumer-grade, digital, wearable devices (including smartphones or wrist-worn devices) for remotely monitoring or predicting changes in mental or physical health among adults with schizophrenia or bipolar disorder. Studies were included that passively collected physiological data (including sleep duration, heart rate, sleep and wake patterns, or physical activity) for at least 3 days. Research-grade actigraphy methods and physically obtrusive devices were excluded. Methods: We conducted a systematic review of the following databases: Cochrane Central Register of Controlled Trials, Technology Assessment, AMED (Allied and Complementary Medicine), APA PsycINFO, Embase, MEDLINE(R), and IEEE XPlore. Searches were completed in May 2024. Results were synthesized narratively due to study heterogeneity and divided into the following phenotypes: physical activity, sleep and circadian rhythm, and heart rate. Results: Overall, 23 studies were included that reported data from 12 distinct studies, mostly using smartphones and centered on relapse prevention. Only 1 study explicitly aimed to address physical health outcomes among people with SMI. In total, data were included from over 500 participants with SMI, predominantly from high-income countries. Most commonly, papers presented physical activity data (n=18), followed by sleep and circadian rhythm data (n=14) and heart rate data (n=6). The use of smartwatches to support data collection were reported by 8 papers; the rest used only smartphones. There was some evidence that lower levels of activity, higher heart rates, and later and irregular sleep onset times were associated with psychiatric diagnoses or poorer symptoms. However, heterogeneity in devices, measures, sampling and statistical approaches complicated interpretation. Conclusions: Consumer-grade wearables show the ability to passively detect digital markers indicative of psychiatric symptoms or mental health status among people with SMI, but few are currently using these to address physical health inequalities. The digital phenotyping field in psychiatry would benefit from moving toward agreed standards regarding data descriptions and outcome measures and ensuring that valuable temporal data provided by wearables are fully exploited. Trial Registration: PROSPERO CRD42022382267; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382267 %M 39773905 %R 10.2196/65143 %U https://mental.jmir.org/2025/1/e65143 %U https://doi.org/10.2196/65143 %U http://www.ncbi.nlm.nih.gov/pubmed/39773905 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e57795 %T User Experiences of and Preferences for Self-Guided Digital Interventions for the Treatment of Mild to Moderate Eating Disorders: Systematic Review and Metasynthesis %A Cheung,Lauryn Gar-Mun %A Thomas,Pamela Carien %A Brvar,Eva %A Rowe,Sarah %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Ct Rd, London, W1T 7NF, United Kingdom, 44 020 7679 2000, s.rowe@ucl.ac.uk %K eating disorders %K anorexia %K bulimia %K binge eating %K other specified feeding or eating disorder %K OSFED %K intervention %K digital intervention %K self-help %K systematic review %D 2025 %7 3.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: Digital interventions typically involve using smartphones or PCs to access online or downloadable self-help and may offer a more accessible and convenient option than face-to-face interventions for some people with mild to moderate eating disorders. They have been shown to substantially reduce eating disorder symptoms, but treatment dropout rates are higher than for face-to-face interventions. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centered digital interventions that are engaging and meet users’ needs. Objective: This study aims to understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a metasynthesis of qualitative studies. We searched 6 databases for published and unpublished literature from 2013 to 2024. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: A total of 8 studies were included after screening 3695 search results. Overall, 7 metathemes were identified. The identified metathemes included the appeal of digital interventions, role of digital interventions in treatment, value of support in treatment, communication at the right level, importance of engagement, shaping knowledge to improve eating disorder behaviors, and design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible and that they fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviors. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalized content and functions. Conclusions: Users found digital interventions for eating disorders practical and effective but stressed the need for interventions to address the full range of symptoms, severity, and individual needs. Future digital interventions should be cocreated with users and offer more personalization. Further research is needed to determine the appropriate balance of professional and peer support and whether these interventions should serve as the first step in the stepped care model. Trial Registration: PROSPERO CRD42023426932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426932 %M 39752210 %R 10.2196/57795 %U https://mental.jmir.org/2025/1/e57795 %U https://doi.org/10.2196/57795 %U http://www.ncbi.nlm.nih.gov/pubmed/39752210 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e63132 %T Ecological Momentary Assessment of Self-Harm Thoughts and Behaviors: Systematic Review of Constructs From the Integrated Motivational-Volitional Model %A Winstone,Lizzy %A Heron,Jon %A John,Ann %A Kirtley,Olivia J %A Moran,Paul %A Muehlenkamp,Jennifer %A O'Connor,Rory C %A Mars,Becky %+ Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PN, United Kingdom, 44 0117 928 7279, lizzy.winstone@bristol.ac.uk %K integrated motivational-volitional model %K IMV model %K ecological momentary assessment %K suicidal and nonsuicidal self-harm thoughts and behaviors %D 2024 %7 9.12.2024 %9 Review %J JMIR Ment Health %G English %X Background: The integrated motivational-volitional model (IMV) is one of the leading theoretical models of suicidal thoughts and behavior. There has been a recent proliferation in the assessment of suicidal and nonsuicidal self-harm thoughts and behaviors (SHTBs) in daily life. Objective: This systematic review synthesized evidence from ecological momentary assessment (EMA) studies in the SHTB literature to address the following questions: (1) Which constructs in the IMV model have been assessed using EMA, and how have they been assessed? (2) Do different constructs from the IMV model fluctuate in daily life? (3) What is the relationship between the different IMV constructs and SHTBs in daily life? Methods: Consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted systematic searches of 5 databases—Web of Science, Embase, MEDLINE, PsycINFO, and Europe PMC Preprints—from inception to March 26, 2024. Results: Our searches resulted in the inclusion and narrative synthesis of 53 studies across 58 papers. A total of 15 IMV constructs were measured using EMA across the included papers. The most frequently measured constructs were thwarted belongingness (24/58, 41% of the papers), future thinking (20/58, 34% of the papers), and perceived burdensomeness (16/58, 28% of the papers). The least frequently measured constructs were humiliation, social problem-solving, mental imagery, and perceived capability for suicide. None of the included papers measured memory biases, goals, norms, or resilience using EMA. Comparison of intraclass correlation coefficients (45/58, 78% of the papers) revealed moderate but inconsistent within-person variance across all the examined constructs. We found evidence (39/58, 67% of the papers) of concurrent associations between almost all constructs and SHTBs in daily life, with some evidence that entrapment, shame, rumination, thwarted belongingness, hopelessness, social support, and impulsivity are additionally associated with SHTBs in lagged (ie, longitudinal) relationships. Conclusions: Comparisons were hindered by variation in methodology, including the populations studied, EMA sampling scheme, operationalization of IMV constructs and SHTBs, and statistical approach used. Our findings suggest that EMA studies are a useful methodology for examining risk factors for SHTBs; however, more research is needed for some IMV constructs. Quality assessment suggested several areas for improvement in the reporting of EMA studies in this field. Trial Registration: PROSPERO CRD42022349514; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=349514 %M 39652869 %R 10.2196/63132 %U https://mental.jmir.org/2024/1/e63132 %U https://doi.org/10.2196/63132 %U http://www.ncbi.nlm.nih.gov/pubmed/39652869 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54966 %T Using Artificial Intelligence to Detect Risk of Family Violence: Protocol for a Systematic Review and Meta-Analysis %A de Boer,Kathleen %A Mackelprang,Jessica L %A Nedeljkovic,Maja %A Meyer,Denny %A Iyer,Ravi %+ Department of Psychological Sciences, Swinburne University of Technology, 34 Wakefield Street, Hawthorn, 3122, Australia, 61 9214 3836, kdeboer@swin.edu.au %K family violence %K artificial intelligence %K natural language processing %K voice signal characteristics %K public health %K behaviors %K research literature %K policy %K prevalence %K detection %K social policy %K prevention %K machine learning %K mental health %K suicide risk %K psychological distress %D 2024 %7 2.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the implementation of prevention strategies, family violence continues to be a prevalent issue worldwide. Current strategies to reduce family violence have demonstrated mixed success and innovative approaches are needed urgently to prevent the occurrence of family violence. Incorporating artificial intelligence (AI) into prevention strategies is gaining research attention, particularly the use of textual or voice signal data to detect individuals at risk of perpetrating family violence. However, no review to date has collated extant research regarding how accurate AI is at identifying individuals who are at risk of perpetrating family violence. Objective: The primary aim of this systematic review and meta-analysis is to assess the accuracy of AI models in differentiating between individuals at risk of engaging in family violence versus those who are not using textual or voice signal data. Methods: The following databases will be searched from conception to the search date: IEEE Xplore, PubMed, PsycINFO, EBSCOhost (Psychology and Behavioral Sciences collection), and Computers and Applied Sciences Complete. ProQuest Dissertations and Theses A&I will also be used to search the grey literature. Studies will be included if they report on human adults and use machine learning to differentiate between low and high risk of family violence perpetration. Studies may use voice signal data or linguistic (textual) data and must report levels of accuracy in determining risk. In the data screening and full-text review and quality analysis phases, 2 researchers will review the search results and discrepancies and decisions will be resolved through masked review of a third researcher. Results will be reported in a narrative synthesis. In addition, a random effects meta-analysis will be conducted using the area under the receiver operating curve reported in the included studies, assuming sufficient eligible studies are identified. Methodological quality of included studies will be assessed using the risk of bias tool in nonrandomized studies of interventions. Results: As of October 2024, the search has not commenced. The review will document the state of the research concerning the accuracy of AI models in detecting the risk of family violence perpetration using textual or voice signal data. Results will be presented in the form of a narrative synthesis. Results of the meta-analysis will be summarized in tabular form and using a forest plot. Conclusions: The findings from this study will clarify the state of the literature on the accuracy of machine learning models to identify individuals who are at high risk of perpetuating family violence. Findings may be used to inform the development of AI and machine learning models that can be used to support possible prevention strategies. Trial Registration: PROSPERO CRD42023481174; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481174 International Registered Report Identifier (IRRID): PRR1-10.2196/54966 %M 39621402 %R 10.2196/54966 %U https://www.researchprotocols.org/2024/1/e54966 %U https://doi.org/10.2196/54966 %U http://www.ncbi.nlm.nih.gov/pubmed/39621402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55736 %T Biomarkers of Response to Internet-Based Psychological Interventions: Systematic Review %A Gotti,Giulia %A Gabelli,Chiara %A Russotto,Sophia %A Madeddu,Fabio %A Courtet,Philippe %A Lopez-Castroman,Jorge %A Zeppegno,Patrizia %A Gramaglia,Carla Maria %A Calati,Raffaella %+ Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, U6 Building, Room 3129, Milan, 20126, Italy, 39 3477752087, raffaella.calati@unimib.it %K biomarker %K cognitive behavioral therapy %K internet-based intervention %K systematic review %K psychological intervention %K mental health intervention %K meta analysis %K psychiatric %K blood glucose %K mindfulness %K stress management %K immune response %K smoking %K cortisol %D 2024 %7 29.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Internet-based psychological interventions provide accessible care to a wide range of users, overcoming some obstacles—such as distance, costs, and safety—that might discourage seeking help for mental issues. It is well known that psychological treatments and programs affect the body, as well as the mind, producing physiological changes that ought to be considered when assessing the efficacy of the intervention. However, the literature investigating changes in biomarkers specifically after internet-based psychological and mental health interventions has not yet extensively inquired into this topic. Objective: This systematic review aims to provide a synthesis of literature examining the effects of internet-based psychological interventions—targeting both clinical (mental and physical) and nonclinical conditions—on biomarkers. A secondary aim was to evaluate whether the biomarkers’ variations were related to a complementary modification of the psychological or physical symptoms or to a general improvement of the participants’ well-being. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. A literature search was performed through 3 databases (PubMed, PsycINFO, and Scopus). Studies examining changes in biomarkers before and after internet-based psychological interventions or programs targeting both clinical and nonclinical samples were included, with no exclusion criteria concerning mental or physical conditions. Results: A total of 24 studies fulfilled the inclusion criteria. These studies involved individuals with psychiatric or psychological problems (n=6, 25%), those with organic or medical diseases (n=10, 42%), and nonclinical populations (n=8, 33%). Concerning psychiatric or psychological problems, cognitive behavioral therapy (CBT) and CBT-informed interventions showed partial effectiveness in decreasing glycated hemoglobin blood glucose level (n=1) and chemokines (n=1) and in increasing connectivity between the default-mode network and the premotor or dorsolateral prefrontal cortex (n=1). Among individuals with organic or medical diseases, studies reported a significant change in cardiac or cardiovascular (n=3), inflammatory (n=2), cortisol (n=2), glycated hemoglobin (n=2), and immune response (n=1) biomarkers after CBT and CBT-informed interventions, and mindfulness and stress management interventions. Lastly, mindfulness, CBT and CBT-informed interventions, and music therapy succeeded in modifying immune response (n=2), cortisol (n=1), α amylase (n=1), posterior cingulate cortex reactivity to smoking cues (n=1), and carbon monoxide (n=1) levels in nonclinical populations. In some of the included studies (n=5), the psychological intervention or program also produced an improvement of the mental or physical condition of the participants or of their general well-being, alongside significant variations in biomarkers; CBT and CBT-informed interventions proved effective in reducing both psychological (n=2) and physical symptoms (n=2), while a mindfulness program successfully lowered cigarette consumption in a nonclinical sample (n=1). Conclusions: Although further evidence is required, we hope to raise awareness on the potential impact of internet-based interventions on biomarkers related to mental and physical health. %M 39612489 %R 10.2196/55736 %U https://www.jmir.org/2024/1/e55736 %U https://doi.org/10.2196/55736 %U http://www.ncbi.nlm.nih.gov/pubmed/39612489 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e63743 %T Digital Health Interventions for Informal Family Caregivers of People With First-Episode Psychosis: Systematic Review on User Experience and Effectiveness %A Münchenberg,Pauline Sarah %A Yessimova,Dinara %A Panteli,Dimitra %A Kurth,Tobias %+ Institute of Public Health, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450570872, pauline.muenchenberg@charite.de %K first-episode psychosis %K early psychosis %K digital health interventions %K telepsychiatry %K informal caregivers %K family caregivers %K telehealth %K severe mental disorders %K psychosis %K digital intervention %K digital health %K mental health %K psychoeducation %K mobile phone %D 2024 %7 28.11.2024 %9 Review %J JMIR Ment Health %G English %X Background: First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective: This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods: A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results: The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions–web-based, videoconferences, and mHealth–were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions: The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration: PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9 %M 39607998 %R 10.2196/63743 %U https://mental.jmir.org/2024/1/e63743 %U https://doi.org/10.2196/63743 %U http://www.ncbi.nlm.nih.gov/pubmed/39607998 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56400 %T Mental Health Monitoring for Young People Through Mood Apps: Protocol for a Scoping Review and Systematic Search in App Stores %A Boege,Selina %A Milne-Ives,Madison %A Ananthakrishnan,Ananya %A Cong,Cen %A Sharma,Aditya %A Anderson,David %A Meinert,Edward %+ Translational and Clinical Research Institute, Newcastle University, Edwardson Building, Newcastle upon Tyne, NE4 5PL, United Kingdom, 44 191 20 83811, edward.meinert@newcastle.ac.uk %K digital health %K mental health %K mood apps %K mobile apps %K mobile phone %D 2024 %7 19.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The researchers have used mobile phones to assist in monitoring, analyzing, and managing moods to acquire insight into mood patterns. There is a lack of evidence in their use as clinical tools and interventions, which necessitates a comprehensive review and quality assessment to understand barriers and facilitators for app implementation as an impactful clinical intervention. Objective: This review aims to (1) provide an overview of the recent evidence on mobile mood-monitoring apps that are intended for facilitating self-management and support of mental health in children, adolescents, and young people; and (2) investigate the quality of publicly available apps. Methods: The study will first involve a scoping review of the literature on mood-monitoring apps for children, adolescents, and young people followed by an evaluation of features of the apps available in the marketplace. The scoping review will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and search 6 databases— Embase, CINAHL, PubMed, ACM Digital Library, Scopus, and Springer LNCS—for relevant studies and reviews published in the last 3 years. The author will then screen the references, extract data from the included studies, and analyze them to synthesize the evidence on mood apps. Next, the Apple App Store and Google Play Store will be searched for mood apps. A total of 2 independent reviewers will screen the apps based on eligibility criteria, and disagreements will be resolved through consensus. The features of the selected apps will then be evaluated using the Mobile Health Index and Navigation framework, and descriptive analysis will be used to synthesize the findings. Results: Literature search and screening began soon after submission of the protocol and is expected to be completed by September 2024. The app evaluation will be completed by October 2024. Conclusions: Combined, the scoping literature review and app evaluation will provide an in-depth overview of the most recent scientific evidence related to mood apps and the quality of apps actually available for use. International Registered Report Identifier (IRRID): PRR1-10.2196/56400 %M 39561357 %R 10.2196/56400 %U https://www.researchprotocols.org/2024/1/e56400 %U https://doi.org/10.2196/56400 %U http://www.ncbi.nlm.nih.gov/pubmed/39561357 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60441 %T The Journey From Nonimmersive to Immersive Multiuser Applications in Mental Health Care: Systematic Review %A Fajnerova,Iveta %A Hejtmánek,Lukáš %A Sedlák,Michal %A Jablonská,Markéta %A Francová,Anna %A Stopková,Pavla %+ Research Center for Virtual Reality in Mental Health and Neuroscience, National Institute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 478, Iveta.fajnerova@nudz.cz %K digital health %K mental health care %K clinical interventions %K multiuser %K immersive %K virtual reality %K VR %K app %K mental health %K online tools %K synthesis %K mobile phone %K PRISMA %D 2024 %7 7.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Over the past 25 years, the development of multiuser applications has seen considerable advancements and challenges. The technological development in this field has emerged from simple chat rooms through videoconferencing tools to the creation of complex, interactive, and often multisensory virtual worlds. These multiuser technologies have gradually found their way into mental health care, where they are used in both dyadic counseling and group interventions. However, some limitations in hardware capabilities, user experience designs, and scalability may have hindered the effectiveness of these applications. Objective: This systematic review aims at summarizing the progress made and the potential future directions in this field while evaluating various factors and perspectives relevant to remote multiuser interventions. Methods: The systematic review was performed based on a Web of Science and PubMed database search covering articles in English, published from January 1999 to March 2024, related to multiuser mental health interventions. Several inclusion and exclusion criteria were determined before and during the records screening process, which was performed in several steps. Results: We identified 49 records exploring multiuser applications in mental health care, ranging from text-based interventions to interventions set in fully immersive environments. The number of publications exploring this topic has been growing since 2015, with a large increase during the COVID-19 pandemic. Most digital interventions were delivered in the form of videoconferencing, with only a few implementing immersive environments. The studies used professional or peer-supported group interventions or a combination of both approaches. The research studies targeted diverse groups and topics, from nursing mothers to psychiatric disorders or various minority groups. Most group sessions occurred weekly, or in the case of the peer-support groups, often with a flexible schedule. Conclusions: We identified many benefits to multiuser digital interventions for mental health care. These approaches provide distributed, always available, and affordable peer support that can be used to deliver necessary help to people living outside of areas where in-person interventions are easily available. While immersive virtual environments have become a common tool in many areas of psychiatric care, such as exposure therapy, our results suggest that this technology in multiuser settings is still in its early stages. Most identified studies investigated mainstream technologies, such as videoconferencing or text-based support, substituting the immersive experience for convenience and ease of use. While many studies discuss useful features of virtual environments in group interventions, such as anonymity or stronger engagement with the group, we discuss persisting issues with these technologies, which currently prevent their full adoption. %M 39509153 %R 10.2196/60441 %U https://www.jmir.org/2024/1/e60441 %U https://doi.org/10.2196/60441 %U http://www.ncbi.nlm.nih.gov/pubmed/39509153 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57400 %T Large Language Models for Mental Health Applications: Systematic Review %A Guo,Zhijun %A Lai,Alvina %A Thygesen,Johan H %A Farrington,Joseph %A Keen,Thomas %A Li,Kezhi %+ Institute of Health Informatics University College, London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 7859 995590, ken.li@ucl.ac.uk %K large language models %K mental health %K digital health care %K ChatGPT %K Bidirectional Encoder Representations from Transformers %K BERT %D 2024 %7 18.10.2024 %9 Review %J JMIR Ment Health %G English %X Background: Large language models (LLMs) are advanced artificial neural networks trained on extensive datasets to accurately understand and generate natural language. While they have received much attention and demonstrated potential in digital health, their application in mental health, particularly in clinical settings, has generated considerable debate. Objective: This systematic review aims to critically assess the use of LLMs in mental health, specifically focusing on their applicability and efficacy in early screening, digital interventions, and clinical settings. By systematically collating and assessing the evidence from current studies, our work analyzes models, methodologies, data sources, and outcomes, thereby highlighting the potential of LLMs in mental health, the challenges they present, and the prospects for their clinical use. Methods: Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, this review searched 5 open-access databases: MEDLINE (accessed by PubMed), IEEE Xplore, Scopus, JMIR, and ACM Digital Library. Keywords used were (mental health OR mental illness OR mental disorder OR psychiatry) AND (large language models). This study included articles published between January 1, 2017, and April 30, 2024, and excluded articles published in languages other than English. Results: In total, 40 articles were evaluated, including 15 (38%) articles on mental health conditions and suicidal ideation detection through text analysis, 7 (18%) on the use of LLMs as mental health conversational agents, and 18 (45%) on other applications and evaluations of LLMs in mental health. LLMs show good effectiveness in detecting mental health issues and providing accessible, destigmatized eHealth services. However, assessments also indicate that the current risks associated with clinical use might surpass their benefits. These risks include inconsistencies in generated text; the production of hallucinations; and the absence of a comprehensive, benchmarked ethical framework. Conclusions: This systematic review examines the clinical applications of LLMs in mental health, highlighting their potential and inherent risks. The study identifies several issues: the lack of multilingual datasets annotated by experts, concerns regarding the accuracy and reliability of generated content, challenges in interpretability due to the “black box” nature of LLMs, and ongoing ethical dilemmas. These ethical concerns include the absence of a clear, benchmarked ethical framework; data privacy issues; and the potential for overreliance on LLMs by both physicians and patients, which could compromise traditional medical practices. As a result, LLMs should not be considered substitutes for professional mental health services. However, the rapid development of LLMs underscores their potential as valuable clinical aids, emphasizing the need for continued research and development in this area. Trial Registration: PROSPERO CRD42024508617; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=508617 %M 39423368 %R 10.2196/57400 %U https://mental.jmir.org/2024/1/e57400 %U https://doi.org/10.2196/57400 %U http://www.ncbi.nlm.nih.gov/pubmed/39423368 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57150 %T Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review %A D'Arcey,Jessica %A Torous,John %A Asuncion,Toni-Rose %A Tackaberry-Giddens,Leah %A Zahid,Aqsa %A Ishak,Mira %A Foussias,George %A Kidd,Sean %+ Schizophrenia Division, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada, 1 647 385 2490, jessica.darcey@mail.utoronto.ca %K schizophrenia %K digital mental health %K personal technology %K access to specialized resources %K mental health %K scoping review %K mental health care %K feasibility %K efficacy %K clinical integration %K support %K specialized care %K care %K database %K schizophrenia spectrum disorder %K text messaging %K text %K user feedback %K usability %K acceptability %K satisfaction %K engagement %K digital health %K digital mental health %K technology %K health technology %K mood disorder %K mood disorders %K neurodevelopment %K eHealth %K mobile phone %D 2024 %7 30.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown. Objective: This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care. Methods: Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes. Conclusions: Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review. %M 39348196 %R 10.2196/57150 %U https://mental.jmir.org/2024/1/e57150 %U https://doi.org/10.2196/57150 %U http://www.ncbi.nlm.nih.gov/pubmed/39348196 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55500 %T Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis %A Omylinska-Thurston,Joanna %A Aithal,Supritha %A Liverpool,Shaun %A Clark,Rebecca %A Moula,Zoe %A Wood,January %A Viliardos,Laura %A Rodríguez-Dorans,Edgar %A Farish-Edwards,Fleur %A Parsons,Ailsa %A Eisenstadt,Mia %A Bull,Marcus %A Dubrow-Marshall,Linda %A Thurston,Scott %A Karkou,Vicky %+ School of Health and Society, University of Salford, Frederick Road Campus, Broad Street, Manchester, M6 6PU, United Kingdom, 44 0161 295 0000, j.omylinska-thurston1@salford.ac.uk %K digital psychotherapies %K depression %K adults %K systematic review %K meta-analysis %K mobile phone %D 2024 %7 30.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Depression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives. Objective: This review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients’ and practitioners’ perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression. Methods: A mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients’ and therapists’ perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups. Results: Of 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included “stand-alone” or non–human contact interventions (58/160, 36.2%), “human contact” interventions (11/160, 6.8%), and “blended” including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=–0.61, 95% CI –0.75 to –0.47; Z=–8.58; P<.001). Subgroup analyses of the studies with different intervention delivery formats and session frequency did not have a statistically significant effect on the results (P=.48 and P=.97, respectively). However, blended approaches revealed a large effect size (Hedges g=–0.793), while interventions involving human contact (Hedges g=–0.42) or no human contact (Hedges g=–0.40) had slightly smaller effect sizes. Conclusions: Digital interventions for depression were found to be effective regardless of format and frequency. Blended interventions have larger effect size than those involving human contact or no human contact. Digital interventions were helpful especially for diverse ethnic groups and young women. Future research should focus on understanding the sources of heterogeneity based on intervention and population characteristics. Trial Registration: PROSPERO CRD42021238462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238462 %M 39348177 %R 10.2196/55500 %U https://mental.jmir.org/2024/1/e55500 %U https://doi.org/10.2196/55500 %U http://www.ncbi.nlm.nih.gov/pubmed/39348177 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56650 %T Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review %A Huang,Sijia %A Wang,Yiyue %A Li,Gen %A Hall,Brian J %A Nyman,Thomas J %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley, Reading, RG6 6ET, United Kingdom, 44 1189875123, t.nyman@reading.ac.uk %K digital health %K digital technology %K digital intervention %K digital interventions %K waiting list %K digital mental health intervention %K DMHI %K digital mental health interventions %K DMHIs %K digital mental health %K mental health intervention %K mental health interventions %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K depression %K depressed %K major depressive disorder %K MDD %K depressive disorder %K depressive %K anxiety %K anxious %K self-guided %K self-guidance %K self-mediated %K self-mediation %K systematic review %K systematic reviews %K mood disorder %K therapy %K tele-therapy %K web-based therapy %D 2024 %7 10.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. Objective: This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. Methods: In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. Results: Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. Conclusions: Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness. %M 39255015 %R 10.2196/56650 %U https://mental.jmir.org/2024/1/e56650 %U https://doi.org/10.2196/56650 %U http://www.ncbi.nlm.nih.gov/pubmed/39255015 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58974 %T Empathic Conversational Agent Platform Designs and Their Evaluation in the Context of Mental Health: Systematic Review %A Sanjeewa,Ruvini %A Iyer,Ravi %A Apputhurai,Pragalathan %A Wickramasinghe,Nilmini %A Meyer,Denny %+ School of Health Sciences, Swinburne University of Technology, PO Box 218, John Street, Hawthorn, 3122, Australia, 61 422587030, rsanjeewa@swin.edu.au %K conversational agents %K chatbots %K virtual assistants %K empathy %K emotionally aware %K mental health %K mental well-being %D 2024 %7 9.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: The demand for mental health (MH) services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence–empowered conversational agents (CAs) a real possibility to help fill this gap. Objective: The objective of this review was to identify existing empathic CA design architectures within the MH care sector and to assess their technical performance in detecting and responding to user emotions in terms of classification accuracy. In addition, the approaches used to evaluate empathic CAs within the MH care sector in terms of their acceptability to users were considered. Finally, this review aimed to identify limitations and future directions for empathic CAs in MH care. Methods: A systematic literature search was conducted across 6 academic databases to identify journal articles and conference proceedings using search terms covering 3 topics: “conversational agents,” “mental health,” and “empathy.” Only studies discussing CA interventions for the MH care domain were eligible for this review, with both textual and vocal characteristics considered as possible data inputs. Quality was assessed using appropriate risk of bias and quality tools. Results: A total of 19 articles met all inclusion criteria. Most (12/19, 63%) of these empathic CA designs in MH care were machine learning (ML) based, with 26% (5/19) hybrid engines and 11% (2/19) rule-based systems. Among the ML-based CAs, 47% (9/19) used neural networks, with transformer-based architectures being well represented (7/19, 37%). The remaining 16% (3/19) of the ML models were unspecified. Technical assessments of these CAs focused on response accuracies and their ability to recognize, predict, and classify user emotions. While single-engine CAs demonstrated good accuracy, the hybrid engines achieved higher accuracy and provided more nuanced responses. Of the 19 studies, human evaluations were conducted in 16 (84%), with only 5 (26%) focusing directly on the CA’s empathic features. All these papers used self-reports for measuring empathy, including single or multiple (scale) ratings or qualitative feedback from in-depth interviews. Only 1 (5%) paper included evaluations by both CA users and experts, adding more value to the process. Conclusions: The integration of CA design and its evaluation is crucial to produce empathic CAs. Future studies should focus on using a clear definition of empathy and standardized scales for empathy measurement, ideally including expert assessment. In addition, the diversity in measures used for technical assessment and evaluation poses a challenge for comparing CA performances, which future research should also address. However, CAs with good technical and empathic performance are already available to users of MH care services, showing promise for new applications, such as helpline services. %M 39250799 %R 10.2196/58974 %U https://mental.jmir.org/2024/1/e58974 %U https://doi.org/10.2196/58974 %U http://www.ncbi.nlm.nih.gov/pubmed/39250799 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56326 %T Smartphone-Delivered Attentional Bias Modification Training for Mental Health: Systematic Review and Meta-Analysis %A Banire,Bilikis %A Orr,Matt %A Burns,Hailey %A McGowan,Youna %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, Sir Charles Tupper Building, 13th Fl., 5850 College Street, Halifax, NS, B34 3H7, Canada, 1 17828825242, banire.bilikis.o@gmail.com %K attentional bias %K mental health problem %K anxiety %K depression %K systematic review %K meta-analysis %K smartphone %K mobile phone %D 2024 %7 2.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Smartphone-delivered attentional bias modification training (ABMT) intervention has gained popularity as a remote solution for alleviating symptoms of mental health problems. However, the existing literature presents mixed results indicating both significant and insignificant effects of smartphone-delivered interventions. Objective: This systematic review and meta-analysis aims to assess the impact of smartphone-delivered ABMT on attentional bias and symptoms of mental health problems. Specifically, we examined different design approaches and methods of administration, focusing on common mental health issues, such as anxiety and depression, and design elements, including gamification and stimulus types. Methods: Our search spanned from 2014 to 2023 and encompassed 4 major databases: MEDLINE, PsycINFO, PubMed, and Scopus. Study selection, data extraction, and critical appraisal were performed independently by 3 authors using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. When necessary, we pooled the standardized mean difference with a 95% CI. In addition, we conducted sensitivity, subgroup, and meta-regression analyses to explore moderator variables of active and placebo ABMT interventions on reducing symptoms of mental health problems and attentional bias. Results: Our review included 12 papers, involving a total of 24,503 participants, and we were able to conduct a meta-analysis on 20 different study samples from 11 papers. Active ABMT exhibited an effect size (Hedges g) of –0.18 (P=.03) in reducing symptoms of mental health problems, while the overall effect remained significant. Similarly, placebo ABMT showed an effect size of –0.38 (P=.008) in reducing symptoms of mental health problems. In addition, active ABMT (Hedges g –0.17; P=.004) had significant effects on reducing attentional bias, while placebo ABMT did not significantly alter attentional bias (Hedges g –0.04; P=.66). Conclusions: Our understanding of smartphone-delivered ABMT’s potential highlights the value of both active and placebo interventions in mental health care. The insights from the moderator analysis also showed that tailoring smartphone-delivered ABMT interventions to specific threat stimuli and considering exposure duration are crucial for optimizing their efficacy. This research underscores the need for personalized approaches in ABMT to effectively reduce attentional bias and symptoms of mental health problems. Trial Registration: PROSPERO CRD42023460749; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460749 %M 39222349 %R 10.2196/56326 %U https://mental.jmir.org/2024/1/e56326 %U https://doi.org/10.2196/56326 %U http://www.ncbi.nlm.nih.gov/pubmed/39222349 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56896 %T Preventive Interventions for Internet Addiction in Young Children: Systematic Review %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K children %K digital device %K internet addiction %K intervention %K prevention %K problematic internet use %K technology %K young children %K problematic use %K preventive %K interventions %K systematic review %K internet %K addiction %K prevent %K reduce %K risk %K risks %K database %K databases %K child %K PICOS %K thematic analysis %K Population, Intervention, Comparison, Outcome, and Study type %D 2024 %7 30.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: In this digital age, children typically start using the internet in early childhood. Studies highlighted that young children are vulnerable to internet addiction due to personal limitations and social influence (eg, family and school). Internet addiction can have long-term harmful effects on children’s health and well-being. The high risk of internet addiction for vulnerable populations like young children has raised questions about how best to prevent the problem. Objective: This review study aimed to investigate the existing interventions and explore future directions to prevent or reduce internet addiction risks in children younger than 12 years. Methods: The systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for relevant literature from 4 research databases (Scopus, Web of Science, PubMed, and PsycINFO). We included 14 primary studies discussing the interventions to prevent or reduce internet addiction risks in young children and their efficacy outcomes. Results: The preventive interventions identified were categorized into four approaches as follows: (1) children’s education, (2) parenting strategy, (3) strategic physical activity, and (4) counseling. Ten interventions showed promising efficacy in preventing or reducing internet addiction risks with small-to-medium effect sizes. Interventions that enhance children’s competencies in having appropriate online behaviors and literacy were more likely to show better efficacy than interventions that force children to reduce screen time. Interventions that shift children’s focus from online activities to real-world activities also showed promising efficacy in reducing engagement with the internet, thereby preventing addictive behaviors. We also identified the limitations of each approach (eg, temporariness, accessibility, and implementation) as valuable considerations in developing future interventions. Conclusions: The findings suggest the need to develop more sustainable and accessible interventions to encourage healthy online behaviors through education, appropriate parenting strategies, and substitutive activities to prevent children’s overdependence on the internet. Developing digital tools and social support systems can be beneficial to improve the capability, efficiency, and accessibility of the interventions. Future interventions also need to consider their appropriateness within familial context or culture and provide adequate implementation training. Last, policy makers and experts can also contribute by making design guidelines to prevent digital product developers from making products that can encourage overuse in children. %R 10.2196/56896 %U https://mental.jmir.org/2024/1/e56896 %U https://doi.org/10.2196/56896 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57401 %T Evaluation of Digital Mental Health Technologies in the United States: Systematic Literature Review and Framework Synthesis %A Catania,Julianna %A Beaver,Steph %A Kamath,Rakshitha S %A Worthington,Emma %A Lu,Minyi %A Gandhi,Hema %A Waters,Heidi C %A Malone,Daniel C %+ Department of Pharmacotherapy, Skaggs College of Pharmacy, University of Utah, Room 4922, 30 S 2000 East, Salt Lake City, UT, 84112, United States, 1 801 581 6257, dan.malone@utah.edu %K mental health %K mobile health %K mHealth %K digital health %K digital therapeutics %K systematic review %K framework synthesis %K mixed methods %D 2024 %7 30.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. Objective: A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. Methods: Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association’s Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. Results: Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. Conclusions: Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind. %M 39213023 %R 10.2196/57401 %U https://mental.jmir.org/2024/1/e57401 %U https://doi.org/10.2196/57401 %U http://www.ncbi.nlm.nih.gov/pubmed/39213023 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58217 %T Efficacy of eHealth Versus In-Person Cognitive Behavioral Therapy for Insomnia: Systematic Review and Meta-Analysis of Equivalence %A Knutzen,Sofie Møgelberg %A Christensen,Dinne Skjærlund %A Cairns,Patrick %A Damholdt,Malene Flensborg %A Amidi,Ali %A Zachariae,Robert %+ Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Alle 11, Bld. 1350, Aarhus, DK8000C, Denmark, 45 24235356, bzach@rm.dk %K sleep disturbance %K digital %K telehealth %K face-to-face %K head-to-head comparison %K CBTI %K cognitive behavioral therapy for insomnia %K mobile phone %D 2024 %7 26.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Insomnia is a prevalent condition with significant health, societal, and economic impacts. Cognitive behavioral therapy for insomnia (CBTI) is recommended as the first-line treatment. With limited accessibility to in-person–delivered CBTI (ipCBTI), electronically delivered eHealth CBTI (eCBTI), ranging from telephone- and videoconference-delivered interventions to fully automated web-based programs and mobile apps, has emerged as an alternative. However, the relative efficacy of eCBTI compared to ipCBTI has not been conclusively determined. Objective: This study aims to test the comparability of eCBTI and ipCBTI through a systematic review and meta-analysis of equivalence based on randomized controlled trials directly comparing the 2 delivery formats. Methods: A comprehensive search across multiple databases was conducted, leading to the identification and analysis of 15 unique randomized head-to-head comparisons of ipCBTI and eCBTI. Data on sleep and nonsleep outcomes were extracted and subjected to both conventional meta-analytical methods and equivalence testing based on predetermined equivalence margins derived from previously suggested minimal important differences. Supplementary Bayesian analyses were conducted to determine the strength of the available evidence. Results: The meta-analysis included 15 studies with a total of 1083 participants. Conventional comparisons generally favored ipCBTI. However, the effect sizes were small, and the 2 delivery formats were statistically significantly equivalent (P<.05) for most sleep and nonsleep outcomes. Additional within-group analyses showed that both formats led to statistically significant improvements (P<.05) in insomnia severity; sleep quality; and secondary outcomes such as fatigue, anxiety, and depression. Heterogeneity analyses highlighted the role of treatment duration and dropout rates as potential moderators of the differences in treatment efficacy. Conclusions: eCBTI and ipCBTI were found to be statistically significantly equivalent for treating insomnia for most examined outcomes, indicating eCBTI as a clinically relevant alternative to ipCBTI. This supports the expansion of eCBTI as a viable option to increase accessibility to effective insomnia treatment. Nonetheless, further research is needed to address the limitations noted, including the high risk of bias in some studies and the potential impact of treatment duration and dropout rates on efficacy. Trial Registration: PROSPERO CRD42023390811; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=390811 %M 39186370 %R 10.2196/58217 %U https://mental.jmir.org/2024/1/e58217 %U https://doi.org/10.2196/58217 %U http://www.ncbi.nlm.nih.gov/pubmed/39186370 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53714 %T Machine Learning, Deep Learning, and Data Preprocessing Techniques for Detecting, Predicting, and Monitoring Stress and Stress-Related Mental Disorders: Scoping Review %A Razavi,Moein %A Ziyadidegan,Samira %A Mahmoudzadeh,Ahmadreza %A Kazeminasab,Saber %A Baharlouei,Elaheh %A Janfaza,Vahid %A Jahromi,Reza %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843-3131, United States, 1 979 458 2337, sasangohar@tamu.edu %K machine learning %K deep learning %K data preprocessing %K stress detection %K stress prediction %K stress monitoring %K mental disorders %D 2024 %7 21.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Mental stress and its consequent mental health disorders (MDs) constitute a significant public health issue. With the advent of machine learning (ML), there is potential to harness computational techniques for better understanding and addressing mental stress and MDs. This comprehensive review seeks to elucidate the current ML methodologies used in this domain to pave the way for enhanced detection, prediction, and analysis of mental stress and its subsequent MDs. Objective: This review aims to investigate the scope of ML methodologies used in the detection, prediction, and analysis of mental stress and its consequent MDs. Methods: Using a rigorous scoping review process with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, this investigation delves into the latest ML algorithms, preprocessing techniques, and data types used in the context of stress and stress-related MDs. Results: A total of 98 peer-reviewed publications were examined for this review. The findings highlight that support vector machine, neural network, and random forest models consistently exhibited superior accuracy and robustness among all ML algorithms examined. Physiological parameters such as heart rate measurements and skin response are prevalently used as stress predictors due to their rich explanatory information concerning stress and stress-related MDs, as well as the relative ease of data acquisition. The application of dimensionality reduction techniques, including mappings, feature selection, filtering, and noise reduction, is frequently observed as a crucial step preceding the training of ML algorithms. Conclusions: The synthesis of this review identified significant research gaps and outlines future directions for the field. These encompass areas such as model interpretability, model personalization, the incorporation of naturalistic settings, and real-time processing capabilities for the detection and prediction of stress and stress-related MDs. %M 39167782 %R 10.2196/53714 %U https://mental.jmir.org/2024/1/e53714 %U https://doi.org/10.2196/53714 %U http://www.ncbi.nlm.nih.gov/pubmed/39167782 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59560 %T Self-Administered Interventions Based on Natural Language Processing Models for Reducing Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis %A Villarreal-Zegarra,David %A Reategui-Rivera,C Mahony %A García-Serna,Jackeline %A Quispe-Callo,Gleni %A Lázaro-Cruz,Gabriel %A Centeno-Terrazas,Gianfranco %A Galvez-Arevalo,Ricardo %A Escobar-Agreda,Stefan %A Dominguez-Rodriguez,Alejandro %A Finkelstein,Joseph %+ Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84108, United States, 1 (801) 581 4080, mahony.reategui@utah.edu %K natural language processing %K depression %K anxiety %K systematic review %K artificial intelligence %K AI %D 2024 %7 21.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: The introduction of natural language processing (NLP) technologies has significantly enhanced the potential of self-administered interventions for treating anxiety and depression by improving human-computer interactions. Although these advances, particularly in complex models such as generative artificial intelligence (AI), are highly promising, robust evidence validating the effectiveness of the interventions remains sparse. Objective: The aim of this study was to determine whether self-administered interventions based on NLP models can reduce depressive and anxiety symptoms. Methods: We conducted a systematic review and meta-analysis. We searched Web of Science, Scopus, MEDLINE, PsycINFO, IEEE Xplore, Embase, and Cochrane Library from inception to November 3, 2023. We included studies with participants of any age diagnosed with depression or anxiety through professional consultation or validated psychometric instruments. Interventions had to be self-administered and based on NLP models, with passive or active comparators. Outcomes measured included depressive and anxiety symptom scores. We included randomized controlled trials and quasi-experimental studies but excluded narrative, systematic, and scoping reviews. Data extraction was performed independently by pairs of authors using a predefined form. Meta-analysis was conducted using standardized mean differences (SMDs) and random effects models to account for heterogeneity. Results: In all, 21 articles were selected for review, of which 76% (16/21) were included in the meta-analysis for each outcome. Most of the studies (16/21, 76%) were recent (2020-2023), with interventions being mostly AI-based NLP models (11/21, 52%); most (19/21, 90%) delivered some form of therapy (primarily cognitive behavioral therapy: 16/19, 84%). The overall meta-analysis showed that self-administered interventions based on NLP models were significantly more effective in reducing both depressive (SMD 0.819, 95% CI 0.389-1.250; P<.001) and anxiety (SMD 0.272, 95% CI 0.116-0.428; P=.001) symptoms compared to various control conditions. Subgroup analysis indicated that AI-based NLP models were effective in reducing depressive symptoms (SMD 0.821, 95% CI 0.207-1.436; P<.001) compared to pooled control conditions. Rule-based NLP models showed effectiveness in reducing both depressive (SMD 0.854, 95% CI 0.172-1.537; P=.01) and anxiety (SMD 0.347, 95% CI 0.116-0.578; P=.003) symptoms. The meta-regression showed no significant association between participants’ mean age and treatment outcomes (all P>.05). Although the findings were positive, the overall certainty of evidence was very low, mainly due to a high risk of bias, heterogeneity, and potential publication bias. Conclusions: Our findings support the effectiveness of self-administered NLP-based interventions in alleviating depressive and anxiety symptoms, highlighting their potential to increase accessibility to, and reduce costs in, mental health care. Although the results were encouraging, the certainty of evidence was low, underscoring the need for further high-quality randomized controlled trials and studies examining implementation and usability. These interventions could become valuable components of public health strategies to address mental health issues. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023472120; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023472120 %M 39167795 %R 10.2196/59560 %U https://mental.jmir.org/2024/1/e59560 %U https://doi.org/10.2196/59560 %U http://www.ncbi.nlm.nih.gov/pubmed/39167795 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56045 %T Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials %A Saboor,Sundas %A Medina,Adrian %A Marciano,Laura %+ Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States, 1 6175828025, lmarciano@hsph.harvard.edu %K positive psychology %K digital interventions %K ill-being %K well-being %K systematic review %K meta-analysis %K smartphone %K mobile phone %D 2024 %7 14.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: The rising prevalence of mental health issues in children, adolescents, and young adults has become an escalating public health issue, impacting approximately 10%-20% of young people on a global scale. Positive psychology interventions (PPIs) can act as powerful mental health promotion tools to reach wide-ranging audiences that might otherwise be challenging to access. This increased access would enable prevention of mental disorders and promotion of widespread well-being by enhancing self-efficacy, thereby supporting the achievement of tangible objectives. Objective: We aimed to conduct a comprehensive synthesis of all randomized controlled trials and controlled trials involving children, adolescents, and young adults, encompassing both clinical and nonclinical populations, to comprehensively evaluate the effectiveness of digital PPIs in this age group. Methods: After a literature search in 9 electronic databases until January 12, 2023, and gray literature until April 2023, we carried out a systematic review of 35 articles, of which 18 (51%) provided data for the meta-analysis. We included randomized controlled trials and controlled trials mainly based on web-based, digital, or smartphone-based interventions using a positive psychology framework as the main component. Studies included participants with a mean age of <35 years. Outcomes of PPIs were classified into indicators of well-being (compassion, life satisfaction, optimism, happiness, resilience, emotion regulation and emotion awareness, hope, mindfulness, purpose, quality of life, gratitude, empathy, forgiveness, motivation, and kindness) and ill-being (depression, anxiety, stress, loneliness, and burnout). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the selection of studies and data extraction. Quality assessment was performed following the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results: For well-being outcomes, meta-analytic results showed that PPIs augmented the feeling of purpose, gratitude, and hope (Hedges g=0.555), compassion (Hedges g=0.447), positive coping behaviors (Hedges g=0.421), body image–related outcomes (Hedges g=0.238), and positive mindset predisposition (Hedges g=0.304). For ill-being outcomes, PPIs reduced cognitive biases (Hedges g=–0.637), negative emotions and mood (Hedges g=–0.369), and stress levels (Hedges g=–0.342). Of note, larger effect sizes were found when a waiting list control group was considered versus a digital control group. A funnel plot showed no publication bias. Meta-regression analyses showed that PPIs tended to show a larger effect size on well-being outcomes in studies including young adults, whereas no specific effect was found for ill-being outcomes. Conclusions: Revised evidence suggests that PPIs benefit young people’s well-being and mitigate ill-being symptoms. Digital platforms offer a unique way to address their mental health challenges, although not without limitations. Future research should explore how they work for the needs of the young population and further examine what specific PPIs or combination of interventions is most beneficial with respect to other digital control groups. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023420092; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420092 %M 39141906 %R 10.2196/56045 %U https://mental.jmir.org/2024/1/e56045 %U https://doi.org/10.2196/56045 %U http://www.ncbi.nlm.nih.gov/pubmed/39141906 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53672 %T Debate and Dilemmas Regarding Generative AI in Mental Health Care: Scoping Review %A Xian,Xuechang %A Chang,Angela %A Xiang,Yu-Tao %A Liu,Matthew Tingchi %+ Department of Communication, Faculty of Social Sciences, University of Macau, University Avenue, Taipa, Macau SAR, 999078, China, 86 88228991, wychang@um.edu.mo %K generative artificial intelligence %K GAI %K ChatGPT %K mental health %K scoping review %K artificial intelligence %K depression %K anxiety %K generative adversarial network %K GAN %K variational autoencoder %K VAE %D 2024 %7 12.8.2024 %9 Review %J Interact J Med Res %G English %X Background: Mental disorders have ranked among the top 10 prevalent causes of burden on a global scale. Generative artificial intelligence (GAI) has emerged as a promising and innovative technological advancement that has significant potential in the field of mental health care. Nevertheless, there is a scarcity of research dedicated to examining and understanding the application landscape of GAI within this domain. Objective: This review aims to inform the current state of GAI knowledge and identify its key uses in the mental health domain by consolidating relevant literature. Methods: Records were searched within 8 reputable sources including Web of Science, PubMed, IEEE Xplore, medRxiv, bioRxiv, Google Scholar, CNKI and Wanfang databases between 2013 and 2023. Our focus was on original, empirical research with either English or Chinese publications that use GAI technologies to benefit mental health. For an exhaustive search, we also checked the studies cited by relevant literature. Two reviewers were responsible for the data selection process, and all the extracted data were synthesized and summarized for brief and in-depth analyses depending on the GAI approaches used (traditional retrieval and rule-based techniques vs advanced GAI techniques). Results: In this review of 144 articles, 44 (30.6%) met the inclusion criteria for detailed analysis. Six key uses of advanced GAI emerged: mental disorder detection, counseling support, therapeutic application, clinical training, clinical decision-making support, and goal-driven optimization. Advanced GAI systems have been mainly focused on therapeutic applications (n=19, 43%) and counseling support (n=13, 30%), with clinical training being the least common. Most studies (n=28, 64%) focused broadly on mental health, while specific conditions such as anxiety (n=1, 2%), bipolar disorder (n=2, 5%), eating disorders (n=1, 2%), posttraumatic stress disorder (n=2, 5%), and schizophrenia (n=1, 2%) received limited attention. Despite prevalent use, the efficacy of ChatGPT in the detection of mental disorders remains insufficient. In addition, 100 articles on traditional GAI approaches were found, indicating diverse areas where advanced GAI could enhance mental health care. Conclusions: This study provides a comprehensive overview of the use of GAI in mental health care, which serves as a valuable guide for future research, practical applications, and policy development in this domain. While GAI demonstrates promise in augmenting mental health care services, its inherent limitations emphasize its role as a supplementary tool rather than a replacement for trained mental health providers. A conscientious and ethical integration of GAI techniques is necessary, ensuring a balanced approach that maximizes benefits while mitigating potential challenges in mental health care practices. %M 39133916 %R 10.2196/53672 %U https://www.i-jmr.org/2024/1/e53672 %U https://doi.org/10.2196/53672 %U http://www.ncbi.nlm.nih.gov/pubmed/39133916 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55785 %T Effects of Electronic Serious Games on Older Adults With Alzheimer’s Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials %A Zuo,Xinyi %A Tang,Yong %A Chen,Yifang %A Zhou,Zhimiao %+ Sociology Department, School of Government, Shenzhen University, 1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China, 86 13670191924, tangyong@szu.edu.cn %K digital serious games %K cognitive ability %K daily behavioral capacity %K mental health %K depression %K older adults with AD and MCI %K AD %K Alzheimer’s disease %K MD %K mild cognitive impairment %K systematic review %K meta-analysis %D 2024 %7 31.7.2024 %9 Review %J JMIR Serious Games %G English %X Background: Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Objective: This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies. Methods: This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed. Results: From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD –2.08, 95% CI –2.94 to –1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests. Conclusions: Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090 %R 10.2196/55785 %U https://games.jmir.org/2024/1/e55785 %U https://doi.org/10.2196/55785 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54064 %T Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review %A Bhawra,Jasmin %A Elsahli,Nadine %A Patel,Jamin %+ CHANGE Research Lab, School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 553466, jasmin.bhawra@torontomu.ca %K climate change %K digital health %K ecoanxiety %K environmental hazards %K food security %K mental health %K scoping review %K smartphone apps %K digital apps %K mobile health %K mobile phone %D 2024 %7 23.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people’s way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. Objective: This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. Methods: A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. Results: From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50%) assessed climate change–related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36%), knowledge databases (n=5, 36%), data collection and analysis (n=3, 21%), gamification (n=1, 7%), and educational resources (n=2, 14%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7%), collaborative (n=1, 7%), and cocreative (n=1, 7%) approaches, to ensure the relevance and use of digital apps. Conclusions: Most digital apps identified provided a service to citizens to either prevent adverse climate change–related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions. %M 39042453 %R 10.2196/54064 %U https://publichealth.jmir.org/2024/1/e54064 %U https://doi.org/10.2196/54064 %U http://www.ncbi.nlm.nih.gov/pubmed/39042453 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e51074 %T Technologies for Supporting Individuals and Caregivers Living With Fetal Alcohol Spectrum Disorder: Scoping Review %A Chu,Joanna Ting Wai %A Wilson,Holly %A Cai,Cynthia Zhiyin %A McCormack,Jessica C %A Newcombe,David %A Bullen,Chris %K fetal alcohol %K scoping review %K technology %K caregivers %K diagnosis %K support %K intervention %K fetal alcohol spectrum disorder %K FASD %K developmental disability %K lifelong support %K caregiver %K accessibility %K alcohol %K alcohol intake %K pregnant substance %K pregnant %K fetal %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %K mobile phone %D 2024 %7 11.7.2024 %9 %J JMIR Ment Health %G English %X Background: Fetal alcohol spectrum disorder (FASD) is a common developmental disability that requires lifelong and ongoing support but is often difficult to find due to the lack of trained professionals, funding, and support available. Technology could provide cost-effective, accessible, and effective support to those living with FASD and their caregivers. Objective: In this review, we aimed to explore the use of technology available for supporting people living with FASD and their caregivers. Methods: We conducted a scoping review to identify studies that included technology for people with FASD or their caregivers; focused on FASD; used an empirical study design; were published since 2005; and used technology for assessment, diagnosis, monitoring, or support for people with FASD. We searched MEDLINE, Web of Science, Scopus, Embase, APA PsycINFO, ACM Digital Library, JMIR Publications journals, the Cochrane Library, EBSCOhost, IEEE, study references, and gray literature to find studies. Searches were conducted in November 2022 and updated in January 2024. Two reviewers (CZC and HW) independently completed study selection and data extraction. Results: In total, 17 studies exploring technology available for people with FASD showed that technology could be effective at teaching skills, supporting caregivers, and helping people with FASD develop skills. Conclusions: Technology could provide support for people affected by FASD; however, currently there is limited technology available, and the potential benefits are largely unexplored. Trial Registration: PROSPERO CRD42022364885; https://tinyurl.com/3zaatu9u %R 10.2196/51074 %U https://mental.jmir.org/2024/1/e51074 %U https://doi.org/10.2196/51074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49431 %T Design of Digital Mental Health Platforms for Family Member Cocompletion: Scoping Review %A Welsh,Ellen T %A McIntosh,Jennifer E %A Vuong,An %A Cloud,Zoe C G %A Hartley,Eliza %A Boyd,James H %+ The Bouverie Centre, School of Psychology and Public Health, La Trobe University, 8 Gardiner Street, Brunswick, 3056, Australia, 61 384814800, e.welsh@latrobe.edu.au %K family therapy %K family %K couples %K eHealth %K digital health %K platform %K platforms %K e–mental health %K internet interventions %K psychosocial interventions %K psychosocial %K synthesis %K review methods %K review methodology %K scoping %K mental health %K utility %K design %K family caregiver %K caregiver %K parent %K child %K development %K cocompletion %K access %K accessibility %K engagement %K families %K dyad %K dyadic %K user engagement %K digital health %K user experience %K mobile phone %D 2024 %7 3.7.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together. Objective: As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families. Methods: A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented. Results: Of the 9527 papers reviewed, 85 (0.89%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver–care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself. Conclusions: In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation. %M 38959030 %R 10.2196/49431 %U https://www.jmir.org/2024/1/e49431 %U https://doi.org/10.2196/49431 %U http://www.ncbi.nlm.nih.gov/pubmed/38959030 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55747 %T Insights Derived From Text-Based Digital Media, in Relation to Mental Health and Suicide Prevention, Using Data Analysis and Machine Learning: Systematic Review %A Sweeney,Colm %A Ennis,Edel %A Mulvenna,Maurice D %A Bond,Raymond %A O'Neill,Siobhan %+ Department of Psychlogy, Ulster University, Cromore Rd, Coleraine, BT52 1SA, United Kingdom, 44 02870 123 456, Sweeney-C23@ulster.ac.uk %K mental health %K machine learning %K text analysis %K digital intervention %D 2024 %7 27.6.2024 %9 Review %J JMIR Ment Health %G English %X Background: Text-based digital media platforms have revolutionized communication and information sharing, providing valuable access to knowledge and understanding in the fields of mental health and suicide prevention. Objective: This systematic review aimed to determine how machine learning and data analysis can be applied to text-based digital media data to understand mental health and aid suicide prevention. Methods: A systematic review of research papers from the following major electronic databases was conducted: Web of Science, MEDLINE, Embase (via MEDLINE), and PsycINFO (via MEDLINE). The database search was supplemented by a hand search using Google Scholar. Results: Overall, 19 studies were included, with five major themes as to how data analysis and machine learning techniques could be applied: (1) as predictors of personal mental health, (2) to understand how personal mental health and suicidal behavior are communicated, (3) to detect mental disorders and suicidal risk, (4) to identify help seeking for mental health difficulties, and (5) to determine the efficacy of interventions to support mental well-being. Conclusions: Our findings show that data analysis and machine learning can be used to gain valuable insights, such as the following: web-based conversations relating to depression vary among different ethnic groups, teenagers engage in a web-based conversation about suicide more often than adults, and people seeking support in web-based mental health communities feel better after receiving online support. Digital tools and mental health apps are being used successfully to manage mental health, particularly through the COVID-19 epidemic, during which analysis has revealed that there was increased anxiety and depression, and web-based communities played a part in reducing isolation during the pandemic. Predictive analytics were also shown to have potential, and virtual reality shows promising results in the delivery of preventive or curative care. Future research efforts could center on optimizing algorithms to enhance the potential of text-based digital media analysis in mental health and suicide prevention. In addressing depression, a crucial step involves identifying the factors that contribute to happiness and using machine learning to forecast these sources of happiness. This could extend to understanding how various activities result in improved happiness across different socioeconomic groups. Using insights gathered from such data analysis and machine learning, there is an opportunity to craft digital interventions, such as chatbots, designed to provide support and address mental health challenges and suicide prevention. %M 38935419 %R 10.2196/55747 %U https://mental.jmir.org/2024/1/e55747 %U https://doi.org/10.2196/55747 %U http://www.ncbi.nlm.nih.gov/pubmed/38935419 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55100 %T Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis %A Lyzwinski,Lynnette %A Mcdonald,Sheila %A Zwicker,Jennifer %A Tough,Suzanne %+ Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr, Calgary, AB, T2N4N1, Canada, 1 403 220 6843, Lynnette.Lyzwinski@ucalgary.ca %K mental health %K knowledge translation %K KT %K flourishing %K youth %K teenagers %K mindfulness %K positive psychology %K telehealth %K implementation %K knowledge dissemination %K pandemic %K COVID-19 %K service delivery %D 2024 %7 25.6.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective: The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. Methods: We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). Results: A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. Conclusions: There is an opportunity to reduce the barriers to implementing tele–mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele–mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation. %M 38916946 %R 10.2196/55100 %U https://pediatrics.jmir.org/2024/1/e55100 %U https://doi.org/10.2196/55100 %U http://www.ncbi.nlm.nih.gov/pubmed/38916946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e40689 %T Digital Phenotyping for Stress, Anxiety, and Mild Depression: Systematic Literature Review %A Choi,Adrien %A Ooi,Aysel %A Lottridge,Danielle %+ School of Computer Science, Faculty of Science, University of Auckland, 38 Princes Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 82930, d.lottridge@auckland.ac.nz %K digital phenotyping %K passive sensing %K stress %K anxiety %K depression %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %K mobile phone %D 2024 %7 23.5.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Unaddressed early-stage mental health issues, including stress, anxiety, and mild depression, can become a burden for individuals in the long term. Digital phenotyping involves capturing continuous behavioral data via digital smartphone devices to monitor human behavior and can potentially identify milder symptoms before they become serious. Objective: This systematic literature review aimed to answer the following questions: (1) what is the evidence of the effectiveness of digital phenotyping using smartphones in identifying behavioral patterns related to stress, anxiety, and mild depression? and (2) in particular, which smartphone sensors are found to be effective, and what are the associated challenges? Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process to identify 36 papers (reporting on 40 studies) to assess the key smartphone sensors related to stress, anxiety, and mild depression. We excluded studies conducted with nonadult participants (eg, teenagers and children) and clinical populations, as well as personality measurement and phobia studies. As we focused on the effectiveness of digital phenotyping using smartphones, results related to wearable devices were excluded. Results: We categorized the studies into 3 major groups based on the recruited participants: studies with students enrolled in universities, studies with adults who were unaffiliated to any particular organization, and studies with employees employed in an organization. The study length varied from 10 days to 3 years. A range of passive sensors were used in the studies, including GPS, Bluetooth, accelerometer, microphone, illuminance, gyroscope, and Wi-Fi. These were used to assess locations visited; mobility; speech patterns; phone use, such as screen checking; time spent in bed; physical activity; sleep; and aspects of social interactions, such as the number of interactions and response time. Of the 40 included studies, 31 (78%) used machine learning models for prediction; most others (n=8, 20%) used descriptive statistics. Students and adults who experienced stress, anxiety, or depression visited fewer locations, were more sedentary, had irregular sleep, and accrued increased phone use. In contrast to students and adults, less mobility was seen as positive for employees because less mobility in workplaces was associated with higher performance. Overall, travel, physical activity, sleep, social interaction, and phone use were related to stress, anxiety, and mild depression. Conclusions: This study focused on understanding whether smartphone sensors can be effectively used to detect behavioral patterns associated with stress, anxiety, and mild depression in nonclinical participants. The reviewed studies provided evidence that smartphone sensors are effective in identifying behavioral patterns associated with stress, anxiety, and mild depression. %M 38780995 %R 10.2196/40689 %U https://mhealth.jmir.org/2024/1/e40689 %U https://doi.org/10.2196/40689 %U http://www.ncbi.nlm.nih.gov/pubmed/38780995 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55750 %T Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis %A Marshall,Paul %A Booth,Millissa %A Coole,Matthew %A Fothergill,Lauren %A Glossop,Zoe %A Haines,Jade %A Harding,Andrew %A Johnston,Rose %A Jones,Steven %A Lodge,Christopher %A Machin,Karen %A Meacock,Rachel %A Nielson,Kristi %A Puddephatt,Jo-Anne %A Rakic,Tamara %A Rayson,Paul %A Robinson,Heather %A Rycroft-Malone,Jo %A Shryane,Nick %A Swithenbank,Zoe %A Wise,Sara %A Lobban,Fiona %+ Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4YW, United Kingdom, 44 01524 522187, p.marshall4@lancaster.ac.uk %K digital mental health %K peer-to-peer support %K social networking %K moderation %K systematic review %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. Objective: This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. Methods: We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. Results: Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. Conclusions: This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. Trial Registration: PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528 %M 38722680 %R 10.2196/55750 %U https://mental.jmir.org/2024/1/e55750 %U https://doi.org/10.2196/55750 %U http://www.ncbi.nlm.nih.gov/pubmed/38722680 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57155 %T Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions %A Smith,Katharine A %A Hardy,Amy %A Vinnikova,Anastasia %A Blease,Charlotte %A Milligan,Lea %A Hidalgo-Mazzei,Diego %A Lambe,Sinéad %A Marzano,Lisa %A Uhlhaas,Peter J %A Ostinelli,Edoardo G %A Anmella,Gerard %A Zangani,Caroline %A Aronica,Rosario %A Dwyer,Bridget %A Torous,John %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 1865 902135, katharine.smith@psych.ox.ac.uk %K digital %K mental health %K severe mental illness %K consensus %K lived experience %K ethics %K user-centered design %K patient and public involvement %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). Objective: An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. Methods: The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Results: Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. Conclusions: The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation. %M 38717799 %R 10.2196/57155 %U https://mental.jmir.org/2024/1/e57155 %U https://doi.org/10.2196/57155 %U http://www.ncbi.nlm.nih.gov/pubmed/38717799 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56056 %T Immersive Technologies for Depression Care: Scoping Review %A Reategui-Rivera,C Mahony %A Villarreal-Zegarra,David %A De La Cruz-Torralva,Kelly %A Díaz-Sánchez,Paquita %A Finkelstein,Joseph %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, United States, 1 801 581 4080, mahony.reategui@utah.edu %K depression %K immersive technologies %K virtual reality %K augmented reality %K mobile phone %D 2024 %7 25.4.2024 %9 Review %J JMIR Ment Health %G English %X Background: Depression significantly impacts quality of life, affecting approximately 280 million people worldwide. However, only 16.5% of those affected receive treatment, indicating a substantial treatment gap. Immersive technologies (IMTs) such as virtual reality (VR) and augmented reality offer new avenues for treating depression by creating immersive environments for therapeutic interventions. Despite their potential, significant gaps exist in the current evidence regarding the design, implementation, and use of IMTs for depression care. Objective: We aim to map the available evidence on IMT interventions targeting depression treatment. Methods: This scoping review followed a methodological framework, and we systematically searched databases for studies on IMTs and depression. The focus was on randomized clinical trials involving adults and using IMTs. The selection and charting process involved multiple reviewers to minimize bias. Results: The search identified 16 peer-reviewed articles, predominantly from Europe (n=10, 63%), with a notable emphasis on Poland (n=9, 56%), which contributed to more than half of the articles. Most of the studies (9/16, 56%) were conducted between 2020 and 2021. Regarding participant demographics, of the 16 articles, 5 (31%) exclusively involved female participants, and 7 (44%) featured participants whose mean or median age was >60 years. Regarding technical aspects, all studies focused on VR, with most using stand-alone VR headsets (14/16, 88%), and interventions typically ranging from 2 to 8 weeks, predominantly in hospital settings (11/16, 69%). Only 2 (13%) of the 16 studies mentioned using a specific VR design framework in planning their interventions. The most frequently used therapeutic approach was Ericksonian psychotherapy, used in 56% (9/16) of the studies. Notably, none of the articles reported using an implementation framework or identified barriers and enablers to implementation. Conclusions: This scoping review highlights the growing interest in using IMTs, particularly VR, for depression treatment but emphasizes the need for more inclusive and comprehensive research. Future studies should explore varied therapeutic approaches and cost-effectiveness as well as the inclusion of augmented reality to fully realize the potential of IMTs in mental health care. %M 38663004 %R 10.2196/56056 %U https://mental.jmir.org/2024/1/e56056 %U https://doi.org/10.2196/56056 %U http://www.ncbi.nlm.nih.gov/pubmed/38663004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48356 %T Electronic Media Use and Sleep Quality: Updated Systematic Review and Meta-Analysis %A Han,Xiaoning %A Zhou,Enze %A Liu,Dong %+ School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 13693388506, bnuliudong@gmail.com %K electronic media %K sleep quality %K meta-analysis %K media types %K cultural difference %D 2024 %7 23.4.2024 %9 Review %J J Med Internet Res %G English %X Background: This paper explores the widely discussed relationship between electronic media use and sleep quality, indicating negative effects due to various factors. However, existing meta-analyses on the topic have some limitations. Objective: The study aims to analyze and compare the impacts of different digital media types, such as smartphones, online games, and social media, on sleep quality. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study performed a systematic meta-analysis of literature across multiple databases, including Web of Science, MEDLINE, PsycINFO, PubMed, Science Direct, Scopus, and Google Scholar, from January 2018 to October 2023. Two trained coders coded the study characteristics independently. The effect sizes were calculated using the correlation coefficient as a standardized measure of the relationship between electronic media use and sleep quality across studies. The Comprehensive Meta-Analysis software (version 3.0) was used to perform the meta-analysis. Statistical methods such as funnel plots were used to assess the presence of asymmetry and a p-curve test to test the p-hacking problem, which can indicate publication bias. Results: Following a thorough screening process, the study involved 55 papers (56 items) with 41,716 participants from over 20 countries, classifying electronic media use into “general use” and “problematic use.” The meta-analysis revealed that electronic media use was significantly linked with decreased sleep quality and increased sleep problems with varying effect sizes across subgroups. A significant cultural difference was also observed in these effects. General use was associated with a significant decrease in sleep quality (P<.001). The pooled effect size was 0.28 (95% CI 0.21-0.35; k=20). Problematic use was associated with a significant increase in sleep problems (P≤.001). The pooled effect size was 0.33 (95% CI 0.28-0.38; k=36). The subgroup analysis indicated that the effect of general smartphone use and sleep problems was r=0.33 (95% CI 0.27-0.40), which was the highest among the general group. The effect of problematic internet use and sleep problems was r=0.51 (95% CI 0.43-0.59), which was the highest among the problematic groups. There were significant differences among these subgroups (general: Qbetween=14.46, P=.001; problematic: Qbetween=27.37, P<.001). The results of the meta-regression analysis using age, gender, and culture as moderators indicated that only cultural difference in the relationship between Eastern and Western culture was significant (Qbetween=6.69; P=.01). All funnel plots and p-curve analyses showed no evidence of publication and selection bias. Conclusions: Despite some variability, the study overall confirms the correlation between increased electronic media use and poorer sleep outcomes, which is notably more significant in Eastern cultures. %M 38533835 %R 10.2196/48356 %U https://www.jmir.org/2024/1/e48356 %U https://doi.org/10.2196/48356 %U http://www.ncbi.nlm.nih.gov/pubmed/38533835 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46593 %T Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review %A Fernández-Álvarez,Javier %A Colombo,Desirée %A Gómez Penedo,Juan Martín %A Pierantonelli,Maitena %A Baños,Rosa María %A Botella,Cristina %+ Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, Castellon de la Plana, 12071, Spain, 34 964 72 80 0, javferalvarez@gmail.com %K social anxiety disorder %K ambulatory assessment %K ecological momentary assessment %K intensive longitudinal methods %K systematic review %K social anxiety %K use %K qualitative synthesis %K emotional %K cognitive %K behavioral %K development %K mental disorder %K anxiety %K mental health %K mobile health %K mHealth %K monitoring %K review %K assessment %K mobile phone %D 2024 %7 4.4.2024 %9 Review %J JMIR Ment Health %G English %X Background: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. Objective: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. Results: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. Conclusions: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder. %M 38574359 %R 10.2196/46593 %U https://mental.jmir.org/2024/1/e46593 %U https://doi.org/10.2196/46593 %U http://www.ncbi.nlm.nih.gov/pubmed/38574359 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52186 %T Effectiveness of Virtual Reality–Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review %A Xu,Joy %A Khanotia,Areej %A Juni,Shmuel %A Ku,Josephine %A Sami,Hana %A Lin,Vallen %A Walterson,Roberta %A Payne,Evelyn %A Jo,Helen %A Rahimpoor-Marnani,Parmin %+ David Geffen School of Medicine at UCLA, 417 Charles E Young Drive West, Los Angeles, CA, 90024, United States, 1 3109481476, joyjxu@gmail.com %K well-being %K well-being %K virtual reality %K VR %K stress, nature %K academic %K student %K intervention %K young adults %K teens %K adolescent %K stressors %K stress management %K systematic review %K accessible %K accessibility %K students %K affordable %D 2024 %7 29.3.2024 %9 Review %J JMIR Ment Health %G English %X Background: Adolescents can be especially vulnerable to various stressors as they are still in their formative years and transitioning into adulthood. Hence, it is important for them to have effective stress management strategies. Objective: This systematic review investigates current well-being interventions that are aimed at reducing stress among young adults. In particular, interventions using the medium of virtual reality (VR) are explored. Methods: This mixed methods systematic review follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, and papers were gathered from databases such as PsycINFO, PubMed, Science Direct, Web of Science, OpenGrey, and Edutopia. Predetermined criteria and specific keywords were used to search for the papers. Search results were screened and extracted with all article screening or extraction delegated among all authors. Any disagreements after reconciliation were settled by a third author. The quality and risk of bias of included studies were assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Tool for Quantitative Studies. Studies were analyzed qualitatively. Results: In total, 20 studies were included, and qualitative analysis was performed to evaluate the effectiveness of VR-based interventions in 3 domains: nature, stress, and academics. Conclusions: Studies using VR interventions, overall, promoted a reduction in stress and an increase in well-being. The findings suggest that VR may serve as an accessible and affordable medium of stress reduction for students and young adults. Larger sample sizes, and a greater number of included studies, may be required in future directions. %M 38551625 %R 10.2196/52186 %U https://mental.jmir.org/2024/1/e52186 %U https://doi.org/10.2196/52186 %U http://www.ncbi.nlm.nih.gov/pubmed/38551625 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51268 %T The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis %A Yeo,GeckHong %A Reich,Stephanie M %A Liaw,Nicole A %A Chia,Elizabeth Yee Min %+ School of Education, University of California, Irvine, 3454 Education, Irvine, CA, 92697, United States, 1 (949) 824 5970, smreich@uci.edu %K review and meta-analysis %K digital mental health literacy %K digital mental health interventions %K mental health functioning %D 2024 %7 29.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. Objective: This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. Methods: We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. Results: Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI −0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. Conclusions: For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995 %M 38421687 %R 10.2196/51268 %U https://www.jmir.org/2024/1/e51268 %U https://doi.org/10.2196/51268 %U http://www.ncbi.nlm.nih.gov/pubmed/38421687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48168 %T Attrition in Conversational Agent–Delivered Mental Health Interventions: Systematic Review and Meta-Analysis %A Jabir,Ahmad Ishqi %A Lin,Xiaowen %A Martinengo,Laura %A Sharp,Gemma %A Theng,Yin-Leng %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agent %K chatbot %K mental health %K mHealth %K attrition %K dropout %K mobile phone %K artificial intelligence %K AI %K systematic review %K meta-analysis %K digital health interventions %D 2024 %7 27.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Conversational agents (CAs) or chatbots are computer programs that mimic human conversation. They have the potential to improve access to mental health interventions through automated, scalable, and personalized delivery of psychotherapeutic content. However, digital health interventions, including those delivered by CAs, often have high attrition rates. Identifying the factors associated with attrition is critical to improving future clinical trials. Objective: This review aims to estimate the overall and differential rates of attrition in CA-delivered mental health interventions (CA interventions), evaluate the impact of study design and intervention-related aspects on attrition, and describe study design features aimed at reducing or mitigating study attrition. Methods: We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science, and conducted a gray literature search on Google Scholar in June 2022. We included randomized controlled trials that compared CA interventions against control groups and excluded studies that lasted for 1 session only and used Wizard of Oz interventions. We also assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool 2.0. Random-effects proportional meta-analysis was applied to calculate the pooled dropout rates in the intervention groups. Random-effects meta-analysis was used to compare the attrition rate in the intervention groups with that in the control groups. We used a narrative review to summarize the findings. Results: The systematic search retrieved 4566 records from peer-reviewed databases and citation searches, of which 41 (0.90%) randomized controlled trials met the inclusion criteria. The meta-analytic overall attrition rate in the intervention group was 21.84% (95% CI 16.74%-27.36%; I2=94%). Short-term studies that lasted ≤8 weeks showed a lower attrition rate (18.05%, 95% CI 9.91%- 27.76%; I2=94.6%) than long-term studies that lasted >8 weeks (26.59%, 95% CI 20.09%-33.63%; I2=93.89%). Intervention group participants were more likely to attrit than control group participants for short-term (log odds ratio 1.22, 95% CI 0.99-1.50; I2=21.89%) and long-term studies (log odds ratio 1.33, 95% CI 1.08-1.65; I2=49.43%). Intervention-related characteristics associated with higher attrition include stand-alone CA interventions without human support, not having a symptom tracker feature, no visual representation of the CA, and comparing CA interventions with waitlist controls. No participant-level factor reliably predicted attrition. Conclusions: Our results indicated that approximately one-fifth of the participants will drop out from CA interventions in short-term studies. High heterogeneities made it difficult to generalize the findings. Our results suggested that future CA interventions should adopt a blended design with human support, use symptom tracking, compare CA intervention groups against active controls rather than waitlist controls, and include a visual representation of the CA to reduce the attrition rate. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022341415; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341415 %M 38412023 %R 10.2196/48168 %U https://www.jmir.org/2024/1/e48168 %U https://doi.org/10.2196/48168 %U http://www.ncbi.nlm.nih.gov/pubmed/38412023 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e48916 %T Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review %A Shahid,Simon %A Kelson,Joshua %A Saliba,Anthony %+ Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Panorama Ave, Bathurst, 2795, Australia, 61 2 6338 4570, jkelson@csu.edu.au %K social anxiety disorder %K social phobia %K virtual reality %K VR %K VR exposure therapy %K effectiveness %K user experience %K safety %K usability %K acceptability %K anxiety %K phobia %K exposure %K systematic %K review methods %K review methodology %K social %K psychiatric %K mental health %K mobile phone %D 2024 %7 8.2.2024 %9 Review %J JMIR Ment Health %G English %X Background: Social anxiety disorder (SAD) is a debilitating psychiatric disorder that affects occupational and social functioning. Virtual reality (VR) therapies can provide effective treatment for people with SAD. However, with rapid innovations in immersive VR technology, more contemporary research is required to examine the effectiveness and concomitant user experience outcomes (ie, safety, usability, acceptability, and attrition) of emerging VR interventions for SAD. Objective: The aim of this systematic review was to examine the effectiveness and user experience of contemporary VR interventions among people with SAD. Methods: The Cochrane Library, Emcare, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science databases were searched between January 1, 2012, and April 26, 2022. Deduplicated search results were screened based on title and abstract information. Full-text examination was conducted on 71 articles. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience outcomes of any immersive VR intervention among people with SAD. A standardized coding sheet was used to extract data on key participant, intervention, comparator, outcome, and study design items. Results: The findings were tabulated and discussed using a narrative synthesis. A total of 18 studies met the inclusion criteria. Conclusions: The findings showed that VR exposure therapy–based interventions can generally provide effective, safe, usable, and acceptable treatments for adults with SAD. The average attrition rate from VR treatment was low (11.36%) despite some reported user experience difficulties, including potential simulator sickness, exposure-based emotional distress, and problems with managing treatment delivered in a synchronous group setting. This review also revealed several research gaps, including a lack of VR treatment studies on children and adolescents with SAD as well as a paucity of standardized assessments of VR user experience interactions. More studies are required to address these issues. Trial Registration: PROSPERO CRD42022353891; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353891 %M 38329804 %R 10.2196/48916 %U https://mental.jmir.org/2024/1/e48916 %U https://doi.org/10.2196/48916 %U http://www.ncbi.nlm.nih.gov/pubmed/38329804 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46637 %T Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis %A Fischer-Grote,Linda %A Fössing,Vera %A Aigner,Martin %A Fehrmann,Elisabeth %A Boeckle,Markus %+ Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6503032923, elisabeth.fehrmann@kl.ac.at %K COVID-19 pandemic %K online/digital mental health intervention %K e-mental health %K anxiety %K social functioning %K depression %K well-being %K psychological distress %K eating disorder %K COVID-19 symptoms %D 2024 %7 5.2.2024 %9 Review %J JMIR Ment Health %G English %X Background: The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. Objective: This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. Methods: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. Results: We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI –0.68 to –0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19–related symptoms were found. Conclusions: The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required. %M 38315524 %R 10.2196/46637 %U https://mental.jmir.org/2024/1/e46637 %U https://doi.org/10.2196/46637 %U http://www.ncbi.nlm.nih.gov/pubmed/38315524 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49577 %T Health Care Professionals’ Views on the Use of Passive Sensing, AI, and Machine Learning in Mental Health Care: Systematic Review With Meta-Synthesis %A Rogan,Jessica %A Bucci,Sandra %A Firth,Joseph %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 161 306 0422, sandra.bucci@manchester.ac.uk %K artificial intelligence %K machine learning %K passive sensing %K mental health care %K clinicians %K views %K meta-synthesis %K review %K mental health %K health care %K health care professionals %K psychology %K psychiatry %K mental health professionals %K mobile phone %D 2024 %7 23.1.2024 %9 Review %J JMIR Ment Health %G English %X Background: Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential barriers to and facilitators of their implementation. Objective: This study aims to review, critically appraise, and synthesize qualitative findings relating to the views of mental health care professionals on the use of passive sensing and AI in mental health care. Methods: A systematic search of qualitative studies was performed using 4 databases. A meta-synthesis approach was used, whereby studies were analyzed using an inductive thematic analysis approach within a critical realist epistemological framework. Results: Overall, 10 studies met the eligibility criteria. The 3 main themes were uses of passive sensing and AI in clinical practice, barriers to and facilitators of use in practice, and consequences for service users. A total of 5 subthemes were identified: barriers, facilitators, empowerment, risk to well-being, and data privacy and protection issues. Conclusions: Although clinicians are open-minded about the use of passive sensing and AI in mental health care, important factors to consider are service user well-being, clinician workloads, and therapeutic relationships. Service users and clinicians must be involved in the development of digital technologies and systems to ensure ease of use. The development of, and training in, clear policies and guidelines on the use of passive sensing and AI in mental health care, including risk management and data security procedures, will also be key to facilitating clinician engagement. The means for clinicians and service users to provide feedback on how the use of passive sensing and AI in practice is being received should also be considered. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022331698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331698 %M 38261403 %R 10.2196/49577 %U https://mental.jmir.org/2024/1/e49577 %U https://doi.org/10.2196/49577 %U http://www.ncbi.nlm.nih.gov/pubmed/38261403 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43882 %T Feasibility, Adherence, and Effectiveness of Blended Psychotherapy for Severe Mental Illnesses: Scoping Review %A Ehrt-Schäfer,Yamina %A Rusmir,Milan %A Vetter,Johannes %A Seifritz,Erich %A Müller,Mario %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 +41583842817, yamina.ehrt@pukzh.ch %K blended psychotherapy %K severe mental illnesses %K digital health intervention %K e-mental health %K scoping review %D 2023 %7 26.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: Blended psychotherapy (bPT) combines face-to-face psychotherapy with digital interventions to enhance the effectiveness of mental health treatment. The feasibility and effectiveness of bPT have been demonstrated for various mental health issues, although primarily for patients with higher levels of functioning. Objective: This scoping review aims to investigate the feasibility, adherence, and effectiveness of bPT for the treatment of patients with severe mental illnesses (SMIs). Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted searches in PubMed, MEDLINE, Embase, PsycINFO, and PsycArticles for studies published until March 23, 2023. Results: Out of 587 screened papers, we incorporated 25 studies encompassing 23 bPT interventions, involving a total of 2554 patients with SMI. The intervention formats and research designs exhibited significant variation. Our findings offer preliminary evidence supporting the feasibility of bPT for SMI, although there is limited research on adherence. Nevertheless, the summarized studies indicated promising attrition rates, spanning from 0% to 37%, implying a potential beneficial impact of bPT on adherence to SMI treatment. The quantity of evidence on the effects of bPT for SMI was limited and challenging to generalize. Among the 15 controlled trials, 4 concluded that bPT interventions were effective compared with controls. However, it is noteworthy that 2 of these studies used the same study population, and the control groups exhibited significant variations. Conclusions: Overall, our review suggests that while bPT appears promising as a treatment method, further research is necessary to establish its effectiveness for SMI. We discuss considerations for clinical implementation, directions, and future research. %M 38147373 %R 10.2196/43882 %U https://mental.jmir.org/2023/1/e43882 %U https://doi.org/10.2196/43882 %U http://www.ncbi.nlm.nih.gov/pubmed/38147373 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e52901 %T Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation %A Smith,Katharine A %A Ostinelli,Edoardo G %A Ede,Roger %A Allard,Lisa %A Thomson,Michaela %A Hewitt,Kiran %A Brown,Petra %A Zangani,Caroline %A Jenkins,Matthew %A Hinze,Verena %A Ma,George %A Pothulu,Prajnesh %A Henshall,Catherine %A Malhi,Gin S %A Every-Palmer,Susanna %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Headington, Oxford, OX3 7JX, United Kingdom, 44 1865902135, katharine.smith@psych.ox.ac.uk %K evidence synthesis %K guidelines %K mental health %K systematic review %K focus group %K survey %K COVID-19 %K pandemic %K digital health %K eHealth %K mobile phone %D 2023 %7 22.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. Objective: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. Methods: The impact and clinical utility of the OxPPL guidance were assessed using clinicians’ feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. Results: Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. Conclusions: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates. %M 38133912 %R 10.2196/52901 %U https://mental.jmir.org/2023/1/e52901 %U https://doi.org/10.2196/52901 %U http://www.ncbi.nlm.nih.gov/pubmed/38133912 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e47250 %T Phone-Based Text Therapy for Youth Mental Health: Rapid Review %A Karnik,Varun %A Henderson,Hamish %A Khan,Urooj Raza %A Boyd,James %+ La Trobe University, 360 Collins Street, Melbourne, 3086, Australia, 61 3 9479 6000, varun.karnik@griffithuni.edu.au %K text therapy %K mHealth %K adolescent health %K distance counseling %K mental illness %K mobile health intervention %K adolescent %K health promotion %K digital mental health intervention %D 2023 %7 14.12.2023 %9 Review %J Interact J Med Res %G English %X Background: Mental illness has become a prevalent issue impacting adolescents worldwide. Many barriers, including stigma and poor health literacy, prevent this population group from accessing reliable mental health care services. Synchronous text–therapy counseling is an underused therapeutic approach in combating adolescent mental illness. Phone-based text therapy is uniquely placed to offer personalized counseling to adolescents through a familiar and engaging treatment modality. Objective: This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health. Methods: Cochrane CENTRAL, Embase, PubMed, and PsycINFO were used to search for suitable literature. Five groups of keywords were used: those related to (1) “therapy,” (2) “text,” (3) “phone,” (4) “youth,” and (5) “mental health.” Eligibility criteria were formed through the PICO (Population, Intervention, Control, and Outcome) framework. Studies were included if a synchronous phone-based text therapy intervention was used in an adolescent population, with an age range of 12-24 years. Only literature available in full-text, English, and a peer-reviewed journal was considered. Furthermore, a date limit of 5 years was set to reflect the recent development of digital interventions for mental health. Pertinent information from each study was tabulated, and a narrative synthesis was used to assess, describe, and organize the included studies comprehensively and concisely. Results: Of the 771 studies dual screened, 7 studies were included in this rapid review. Most of the exclusions occurred due to the use of the wrong intervention, such as asynchronous messaging. The selected studies had a low risk of bias and were suitable for the review. All interventional trials demonstrated reductions in mental health symptoms, primarily depression and anxiety. Most studies displayed high usability among participants, while data were unclear regarding accessibility. Conclusions: This review reveals the high potential of phone-based text therapy as an intervention for adolescents experiencing mental illness. We hope that this review promotes further refinement of text-based phone therapies and encourages future research on this subject matter. %M 38096012 %R 10.2196/47250 %U https://www.i-jmr.org/2023/1/e47250 %U https://doi.org/10.2196/47250 %U http://www.ncbi.nlm.nih.gov/pubmed/38096012 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46778 %T Digital Phenotyping for Monitoring Mental Disorders: Systematic Review %A Bufano,Pasquale %A Laurino,Marco %A Said,Sara %A Tognetti,Alessandro %A Menicucci,Danilo %+ Institute of Clinical Physiology, National Research Council, via Giuseppe Moruzzi,1, Pisa, 56124, Italy, 39 0503152181, marco.laurino@cnr.it %K digital phenotyping %K mobile %K mental health %K smartphone %K mobile sensing %K passive sensing %K active sensing %K digital phenotype %K digital biomarker %K mobile phone %D 2023 %7 13.12.2023 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the impact and spread of mental illness and made health services difficult to access; therefore, there is a need for remote, pervasive forms of mental health monitoring. Digital phenotyping is a new approach that uses measures extracted from spontaneous interactions with smartphones (eg, screen touches or movements) or other digital devices as markers of mental status. Objective: This review aimed to evaluate the feasibility of using digital phenotyping for predicting relapse or exacerbation of symptoms in patients with mental disorders through a systematic review of the scientific literature. Methods: Our research was carried out using 2 bibliographic databases (PubMed and Scopus) by searching articles published up to January 2023. By following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, we started from an initial pool of 1150 scientific papers and screened and extracted a final sample of 29 papers, including studies concerning clinical populations in the field of mental health, which were aimed at predicting relapse or exacerbation of symptoms. The systematic review has been registered on the web registry Open Science Framework. Results: We divided the results into 4 groups according to mental disorder: schizophrenia (9/29, 31%), mood disorders (15/29, 52%), anxiety disorders (4/29, 14%), and substance use disorder (1/29, 3%). The results for the first 3 groups showed that several features (ie, mobility, location, phone use, call log, heart rate, sleep, head movements, facial and vocal characteristics, sociability, social rhythms, conversations, number of steps, screen on or screen off status, SMS text message logs, peripheral skin temperature, electrodermal activity, light exposure, and physical activity), extracted from data collected via the smartphone and wearable wristbands, can be used to create digital phenotypes that could support gold-standard assessment and could be used to predict relapse or symptom exacerbations. Conclusions: Thus, as the data were consistent for almost all the mental disorders considered (mood disorders, anxiety disorders, and schizophrenia), the feasibility of this approach was confirmed. In the future, a new model of health care management using digital devices should be integrated with the digital phenotyping approach and tailored mobile interventions (managing crises during relapse or exacerbation). %M 38090800 %R 10.2196/46778 %U https://www.jmir.org/2023/1/e46778 %U https://doi.org/10.2196/46778 %U http://www.ncbi.nlm.nih.gov/pubmed/38090800 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47487 %T Digital Cognitive Assessment Tests for Older Adults: Systematic Literature Review %A Cubillos,Claudio %A Rienzo,Antonio %+ Escuela de Ingeniería Biomédica, Universidad de Valparaiso, General Cruz 222, Valparaíso, 2362905, Chile, 56 998291207, antonio.rienzo@uv.cl %K cognitive digital test %K systematic review %K cognitive screening %K digital interventions %K older adults %D 2023 %7 8.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: The global health pandemic has affected the increasing older adult population, especially those with mental illnesses. It is necessary to prevent cases of cognitive impairment in adults early on, and this requires the support of information and communication technologies for evaluating and training cognitive functions. This can be achieved through computer applications designed for cognitive assessment. Objective: In this review, we aimed to assess the state of the art of the current platforms and digital test applications for cognitive evaluation, with a focus on older adults. Methods: A systematic literature search was conducted on 3 databases (Web of Science, PubMed, and Scopus) to retrieve recent articles on the applications of digital tests for cognitive assessment and analyze them based on the methodology used. Four research questions were considered. Through the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, following the application of inclusion and exclusion criteria, a total of 20 articles were finally reviewed. Results: Some gaps and trends were identified regarding the types of digital applications and technologies used, the evaluated effects on cognitive domains, and the psychometric parameters and personal characteristics considered for validation. Conclusions: Computerized tests (similar to paper-and-pencil tests) and test batteries (on computers, tablets, or web platforms) were the predominant types of assessments. Initial studies with simulators, virtual environments, and daily-life activity games were also conducted. Diverse validation methods and psychometric properties were observed; however, there was a lack of evaluations that involved specific populations with diverse education levels, cultures, and degrees of technology acceptance. In addition, these evaluations should consider emotional and usability aspects. %M 38064247 %R 10.2196/47487 %U https://mental.jmir.org/2023/1/e47487 %U https://doi.org/10.2196/47487 %U http://www.ncbi.nlm.nih.gov/pubmed/38064247 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48991 %T Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review %A Saad,Fiby %A Eisenstadt,Mia %A Liverpool,Shaun %A Carlsson,Courtney %A Vainieri,Isabella %+ Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872684 ext 2684, ucjuiva@ucl.ac.uk %K mental health apps %K racial and ethnic minority groups %K self-guided %K mental health %K culturally appropriate technology %D 2023 %7 6.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups. Objective: In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature. Methods: A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis. Results: A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues. Conclusions: Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted. %M 38055315 %R 10.2196/48991 %U https://mental.jmir.org/2023/1/e48991 %U https://doi.org/10.2196/48991 %U http://www.ncbi.nlm.nih.gov/pubmed/38055315 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51318 %T The Efficacy and Therapeutic Alliance of Augmented Reality Exposure Therapy in Treating Adults With Phobic Disorders: Systematic Review %A Hasan,Safa %A Alhaj,Hamid %A Hassoulas,Athanasios %+ University of Sharjah, College of Medicine, University of Shajah, Sharjah, United Arab Emirates, 971 65057239, halhaj@sharjah.ac.ae %K augmented reality %K virtual reality %K anxiety disorders %K phobic disorders %K exposure therapy %K augmented reality exposure %K phobia %K excessive fear %K prevalence %K technology %K cost-effectiveness %K fear %K phobia %K phobic %D 2023 %7 30.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient’s life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment. Objective: This systematic review investigated the novel technology’s efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia. Methods: An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022. Results: A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object. Conclusions: The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET’s cost-effectiveness and examine its efficacy in other populations and anxiety conditions. %M 38032710 %R 10.2196/51318 %U https://mental.jmir.org/2023/1/e51318 %U https://doi.org/10.2196/51318 %U http://www.ncbi.nlm.nih.gov/pubmed/38032710 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48754 %T Wearable Artificial Intelligence for Detecting Anxiety: Systematic Review and Meta-Analysis %A Abd-alrazaq,Alaa %A AlSaad,Rawan %A Harfouche,Manale %A Aziz,Sarah %A Ahmed,Arfan %A Damseh,Rafat %A Sheikh,Javaid %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Ezdan Street, Doha, M343A8, Qatar, 974 44928812, aaa4027@qatar-med.cornell.edu %K anxiety %K artificial intelligence %K wearable devices %K machine learning %K systematic review %K mobile phone %D 2023 %7 8.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Anxiety disorders rank among the most prevalent mental disorders worldwide. Anxiety symptoms are typically evaluated using self-assessment surveys or interview-based assessment methods conducted by clinicians, which can be subjective, time-consuming, and challenging to repeat. Therefore, there is an increasing demand for using technologies capable of providing objective and early detection of anxiety. Wearable artificial intelligence (AI), the combination of AI technology and wearable devices, has been widely used to detect and predict anxiety disorders automatically, objectively, and more efficiently. Objective: This systematic review and meta-analysis aims to assess the performance of wearable AI in detecting and predicting anxiety. Methods: Relevant studies were retrieved by searching 8 electronic databases and backward and forward reference list checking. In total, 2 reviewers independently carried out study selection, data extraction, and risk-of-bias assessment. The included studies were assessed for risk of bias using a modified version of the Quality Assessment of Diagnostic Accuracy Studies–Revised. Evidence was synthesized using a narrative (ie, text and tables) and statistical (ie, meta-analysis) approach as appropriate. Results: Of the 918 records identified, 21 (2.3%) were included in this review. A meta-analysis of results from 81% (17/21) of the studies revealed a pooled mean accuracy of 0.82 (95% CI 0.71-0.89). Meta-analyses of results from 48% (10/21) of the studies showed a pooled mean sensitivity of 0.79 (95% CI 0.57-0.91) and a pooled mean specificity of 0.92 (95% CI 0.68-0.98). Subgroup analyses demonstrated that the performance of wearable AI was not moderated by algorithms, aims of AI, wearable devices used, status of wearable devices, data types, data sources, reference standards, and validation methods. Conclusions: Although wearable AI has the potential to detect anxiety, it is not yet advanced enough for clinical use. Until further evidence shows an ideal performance of wearable AI, it should be used along with other clinical assessments. Wearable device companies need to develop devices that can promptly detect anxiety and identify specific time points during the day when anxiety levels are high. Further research is needed to differentiate types of anxiety, compare the performance of different wearable devices, and investigate the impact of the combination of wearable device data and neuroimaging data on the performance of wearable AI. Trial Registration: PROSPERO CRD42023387560; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387560 %M 37938883 %R 10.2196/48754 %U https://www.jmir.org/2023/1/e48754 %U https://doi.org/10.2196/48754 %U http://www.ncbi.nlm.nih.gov/pubmed/37938883 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48404 %T Freely Available Training Videos for Suicide Prevention: Scoping Review %A Wislocki,Katherine %A Jager-Hyman,Shari %A Brady,Megan %A Weiss,Michal %A Schaechter,Temma %A Khazanov,Gabriela %A Young,Sophia %A Becker-Haimes,Emily %+ Department of Psychological Science, University of California, Irvine, 214 Pereira Drive, Irvine, CA, 92617, United States, 1 9498246803, kwislock@uci.edu %K freely available videos %K asynchronous training %K suicide prevention %K evidence-based practice %K dissemination %K implementation %D 2023 %7 3.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. Objective: This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. Methods: A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. Results: Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. Conclusions: Results suggested an abundance of videos providing broad informational content (eg, “signs and symptoms of someone at risk for suicide”) and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process. %M 37921847 %R 10.2196/48404 %U https://mental.jmir.org/2023/1/e48404 %U https://doi.org/10.2196/48404 %U http://www.ncbi.nlm.nih.gov/pubmed/37921847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48905 %T Investigating Substance Use via Reddit: Systematic Scoping Review %A Chi,Yu %A Chen,Huai-yu %+ School of Information Science, University of Kentucky, 160 Patterson Dr, Lexington, KY, 40506, United States, 1 4125396621, yu.chi@uky.edu %K substance use %K systematic scoping review %K Reddit %K social media %K drug use %K tobacco use %K alcohol use %D 2023 %7 25.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Reddit’s (Reddit Inc) large user base, diverse communities, and anonymity make it a useful platform for substance use research. Despite a growing body of literature on substance use on Reddit, challenges and limitations must be carefully considered. However, no systematic scoping review has been conducted on the use of Reddit as a data source for substance use research. Objective: This review aims to investigate the use of Reddit for studying substance use by examining previous studies’ objectives, reasons, limitations, and methods for using Reddit. In addition, we discuss the implications and contributions of previous studies and identify gaps in the literature that require further attention. Methods: A total of 7 databases were searched using keyword combinations including Reddit and substance-related keywords in April 2022. The initial search resulted in 456 articles, and 227 articles remained after removing duplicates. All included studies were peer reviewed, empirical, available in full text, and pertinent to Reddit and substance use, and they were all written in English. After screening, 60 articles met the eligibility criteria for the review, with 57 articles identified from the initial database search and 3 from the ancestry search. A codebook was developed, and qualitative content analysis was performed to extract relevant evidence related to the research questions. Results: The use of Reddit for studying substance use has grown steadily since 2015, with a sharp increase in 2021. The primary objective was to identify tendencies and patterns in various types of substance use discussions (52/60, 87%). Reddit was also used to explore unique user experiences, propose methodologies, investigate user interactions, and develop interventions. A total of 9 reasons for using Reddit to study substance use were identified, such as the platform’s anonymity, its widespread popularity, and the explicit topics of subreddits. However, 7 limitations were noted, including the platform’s low representativeness of the general population with substance use and the lack of demographic information. Most studies use application programming interfaces for data collection and quantitative approaches for analysis, with few using qualitative approaches. Machine learning algorithms are commonly used for natural language processing tasks. The theoretical, methodological, and practical implications and contributions of the included articles are summarized and discussed. The most prevalent practical implications are investigating prevailing topics in Reddit discussions, providing recommendations for clinical practices and policies, and comparing Reddit discussions on substance use across various sources. Conclusions: This systematic scoping review provides an overview of Reddit’s use as a data source for substance use research. Although the limitations of Reddit data must be considered, analyzing them can be useful for understanding patterns and user experiences related to substance use. Our review also highlights gaps in the literature and suggests avenues for future research. %M 37878361 %R 10.2196/48905 %U https://www.jmir.org/2023/1/e48905 %U https://doi.org/10.2196/48905 %U http://www.ncbi.nlm.nih.gov/pubmed/37878361 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44658 %T The Effectiveness of Fully Automated Digital Interventions in Promoting Mental Well-Being in the General Population: Systematic Review and Meta-Analysis %A Groot,Julia %A MacLellan,Alexander %A Butler,Madelaine %A Todor,Elisa %A Zulfiqar,Mahnoor %A Thackrah,Timothy %A Clarke,Christopher %A Brosnan,Mark %A Ainsworth,Ben %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01225 383800, jmdg20@bath.ac.uk %K mental well-being %K promotion %K intervention %K digital %K web-based %K apps %K mobile phone %D 2023 %7 19.10.2023 %9 Review %J JMIR Ment Health %G English %X Background: Recent years have highlighted an increasing need to promote mental well-being in the general population. This has led to a rapidly growing market for fully automated digital mental well-being tools. Although many individuals have started using these tools in their daily lives, evidence on the overall effectiveness of digital mental well-being tools is currently lacking. Objective: This study aims to review the evidence on the effectiveness of fully automated digital interventions in promoting mental well-being in the general population. Methods: Following the preregistration of the systematic review protocol on PROSPERO, searches were carried out in MEDLINE, Web of Science, Cochrane, PsycINFO, PsycEXTRA, Scopus, and ACM Digital (initial searches in February 2022; updated in October 2022). Studies were included if they contained a general population sample and a fully automated digital intervention that exclusively used psychological mental well-being promotion activities. Two reviewers, blinded to each other’s decisions, conducted data selection, extraction, and quality assessment of the included studies. Narrative synthesis and a random-effects model of per-protocol data were adopted. Results: We included 19 studies that involved 7243 participants. These studies included 24 fully automated digital mental well-being interventions, of which 15 (63%) were included in the meta-analysis. Compared with no intervention, there was a significant small effect of fully automated digital mental well-being interventions on mental well-being in the general population (standardized mean difference 0.19, 95% CI 0.04-0.33; P=.02). Specifically, mindfulness-, acceptance-, commitment-, and compassion-based interventions significantly promoted mental well-being in the general population (P=.006); insufficient evidence was available for positive psychology and cognitive behavioral therapy–based interventions; and contraindications were found for integrative approaches. Overall, there was substantial heterogeneity, which could be partially explained by the intervention duration, comparator, and study outcomes. The risk of bias was high, and confidence in the quality of the evidence was very low (Grading of Recommendations, Assessment, Development, and Evaluations), primarily because of the high rates of study dropout (average 37%; range 0%-85%) and suboptimal intervention adherence (average 40%). Conclusions: This study provides a novel contribution to knowledge regarding the effectiveness, strengths, and weaknesses of fully automated digital mental well-being interventions in the general population. Future research and practice should consider these findings when developing fully automated digital mental well-being tools. In addition, research should aim to investigate positive psychology and cognitive behavioral therapy–based tools as well as develop further strategies to improve adherence and reduce dropout in fully automated digital mental well-being interventions. Finally, it should aim to understand when and for whom these interventions are particularly beneficial. Trial Registration: PROSPERO CRD42022310702; https://tinyurl.com/yc7tcwy7 %M 37856172 %R 10.2196/44658 %U https://mental.jmir.org/2023/1/e44658 %U https://doi.org/10.2196/44658 %U http://www.ncbi.nlm.nih.gov/pubmed/37856172 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47433 %T The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations %A Taher,Rayan %A Hsu,Che-Wei %A Hampshire,Chloe %A Fialho,Carolina %A Heaysman,Clare %A Stahl,Daniel %A Shergill,Sukhi %A Yiend,Jenny %+ Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, jenny.yiend@kcl.ac.uk %K digital %K digital therapeutics %K mental health %K psychological %K safety %K risk %K negative effects %K harm %K adverse event %K risk mitigation %K mobile phone %D 2023 %7 9.10.2023 %9 Review %J JMIR Ment Health %G English %X Background: Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as face-to-face therapies, pose risks to patients. A safe intervention is considered one in which the measured benefits outweigh the identified and mitigated risks. Objective: This study aims to review the literature to assess how DMHIs assess safety, what risks are reported, and how they are mitigated in both the research and postmarket phases and building on existing recommendations for assessing, reporting, and mitigating safety in the DMHI and standardizing practice. Methods: PsycINFO, Embase, and MEDLINE databases were searched for studies that addressed the safety of DMHIs. The inclusion criteria were any study that addressed the safety of a clinical DMHI, even if not as a main outcome, in an adult population, and in English. As the outcome data were mainly qualitative in nature, a meta-analysis was not possible, and qualitative analysis was used to collate the results. Quantitative results were synthesized in the form of tables and percentages. To illustrate the use of a single common safety metric across studies, we calculated odds ratios and CIs, wherever possible. Results: Overall, 23 studies were included in this review. Although many of the included studies assessed safety by actively collecting adverse event (AE) data, over one-third (8/23, 35%) did not assess or collect any safety data. The methods and frequency of safety data collection varied widely, and very few studies have performed formal statistical analyses. The main treatment-related reported AE was symptom deterioration. The main method used to mitigate risk was exclusion of high-risk groups. A secondary web-based search found that 6 DMHIs were available for users or patients to use (postmarket phase), all of which used indications and contraindications to mitigate risk, although there was no evidence of ongoing safety review. Conclusions: The findings of this review show the need for a standardized classification of AEs, a standardized method for assessing AEs to statically analyze AE data, and evidence-based practices for mitigating risk in DMHIs, both in the research and postmarket phases. This review produced 7 specific, measurable, and achievable recommendations with the potential to have an immediate impact on the field, which were implemented across ongoing and future research. Improving the quality of DMHI safety data will allow meaningful assessment of the safety of DMHIs and confidence in whether the benefits of a new DMHI outweigh its risks. Trial Registration: PROSPERO CRD42022333181; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333181 %M 37812471 %R 10.2196/47433 %U https://mental.jmir.org/2023/1/e47433 %U https://doi.org/10.2196/47433 %U http://www.ncbi.nlm.nih.gov/pubmed/37812471 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46877 %T Efficacy, Safety, and Evaluation Criteria of mHealth Interventions for Depression: Systematic Review %A Duarte-Díaz,Andrea %A Perestelo-Pérez,Lilisbeth %A Gelabert,Estel %A Robles,Noemí %A Pérez-Navarro,Antoni %A Vidal-Alaball,Josep %A Solà-Morales,Oriol %A Sales Masnou,Ariadna %A Carrion,Carme %+ Canary Islands Health Research Institute Foundation (FIISC), Camino Candelaria, 44, El Rosario, 38109, Spain, 34 922478320, andrea.duartediaz@sescs.es %K mobile health %K mHealth %K apps %K depression %K systematic review %K meta-analysis %D 2023 %7 27.9.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a significant public health issue that can lead to considerable disability and reduced quality of life. With the rise of technology, mobile health (mHealth) interventions, particularly smartphone apps, are emerging as a promising approach for addressing depression. However, the lack of standardized evaluation tools and evidence-based principles for these interventions remains a concern. Objective: In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of mHealth interventions for depression and identify the criteria and evaluation tools used for their assessment. Methods: A systematic review and meta-analysis of the literature was carried out following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies that recruited adult patients exhibiting elevated depressive symptoms or those diagnosed with depressive disorders and aimed to assess the effectiveness or safety of mHealth interventions were eligible for consideration. The primary outcome of interest was the reduction of depressive symptoms, and only randomized controlled trials (RCTs) were included in the analysis. The risk of bias in the original RCTs was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. Results: A total of 29 RCTs were included in the analysis after a comprehensive search of electronic databases and manual searches. The efficacy of mHealth interventions in reducing depressive symptoms was assessed using a random effects meta-analysis. In total, 20 RCTs had an unclear risk of bias and 9 were assessed as having a high risk of bias. The most common element in mHealth interventions was psychoeducation, followed by goal setting and gamification strategies. The meta-analysis revealed a significant effect for mHealth interventions in reducing depressive symptoms compared with nonactive control (Hedges g=−0.62, 95% CI −0.87 to −0.37, I2=87%). Hybrid interventions that combined mHealth with face-to-face sessions were found to be the most effective. Three studies compared mHealth interventions with active controls and reported overall positive results. Safety analyses showed that most studies did not report any study-related adverse events. Conclusions: This review suggests that mHealth interventions can be effective in reducing depressive symptoms, with hybrid interventions achieving the best results. However, the high level of heterogeneity in the characteristics and components of mHealth interventions indicates the need for personalized approaches that consider individual differences, preferences, and needs. It is also important to prioritize evidence-based principles and standardized evaluation tools for mHealth interventions to ensure their efficacy and safety in the treatment of depression. Overall, the findings of this study support the use of mHealth interventions as a viable method for delivering mental health care. Trial Registration: PROSPERO CRD42022304684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304684 %M 37756042 %R 10.2196/46877 %U https://mental.jmir.org/2023/1/e46877 %U https://doi.org/10.2196/46877 %U http://www.ncbi.nlm.nih.gov/pubmed/37756042 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45540 %T The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review %A Marciano,Laura %A Vocaj,Emanuela %A Bekalu,Mesfin A %A La Tona,Antonino %A Rocchi,Giulia %A Viswanath,Kasisomayajula %+ Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 6175828025, lmarciano@hsph.harvard.edu %K mobile assessment %K ecological momentary assessments %K EMAs %K digital phenotyping %K umbrella review %K youth %K mental health %K mobile phone %D 2023 %7 19.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals’ data. Objective: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. Methods: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. Results: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. Conclusions: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. Trial Registration: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717 %M 37725422 %R 10.2196/45540 %U https://www.jmir.org/2023/1/e45540 %U https://doi.org/10.2196/45540 %U http://www.ncbi.nlm.nih.gov/pubmed/37725422 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49255 %T Psychological Inoculation for Credibility Assessment, Sharing Intention, and Discernment of Misinformation: Systematic Review and Meta-Analysis %A Lu,Chang %A Hu,Bo %A Li,Qiang %A Bi,Chao %A Ju,Xing-Da %+ School of Psychology, Northeast Normal University, Northeast Normal University, No. 5268, Renmin Street, Nanguan District, Changchun City, Jilin Province, 130024, China, 86 13086868264, juxd513@nenu.edu.cn %K psychological inoculation %K misinformation %K discernment %K sharing %K meta-analysis %D 2023 %7 29.8.2023 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of misinformation poses a substantial threat to individuals’ daily lives, necessitating the deployment of effective remedial approaches. One promising strategy is psychological inoculation, which pre-emptively immunizes individuals against misinformation attacks. However, uncertainties remain regarding the extent to which psychological inoculation effectively enhances the capacity to differentiate between misinformation and real information. Objective: To reduce the potential risk of misinformation about digital health, this study aims to examine the effectiveness of psychological inoculation in countering misinformation with a focus on several factors, including misinformation credibility assessment, real information credibility assessment, credibility discernment, misinformation sharing intention, real information sharing intention, and sharing discernment. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a meta-analysis by searching 4 databases (Web of Science, APA PsycINFO, Proquest, and PubMed) for empirical studies based on inoculation theory and outcome measure–related misinformation published in the English language. Moderator analyses were used to examine the differences in intervention strategy, intervention type, theme, measurement time, team, and intervention design. Results: Based on 42 independent studies with 42,530 subjects, we found that psychological inoculation effectively reduces misinformation credibility assessment (d=–0.36, 95% CI –0.50 to –0.23; P<.001) and improves real information credibility assessment (d=0.20, 95% CI 0.06-0.33; P=.005) and real information sharing intention (d=0.09, 95% CI 0.03-0.16; P=.003). However, psychological inoculation does not significantly influence misinformation sharing intention (d=–0.35, 95% CI –0.79 to 0.09; P=.12). Additionally, we find that psychological inoculation effectively enhances credibility discernment (d=0.20, 95% CI 0.13-0.28; P<.001) and sharing discernment (d=0.18, 95% CI 0.12-0.24; P<.001). Regarding health misinformation, psychological inoculation effectively decreases misinformation credibility assessment and misinformation sharing intention. The results of the moderator analyses showed that content-based, passive inoculation was more effective in increasing credibility and sharing intention. The theme of climate change demonstrates a stronger effect on real information credibility. Comparing intervention types showed that pre-post interventions are more effective for misinformation credibility assessment, while post-only interventions are better for credibility discernment. Conclusions: This study indicated that psychological inoculation enhanced individuals’ ability to discern real information from misinformation and share real information. Incorporating psychological inoculation to cultivate an informed public is crucial for societal resilience against misinformation threats in an age of information proliferation. As a scalable and cost-effective intervention strategy, institutions can apply psychological inoculation to mitigate potential misinformation crises. %M 37560816 %R 10.2196/49255 %U https://www.jmir.org/2023/1/e49255 %U https://doi.org/10.2196/49255 %U http://www.ncbi.nlm.nih.gov/pubmed/37560816 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46949 %T Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity %A Litke,Shannon Grace %A Resnikoff,Annie %A Anil,Ashley %A Montgomery,Meredith %A Matta,Rishabh %A Huh-Yoo,Jina %A Daly,Brian P %+ Department of Psychological and Brain Sciences, Drexel University, Stratton Hall Suite 118/119, 3201 Chestnut Street, Philadelphia, PA, 19104, United States, 1 7329938165, sgl46@drexel.edu %K mHealth %K mobile app %K children %K adolescents %K mental health %K effectiveness %K efficacy %K scoping review %K mobile phone %D 2023 %7 23.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. Objective: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? Methods: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app–based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. Results: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. Conclusions: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process. %M 37610818 %R 10.2196/46949 %U https://mental.jmir.org/2023/1/e46949 %U https://doi.org/10.2196/46949 %U http://www.ncbi.nlm.nih.gov/pubmed/37610818 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46925 %T Long-Term Efficacy of Internet-Based Cognitive Behavioral Therapy Self-Help Programs for Adults With Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Mamukashvili-Delau,Megi %A Koburger,Nicole %A Dietrich,Sandra %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Klinik und Poliklinik für Psychiatrie und Psychotherapie Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 0341 97 24464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K depression %K internet-based cognitive behavioral therapy %K iCBT %K self-help %K minimal guidance %K long-term %K follow-up %K mental health %K psychotherapy %K cognitive behavioral therapy %K CBT %K systematic review %K meta-analysis %K meta-analyses %K review method %D 2023 %7 22.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a worldwide mental disorder and a leading cause of disability. Many people with depression do not want to take medication or have the motivation to seek psychotherapy treatment for many reasons. Guided internet-based self-help programs may be a promising solution for addressing these issues. This kind of intervention has proven to be effective in reducing depression symptoms on a short-term scale. However, as treatment often is a long-term rehabilitation process, it is important to examine not only the short-term effects of internet-based cognitive behavioral therapy (iCBT) self-help treatment but also the follow-up or long-term efficacy of this kind of intervention. Objective: This systematic review and meta-analysis aimed to identify studies that examined follow-up data ≥8 weeks after posttreatment measurements and thereby examined the long-term efficacy of iCBT self-help programs with minimal weekly guidance for people with depression. It aimed to analyze the long-term efficacy of iCBT treatments compared to control conditions as well as long-term efficacy within the iCBT treatment conditions. Additionally, it aimed to conduct subgroup analyses according to the follow-up time points for each outcome. Finally, it examined long-term improvements in quality of life. Methods: The Cochrane Collaboration Depression, Anxiety, and Neurosis Controlled Trials Register (CCDANCTR), grey literature, reference lists, and correspondence were used to search for published and unpublished randomized controlled trials (RCTs) that reported the long-term or follow-up efficacy of computer-based or iCBT self-help treatments for depression with minimal guidance of up to 10 min/wk. The search took place between 2015 and 2022 (October). Results: The search resulted in a total of 2809 study abstracts, of which 15 studies (with 17 samples) met all inclusion criteria and were included in the long-term analysis. The results showed that the depression outcomes of all follow-up time points together in the treatment conditions were favored over the control conditions with a medium effect size of 0.43 (n=1689 participants; 9 RCTs; standardized mean difference [SMD] –0.43, 95% CI –0.67 to –0.20; P<.001). The analysis of long-term efficacy within the iCBT treatment conditions showed that the follow-up outcomes of the treatment groups were favored over the posttreatment outcomes with a small effect size of 0.20 (n=2196 participants; 17 RCTs; SMD 0.20, 95% CI 0.07-0.49; P=.003). Findings for improving quality of life also showed that the iCBT conditions were favored over the control conditions with a small effect size of 0.19 (n=1345 participants; 3 RCTs; SMD 0.19, 95% CI 0.08-0.30; P<.001). Conclusions: This systematic review and meta-analysis found that iCBT self-help interventions had a superior long-term efficacy for individuals with depressive symptoms compared to control groups. The within-group analysis of iCBT treatment conditions also showed statistically significant improvements in reducing depressive symptoms at follow-up compared to posttreatment measurements. %M 37606990 %R 10.2196/46925 %U https://mental.jmir.org/2023/1/e46925 %U https://doi.org/10.2196/46925 %U http://www.ncbi.nlm.nih.gov/pubmed/37606990 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46148 %T Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review %A Neumann,Ariana %A König,Hans-Helmut %A Bokermann,Josephine %A Hajek,André %+ Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 40 7410 54202, ar.neumann@uke.de %K telemedicine %K digital health %K teletherapy %K mental health %K use %K satisfaction %D 2023 %7 18.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. Objective: The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. Methods: This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. Results: Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). Conclusions: The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. Trial Registration: PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5 %M 37594785 %R 10.2196/46148 %U https://mental.jmir.org/2023/1/e46148 %U https://doi.org/10.2196/46148 %U http://www.ncbi.nlm.nih.gov/pubmed/37594785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43727 %T Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review %A Forbes,Ainslie %A Keleher,Madeline Rose %A Venditto,Michael %A DiBiasi,Faith %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 301 956 2702, ainslie.forbes@otsuka-us.com %K digital therapeutics %K digital interventions %K digital health %K mobile health %K mobile phone %K depression %K major depressive disorder %K engagement %K adherence %K systematic literature review %D 2023 %7 11.8.2023 %9 Review %J J Med Internet Res %G English %X Background: New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. Objective: This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. Methods: We focused on a participant population of adults (aged ≥18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. Results: This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. Conclusions: Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations. %M 37566447 %R 10.2196/43727 %U https://www.jmir.org/2023/1/e43727 %U https://doi.org/10.2196/43727 %U http://www.ncbi.nlm.nih.gov/pubmed/37566447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44922 %T The Impact of Social Media Use Interventions on Mental Well-Being: Systematic Review %A Plackett,Ruth %A Blyth,Alexandra %A Schartau,Patricia %+ Research Department of Primary Care & Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 20 3108 3096, ruth.plackett.15@ucl.ac.uk %K review %K social media %K mental well-being %K mental health %K addiction %K intervention %K mobile phone %D 2023 %7 11.8.2023 %9 Review %J J Med Internet Res %G English %X Background: There is some evidence that more social media use is related to poorer mental well-being and that social media use can become problematic when it starts to interfere with a person’s daily life and mental well-being. To address this issue and improve users’ mental well-being, social media use interventions (eg, abstinence from social media) have been developed and evaluated. However, there is limited understanding of the effectiveness of these interventions in improving mental well-being. Objective: This systematic review aimed to synthesize the literature on the effectiveness of social media use interventions in improving mental well-being in adults. Methods: A systematic search (January 1, 2004, to July 31, 2022) was completed across 3 databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Experimental studies evaluating the impact of social media use interventions on mental well-being in adults were included. Outcomes related to mental well-being, such as depression, anxiety, stress, and loneliness, were included. A narrative synthesis without meta-analysis was completed to summarize the study characteristics and effectiveness by outcome and intervention type. The Effective Public Health Practice Project Quality Assessment Tool was used to measure the quality of the studies. Results: Of the 2785 studies identified through the systematic search, 23 (0.83%) were included in the analysis. Many of the included studies (9/23, 39%) found improvements in mental well-being, some (7/23, 30%) found mixed effects, and others (7/23, 30%) found no effect on mental well-being. Therapy-based interventions that used techniques such as cognitive behavioral therapy were more effective than limiting use of social media or full abstinence from social media, with 83% (5/6) of these studies showing improvements in mental well-being compared with 20% (1/5) and 25% (3/12), respectively. Depression was the most frequently investigated and improved outcome with 70% (7/10) of the studies showing a significant improvement in depression after the intervention, whereas other outcomes showed more varied results. Quality was poor, with 96% (22/23) of the studies receiving a weak global score, mostly for issues related to selection bias because most of the studies (16/23, 70%) used a convenience sampling of university students. Conclusions: This review provides some evidence that social media use interventions are effective in improving mental well-being, especially for depression and when using therapy-based interventions. Further experimental and longitudinal research is needed with representative samples to investigate who may benefit most from social media use interventions. This will help to develop guidance and recommendations for policy makers and clinicians on how best to manage problematic social media use. %M 37565693 %R 10.2196/44922 %U https://www.jmir.org/2023/1/e44922 %U https://doi.org/10.2196/44922 %U http://www.ncbi.nlm.nih.gov/pubmed/37565693 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46590 %T The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review %A Veldmeijer,Lars %A Terlouw,Gijs %A Van Os,Jim %A Van Dijk,Olga %A Van 't Veer,Job %A Boonstra,Nynke %+ Department of Psychiatry, Utrecht University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 6 82874768, lars.veldmeijer@nhlstenden.com %K design approaches %K innovation %K psychiatry %K mental health care %K involvement %K service users %K people with lived experience %K cocreation %K mobile phone %D 2023 %7 25.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. Objective: In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. Methods: The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. Results: We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants’ continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. Conclusions: This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner. %M 37490326 %R 10.2196/46590 %U https://mental.jmir.org/2023/1/e46590 %U https://doi.org/10.2196/46590 %U http://www.ncbi.nlm.nih.gov/pubmed/37490326 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44195 %T Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Scoping Review %A Soares,Juliana Pontes %A Lopes,Rayssa Horácio %A Mendonça,Paula Beatriz de Souza %A Silva,Cícera Renata Diniz Vieira %A Rodrigues,Cláudia Cristiane Filgueira Martins %A Castro,Janete Lima de %+ Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Av Senador Salgado Filho, 3000 – Bairro: Lagoa Nova, Natal, 59078–970, Brazil, 55 83991627740, juliana.pontes@ufrr.br %K burnout professional %K burnout %K health care professional %K health personnel %K health professionals %K Maslach Burnout Inventory %K mental health %K occupational health %K public health services %K public health %K workplace stress %D 2023 %7 21.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: Work can be considered a source of living, well-being, and socioeconomic development. When the work environment negatively influences individuals, it may trigger emotional disturbances, behavioral problems, chronic stress conditions, and illnesses such as burnout syndrome (BS). Recently, studies on BS have increased and placed a special focus on health care professionals. The prevalence of BS among health professionals is associated with their chronic exposure to human hardship and long working hours without proper rest. These factors have contributed to greater stress and high physical and emotional exhaustion levels. Objective: This study aims to identify and map studies using the Maslach Burnout Inventory (MBI) scale to identify burnout syndrome in health professionals working in public health services. Methods: This scoping review was developed based on the Joanna Briggs Institute (JBI) Reviewers Manual and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 6 databases were searched to identify relevant studies: Embase, LILACS, MEDLINE or PubMed, PsycInfo, Scopus, and Web of Science. Gray literature was consulted on ProQuest Dissertations and Theses Global, Google Scholar, Brazilian Digital Library of Theses and Dissertations, and Open Access Theses and Dissertations. Additionally, the reference lists were searched to retrieve studies not previously selected. The steps followed in this study were proposed by Arskey and O’Malley and Levac, Colquhoun, and O’Brien: identification of research questions, identification of potential studies, study selection, data extraction and imputation, data analyses and interpretation, and consultation with stakeholders. The detailed methodology was published in a protocol. Results: A total of 55 articles were identified after screening for eligibility criteria, published between 1999 and 2021 in 32 countries. Most reports were published in Brazil, Spain, and China. A total of 22 versions of the MBI were identified, presenting different items, scores, and cutoff points. The included studies had recommendations and implications for clinical practice. The consultation with stakeholders allowed knowledge translation for those interested in BS. Conclusions: Studies mostly included physicians (34/55, 61.8%) and nurses (24/55, 43.6%), and the original version of MBI was predominantly used. Divergences in BS classification were highlighted, which may be related to MBI cross-cultural adaptations and applications in other countries. This study contributes to the advancement of research regarding burnout syndrome as an occupational illness since it has harmful consequences for workers, health care services, and the quality of care provided to the population. %M 37477960 %R 10.2196/44195 %U https://mental.jmir.org/2023/1/e44195 %U https://doi.org/10.2196/44195 %U http://www.ncbi.nlm.nih.gov/pubmed/37477960 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e45572 %T Wearable and Mobile Technologies for the Evaluation and Treatment of Obsessive-Compulsive Disorder: Scoping Review %A Frank,Adam C %A Li,Ruibei %A Peterson,Bradley S %A Narayanan,Shrikanth S %+ Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar St Suite 2200, Los Angeles, CA, 90033, United States, 1 323 442 6000, adam.frank@med.usc.edu %K wearable %K smartphone %K obsessive-compulsive disorder %K OCD %K digital %K phenotype %K biomarker %K mobile phone %D 2023 %7 18.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: Smartphones and wearable biosensors can continuously and passively measure aspects of behavior and physiology while also collecting data that require user input. These devices can potentially be used to monitor symptom burden; estimate diagnosis and risk for relapse; predict treatment response; and deliver digital interventions in patients with obsessive-compulsive disorder (OCD), a prevalent and disabling psychiatric condition that often follows a chronic and fluctuating course and may uniquely benefit from these technologies. Objective: Given the speed at which mobile and wearable technologies are being developed and implemented in clinical settings, a continual reappraisal of this field is needed. In this scoping review, we map the literature on the use of wearable devices and smartphone-based devices or apps in the assessment, monitoring, or treatment of OCD. Methods: In July 2022 and April 2023, we conducted an initial search and an updated search, respectively, of multiple databases, including PubMed, Embase, APA PsycINFO, and Web of Science, with no restriction on publication period, using the following search strategy: (“OCD” OR “obsessive” OR “obsessive-compulsive”) AND (“smartphone” OR “phone” OR “wearable” OR “sensing” OR “biofeedback” OR “neurofeedback” OR “neuro feedback” OR “digital” OR “phenotyping” OR “mobile” OR “heart rate variability” OR “actigraphy” OR “actimetry” OR “biosignals” OR “biomarker” OR “signals” OR “mobile health”). Results: We analyzed 2748 articles, reviewed the full text of 77 articles, and extracted data from the 25 articles included in this review. We divided our review into the following three parts: studies without digital or mobile intervention and with passive data collection, studies without digital or mobile intervention and with active or mixed data collection, and studies with a digital or mobile intervention. Conclusions: Use of mobile and wearable technologies for OCD has developed primarily in the past 15 years, with an increasing pace of related publications. Passive measures from actigraphy generally match subjective reports. Ecological momentary assessment is well tolerated for the naturalistic assessment of symptoms, may capture novel OCD symptoms, and may also document lower symptom burden than retrospective recall. Digital or mobile treatments are diverse; however, they generally provide some improvement in OCD symptom burden. Finally, ongoing work is needed for a safe and trusted uptake of technology by patients and providers. %M 37463010 %R 10.2196/45572 %U https://mental.jmir.org/2023/1/e45572 %U https://doi.org/10.2196/45572 %U http://www.ncbi.nlm.nih.gov/pubmed/37463010 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44998 %T The Use of Virtual Reality Interventions to Promote Positive Mental Health: Systematic Literature Review %A Li Pira,Giorgio %A Aquilini,Beatrice %A Davoli,Alessandro %A Grandi,Silvana %A Ruini,Chiara %+ Department for Life Quality Studies, University of Bologna, Corso d’Augusto 237, Rimini, 47921, Italy, 39 0547 338533, chiara.ruini@unibo.it %K positive mental health %K well-being %K virtual reality %K interventions %K psychopathology %K mobile phone %D 2023 %7 6.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: A large body of research has documented the efficacy of psychological interventions integrated with virtual reality (VR) therapies in treating psychiatric disorders. However, the concept of positive mental health calls for a 2-fold approach in which both symptoms and positive functioning should be addressed by modern interventions. Objective: This review aimed to summarize studies that applied VR therapies by embracing the positive mental health perspective. Methods: A literature search was conducted by entering the following keywords—“virtual reality” AND “intervention” OR “treatment” OR “therapy” AND “mental health” NOT “systematic review or meta-analysis”—and limiting it to “journal article” and the English language. To be included in this review, articles had to present at least one quantitative measure of positive functioning and one quantitative measure of symptoms or distress and had to investigate adult populations, including populations with psychiatric disorders. Results: A total of 20 articles were included. They described various VR protocols that were applied for the treatment of anxiety disorders (5/20, 25%), depression (2/20, 10%), posttraumatic stress disorder (3/20, 15%), psychosis (3/20, 15%), and stress (7/20, 35%). Most of the studies (13/20, 65%) showed the beneficial effects of VR therapies in improving stress and negative symptoms. However, 35% (7/20) of the studies showed no or a small effect on the various dimensions of positivity, particularly in clinical samples. Conclusions: VR interventions might be cost-effective and largely scalable, but further research is needed to develop existing VR software and treatments according to the modern positive mental health approach. %M 37410520 %R 10.2196/44998 %U https://mental.jmir.org/2023/1/e44998 %U https://doi.org/10.2196/44998 %U http://www.ncbi.nlm.nih.gov/pubmed/37410520 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44790 %T Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis %A Shaker,Ali Abbas %A Austin,Stephen F %A Storebø,Ole Jakob %A Schaug,Julie Perrine %A Ayad,Alaa %A Sørensen,John Aasted %A Tarp,Kristine %A Bechmann,Henrik %A Simonsen,Erik %+ Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Fælledvej 6, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K telemedicine %K telepsychiatry %K video consultation %K mobile health %K mHealth %K eHealth %K COVID-19 %K synchronous technology %K anxiety %K psychiatry %K patient satisfaction %K depression %K posttraumatic stress disorder %K PTSD %D 2023 %7 5.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. Objective: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. Methods: A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. Results: A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference −0.01, 95% CI −0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (−0.66, 95% CI −1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI −0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). Conclusions: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357 %M 37277113 %R 10.2196/44790 %U https://mental.jmir.org/2023/1/e44790 %U https://doi.org/10.2196/44790 %U http://www.ncbi.nlm.nih.gov/pubmed/37277113 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40163 %T The Use of Photoplethysmography in the Assessment of Mental Health: Scoping Review %A Lyzwinski,Lynnette Nathalie %A Elgendi,Mohamed %A Menon,Carlo %+ Biomedical and Mobile Health Technology Lab, Department of Health Sciences and Technology, ETH Zurich, Lengghalde 5, Zurich, 8008, Switzerland, 41 44 510 72 2, carlo.menon@hest.ethz.ch %K photoplethysmography %K PPG %K mental health %K depression %K anxiety %K suicide %K mobile phone %D 2023 %7 29.5.2023 %9 Review %J JMIR Ment Health %G English %X Background: With the rise in mental health problems globally, mobile health provides opportunities for timely medical care and accessibility. One emerging area of mobile health involves the use of photoplethysmography (PPG) to assess and monitor mental health. Objective: In recent years, there has been an increase in the use of PPG-based technology for mental health. Therefore, we conducted a review to understand how PPG has been evaluated to assess a range of mental health and psychological problems, including stress, depression, and anxiety. Methods: A scoping review was performed using PubMed and Google Scholar databases. Results: A total of 24 papers met the inclusion criteria and were included in this review. We identified studies that assessed mental health via PPG using finger- and face-based methods as well as smartphone-based methods. There was variation in study quality. PPG holds promise as a potential complementary technology for detecting changes in mental health, including depression and anxiety. However, rigorous validation is needed in diverse clinical populations to advance PPG technology in tackling mental health problems. Conclusions: PPG holds promise for assessing mental health problems; however, more research is required before it can be widely recommended for clinical use. %M 37247209 %R 10.2196/40163 %U https://mental.jmir.org/2023/1/e40163 %U https://doi.org/10.2196/40163 %U http://www.ncbi.nlm.nih.gov/pubmed/37247209 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41643 %T Internet-Based Behavioral Activation for Depression: Systematic Review and Meta-Analysis %A Alber,Carolin Sophie %A Krämer,Lena Violetta %A Rosar,Sophia Marie %A Mueller-Weinitschke,Claudia %+ Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstraße 41, Freiburg, 79085, Germany, 49 (0)761 203 9439, claudia.mueller-weinitschke@psychologie.uni-freiburg.de %K behavioral activation %K depression %K systematic review %K meta-analysis %K internet- and mobile-based intervention %D 2023 %7 25.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Behavioral activation is an effective treatment for reducing depression. As depressive disorders affect many people worldwide, internet-based behavioral activation (iBA) could provide enhanced treatment access. Objective: This study aimed to investigate whether iBA is effective in reducing depressive symptoms and to assess the impact on secondary outcomes. Methods: We systematically searched MEDLINE, PsycINFO, PSYNDEX, and CENTRAL up to December 2021 for eligible randomized controlled trials. In addition, a reference search was conducted. Title and abstract screening, as well as a full-text screening, was conducted by 2 independent reviewers. Randomized controlled trials that investigated the effectiveness of iBA for depression as a treatment or main component were included. Randomized controlled trials had to report depressive symptoms, with a quantitative outcome measure and assess an adult population with depressive symptoms above cutoff. Two independent reviewers performed the data extraction and risk of bias assessment. Data were pooled in random-effects meta-analyses. The primary outcome was self-reported depressive symptoms posttreatment. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Results: A total of 12 randomized controlled trials, with 3274 participants (88% female, 43.61 years) were included. iBA was more effective in reducing depressive symptom severity posttreatment than inactive control groups (standardized mean difference −0.49; 95% CI −0.63 to −0.34; P<.001). The overall level of heterogeneity was moderate to substantial (I2=53%). No significant effect of iBA on depressive symptoms could be found at 6-month follow-up. Participants assigned to iBA also experienced a significant reduction of anxiety and a significant increase in quality of life and activation compared to the inactive control groups. The results remained robust in multiple sensitivity analyses. The risk of bias assessment revealed at least some concerns for all studies, and there was evidence of slight publication bias. Conclusions: This systematic review and meta-analysis implies that iBA is effective in reducing depressive symptoms. It represents a promising treatment option, providing treatment access where no treatment is available yet. Trial Registration: International Prospective Register of Systematic Reviews CRD42021236822; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236822 %M 37227760 %R 10.2196/41643 %U https://www.jmir.org/2023/1/e41643 %U https://doi.org/10.2196/41643 %U http://www.ncbi.nlm.nih.gov/pubmed/37227760 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43240 %T Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review %A Lundin,Robert M %A Yeap,Yuhern %A Menkes,David B %+ Change to Improve Mental Health, Mental Health Drugs and Alcohol Services, Barwon Health, Level 1/126 Little Malop St, Geelong, 3220, Australia, 61 34215000, robert@lundin.no %K virtual reality %K augmented reality %K mental health %K side effects %K adverse events %K hardware %K VR %K software %K AR %K cybersickness %K reporting standards %D 2023 %7 5.5.2023 %9 Review %J JMIR Ment Health %G English %X Background: Virtual reality (VR) and augmented reality (AR) are emerging treatment modalities in psychiatry, which are capable of producing clinical outcomes broadly comparable to those achieved with standard psychotherapies. Objective: Because the side effect profile associated with the clinical use of VR and AR remains largely unknown, we systematically reviewed available evidence of their adverse effects. Methods: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across 3 mental health databases (PubMed, PsycINFO, and Embase) to identify VR and AR interventions targeting mental health diagnoses. Results: Of 73 studies meeting the inclusion criteria, 7 reported worsening clinical symptoms or an increased fall risk. Another 21 studies reported “no adverse effects” but failed to identify obvious adverse effects, mainly cybersickness, documented in their results. More concerningly, 45 of the 73 studies made no mention of adverse effects whatsoever. Conclusions: An appropriate screening tool would help ensure that VR adverse effects are correctly identified and reported. %M 37145841 %R 10.2196/43240 %U https://mental.jmir.org/2023/1/e43240 %U https://doi.org/10.2196/43240 %U http://www.ncbi.nlm.nih.gov/pubmed/37145841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43102 %T Attitudes of Children, Adolescents, and Their Parents Toward Digital Health Interventions: Scoping Review %A d'Halluin,Arnaud %A Costa,Marie %A Morgiève,Margot %A Sebbane,Déborah %+ WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Métropole, 211 Rue Roger Salengro, Lille - Hellemmes, 59260, France, 33 3 20 43 71 00, arndhalluin59@gmail.com %K eHealth %K mental health %K children and adolescents %K attitude %K scoping review %K mobile phone %K digital health intervention %K DHI %D 2023 %7 2.5.2023 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of mental health problems in children and adolescents is high. As these problems can impact this population’s developmental trajectories, they constitute a public health concern. This situation is accentuated by the fact that children and adolescents infrequently seek help. Digital health interventions (DHIs) offer an opportunity to bridge the treatment gap between health care needs and patient engagement in care. Additional detailed research is needed to identify how children and adolescents can be empowered to access help through DHIs. In this context, an understanding of their attitudes toward digital health appears to be a necessary first step in facilitating the effective implementation of DHIs. Objective: This study aimed to establish an inventory of children’s, adolescents’, and their parents’ attitudes toward DHIs. Methods: A scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) recommendations was performed using the MEDLINE, Embase, and PsycINFO databases. This research was conducted using 3 key concepts: “child and adolescent mental health service users,” “digital health interventions,” and “attitudes.” Data extracted included the name of the publishing journal, the methodology used, the target population, the DHI studied, and the principal results. Results: Of 1548 studies found, 30 (1.94%) were included in our analysis. Among these, 13 concerned satisfaction, 24 concerned preferences, 22 concerned the use of DHI, 11 concerned perception, and 10 concerned needs. Conclusions: The results of this study provide a better understanding of the factors influencing children’s and adolescents’ attitudes toward digital health and DHIs. The continued growth of DHIs can help reduce barriers to mental health care. Future research on these interventions should investigate the needs of the targeted populations to increase their engagement in care. %M 37129931 %R 10.2196/43102 %U https://www.jmir.org/2023/1/e43102 %U https://doi.org/10.2196/43102 %U http://www.ncbi.nlm.nih.gov/pubmed/37129931 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42403 %T The Role of Compassionate Technology in Blended and Digital Mental Health Interventions: Systematic Scoping Review %A van Lotringen,Charlotte %A Lusi,Benedetta %A Westerhof,Gerben J %A Ludden,Geke D S %A Kip,Hanneke %A Kelders,Saskia M %A Noordzij,Matthijs L %+ Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, Netherlands, 31 534892100, c.m.vanlotringen@utwente.nl %K compassionate technology %K digital mental health interventions %K eHealth %K e–mental health %K compassion %K mental health care %D 2023 %7 7.4.2023 %9 Review %J JMIR Ment Health %G English %X Background: An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by clients and more accessible and economically viable care. However, digital mental health interventions (DMHIs) have not been widely implemented in daily practice. Developing and evaluating DMHIs around important mental health care values, such as compassion, could be key for a better integration of technology in the mental health care context. Objective: This systematic scoping review explored the literature for previous instances where technology for mental health care has been linked to compassion or empathy to investigate how DMHIs can support compassion in mental health care. Methods: Searches were conducted in the PsycINFO, PubMed, Scopus, and Web of Science databases, and screening by 2 reviewers resulted in 33 included articles. From these articles, we extracted the following data: technology types, goals, target groups, and roles of the technologies in the intervention; study designs; outcome measures; and the extent to which the technologies met a 5-step proposed definition of compassion. Results: We found 3 main ways in which technology can contribute to compassion in mental health care: by showing compassion to people, by enhancing self-compassion in people, or by facilitating compassion between people. However, none of the included technologies met all 5 elements of compassion nor were they evaluated in terms of compassion. Conclusions: We discuss the potential of compassionate technology, its challenges, and the need to evaluate technology for mental health care on compassion. Our findings could contribute to the development of compassionate technology, in which elements of compassion are explicitly embedded in its design, use, and evaluation. %M 37027207 %R 10.2196/42403 %U https://mental.jmir.org/2023/1/e42403 %U https://doi.org/10.2196/42403 %U http://www.ncbi.nlm.nih.gov/pubmed/37027207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38042 %T Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study %A Elledge,Daniel K %A Lee,Simon Craddock %A Stewart,Sunita M %A Pop,Radu %A Trivedi,Madhukar H %A Hughes,Jennifer L %+ Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9119, United States, 1 214 648 0188, madhukar.trivedi@utsouthwestern.edu %K youth %K prevention %K resilience %K mental health app %K mobile phone %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes. Objective: This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience. Methods: In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use. Results: Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback. Conclusions: Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research. %M 36947113 %R 10.2196/38042 %U https://formative.jmir.org/2023/1/e38042 %U https://doi.org/10.2196/38042 %U http://www.ncbi.nlm.nih.gov/pubmed/36947113 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43066 %T Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis %A Kim,Jiyeong %A Aryee,Lois M D %A Bang,Heejung %A Prajogo,Steffi %A Choi,Yong K %A Hoch,Jeffrey S %A Prado,Elizabeth L %+ Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, United States, 1 5307522793, jiykim@ucdavis.edu %K digital mental health %K mHealth %K mobile health %K digital health %K low- and middle-income country %K depression %K anxiety %K mobile phone %D 2023 %7 20.3.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. Objective: We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. Results: Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were −0.61 (95% CI −0.78 to −0.44; n=67 comparisons) for depression and −0.73 (95% CI −0.93 to −0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. Conclusions: Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. Trial Registration: PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709 %M 36939820 %R 10.2196/43066 %U https://mental.jmir.org/2023/1/e43066 %U https://doi.org/10.2196/43066 %U http://www.ncbi.nlm.nih.gov/pubmed/36939820 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42646 %T Capturing the Dynamics of the Social Environment Through Experience Sampling Methods, Passive Sensing, and Egocentric Networks: Scoping Review %A Langener,Anna M %A Stulp,Gert %A Kas,Martien J %A Bringmann,Laura F %+ Groningen Institute for Evolutionary Life Sciences, Nijenborgh 7, Groningen, 9747 AG, Netherlands, 31 050 363 8, langener95@gmail.com %K social context %K experience sampling method %K egocentric network %K digital phenotyping %K passive measures %K ambulatory assessment %K mobile phone %D 2023 %7 17.3.2023 %9 Review %J JMIR Ment Health %G English %X Background: Social interactions are important for well-being, and therefore, researchers are increasingly attempting to capture people’s social environment. Many different disciplines have developed tools to measure the social environment, which can be highly variable over time. The experience sampling method (ESM) is often used in psychology to study the dynamics within a person and the social environment. In addition, passive sensing is often used to capture social behavior via sensors from smartphones or other wearable devices. Furthermore, sociologists use egocentric networks to track how social relationships are changing. Each of these methods is likely to tap into different but important parts of people’s social environment. Thus far, the development and implementation of these methods have occurred mostly separately from each other. Objective: Our aim was to synthesize the literature on how these methods are currently used to capture the changing social environment in relation to well-being and assess how to best combine these methods to study well-being. Methods: We conducted a scoping review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: We included 275 studies. In total, 3 important points follow from our review. First, each method captures a different but important part of the social environment at a different temporal resolution. Second, measures are rarely validated (>70% of ESM studies and 50% of passive sensing studies were not validated), which undermines the robustness of the conclusions drawn. Third, a combination of methods is currently lacking (only 15/275, 5.5% of the studies combined ESM and passive sensing, and no studies combined all 3 methods) but is essential in understanding well-being. Conclusions: We highlight that the practice of using poorly validated measures hampers progress in understanding the relationship between the changing social environment and well-being. We conclude that different methods should be combined more often to reduce the participants’ burden and form a holistic perspective on the social environment. %M 36930210 %R 10.2196/42646 %U https://mental.jmir.org/2023/1/e42646 %U https://doi.org/10.2196/42646 %U http://www.ncbi.nlm.nih.gov/pubmed/36930210 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42501 %T Identifying and Categorizing Adverse Events in Trials of Digital Mental Health Interventions: Narrative Scoping Review of Trials in the International Standard Randomized Controlled Trial Number Registry %A Gómez Bergin,Aislinn D %A Valentine,Althea Z %A Rennick-Egglestone,Stefan %A Slade,Mike %A Hollis,Chris %A Hall,Charlotte L %+ National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2TU, United Kingdom, 44 0115 823 2438, charlotte.hall@nottingham.ac.uk %K adverse events %K harm %K psychological interventions %K clinical trials %K review %K digital %K mobile phone %D 2023 %7 22.2.2023 %9 Review %J JMIR Ment Health %G English %X Background: To contextualize the benefits of an intervention, it is important that adverse events (AEs) are reported. This is potentially difficult in trials of digital mental health interventions, where delivery may be remote and the mechanisms of actions less understood. Objective: We aimed to explore the reporting of AEs in randomized controlled trials of digital mental health interventions. Methods: The International Standard Randomized Controlled Trial Number database was searched for trials registered before May 2022. Using advanced search filters, we identified 2546 trials in the category of mental and behavioral disorders. These trials were independently reviewed by 2 researchers against the eligibility criteria. Trials were included where digital mental health interventions for participants with a mental health disorder were evaluated through a completed randomized controlled trial (protocol and primary results publication published). Published protocols and primary results publications were then retrieved. Data were extracted independently by 3 researchers, with discussion to reach consensus when required. Results: Twenty-three trials met the eligibility criteria, of which 16 (69%) included a statement on AEs within a publication, but only 6 (26%) reported AEs within their primary results publication. Seriousness was referred to by 6 trials, relatedness by 4, and expectedness by 2. More interventions delivered with human support (9/11, 82%) than those with only remote or no support (6/12, 50%) included a statement on AEs, but they did not report more AEs. Several reasons for participant dropout were identified by trials that did not report AEs, of which some were identifiable or related to AEs, including serious AEs. Conclusions: There is significant variation in the reporting of AEs in trials of digital mental health interventions. This variation may reflect limited reporting processes and difficulty recognizing AEs related to digital mental health interventions. There is a need to develop guidelines specifically for these trials to improve future reporting. %M 36811940 %R 10.2196/42501 %U https://mental.jmir.org/2023/1/e42501 %U https://doi.org/10.2196/42501 %U http://www.ncbi.nlm.nih.gov/pubmed/36811940 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43730 %T The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis %A Zhong,Shaoling %A Yang,Xinhu %A Pan,Zihua %A Fan,Yu %A Chen,Yanan %A Yu,Xin %A Zhou,Liang %+ The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, 510370, China, 86 81268045, liangzhou_csu@vip.163.com %K digital medicine %K COVID-19 %K mental health services %K psychological well-being %K COVID-19 pandemic %D 2023 %7 13.2.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath. Objective: In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews. Results: This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=−0.49; 95% CI −0.74 to −0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=−0.66; 95% CI −1.23 to −1.0; P=.02) significantly. Conclusions: The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post–COVID-19 era. Trial Registration: PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym %M 36634261 %R 10.2196/43730 %U https://publichealth.jmir.org/2023/1/e43730 %U https://doi.org/10.2196/43730 %U http://www.ncbi.nlm.nih.gov/pubmed/36634261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e36964 %T The Empowering Role of Web-Based Help Seeking on Depressive Symptoms: Systematic Review and Meta-analysis %A Bizzotto,Nicole %A Marciano,Laura %A de Bruijn,Gert-Jan %A Schulz,Peter Johannes %+ Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 58 666 4724, peter.schulz@usi.ch %K web-based help-seeking %K support groups %K depressive symptoms %K internet %K mental health %K empowerment %D 2023 %7 2.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Most research on web-based help seeking for mental health problems has focused on the antecedents of this behavior. Therefore, little is known about the outcomes of web-based help seeking in general or in specific mental health issues. Objective: This study was a systematic review and meta-analysis of the literature on the antecedents and consequences of web-based help-seeking behaviors for depressive symptoms. Methods: A systematic literature search was carried out in 6 scientific databases, leading to 48 studies (for a total of 314,921 participants) included in the qualitative synthesis and 19 included in the meta-analysis. Results: The results indicated a positive relationship between depressive symptoms and web-based help-seeking behaviors through online support groups (r=0.089; P=.009), and Generation Z (r=0.102; P=.008) tended to participate in support groups more than previous generations. In addition, web-based help seeking was positively related to empowerment (r=0.245; P=.004). Other forms of support reported included the internet and specific self-help tools, but no significant relationships were found with depressive symptoms. Conclusions: More studies examining the outcomes are needed, together with a more rigorous assessment of web-based help-seeking behaviors. Ultimately, we propose a summary framework for the literature on this topic, including the antecedents, patterns of use, and outcomes of web-based help seeking in the context of depressive symptoms. %M 36729571 %R 10.2196/36964 %U https://www.jmir.org/2023/1/e36964 %U https://doi.org/10.2196/36964 %U http://www.ncbi.nlm.nih.gov/pubmed/36729571 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42611 %T The Use of Sensors to Detect Anxiety for In-the-Moment Intervention: Scoping Review %A Dobson,Rosie %A Li,Linwei Lily %A Garner,Katie %A Tane,Taria %A McCool,Judith %A Whittaker,Robyn %+ National Institute for Health Innovation, University of Auckland, Building 507, Grafton Campus, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 373 7599, r.dobson@auckland.ac.nz %K anxiety %K wearables %K sensors %K mental health %K digital mental health %K digital health intervention %K wearable device %D 2023 %7 2.2.2023 %9 Review %J JMIR Ment Health %G English %X Background: With anxiety a growing issue and barriers to accessing support services, there is a need for innovative solutions to provide early intervention. In-the-moment interventions support individuals to recognize early signs of distress and use coping mechanisms to prevent or manage this distress. There is potential for wearable sensors linked to an individual’s mobile phone to provide in-the-moment support tailored to individual needs and physiological responses. Objective: The aim of this scoping review is to examine the role of sensors in detecting the physiological signs of anxiety to initiate and direct interventions for its management. Methods: Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, ProQuest, and Scopus. Studies were identified if they were conducted with people with stress or anxiety or at risk of anxiety and included a wearable sensor providing real-time data for in-the-moment management of anxiety. Results: Of the 1087 studies identified, 11 studies were included in the review, including 5 randomized controlled trials and 6 pilot or pretesting studies. The results showed that most studies successfully demonstrated improvements in their target variables. This included overall anxiety and stress levels, and the implementation of in-the-moment stress and anxiety management techniques such as diaphragmatic breathing. There was wide variation in the types of sensors used, physiological measures, and sensor-linked interventions. Conclusions: This review indicates that sensors are potentially a useful tool in detecting anxiety and facilitating the implementation of a known control mechanism to reduce anxiety and improve mood, but further work is needed to understand the acceptability and effectiveness of this type of intervention. %M 36729590 %R 10.2196/42611 %U https://mental.jmir.org/2023/1/e42611 %U https://doi.org/10.2196/42611 %U http://www.ncbi.nlm.nih.gov/pubmed/36729590 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42045 %T Methodological and Quality Flaws in the Use of Artificial Intelligence in Mental Health Research: Systematic Review %A Tornero-Costa,Roberto %A Martinez-Millana,Antonio %A Azzopardi-Muscat,Natasha %A Lazeri,Ledia %A Traver,Vicente %A Novillo-Ortiz,David %+ Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Marmorej 51, Copenhagen, 2100, Denmark, 45 45 33 7198, dnovillo@who.int %K artificial intelligence %K mental health %K health research %K review methodology %K systematic review %K research methodology %K research quality %K trial methodology %D 2023 %7 2.2.2023 %9 Review %J JMIR Ment Health %G English %X Background: Artificial intelligence (AI) is giving rise to a revolution in medicine and health care. Mental health conditions are highly prevalent in many countries, and the COVID-19 pandemic has increased the risk of further erosion of the mental well-being in the population. Therefore, it is relevant to assess the current status of the application of AI toward mental health research to inform about trends, gaps, opportunities, and challenges. Objective: This study aims to perform a systematic overview of AI applications in mental health in terms of methodologies, data, outcomes, performance, and quality. Methods: A systematic search in PubMed, Scopus, IEEE Xplore, and Cochrane databases was conducted to collect records of use cases of AI for mental health disorder studies from January 2016 to November 2021. Records were screened for eligibility if they were a practical implementation of AI in clinical trials involving mental health conditions. Records of AI study cases were evaluated and categorized by the International Classification of Diseases 11th Revision (ICD-11). Data related to trial settings, collection methodology, features, outcomes, and model development and evaluation were extracted following the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline. Further, evaluation of risk of bias is provided. Results: A total of 429 nonduplicated records were retrieved from the databases and 129 were included for a full assessment—18 of which were manually added. The distribution of AI applications in mental health was found unbalanced between ICD-11 mental health categories. Predominant categories were Depressive disorders (n=70) and Schizophrenia or other primary psychotic disorders (n=26). Most interventions were based on randomized controlled trials (n=62), followed by prospective cohorts (n=24) among observational studies. AI was typically applied to evaluate quality of treatments (n=44) or stratify patients into subgroups and clusters (n=31). Models usually applied a combination of questionnaires and scales to assess symptom severity using electronic health records (n=49) as well as medical images (n=33). Quality assessment revealed important flaws in the process of AI application and data preprocessing pipelines. One-third of the studies (n=56) did not report any preprocessing or data preparation. One-fifth of the models were developed by comparing several methods (n=35) without assessing their suitability in advance and a small proportion reported external validation (n=21). Only 1 paper reported a second assessment of a previous AI model. Risk of bias and transparent reporting yielded low scores due to a poor reporting of the strategy for adjusting hyperparameters, coefficients, and the explainability of the models. International collaboration was anecdotal (n=17) and data and developed models mostly remained private (n=126). Conclusions: These significant shortcomings, alongside the lack of information to ensure reproducibility and transparency, are indicative of the challenges that AI in mental health needs to face before contributing to a solid base for knowledge generation and for being a support tool in mental health management. %M 36729567 %R 10.2196/42045 %U https://mental.jmir.org/2023/1/e42045 %U https://doi.org/10.2196/42045 %U http://www.ncbi.nlm.nih.gov/pubmed/36729567 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40330 %T Digital Health Technology to Support Health Care Professionals and Family Caregivers Caring for Patients With Cognitive Impairment: Scoping Review %A Choukou,Mohamed-Amine %A Olatoye,Funminiyi %A Urbanowski,Reg %A Caon,Maurizio %A Monnin,Caroline %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada, 1 2043334778, amine.choukou@umanitoba.ca %K digital health %K behavior change %K mental health %K cognitive impairment %D 2023 %7 11.1.2023 %9 Review %J JMIR Ment Health %G English %X Background: Digital health technology is a promising way of supporting health care providers and family caregivers as they care for patients with cognitive impairment. Objective: This scoping review aimed to portray the use of digital health technology to assist health care providers and family caregivers in caring for patients with cognitive impairment who live in the community or in a facility. Methods: We conducted a scoping review of peer-reviewed scientific articles available in MEDLINE, PsycINFO, Scopus, and CINAHL with Full Text, as well as gray literature available in preprint servers, theses depositories, and various national and international dementia organizations’ websites. The search yielded 975 articles, of which we included 7 (0.7%) in the review. Results: Of the 7 interventions included in the retrieved manuscripts, 2 (29%) were digital calendar reminder systems to support activities of daily living and medication management; 2 (29%) were apps on tablet devices to simulate the presence of family before therapy interventions; 1 (14%) was a social robot used in therapeutic sessions to include elements of musicotherapy, reminiscence, cognitive games, and relaxation; 1 (14%) was a commercially available computer system that provides access to various recreational leisure activities; and 1 (14%) was a web-based self-management support system that helps family caregivers to deal with behavior changes in a relative with dementia. Of the 7 articles, only 1 (14%) reported on the use of a behavior change theory, namely a comprehensive process model of engagement coupled with cognitive stimulation therapy. Conclusions: Literature on the topic is scarce, recent, and heterogeneous. There is a clear need for a theoretical framework to conceptualize and govern the use of behavior change models that incorporate technology for patients with cognitive impairment. %M 36630174 %R 10.2196/40330 %U https://mental.jmir.org/2023/1/e40330 %U https://doi.org/10.2196/40330 %U http://www.ncbi.nlm.nih.gov/pubmed/36630174 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e38955 %T Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis %A Schiller,Crystal Edler %A Prim,Julianna %A Bauer,Anna E %A Lux,Linda %A Lundegard,Laura Claire %A Kang,Michelle %A Hellberg,Samantha %A Thompson,Katherine %A Webber,Theresa %A Teklezghi,Adonay %A Pettee,Noah %A Gaffney,Katherine %A Hodgins,Gabrielle %A Rahman,Fariha %A Steinsiek,J Nikki %A Modi,Anita %A Gaynes,Bradley N %+ Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, 304 MacNider Hall, Chapel Hill, NC, 27599-7160, United States, 1 919 966 4810, crystal_schiller@med.unc.edu %K depression %K virtual %K treatment %K therapy %K efficacy %K virtual care %K meta-analysis %K review %K mental health %K depressive disorder %K virtual intervention %K digital intervention %K digital health %K eHealth %K health outcome %K digital mental health %K health intervention %D 2023 %7 9.1.2023 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has created an epidemic of distress-related mental disorders such as depression, while simultaneously necessitating a shift to virtual domains of mental health care; yet, the evidence to support the use of virtual interventions is unclear. Objective: The purpose of this study was to evaluate the efficacy of virtual interventions for depressive disorders by addressing three key questions: (1) Does virtual intervention provide better outcomes than no treatment or other control conditions (ie, waitlist, treatment as usual [TAU], or attention control)? (2) Does in-person intervention provide better outcomes than virtual intervention? (3) Does one type of virtual intervention provide better outcomes than another? Methods: We searched the PubMed, EMBASE, and PsycINFO databases for trials published from January 1, 2010, to October 30, 2021. We included randomized controlled trials of adults with depressive disorders that tested a virtual intervention and used a validated depression measure. Primary outcomes were defined as remission (ie, no longer meeting the clinical cutoff for depression), response (ie, a clinically significant reduction in depressive symptoms), and depression severity at posttreatment. Two researchers independently selected studies and extracted data using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was evaluated based on Agency for Healthcare and Research Quality guidelines. We calculated odds ratios (ORs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes. Results: We identified 3797 references, 24 of which were eligible. Compared with waitlist, virtual intervention had higher odds of remission (OR 10.30, 95% CI 5.70-18.60; N=619 patients) and lower posttreatment symptom severity (SMD 0.81, 95% CI 0.52-1.10; N=1071). Compared with TAU and virtual attention control conditions, virtual intervention had higher odds of remission (OR 2.27, 95% CI 1.10-3.35; N=512) and lower posttreatment symptom severity (SMD 0.25, 95% CI 0.09-0.42; N=573). In-person intervention outcomes were not significantly different from virtual intervention outcomes (eg, remission OR 0.84, CI 0.51-1.37; N=789). No eligible studies directly compared one active virtual intervention to another. Conclusions: Virtual interventions were efficacious compared with control conditions, including waitlist control, TAU, and attention control. Although the number of studies was relatively small, the strength of evidence was moderate that in-person interventions did not yield significantly better outcomes than virtual interventions for depressive disorders. %M 36622747 %R 10.2196/38955 %U https://mental.jmir.org/2023/1/e38955 %U https://doi.org/10.2196/38955 %U http://www.ncbi.nlm.nih.gov/pubmed/36622747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38204 %T Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Rohrbach,Pieter J %A Dingemans,Alexandra E %A Evers,Catharine %A Van Furth,Eric F %A Spinhoven,Philip %A Aardoom,Jiska J %A Lähde,Irene %A Clemens,Fleur C %A Van den Akker-Van Marle,M Elske %+ GGZ Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, PO Box 405, Leiden, 2300 AK, Netherlands, 31 634642298, p.j.rohrbach@lumc.nl %K economic evaluation %K cost-benefit analysis %K methods of economic evaluation %K meta-analysis %K eHealth %K internet-based interventions %K mental disorders %K mental health %K systematic review %K randomized controlled trial %K mobile phone %D 2023 %7 5.1.2023 %9 Review %J J Med Internet Res %G English %X Background: The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed. Objective: The aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled. Results: The search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI −0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results. Conclusions: The findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. Trial Registration: PROSPERO CRD42019141659; https://tinyurl.com/3cu99b34 %M 36602854 %R 10.2196/38204 %U https://www.jmir.org/2023/1/e38204 %U https://doi.org/10.2196/38204 %U http://www.ncbi.nlm.nih.gov/pubmed/36602854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39128 %T Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis %A Chen,Bin %A Yang,Ting %A Xiao,Lei %A Xu,Changxia %A Zhu,Chunqin %+ Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Number 155, Hanzhong Road, Nanjing, 210001, China, 86 13951086486, zhu504123@163.com %K digital health %K mobile mindfulness meditation %K mental health %K university students %K meta-analysis %D 2023 %7 3.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students. Objective: This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience. Methods: We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis. Results: A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD –0.41, 95% CI –0.59 to –0.23; P<.001) and alleviating anxiety (SMD –0.29, 95% CI –0.50 to –0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD –0.14, 95% CI –0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD –0.33, 95% CI –0.53 to –0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI –0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The “without company support” group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the “with company support” group (SMD 1.17, 95% CI –0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD –0.06, 95% CI –0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low. Conclusions: MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585 %M 36596239 %R 10.2196/39128 %U https://www.jmir.org/2023/1/e39128 %U https://doi.org/10.2196/39128 %U http://www.ncbi.nlm.nih.gov/pubmed/36596239 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e42301 %T Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review %A Kruse,Clemens Scott %A Betancourt,Jose A %A Gonzales,Matthew %A Dickerson,Kennedy %A Neer,Miah %+ School of Health Administration, Texas State University, 601 University Drive, Encino, 250, San Marcos, TX, 78666, United States, 1 512 245 4462, scottkruse@txstate.edu %K mHealth %K telemedicine %K mental health %K behavioral health %K anxiety %K mobile device %K smartphone %K SMS text messaging %K RCT %D 2022 %7 27.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mental health is a complex condition, highly related to emotion. The COVID-19 pandemic caused a significant spike in depression (from isolation) and anxiety (event related). Mobile Health (mHealth) and telemedicine offer solutions to augment patient care, provide education, improve symptoms of depression, and assuage fears and anxiety. Objective: This review aims to assess the effectiveness of mHealth to provide mental health care by analyzing articles published in the last year in peer-reviewed, academic journals using strong methodology (randomized controlled trial). Methods: We queried 4 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ScienceDirect) using a standard Boolean search string. We conducted this systematic literature review in accordance with the Kruse protocol and reported it in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist (n=33). Results: A total of 4 interventions (mostly mHealth) from 14 countries identified improvements in primary outcomes of depression and anxiety as well as in several secondary outcomes, namely, quality of life, mental well-being, cognitive flexibility, distress, sleep, self-efficacy, anger, decision conflict, decision regret, digestive disturbance, pain, and medication adherence. Conclusions: mHealth interventions can provide education, treatment augmentation, and serve as the primary modality in mental health care. The mHealth modality should be carefully considered when evaluating modes of care. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022343489; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=343489 %M 36194896 %R 10.2196/42301 %U https://mental.jmir.org/2022/12/e42301 %U https://doi.org/10.2196/42301 %U http://www.ncbi.nlm.nih.gov/pubmed/36194896 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e38049 %T The Effectiveness of Internet-Guided Self-help Interventions to Promote Physical Activity Among Individuals With Depression: Systematic Review %A Tang,Yiling %A Gierc,Madelaine %A Lam,Raymond W %A Liu,Sam %A Faulkner,Guy %+ School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada, 1 6048222211, yilingtt@student.ubc.ca %K physical activity %K eHealth %K mobile health %K mHealth %K depression %K systematic review %K internet %K mobile phone %D 2022 %7 12.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a prevalent and debilitating mental disorder and a leading cause of disability worldwide. Physical activity (PA) interventions have been shown to alleviate depressive symptoms. However, not all patients have access to PA programing tailored for depression. Internet-guided self-help (IGSH) interventions may be an effective option for increasing PA among people with depression who cannot or prefer not to access supervised exercise treatment. Objective: We aimed to evaluate the effectiveness of IGSH interventions in increasing PA and alleviating depressive symptoms in people with depression. Methods: A systematic literature search was conducted for randomized controlled trials and quasiexperimental studies using 9 electronic databases. The review was registered in PROSPERO (2020 CRD42020221713). Results: A total of 4 randomized controlled trials (430 participants) met the inclusion criteria. Of these, 3 were web-based and 1 was app-based. Three studies found IGSH interventions to have medium to large effects on decreasing depressive symptoms but not on increasing PA compared with waitlist or usual care. One study showed increased self-reported PA but no significant difference in depressive symptoms in the intervention group compared with the control group. Goal setting was the most common behavior change technique used in the interventions. Dropout rates within the intervention groups were relatively low (0%-19%). Conclusions: Our findings suggested that IGSH PA interventions are feasible and have the potential to reduce depressive symptoms in people with depression. More well-designed and tailored interventions with different combinations of behavior change techniques, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions to increase PA among people with depression. Trial Registration: PROSPERO CRD42020221713; https://tinyurl.com/ysaua5bu %M 36508243 %R 10.2196/38049 %U https://mental.jmir.org/2022/12/e38049 %U https://doi.org/10.2196/38049 %U http://www.ncbi.nlm.nih.gov/pubmed/36508243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39727 %T Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis %A Han,Areum %A Kim,Tae Hui %+ Department of Psychiatry, Yonsei Wonju Medical College, Ilsan-ro 20, Wonju, 26426, Republic of Korea, 82 337410534, gooddr@yonsei.ac.kr %K acceptance and commitment therapy %K anxiety %K depression %K internet-based intervention %K meta-analysis %K psychological distress %K quality of life %K stress %K systematic review %D 2022 %7 9.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic approach that involves mindfulness processes and behavior change processes for valued living. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of internet-based ACT (iACT) for depressive symptoms, anxiety, stress, psychological distress, and quality of life (QoL). Methods: PubMed, CINAHL, PsycINFO, and SCOPUS databases were searched to identify relevant RCTs published up to June 5, 2021. The included RCTs were assessed using the Cochrane Collaboration risk-of-bias tool. The use of either a random effects model or fixed effects model was determined using I2 statistic values for heterogeneity. Subgroup analyses were conducted according to the type of control group, the use of therapist guidance, delivery modes, and the use of targeted participants, when applicable. Results: A total of 39 RCTs met the inclusion criteria. Meta-analyses found small effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL at the immediate posttest and follow-up. There was no significant effect of iACT on stress at follow-up. Subgroup analyses showed small to medium effects of iACT on all the outcomes at the immediate posttest and follow-up compared with the passive control groups. In contrast, subgroup analyses that compared iACT with active control groups found no differences between groups on stress, psychological distress, and QoL at the immediate posttest or on depressive symptoms, anxiety, and stress at follow-up. In addition, subgroup analyses conducted according to the use of therapist guidance, delivery modes, and the use of targeted participants found no statistically significant subgroup differences among studies in all the outcomes, except for the subgroup difference among studies according to the use of targeted participants for depressive symptoms at the immediate posttest (ie, a statistically significant, larger effect of iACT when studies targeted people with depressive symptoms). The overall risk of bias across the studies was unclear. Conclusions: The findings of this study contribute to the body of evidence regarding the effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL and may be applicable in any population, as ACT is a transdiagnostic approach. Few studies have compared iACT with active control conditions, especially for stress and psychological distress at the immediate posttest and follow-up. In addition, the active control conditions varied among the included studies. Further high-quality studies are needed to better understand whether iACT is comparable or superior to other evidence-based interventions, such as cognitive behavioral therapy, in decreasing depressive symptoms, anxiety, stress, and psychological distress and improving QoL. %M 36485030 %R 10.2196/39727 %U https://www.jmir.org/2022/12/e39727 %U https://doi.org/10.2196/39727 %U http://www.ncbi.nlm.nih.gov/pubmed/36485030 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e36056 %T Meeting the Unmet Needs of Individuals With Mental Disorders: Scoping Review on Peer-to-Peer Web-Based Interactions %A Storman,Dawid %A Jemioło,Paweł %A Swierz,Mateusz Jan %A Sawiec,Zuzanna %A Antonowicz,Ewa %A Prokop-Dorner,Anna %A Gotfryd-Burzyńska,Marcelina %A Bala,Malgorzata M %+ Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7a, Krakow, 31-034, Poland, 48 502846363, dawid.storman@doctoral.uj.edu.pl %K scoping review %K peer-to-peer interactions %K mental disorders %K web-based interactions %D 2022 %7 5.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: An increasing number of online support groups are providing advice and information on topics related to mental health. Objective: This study aimed to investigate the needs that internet users meet through peer-to-peer interactions. Methods: A search of 4 databases was performed until August 15, 2022. Qualitative or mixed methods (ie, qualitative and quantitative) studies investigating interactions among internet users with mental disorders were included. The φ coefficient was used and machine learning techniques were applied to investigate the associations between the type of mental disorders and web-based interactions linked to seeking help or support. Results: Of the 13,098 identified records, 44 studies (analyzed in 54 study-disorder pairs) that assessed 82,091 users and 293,103 posts were included. The most frequent interactions were noted for people with eating disorders (14/54, 26%), depression (12/54, 22%), and psychoactive substance use disorders (9/54, 17%). We grouped interactions between users into 42 codes, with the empathy or compassion code being the most common (41/54, 76%). The most frequently coexisting codes were request for information and network (35 times; φ=0.5; P<.001). The algorithms that provided the best accuracy in classifying disorders by interactions were decision trees (44/54, 81%) and logistic regression (40/54, 74%). The included studies were of moderate quality. Conclusions: People with mental disorders mostly use the internet to seek support, find answers to their questions, and chat. The results of this analysis should be interpreted as a proof of concept. More data on web-based interactions among these people might help apply machine learning methods to develop a tool that might facilitate screening or even support mental health assessment. %M 36469366 %R 10.2196/36056 %U https://mental.jmir.org/2022/12/e36056 %U https://doi.org/10.2196/36056 %U http://www.ncbi.nlm.nih.gov/pubmed/36469366 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e41891 %T Implementation of e–Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis %A Coumoundouros,Chelsea %A Mårtensson,Erika %A Ferraris,Giulia %A Zuidberg,Justine Margaux %A von Essen,Louise %A Sanderman,Robbert %A Woodford,Joanne %+ Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, MTC-huset: Dag Hammarskjölds väg 14B, 1 tr, Uppsala, 751 85, Sweden, 46 729 999 211, chelsea.coumoundouros@kbh.uu.se %K informal caregivers %K e–mental health %K implementation %K chronic diseases %K systematic review %K thematic synthesis %K qualitative comparative analysis %K Consolidated Framework for Implementation Research %D 2022 %7 30.11.2022 %9 Review %J JMIR Ment Health %G English %X Background: Informal caregivers commonly experience mental health difficulties related to their caregiving role. e–Mental health interventions provide mental health support in a format that may be more accessible to informal caregivers. However, e–mental health interventions are seldom implemented in real-world practice. Objective: This mixed methods systematic review aimed to examine factors associated with the effectiveness and implementation of e–mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: combinations of implementation and intervention characteristics sufficient for intervention effectiveness were explored using qualitative comparative analysis, and barriers to and facilitators of implementation of e–mental health interventions for informal caregivers were explored using thematic synthesis. Methods: We identified relevant studies published from January 1, 2007, to July 6, 2022, by systematically searching 6 electronic databases and various secondary search strategies. Included studies reported on the effectiveness or implementation of e–mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers’ mental health outcomes were included in a crisp-set qualitative comparative analysis. We assessed randomized controlled trials for bias using the Risk of Bias 2.0 tool, and we assessed how pragmatic or explanatory their trial design was using the Pragmatic Explanatory Continuum Indicator Summary 2 tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research to identify barriers to and facilitators of implementation. Results: Overall, 53 reports, representing 29 interventions, were included in the review. Most interventions (27/29, 93%) focused on informal cancer or dementia caregivers. In total, 14 reports were included in the qualitative comparative analysis, exploring conditions including the presence of peer or professional support and key persuasive design features. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. Overall, 44 reports were included in the thematic synthesis, and 152 barriers and facilitators were identified, with the majority related to the intervention and individual characteristic domains of the Consolidated Framework for Implementation Research. Implementation barriers and facilitators in the inner setting (eg, organizational culture) and outer setting (eg, external policies and resources) domains were largely unexplored. Conclusions: e–Mental health interventions for informal caregivers tend to be well-designed, with several barriers to and facilitators of implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers to and facilitators of implementing e–mental health interventions for informal caregivers, focusing on inner and outer setting barriers and facilitators. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020155727; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020155727 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035406 %M 36314782 %R 10.2196/41891 %U https://mental.jmir.org/2022/11/e41891 %U https://doi.org/10.2196/41891 %U http://www.ncbi.nlm.nih.gov/pubmed/36314782 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38206 %T Automated Digital Interventions and Smoking Cessation: Systematic Review and Meta-analysis Relating Efficiency to a Psychological Theory of Intervention Perspective %A Sha,Leihao %A Yang,Xia %A Deng,Renhao %A Wang,Wen %A Tao,YuJie %A Cao,HaiLing %A Ma,Qianshu %A Wang,Hao %A Nie,Yirou %A Leng,Siqi %A Lv,Qiuyue %A Li,Xiaojing %A Wang,Huiyao %A Meng,Yajing %A Xu,Jiajun %A Greenshaw,Andrew J %A Li,Tao %A Guo,Wan-jun %+ Mental Health Center and Sichuan Clinical Medical Research Center for Mental Disorders, West China Hospital of Sichuan University, No. 28 Dianxin South St, Chengdu, 610041, China, 86 28 8542356, guowjcn@163.com %K smoking cessation %K automated %K digital intervention %K psychological theory %K meta-analysis %K systematic review %K public health %K side effects %K interventions %K randomized controlled trial %K self-help %D 2022 %7 16.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Smoking remains a highly significant preventable global public health problem. In this context, digital interventions offer great advantages in terms of a lack of biological side effects, possibility of automatic delivery, and consequent human resource savings relative to traditional interventions. Such interventions have been studied in randomized controlled trials (RCTs) but have not been systematically reviewed with the inclusion of text-based and multiplatform-based interventions. In addition, this area has not been evaluated from the perspective of the psychological theoretical basis of intervention. Objective: The aim of this paper is to assess the efficiency of digital interventions in RCT studies of smoking cessation and to evaluate the effectiveness of the strategies used for digital interventions. Methods: An electronic search of RCTs was conducted using PubMed, Embase, and the Cochrane Library by June 30, 2021. Eligible studies had to compare automated digital intervention (ADI) to the use of a self-help guideline or no intervention. Participants were current smokers (aged 16 years or older). As the main outcome, abstinence after endpoint was extracted from the studies. Systematic review and meta-analysis were conducted to assess the efficiency of ADIs. Metaregressions were conducted to assess the relationship between intervention theory and effectiveness. Results: A total of 19 trials (15,472 participants) were included in the analysis. The overall abstinence rate (95% CI) at the endpoint was 17.8% (17.0-18.7). The overall risk ratio of the intervention group compared to the controls at the endpoint was 17.8% (17.0-18.7). Cochrane risk-of-bias tool for randomized trials (ROB 2) suggested that most of the studies had a low risk of bias (56.3%). Psychological theory–related constructs or predictors, which refer to other theory-based concepts (rather than only behavioral theory) such as craving or anxiety, are associated with effectiveness. Conclusions: This study found that ADI had a clear positive effect compared to self-help guidelines or to no intervention, and effectiveness was associated with theory-related constructs or predictors. ADIs should be promoted by policy makers and clinical practitioners to address the huge gap between the need for smoking cessation and availability of traditional treatment resources. Possible increases in ADI efficiency may be achieved by optimally integrating psychotherapeutic theories and techniques. Trial Registration: PROSPERO CRD42021256593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256593 %M 36383408 %R 10.2196/38206 %U https://www.jmir.org/2022/11/e38206 %U https://doi.org/10.2196/38206 %U http://www.ncbi.nlm.nih.gov/pubmed/36383408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40946 %T Examining Mental Workload Relating to Digital Health Technologies in Health Care: Systematic Review %A Kremer,Lisanne %A Lipprandt,Myriam %A Röhrig,Rainer %A Breil,Bernhard %+ Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstr. 49, Krefeld, 47805, Germany, 49 2151 8226678, Lisanne.Kremer@hs-niederrhein.de %K mental workload %K mental workload measurement %K assessment %K health care professional %K health information system(s) %K digital health technology %K systematic review %D 2022 %7 28.10.2022 %9 Review %J J Med Internet Res %G English %X Background: The workload in health care is increasing and hence, mental health issues are on the rise among health care professionals (HCPs). The digitization of patient care could be related to the increase in stress levels. It remains unclear whether the health information system or systems and digital health technologies (DHTs) being used in health care relieve the professionals or whether they represent a further burden. The mental construct that best describes this burden of technologies is mental workload (MWL). The measurement methods of MWL are particularly relevant in this sensitive setting. Objective: This review aimed to address 2 different but related objectives: identifying the factors that contribute to the MWL of HCPs when using DHT and examining and exploring the applied assessments for the measurement of MWL with a special focus on eye tracking. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement, we conducted a systematic review and processed a literature search in the following databases: MEDLINE (PubMed), Web of Science, Academic Search Premier and CINAHL (EBSCO), and PsycINFO. Studies were eligible if they assessed the MWL of HCPs related to DHT. The review was conducted as per the following steps: literature search, article selection, data extraction, quality assessment (using the Standard Quality Assessment Criteria for Evaluation Primary Research Papers From a Variety of Fields [QualSyst]), data analysis, and data synthesis (narrative and tabular). The process was performed by 2 reviewers (in cases of disagreement, a third reviewer was involved). Results: The literature search process resulted in 25 studies that fit the inclusion criteria and examined the MWL of health care workers resulting from the use of DHT in health care settings. Most studies had sample sizes of 10-50 participants, were conducted in the laboratory, and had quasi-experimental or cross-sectional designs. The main results can be grouped into two categories: assessment methods and factors related to DHT that contribute to MWL. Most studies applied subjective methods for the assessment of MWL. Eye tracking did not play a major role in the selected studies. The factors contributing to a higher MWL were clustered into organizational and systemic factors. Conclusions: Our review of 25 papers shows a diverse assessment approach toward the MWL of HCPs related to DHT as well as 2 groups of relevant contributing factors to MWL. Our results are limited in terms of interpretability and causality due to methodological weaknesses of the included studies and may be limited by some shortcomings in the search process. Future research should concentrate on adequate assessments of the MWL of HCPs dependent on the setting, the evaluation of quality criteria, and further assessment of the contributing factors to MWL. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271 %M 36306159 %R 10.2196/40946 %U https://www.jmir.org/2022/10/e40946 %U https://doi.org/10.2196/40946 %U http://www.ncbi.nlm.nih.gov/pubmed/36306159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39204 %T Digital Mental Health Interventions for Depression: Scoping Review of User Engagement %A Lipschitz,Jessica M %A Van Boxtel,Rachel %A Torous,John %A Firth,Joseph %A Lebovitz,Julia G %A Burdick,Katherine E %A Hogan,Timothy P %+ Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, United States, 1 617 732 6548, jlipschitz@bwh.harvard.edu %K mHealth %K mobile apps %K engagement %K adherence %K randomized controlled trials %K depression %D 2022 %7 14.10.2022 %9 Review %J J Med Internet Res %G English %X Background: While many digital mental health interventions (DMHIs) have been found to be efficacious, patient engagement with DMHIs has increasingly emerged as a concern for implementation in real-world clinical settings. To address engagement, we must first understand what standard engagement levels are in the context of randomized controlled trials (RCTs) and how these compare with other treatments. Objective: This scoping review aims to examine the state of reporting on intervention engagement in RCTs of mobile app–based interventions intended to treat symptoms of depression. We sought to identify what engagement metrics are and are not routinely reported as well as what the metrics that are reported reflect about standard engagement levels. Methods: We conducted a systematic search of 7 databases to identify studies meeting our eligibility criteria, namely, RCTs that evaluated use of a mobile app–based intervention in adults, for which depressive symptoms were a primary outcome of interest. We then extracted 2 kinds of information from each article: intervention details and indices of DMHI engagement. A 5-element framework of minimum necessary DMHI engagement reporting was derived by our team and guided our data extraction. This framework included (1) recommended app use as communicated to participants at enrollment and, when reported, app adherence criteria; (2) rate of intervention uptake among those assigned to the intervention; (3) level of app use metrics reported, specifically number of uses and time spent using the app; (4) duration of app use metrics (ie, weekly use patterns); and (5) number of intervention completers. Results: Database searching yielded 2083 unique records. Of these, 22 studies were eligible for inclusion. Only 64% (14/22) of studies included in this review specified rate of intervention uptake. Level of use metrics was only reported in 59% (13/22) of the studies reviewed. Approximately one-quarter of the studies (5/22, 23%) reported duration of use metrics. Only half (11/22, 50%) of the studies reported the number of participants who completed the app-based components of the intervention as intended or other metrics related to completion. Findings in those studies reporting metrics related to intervention completion indicated that between 14.4% and 93.0% of participants randomized to a DMHI condition completed the intervention as intended or according to a specified adherence criteria. Conclusions: Findings suggest that engagement was underreported and widely varied. It was not uncommon to see completion rates at or below 50% (11/22) of those participants randomized to a treatment condition or to simply see completion rates not reported at all. This variability in reporting suggests a failure to establish sufficient reporting standards and limits the conclusions that can be drawn about level of engagement with DMHIs. Based on these findings, the 5-element framework applied in this review may be useful as a minimum necessary standard for DMHI engagement reporting. %M 36240001 %R 10.2196/39204 %U https://www.jmir.org/2022/10/e39204 %U https://doi.org/10.2196/39204 %U http://www.ncbi.nlm.nih.gov/pubmed/36240001 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37342 %T Guided Internet-Delivered Treatment for Depression: Scoping Review %A Børtveit,Line %A Dechsling,Anders %A Sütterlin,Stefan %A Nordgreen,Tine %A Nordahl-Hansen,Anders %+ Faculty of Health, Welfare and Organisation, Østfold University College, Høgskolen i Østfold, Postboks 700, Halden, 1757, Norway, 47 93203985, linebortveit@gmail.com %K web-based therapy %K computer-assisted therapy %K internet %K digital interventions %K major depression %K mental health %K mobile phone %D 2022 %7 4.10.2022 %9 Review %J JMIR Ment Health %G English %X Background: Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. Objective: The aim of this study was to provide an overview of this research area and identify potential gaps in the research. Methods: In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. Results: A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. Conclusions: This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies. %M 36194467 %R 10.2196/37342 %U https://mental.jmir.org/2022/10/e37342 %U https://doi.org/10.2196/37342 %U http://www.ncbi.nlm.nih.gov/pubmed/36194467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e39686 %T Digital Interventions for Psychological Well-being in University Students: Systematic Review and Meta-analysis %A Ferrari,Madeleine %A Allan,Stephanie %A Arnold,Chelsea %A Eleftheriadis,Dina %A Alvarez-Jimenez,Mario %A Gumley,Andrew %A Gleeson,John F %+ Healthy Brain and Mind Research Centre, Australian Catholic University, 25a Barker Road, Strathfield campus, Sydney, 2135, Australia, 61 0297014726, madeleine.ferrari@acu.edu.au %K psychological well-being %K mental health %K university students %K higher education students %K college students %K digital intervention %K web-based intervention %K mobile phone %K meta-analysis %K systematic review %D 2022 %7 28.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Life at university provides important opportunities for personal growth; however, this developmental phase also coincides with the peak period of risk for the onset of mental health disorders. In addition, specific university lifestyle factors, including impaired sleep and academic and financial stress, are known to exacerbate psychological distress in students. As a result, university students have been identified as a vulnerable population who often experience significant barriers to accessing psychological treatment. Digital psychological interventions are emerging as a promising solution for this population, but their effectiveness remains unclear. Objective: This systematic review and meta-analysis aimed to assess digital interventions targeting psychological well-being among university students. Methods: Database searches were conducted on December 2, 2021, via Embase, MEDLINE, PsycINFO, and Web of Science. Results: A total of 13 eligible studies were identified, 10 (77%) of which were included in the meta-analysis. Mean pre-post effect sizes indicated that such interventions led to small and significant improvement in psychological well-being (Hedges g=0.32, 95% CI 0.23-0.4; P<.001). These effects remained, albeit smaller, when studies that included a wait-list control group were excluded (Hedges g=0.22, 95% CI 0.08-0.35; P=.002). An analysis of acceptance and commitment therapy approaches revealed small and significant effects (k=6; Hedges g=0.35, 95% CI 0.25-0.45; P<.001). Conclusions: Digital psychological interventions hold considerable promise for university students, although features that optimize service delivery and outcomes require further assessment. Trial Registration: PROSPERO CRD42020196654; https:/www.crd.york.ac.uk/prospero/display_record.php?RecordID=196654 %M 36169988 %R 10.2196/39686 %U https://www.jmir.org/2022/9/e39686 %U https://doi.org/10.2196/39686 %U http://www.ncbi.nlm.nih.gov/pubmed/36169988 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e37776 %T Trends in Effectiveness of Organizational eHealth Interventions in Addressing Employee Mental Health: Systematic Review and Meta-analysis %A Stratton,Elizabeth %A Lampit,Amit %A Choi,Isabella %A Malmberg Gavelin,Hanna %A Aji,Melissa %A Taylor,Jennifer %A Calvo,Rafael A %A Harvey,Samuel B %A Glozier,Nick %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington,, London, SW7 9EG, United Kingdom, 44 20 7594 888, r.calvo@imperial.ac.uk %K eHealth %K mental health %K employee %K systematic review %K mobile phone %D 2022 %7 27.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Mental health conditions are considered the leading cause of disability, sickness absence, and long-term work incapacity. eHealth interventions provide employees with access to psychological assistance. There has been widespread implementation and provision of eHealth interventions in the workplace as an inexpensive and anonymous way of addressing common mental disorders. Objective: This updated review aimed to synthesize the literature on the efficacy of eHealth interventions for anxiety, depression, and stress outcomes in employee samples in organizational settings and evaluate whether their effectiveness has improved over time. Methods: Systematic searches of relevant articles published from 2004 to July 2020 of eHealth intervention trials (app- or web-based) focusing on the mental health of employees were conducted. The quality and bias of all studies were assessed. We extracted means and SDs from publications by comparing the differences in effect sizes (Hedge g) in standardized mental health outcomes. We meta-analyzed these data using a random-effects model. Results: We identified a tripling of the body of evidence, with 75 trials available for meta-analysis from a combined sample of 14,747 articles. eHealth interventions showed small positive effects for anxiety (Hedges g=0.26, 95% CI 0.13-0.39; P<.001), depression (Hedges g=0.26, 95% CI 0.19-0.34; P<.001), and stress (Hedges g=0.25, 95% CI 0.17-0.34; P<.001) in employees’ after intervention, with similar effects seen at the medium-term follow-up. However, there was evidence of no increase in the effectiveness of these interventions over the past decade. Conclusions: This review and meta-analysis confirmed that eHealth interventions have a small positive impact on reducing mental health symptoms in employees. Disappointingly, we found no evidence that, despite the advances in technology and the enormous resources in time, research, and finance devoted to this area for over a decade, better interventions are being produced. Hopefully, these small effect sizes do not represent optimum outcomes in organizational settings. Trial Registration: PROSPERO CRD42020185859; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=185859 %M 36166285 %R 10.2196/37776 %U https://www.jmir.org/2022/9/e37776 %U https://doi.org/10.2196/37776 %U http://www.ncbi.nlm.nih.gov/pubmed/36166285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38030 %T Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review %A Shah,Amika %A Hussain-Shamsy,Neesha %A Strudwick,Gillian %A Sockalingam,Sanjeev %A Nolan,Robert P %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, amika.shah@mail.utoronto.ca %K depression %K anxiety %K multiple chronic conditions %K chronic disease %K mental health %K psychiatry %K digital health %K eHealth %K telehealth %K mobile health %K mHealth %K telemedicine %D 2022 %7 26.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored. Objective: This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions. Methods: A scoping review of the literature was conducted using the Arksey and O’Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research. Results: Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI. Conclusions: As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research. %M 36155409 %R 10.2196/38030 %U https://www.jmir.org/2022/9/e38030 %U https://doi.org/10.2196/38030 %U http://www.ncbi.nlm.nih.gov/pubmed/36155409 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e40924 %T Efficacy and Conflicts of Interest in Randomized Controlled Trials Evaluating Headspace and Calm Apps: Systematic Review %A O'Daffer,Alison %A Colt,Susannah F %A Wasil,Akash R %A Lau,Nancy %+ Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 884 4211, alison.odaffer@seattlechildrens.org %K mHealth %K psychological interventions %K mobile health %K mental health %K health applications %K health apps %K mindfulness %K meditation app %K digital health application %K digital health intervention %D 2022 %7 20.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Although there are thousands of mental health apps, 2 apps, Headspace and Calm, claim a large percentage of the marketplace. These two mindfulness and meditation apps have reached tens of millions of active users. To guide consumers, clinicians, and researchers, we performed a systematic review of randomized controlled trials (RCTs) of Headspace and Calm. Objective: Our study aimed to evaluate intervention efficacy, risk of bias, and conflicts of interest (COIs) in the evidence base for Headspace and Calm, the two most popular mental health apps at the time of our search. Methods: To identify studies, we searched academic databases (Google Scholar, MEDLINE, and PsycINFO) and the websites of Headspace and Calm in May 2021 for RCTs of Headspace and Calm testing efficacy via original data collection, published in English in peer-reviewed journals. For each study, we coded (1) study characteristics (eg, participants, sample size, and outcome measures), (2) intervention characteristics (eg, free vs paid version of the app and intended frequency of app usage), (3) all study outcomes, (4) Cochrane risk of bias variables, and (5) COI variables (eg, presence or absence of a preregistration and the presence or absence of a COI statement involving the company). Results: We identified 14 RCTs of Headspace and 1 RCT of Calm. Overall, 93% (13/14) of RCTs of Headspace and 100% (1/1) of RCTs of Calm recruited participants from a nonclinical population. Studies commonly measured mindfulness, well-being, stress, depressive symptoms, and anxiety symptoms. Headspace use improved depression in 75% of studies that evaluated it as an outcome. Findings were mixed for mindfulness, well-being, stress, and anxiety, but at least 40% of studies showed improvement for each of these outcomes. Studies were generally underpowered to detect “small” or “medium” effect sizes. Furthermore, 50% (7/14) of RCTs of Headspace and 0% (0/1) of RCTs of Calm reported a COI that involved Headspace or Calm (the companies). The most common COI was the app company providing premium app access for free for participants, and notably, 14% (2/14) of RCTs of Headspace reported Headspace employee involvement in study design, execution, and data analysis. Only 36% (5/14) of RCTs of Headspace were preregistered, and the 1 RCT of Calm was not preregistered. Conclusions: The empirical research on Headspace appears promising, whereas there is an absence of randomized trials on Calm. Limitations of this study include an inability to compare Headspace and Calm owing to the dearth of RCTs studying Calm and the reliance on author reports to evaluate COIs. When determining whether or not mental health apps are of high quality, identification of high-quality apps and evaluation of their effectiveness and investigators’ COIs should be ensured. %M 36125880 %R 10.2196/40924 %U https://mental.jmir.org/2022/9/e40924 %U https://doi.org/10.2196/40924 %U http://www.ncbi.nlm.nih.gov/pubmed/36125880 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e36662 %T Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review %A Park,Jennifer J %A King,Daniel L %A Wilkinson-Meyers,Laura %A Rodda,Simone N %+ School of Population Health, The University of Auckland, Building 507, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 210 822 6685, jpar956@aucklanduni.ac.nz %K systematic review %K gambling %K gaming %K internet intervention %K pornography %K treatment %K social media %D 2022 %7 9.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated. Objective: This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior. Methods: A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool. Results: The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms. Conclusions: Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials. %M 36083612 %R 10.2196/36662 %U https://mental.jmir.org/2022/9/e36662 %U https://doi.org/10.2196/36662 %U http://www.ncbi.nlm.nih.gov/pubmed/36083612 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e39454 %T Effectiveness and Minimum Effective Dose of App-Based Mobile Health Interventions for Anxiety and Depression Symptom Reduction: Systematic Review and Meta-Analysis %A Lu,Sheng-Chieh %A Xu,Mindy %A Wang,Mei %A Hardi,Angela %A Cheng,Abby L %A Chang,Su-Hsin %A Yen,Po-Yin %+ Department of Symptom Research, University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd, Houston, TX, 77030, United States, 1 7137944453, Slu4@mdanderson.org %K mental health %K mobile health %K smartphone apps %K intervention dose effectiveness %K systematic review and meta-analysis %D 2022 %7 7.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mobile health (mHealth) apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews support the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long the minimum treatment “dose” is for an mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness. Objective: Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose effectiveness of app-based mHealth interventions for anxiety and depression symptom reduction. Methods: We conducted a literature search on 7 databases (ie, Ovid MEDLINE, Embase, PsycInfo, Scopus, Cochrane Library (eg, CENTRAL), ScienceDirect, and ClinicalTrials, for publications from January 2012 to April 2020. We included randomized controlled trials (RCTs) evaluating app-based mHealth interventions for anxiety and depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We estimated the pooled effect size using Hedge g and appraised study quality using the revised Cochrane risk-of-bias tool for RCTs. Results: We included 15 studies involving 2627 participants for 18 app-based mHealth interventions. Participants in the intervention groups showed a significant effect on anxiety (Hedge g=–.10, 95% CI –0.14 to –0.06, I2=0%) but not on depression (Hedge g=–.08, 95% CI –0.23 to 0.07, I2=4%). Interventions of at least 7 weeks’ duration had larger effect sizes on anxiety symptom reduction. Conclusions: There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to nonsignificant effects of the interventions and study quality concerns. The recommended dose of mHealth interventions and the sustainability of intervention effectiveness remain unclear and require further investigation. %M 36069841 %R 10.2196/39454 %U https://mental.jmir.org/2022/9/e39454 %U https://doi.org/10.2196/39454 %U http://www.ncbi.nlm.nih.gov/pubmed/36069841 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e37354 %T The Apple Watch for Monitoring Mental Health–Related Physiological Symptoms: Literature Review %A Lui,Gough Yumu %A Loughnane,Dervla %A Polley,Caitlin %A Jayarathna,Titus %A Breen,Paul P %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia, 61 298525222, G.Lui@westernsydney.edu.au %K Apple Watch %K data %K validation %K mental health %K psychology %K precision medicine %K heart rate variability %K energy expenditure %K sleep tracking %K digital health %K mobile phone %D 2022 %7 7.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: An anticipated surge in mental health service demand related to COVID-19 has motivated the use of novel methods of care to meet demand, given workforce limitations. Digital health technologies in the form of self-tracking technology have been identified as a potential avenue, provided sufficient evidence exists to support their effectiveness in mental health contexts. Objective: This literature review aims to identify current and potential physiological or physiologically related monitoring capabilities of the Apple Watch relevant to mental health monitoring and examine the accuracy and validation status of these measures and their implications for mental health treatment. Methods: A literature review was conducted from June 2021 to July 2021 of both published and gray literature pertaining to the Apple Watch, mental health, and physiology. The literature review identified studies validating the sensor capabilities of the Apple Watch. Results: A total of 5583 paper titles were identified, with 115 (2.06%) reviewed in full. Of these 115 papers, 19 (16.5%) were related to Apple Watch validation or comparison studies. Most studies showed that the Apple Watch could measure heart rate acceptably with increased errors in case of movement. Accurate energy expenditure measurements are difficult for most wearables, with the Apple Watch generally providing the best results compared with peers, despite overestimation. Heart rate variability measurements were found to have gaps in data but were able to detect mild mental stress. Activity monitoring with step counting showed good agreement, although wheelchair use was found to be prone to overestimation and poor performance on overground tasks. Atrial fibrillation detection showed mixed results, in part because of a high inconclusive result rate, but may be useful for ongoing monitoring. No studies recorded validation of the Sleep app feature; however, accelerometer-based sleep monitoring showed high accuracy and sensitivity in detecting sleep. Conclusions: The results are encouraging regarding the application of the Apple Watch in mental health, particularly as heart rate variability is a key indicator of changes in both physical and emotional states. Particular benefits may be derived through avoidance of recall bias and collection of supporting ecological context data. However, a lack of methodologically robust and replicated evidence of user benefit, a supportive health economic analysis, and concerns about personal health information remain key factors that must be addressed to enable broader uptake. %M 36069848 %R 10.2196/37354 %U https://mental.jmir.org/2022/9/e37354 %U https://doi.org/10.2196/37354 %U http://www.ncbi.nlm.nih.gov/pubmed/36069848 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e39182 %T The Effects of Internet-Based Acceptance and Commitment Therapy on Process Measures: Systematic Review and Meta-analysis %A Han,Areum %A Kim,Tae Hui %+ Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon province, 26426, Republic of Korea, 82 337410534, gooddr@yonsei.ac.kr %K acceptance and commitment therapy %K process measure %K internet-based intervention %K digital mental health %K meta-analysis %K mindfulness %K systematic review %D 2022 %7 30.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures. Methods: A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable. Results: A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear. Conclusions: Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT. %M 36040783 %R 10.2196/39182 %U https://www.jmir.org/2022/8/e39182 %U https://doi.org/10.2196/39182 %U http://www.ncbi.nlm.nih.gov/pubmed/36040783 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e25716 %T Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review %A Babbage,Camilla M %A Jackson,Georgina M %A Davies,E Bethan %A Nixon,Elena %+ National Institute for Health and Care Research (NIHR) MindTech Medtech Co-operative, Mental Health & Clinical Neurosciences, Institute of Mental Health, University of Nottingham, University Of Nottingham Innovation Park, Nottingham, NG7 2TU, United Kingdom, 44 1158232438, Camilla.Babbage@nottingham.ac.uk %K digital health interventions %K psychological well-being %K mental well-being %K mental disorders %K mental health %K children and young people %K self-help %K systematic review %D 2022 %7 26.8.2022 %9 Review %J JMIR Ment Health %G English %X Background: Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective: The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods: A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results: Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions: The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration: PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz %M 36018675 %R 10.2196/25716 %U https://mental.jmir.org/2022/8/e25716 %U https://doi.org/10.2196/25716 %U http://www.ncbi.nlm.nih.gov/pubmed/36018675 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e38600 %T Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review %A Zangani,Caroline %A Ostinelli,Edoardo G %A Smith,Katharine A %A Hong,James S W %A Macdonald,Orla %A Reen,Gurpreet %A Reid,Katherine %A Vincent,Charles %A Syed Sheriff,Rebecca %A Harrison,Paul J %A Hawton,Keith %A Pitman,Alexandra %A Bale,Rob %A Fazel,Seena %A Geddes,John R %A Cipriani,Andrea %+ Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 1865 618228, andrea.cipriani@psych.ox.ac.uk %K COVID-19 %K coronavirus %K mental health services %K telemental health %K telepsychiatry %K face-to-face %D 2022 %7 22.8.2022 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. Objective: We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. Methods: We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country’s COVID-19 Stringency Index, which reflects the stringency of a government’s response to COVID-19 restrictions at a specific time. Results: Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries’ face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. Conclusions: During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients’ preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users. %M 35994310 %R 10.2196/38600 %U https://mental.jmir.org/2022/8/e38600 %U https://doi.org/10.2196/38600 %U http://www.ncbi.nlm.nih.gov/pubmed/35994310 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e37640 %T Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review %A Li,Sophie H %A Achilles,Melinda R %A Werner-Seidler,Aliza %A Beames,Joanne R %A Subotic-Kerry,Mirjana %A O'Dea,Bridianne %+ Black Dog Institute and School of Psychology, The University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 411116615, s.h.li@blackdog.org.au %K adherence %K youth %K digital %K cognitive behavioral therapy %K review %K mobile phone %D 2022 %7 17.8.2022 %9 Review %J JMIR Ment Health %G English %X Background: Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. Objective: This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. Methods: A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. Results: There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. Conclusions: Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. Trial Registration: PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram %M 35976180 %R 10.2196/37640 %U https://mental.jmir.org/2022/8/e37640 %U https://doi.org/10.2196/37640 %U http://www.ncbi.nlm.nih.gov/pubmed/35976180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36620 %T Understanding Engagement in Digital Mental Health and Well-being Programs for Women in the Perinatal Period: Systematic Review Without Meta-analysis %A Davis,Jacqueline A %A Ohan,Jeneva L %A Gibson,Lisa Y %A Prescott,Susan L %A Finlay-Jones,Amy L %+ Telethon Kids Institute, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 478173989, jackie.davis@telethonkids.org.au %K digital interventions %K perinatal %K mental health %K well-being %K logic model %K systematic review %K mobile phone %D 2022 %7 9.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Pregnancy and the postnatal period can be a time of increased psychological distress, which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health in women during the perinatal period. Although studies report efficacy, a key concern regarding web-based interventions is the lack of engagement leading to drop out, lack of participation, or reduced potential intervention benefits. Objective: This systematic review aimed to understand the reporting and levels of engagement in studies of digital psychological mental health or well-being interventions administered during the perinatal period. Specific objectives were to understand how studies report engagement across 4 domains specified in the Connect, Attend, Participate, and Enact (CAPE) model, make recommendations on best practices to report engagement in digital mental health interventions (DMHIs), and understand levels of engagement in intervention studies in this area. To maximize the utility of this systematic review, we intended to develop practical tools for public health use: to develop a logic model to reference the theory of change, evaluate the studies using the CAPE framework, and develop a guide for future data collection to enable consistent reporting in digital interventions. Methods: This systematic review used the Cochrane Synthesis Without Meta-analysis reporting guidelines. This study aimed to identify studies reporting DMHIs delivered during the perinatal period in women with subclinical mood symptoms. A systematic database search was used to identify relevant papers using the Ovid Platform for MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, and Medical Subject Headings on Demand for all English-language articles published in the past 10 years. Results: Searches generated a database of 3473 potentially eligible studies, with a final selection of 16 (0.46%) studies grouped by study design. Participant engagement was evaluated using the CAPE framework and comparable variables were described. All studies reported at least one engagement metric. However, the measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment (ie, participants’ real-world use of intervention skills), with only 38% (6/16) of studies clearly recording longer-term practice through postintervention interviews. The logic model proposes ways of conceptualizing and reporting engagement details in DMHIs more consistently in the future. Conclusions: The perinatal period is the optimal time to intervene with strength-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skill use beyond the intervention period. Our results indicate variability in the reporting of both short- and long-term participant engagement behaviors, and we recommend the adoption of standardized reporting metrics in future digital interventions. Trial Registration: PROSPERO CRD42020162283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162283 %M 35943773 %R 10.2196/36620 %U https://www.jmir.org/2022/8/e36620 %U https://doi.org/10.2196/36620 %U http://www.ncbi.nlm.nih.gov/pubmed/35943773 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e34254 %T The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis %A Conley,Colleen S %A Raposa,Elizabeth B %A Bartolotta,Kate %A Broner,Sarah E %A Hareli,Maya %A Forbes,Nicola %A Christensen,Kirsten M %A Assink,Mark %+ Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL, 60660, United States, 1 7735083603, cconley@luc.edu %K meta-analysis %K mental health %K well-being %K intervention %K treatment %K youth %K technology %K smartphone %K mobile phone %K app %K mobile health %D 2022 %7 29.7.2022 %9 Review %J JMIR Ment Health %G English %X Background: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. Conclusions: Overall, this study’s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings. %M 35904845 %R 10.2196/34254 %U https://mental.jmir.org/2022/7/e34254 %U https://doi.org/10.2196/34254 %U http://www.ncbi.nlm.nih.gov/pubmed/35904845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36004 %T The Effects of Nonclinician Guidance on Effectiveness and Process Outcomes in Digital Mental Health Interventions: Systematic Review and Meta-analysis %A Leung,Calista %A Pei,Julia %A Hudec,Kristen %A Shams,Farhud %A Munthali,Richard %A Vigo,Daniel %+ Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T2B8, Canada, 1 6048228048, daniel.vigo@ubc.ca %K digital mental health %K nonclinician guidance %K e-Mental health intervention %K internet-based intervention %K mental health %K task shifting %K digital health %K digital health intervention %K patient outcome %D 2022 %7 15.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective: This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods: Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results: Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions: Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226 %M 35511463 %R 10.2196/36004 %U https://www.jmir.org/2022/6/e36004 %U https://doi.org/10.2196/36004 %U http://www.ncbi.nlm.nih.gov/pubmed/35511463 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e38249 %T Interventions in Chinese Undergraduate Students’ Mental Health: Systematic Review %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Li,Rongying %A Qian,Xiaobo %A Zhang,Xiaomin %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, No 9 Seyuan Rd, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K systematic review %K intervention %K mental health %K depression %K anxiety %K stress %K Chinese undergraduate students %D 2022 %7 15.6.2022 %9 Review %J Interact J Med Res %G English %X Background: Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students’ mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being. Objective: The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students’ affairs counselors, and mental health providers. Methods: We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis. Results: We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students’ affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers. Conclusions: This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students’ mental health is a research topic worth further investigation. %M 35704383 %R 10.2196/38249 %U https://www.i-jmr.org/2022/1/e38249 %U https://doi.org/10.2196/38249 %U http://www.ncbi.nlm.nih.gov/pubmed/35704383 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e35260 %T Internet-Delivered Cognitive Behavioral Therapy in Patients With Irritable Bowel Syndrome: Systematic Review and Meta-Analysis %A Kim,Hyunjung %A Oh,Younjae %A Chang,Sun Ju %+ College of Nursing, Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 10 5226 8262, changsj@snu.ac.kr %K cognitive behavioral therapy %K irritable bowel syndrome %K internet %K symptom %K quality of life %D 2022 %7 10.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Irritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome. Objective: This study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness. Methods: This meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis. Results: The internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] –0.633; 95% CI –0.861 to –0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (–0.372; 95% CI –0.704 to –0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD –0.391; 95% CI –0.560 to –0.221), and long-term follow-up (SMD –0.357; 95% CI –0.541 to –0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period. Conclusions: This review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future. %M 35687389 %R 10.2196/35260 %U https://www.jmir.org/2022/6/e35260 %U https://doi.org/10.2196/35260 %U http://www.ncbi.nlm.nih.gov/pubmed/35687389 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e35591 %T Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review %A Vial,Stéphane %A Boudhraâ,Sana %A Dumont,Mathieu %+ Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, École de Design, Université du Québec à Montréal, 1440 rue Sanguinet, Montréal, QC, H2X 3X9, Canada, 1 514 987 3000 ext 3919, vial.stephane@uqam.ca %K design %K human-centered design %K user experience %K mental health %K digital mental health %D 2022 %7 7.6.2022 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development. Objective: The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research. Methods: An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies. Results: A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41%), codesign (6/27, 22%), user-centered design (5/27, 19%), or a specific design method (5/27, 19%). Just over half (15/27, 56%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27% (8/30) of all the included studies explicitly mentioned the presence of designers on their team. Conclusions: Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research. %M 35671081 %R 10.2196/35591 %U https://mental.jmir.org/2022/6/e35591 %U https://doi.org/10.2196/35591 %U http://www.ncbi.nlm.nih.gov/pubmed/35671081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e30065 %T Computerized Psychological Interventions in Veterans and Service Members: Systematic Review of Randomized Controlled Trials %A Pearson,Rahel %A Carl,Emily %A Creech,Suzannah K %+ Veterans Health Administration Veterans Integrated Service Network 17, Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive (151C), Waco, TX, 76711, United States, 1 2542975155, rahel.pearson@va.gov %K computer %K digital %K internet %K interventions %K veterans %K service members %K review %K mobile phone %D 2022 %7 3.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Computerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings. Objective: In this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research. Methods: Systematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non–computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes. Results: This review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes. Conclusions: Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment. %M 35657663 %R 10.2196/30065 %U https://www.jmir.org/2022/6/e30065 %U https://doi.org/10.2196/30065 %U http://www.ncbi.nlm.nih.gov/pubmed/35657663 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e35099 %T Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis %A Rodríguez-Rivas,Matías E %A Cangas,Adolfo J %A Cariola,Laura A %A Varela,Jorge J %A Valdebenito,Sara %+ Facultad de Psicología, Universidad del Desarrollo, Avenida Plaza 680, Santiago, Chile, 56 223279110, matrodriguezr@udd.cl %K stigma %K mental illness %K technology-based %K serious games %K virtual reality %K e-contact %K simulation intervention %K internet intervention %K meta-analysis %D 2022 %7 30.5.2022 %9 Review %J JMIR Serious Games %G English %X Background: Stigma toward people with mental illness presents serious consequences for the impacted individuals, such as social exclusion and increased difficulties in the recovery process. Recently, several interventions have been developed to mitigate public stigma, based on the use of innovative technologies, such as virtual reality and video games. Objective: This review aims to systematically review, synthesize, measure, and critically discuss experimental studies that measure the effect of technological interventions on stigmatization levels. Methods: This systematic review and meta-analysis was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and included studies in English and Spanish published between 2016 and 2021. Searches were run in 5 different databases (ie, PubMed, PsycInfo, Scopus, Cochrane Library, and ScienceDirect). Only randomized controlled trials were included. Two independent reviewers determined the eligibility, extracted data, and rated methodological quality of the studies. Meta-analyses were performed using the Comprehensive Meta-Analysis software. Results: Based on the 1158 articles screened, 72 articles were evaluated as full text, of which 9 were included in the qualitative and quantitative syntheses. A diversity of interventions was observed, including video games, audiovisual simulation of hallucinations, virtual reality, and electronic contact with mental health services users. The meta-analysis (n=1832 participants) demonstrated that these interventions had a consistent medium effect on reducing the level of public stigma (d=–0.64; 95% CI 0.31-0.96; P<.001). Conclusions: Innovative interventions involving the use of technologies are an effective tool in stigma reduction, therefore new challenges are proposed and discussed for the demonstration of their adaptability to different contexts and countries, thus leading to their massification. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021261935; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021261935 %M 35635744 %R 10.2196/35099 %U https://games.jmir.org/2022/2/e35099 %U https://doi.org/10.2196/35099 %U http://www.ncbi.nlm.nih.gov/pubmed/35635744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e26015 %T eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review %A Stewart,Elizabeth %A Milton,Alyssa %A Yee,Hannah Frances %A Song,Michael Jae %A Roberts,Anna %A Davenport,Tracey %A Hickie,Ian %+ Brain and Mind Centre, The University of Sydney, 94-100 Mallett Street Camperdown, Sydney, 2050, Australia, 61 0404060549, lizziestewart@gmail.com %K eHealth %K children %K young people %K health %K technology %K mobile phone %D 2022 %7 12.5.2022 %9 Review %J J Med Internet Res %G English %X Background: eHealth tools that assess and track health outcomes in children or young people are an emerging type of technology that has the potential to reform health service delivery and facilitate integrated, interdisciplinary care. Objective: The aim of this review is to summarize eHealth tools that have assessed and tracked health in children or young people to provide greater clarity around the populations and settings in which they have been used, characteristics of digital devices (eg, health domains, respondents, presence of tracking, and connection to care), primary outcomes, and risks and challenges of implementation. Methods: A search was conducted in PsycINFO, PubMed or MEDLINE, and Embase in April 2020. Studies were included if they evaluated a digital device whose primary purpose was to assess and track health, focused on children or young people (birth to the age of 24 years), reported original research, and were published in peer-reviewed journals in English. Results: A total of 39 papers were included in this review. The sample sizes ranged from 7 to 149,329 participants (median 163, mean 5155). More studies were conducted in urban (18/39, 46%) regions than in rural (3/39, 8%) regions or a combination of urban and rural areas (8/39, 21%). Devices were implemented in three main settings: outpatient health clinics (12/39, 31%), hospitals (14/39, 36%), community outreach (10/39, 26%), or a combination of these settings (3/39, 8%). Mental and general health were the most common health domains assessed, with a single study assessing multiple health domains. Just under half of the devices tracked children’s health over time (16/39, 41%), and two-thirds (25/39, 64%) connected children or young people to clinical care. It was more common for information to be collected from a single informant (ie, the child or young person, trained health worker, clinician, and parent or caregiver) than from multiple informants. The health of children or young people was assessed as a primary or secondary outcome in 36% (14/39) of studies; however, only 3% (1/39) of studies assessed whether using the digital tool improved the health of users. Most papers reported early phase research (formative or process evaluations), with fewer outcome evaluations and only 3 randomized controlled trials. Identified challenges or risks were related to accessibility, clinical utility and safety, uptake, data quality, user interface or design aspects of the device, language proficiency or literacy, sociocultural barriers, and privacy or confidentiality concerns; ways to address these barriers were not thoroughly explored. Conclusions: eHealth tools that assess and track health in children or young people have the potential to enhance health service delivery; however, a strong evidence base validating the clinical utility, efficacy, and safety of tools is lacking, and more thorough investigation is needed to address the risks and challenges of using these emerging technologies in clinical care. At present, there is greater potential for the tools to facilitate multi-informant, multidomain assessments and longitudinally track health over time and room for further implementation in rural or remote regions and community settings around the world. %M 35550285 %R 10.2196/26015 %U https://www.jmir.org/2022/5/e26015 %U https://doi.org/10.2196/26015 %U http://www.ncbi.nlm.nih.gov/pubmed/35550285 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35159 %T Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review %A Philippe,Tristan J %A Sikder,Naureen %A Jackson,Anna %A Koblanski,Maya E %A Liow,Eric %A Pilarinos,Andreas %A Vasarhelyi,Krisztina %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 604 875 4111 ext 64710, Krisztina.Vasarhelyi@vch.ca %K digital health %K telepsychology %K computer-assisted therapy %K online therapy %K mobile applications %K mobile apps %K telemedicine %K telepsychiatry %K virtual reality exposure therapy %K mental health %K COVID-19 %D 2022 %7 12.5.2022 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. Objective: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. Methods: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. Results: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions. %M 35551058 %R 10.2196/35159 %U https://mental.jmir.org/2022/5/e35159 %U https://doi.org/10.2196/35159 %U http://www.ncbi.nlm.nih.gov/pubmed/35551058 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33551 %T Internet-Delivered Interventions for Depression and Anxiety Symptoms in Children and Young People: Systematic Review and Meta-analysis %A Eilert,Nora %A Wogan,Rebecca %A Leen,Aisling %A Richards,Derek %+ e-Mental Health Group, School of Psychology, University of Dublin Trinity College, College Green, Dublin, D02 PN40, Ireland, 353 18961886, neilert@tcd.ie %K internet-delivered interventions %K children and young people %K depression %K anxiety %K digital health %D 2022 %7 12.5.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP). Objective: In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP. Methods: Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol. Results: A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=−0.25, 95% CI −0.38 to −0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=−0.27, 95% CI −0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=−0.01, 95% CI −0.23 to 0.21; P=.94). Conclusions: The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP. Trial Registration: PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171 %M 35551071 %R 10.2196/33551 %U https://pediatrics.jmir.org/2022/2/e33551 %U https://doi.org/10.2196/33551 %U http://www.ncbi.nlm.nih.gov/pubmed/35551071 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e34655 %T Acceptability of Web-Based Mental Health Interventions in the Workplace: Systematic Review %A Scheutzow,Johanna %A Attoe,Chris %A Harwood,Joshua %+ Department of Psychosis, Institute of Psychiatry, Psychology and Neuroscience, School of Academic Psychiatry, King’s College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, johanna.scheutzow2512@gmail.com %K acceptability %K e-mental health %K online mental health interventions %K occupational online interventions %K employees %K mobile phone %D 2022 %7 11.5.2022 %9 Review %J JMIR Ment Health %G English %X Background: Web-based interventions have proven to be effective not only in clinical populations but also in the occupational setting. Recent studies conducted in the work environment have focused on the effectiveness of these interventions. However, the role of employees’ acceptability of web-based interventions and programs has not yet enjoyed a similar level of attention. Objective: The objective of this systematic review was to conduct the first comprehensive study on employees’ level of acceptability of web-based mental health interventions based on direct and indirect measures, outline the utility of different types of web-based interventions for work-related mental health issues, and build a research base in the field. Methods: The search was conducted between October 2018 and July 2019 and allowed for any study design. The studies used either qualitative or quantitative data sources. The web-based interventions were generally aimed at supporting employees with their mental health issues. The study characteristics were outlined in a table as well as graded based on their quality using a traffic light schema. The level of acceptability was individually rated using commonly applied methods, including percentile quartiles ranging from low to very high. Results: A total of 1303 studies were identified through multiple database searches and additional resources, from which 28 (2%) were rated as eligible for the synthesis. The results of employees’ acceptability levels were mixed, and the studies were very heterogeneous in design, intervention characteristics, and population. Approximately 79% (22/28) of the studies outlined acceptability measures from high to very high, and 54% (15/28) of the studies reported acceptability levels from low to moderate (overlap when studies reported both quantitative and qualitative results). Qualitative studies also provided insights into barriers and preferences, including simple and tailored application tools as well as the preference for nonstigmatized language. However, there were multiple flaws in the methodology of the studies, such as the blinding of participants and personnel. Conclusions: The results outline the need for further research with more homogeneous acceptability studies to draw a final conclusion. However, the underlying results show that there is a tendency toward general acceptability of web-based interventions in the workplace, with findings of general applicability to the use of web-based mental health interventions. %M 35544305 %R 10.2196/34655 %U https://mental.jmir.org/2022/5/e34655 %U https://doi.org/10.2196/34655 %U http://www.ncbi.nlm.nih.gov/pubmed/35544305 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e25249 %T Data Visualization for Chronic Neurological and Mental Health Condition Self-management: Systematic Review of User Perspectives %A Polhemus,Ashley %A Novak,Jan %A Majid,Shazmin %A Simblett,Sara %A Morris,Daniel %A Bruce,Stuart %A Burke,Patrick %A Dockendorf,Marissa F %A Temesi,Gergely %A Wykes,Til %+ Merck Research Labs, Information Technology, Merck, Sharpe, & Dohme, The Circle 66, Zurich, 8058, Switzerland, 41 764922388, ashley.polhemus@uzh.ch %K digital health %K remote measurement technology %K neurology %K mental health %K data visualization %K user-centered design %D 2022 %7 28.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Remote measurement technologies (RMT) such as mobile health devices and apps are increasingly used by those living with chronic neurological and mental health conditions. RMT enables real-world data collection and regular feedback, providing users with insights about their own conditions. Data visualizations are an integral part of RMT, although little is known about visualization design preferences from the perspectives of those living with chronic conditions. Objective: The aim of this review was to explore the experiences and preferences of individuals with chronic neurological and mental health conditions on data visualizations derived from RMT to manage health. Methods: In this systematic review, we searched peer-reviewed literature and conference proceedings (PubMed, IEEE Xplore, EMBASE, Web of Science, Association for Computing Machinery Computer-Human Interface proceedings, and the Cochrane Library) for original papers published between January 2007 and September 2021 that reported perspectives on data visualization of people living with chronic neurological and mental health conditions. Two reviewers independently screened each abstract and full-text article, with disagreements resolved through discussion. Studies were critically appraised, and extracted data underwent thematic synthesis. Results: We identified 35 eligible publications from 31 studies representing 12 conditions. Coded data coalesced into 3 themes: desire for data visualization, impact of visualizations on condition management, and visualization design considerations. Data visualizations were viewed as an integral part of users’ experiences with RMT, impacting satisfaction and engagement. However, user preferences were diverse and often conflicting both between and within conditions. Conclusions: When used effectively, data visualizations are valuable, engaging components of RMT. They can provide structure and insight, allowing individuals to manage their own health more effectively. However, visualizations are not “one-size-fits-all,” and it is important to engage with potential users during visualization design to understand when, how, and with whom the visualizations will be used to manage health. %M 35482368 %R 10.2196/25249 %U https://mental.jmir.org/2022/4/e25249 %U https://doi.org/10.2196/25249 %U http://www.ncbi.nlm.nih.gov/pubmed/35482368 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e35928 %T Natural Language Processing Methods and Bipolar Disorder: Scoping Review %A Harvey,Daisy %A Lobban,Fiona %A Rayson,Paul %A Warner,Aaron %A Jones,Steven %+ Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4YG, United Kingdom, 44 152465201, d.harvey4@lancaster.ac.uk %K bipolar disorder %K mental health %K mental illness %K natural language processing %K computational linguistics %D 2022 %7 22.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Health researchers are increasingly using natural language processing (NLP) to study various mental health conditions using both social media and electronic health records (EHRs). There is currently no published synthesis that relates specifically to the use of NLP methods for bipolar disorder, and this scoping review was conducted to synthesize valuable insights that have been presented in the literature. Objective: This scoping review explored how NLP methods have been used in research to better understand bipolar disorder and identify opportunities for further use of these methods. Methods: A systematic, computerized search of index and free-text terms related to bipolar disorder and NLP was conducted using 5 databases and 1 anthology: MEDLINE, PsycINFO, Academic Search Ultimate, Scopus, Web of Science Core Collection, and the ACL Anthology. Results: Of 507 identified studies, a total of 35 (6.9%) studies met the inclusion criteria. A narrative synthesis was used to describe the data, and the studies were grouped into four objectives: prediction and classification (n=25), characterization of the language of bipolar disorder (n=13), use of EHRs to measure health outcomes (n=3), and use of EHRs for phenotyping (n=2). Ethical considerations were reported in 60% (21/35) of the studies. Conclusions: The current literature demonstrates how language analysis can be used to assist in and improve the provision of care for people living with bipolar disorder. Individuals with bipolar disorder and the medical community could benefit from research that uses NLP to investigate risk-taking, web-based services, social and occupational functioning, and the representation of gender in bipolar disorder populations on the web. Future research that implements NLP methods to study bipolar disorder should be governed by ethical principles, and any decisions regarding the collection and sharing of data sets should ultimately be made on a case-by-case basis, considering the risk to the data participants and whether their privacy can be ensured. %M 35451984 %R 10.2196/35928 %U https://mental.jmir.org/2022/4/e35928 %U https://doi.org/10.2196/35928 %U http://www.ncbi.nlm.nih.gov/pubmed/35451984 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35940 %T Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis %A Imai,Hissei %A Tajika,Aran %A Narita,Hisashi %A Yoshinaga,Naoki %A Kimura,Kenichi %A Nakamura,Hideki %A Takeshima,Nozomi %A Hayasaka,Yu %A Ogawa,Yusuke %A Furukawa,Toshi %+ Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 75 753 9491, ihits@hotmail.com %K randomized controlled trial %K RCT %K information technology %K psychotherapy %K treatment adherence %K anxiety disorder %K anxiety %K OCD %K obsessive-compulsive disorder %K systematic review %K meta-analysis %K mental health %K computer-assisted %K therapy %K efficacy %K acceptability %K eHealth %K mental illness %D 2022 %7 21.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective: This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods: Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results: We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions: Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644 %M 35451993 %R 10.2196/35940 %U https://www.jmir.org/2022/4/e35940 %U https://doi.org/10.2196/35940 %U http://www.ncbi.nlm.nih.gov/pubmed/35451993 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e36094 %T Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review %A Guemghar,Imane %A Pires de Oliveira Padilha,Paula %A Abdel-Baki,Amal %A Jutras-Aswad,Didier %A Paquette,Jesseca %A Pomey,Marie-Pascale %+ Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 850 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 343 6111 ext 1364, marie-pascale.pomey@umontreal.ca %K social robots %K socially assistive robots %K SARs %K mental health %K mental health services %K dementia %K autism spectrum disorder %K schizophrenia %K depression %K scoping review %D 2022 %7 19.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O’Malley’s framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. %M 35438639 %R 10.2196/36094 %U https://mental.jmir.org/2022/4/e36094 %U https://doi.org/10.2196/36094 %U http://www.ncbi.nlm.nih.gov/pubmed/35438639 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33450 %T Problematic Social Media Use in Adolescents and Young Adults: Systematic Review and Meta-analysis %A Shannon,Holly %A Bush,Katie %A Villeneuve,Paul J %A Hellemans,Kim GC %A Guimond,Synthia %+ Department of Psychiatry, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 6135708402, synthia.guimond@theroyal.ca %K problematic social media use %K depression %K anxiety %K stress %D 2022 %7 14.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Technology is ever evolving, with more and more diverse activities becoming possible on screen-based devices. However, participating in a heavy screen-based lifestyle may come at a cost. Our hypothesis was that problematic social media use increased the prevalence of mental health outcomes. Objective: This study seeks to systematically examine problematic social media use in youth and its association with symptoms of depression, anxiety, and stress. Methods: A systematic search was conducted to identify studies in adolescents and young adults, using the databases Engineering Village, Psycinfo, Pubmed, and Web of Science. A total of 18 studies were identified, with a total of 9269 participants in our review and included in the meta-analysis. Results: Our metaregression shows moderate but statistically significant correlations between problematic social media use and depression (r=0.273, P<.001), anxiety (r=0.348, P<.001), and stress (r=0.313, P<.001). We did not find evidence of heterogeneity of these summary correlations by age, gender, or year of publication. Conclusions: This study provides further evidence of the association between problematic social media use and negative mental health among adolescents and young adults and supports future research to focus on the underlying mechanisms of problematic use of social media. Trial Registration: PROSPERO CRD42021222309; https://tinyurl.com/2p9y4bjx %M 35436240 %R 10.2196/33450 %U https://mental.jmir.org/2022/4/e33450 %U https://doi.org/10.2196/33450 %U http://www.ncbi.nlm.nih.gov/pubmed/35436240 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29842 %T Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis %A Wickersham,Alice %A Barack,Tamara %A Cross,Lauren %A Downs,Johnny %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 (0)20 7848 0002, alice.wickersham@kcl.ac.uk %K adolescent %K anxiety %K depression %K meta-analysis %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Depression and anxiety are major public health concerns among adolescents. Computerized cognitive behavioral therapy (cCBT) has emerged as a potential intervention, but its efficacy in adolescents remains unestablished. Objective: This review aimed to systematically review and meta-analyze findings on the efficacy of cCBT for the treatment of adolescent depression and anxiety. Methods: Embase, PsycINFO, and Ovid MEDLINE were systematically searched for randomized controlled trials in English, which investigated the efficacy of cCBT for reducing self-reported depression or anxiety in adolescents aged 11 to 19 years. Titles, abstracts, and full texts were screened for eligibility by 2 independent researchers (TB and LC). A random-effects meta-analysis was conducted to pool the effects of cCBT on depression and anxiety symptom scores compared with the control groups. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool. Results: A total of 16 randomized controlled trials were eligible for inclusion in this review, of which 13 (81%) were included in the meta-analysis. The quality of the studies was mixed, with 5 (31%) studies rated as good overall, 2 (13%) rated as fair, and 9 (56%) rated as poor. Small but statistically significant effects of cCBT were detected, with cCBT conditions showing lower symptom scores at follow-up compared with control conditions for both anxiety (standardized mean difference −0.21, 95% CI −0.33 to −0.09; I2=36.2%) and depression (standardized mean difference −0.23, 95% CI −0.39 to −0.07; I2=59.5%). Secondary analyses suggested that cCBT may be comparable with alternative, active interventions (such as face-to-face therapy or treatment as usual). Conclusions: This meta-analysis reinforces the efficacy of cCBT for the treatment of anxiety and depression and is the first to examine this exclusively in adolescents. Future research could aim to identify the active components of these interventions toward optimizing their development and increasing the feasibility and acceptability of cCBT in this age group. Trial Registration: PROSPERO CRD42019141941; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941 %M 35404263 %R 10.2196/29842 %U https://www.jmir.org/2022/4/e29842 %U https://doi.org/10.2196/29842 %U http://www.ncbi.nlm.nih.gov/pubmed/35404263 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33307 %T Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review %A Bernstein,Emily E %A Weingarden,Hilary %A Wolfe,Emma C %A Hall,Margaret D %A Snorrason,Ivar %A Wilhelm,Sabine %+ Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 6177246032, eebernstein@mgh.harvard.edu %K digital health %K mental health %K cognitive behavioral therapy %K coaching %K guided %K mobile app %K emotional disorder %K mobile phone %D 2022 %7 8.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. Objective: The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. Methods: We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. Results: Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. Conclusions: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis. %M 35394434 %R 10.2196/33307 %U https://www.jmir.org/2022/4/e33307 %U https://doi.org/10.2196/33307 %U http://www.ncbi.nlm.nih.gov/pubmed/35394434 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e32824 %T The Current State and Validity of Digital Assessment Tools for Psychiatry: Systematic Review %A Martin-Key,Nayra A %A Spadaro,Benedetta %A Funnell,Erin %A Barker,Eleanor Jane %A Schei,Thea Sofie %A Tomasik,Jakub %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 diagnostic accuracy %K digital mental health %K digital questionnaire %K psychiatry %K systematic review %D 2022 %7 30.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Given the role digital technologies are likely to play in the future of mental health care, there is a need for a comprehensive appraisal of the current state and validity (ie, screening or diagnostic accuracy) of digital mental health assessments. Objective: The aim of this review is to explore the current state and validity of question-and-answer–based digital tools for diagnosing and screening psychiatric conditions in adults. Methods: This systematic review was based on the Population, Intervention, Comparison, and Outcome framework and was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO were systematically searched for articles published between 2005 and 2021. A descriptive evaluation of the study characteristics and digital solutions and a quantitative appraisal of the screening or diagnostic accuracy of the included tools were conducted. Risk of bias and applicability were assessed using the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2. Results: A total of 28 studies met the inclusion criteria, with the most frequently evaluated conditions encompassing generalized anxiety disorder, major depressive disorder, and any depressive disorder. Most of the studies used digitized versions of existing pen-and-paper questionnaires, with findings revealing poor to excellent screening or diagnostic accuracy (sensitivity=0.32-1.00, specificity=0.37-1.00, area under the receiver operating characteristic curve=0.57-0.98) and a high risk of bias for most of the included studies. Conclusions: The field of digital mental health tools is in its early stages, and high-quality evidence is lacking. International Registered Report Identifier (IRRID): RR2-10.2196/25382 %M 35353053 %R 10.2196/32824 %U https://mental.jmir.org/2022/3/e32824 %U https://doi.org/10.2196/32824 %U http://www.ncbi.nlm.nih.gov/pubmed/35353053 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34760 %T Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews %A Villarreal-Zegarra,David %A Alarcon-Ruiz,Christoper A %A Melendez-Torres,GJ %A Torres-Puente,Roberto %A Navarro-Flores,Alba %A Cavero,Victoria %A Ambrosio-Melgarejo,Juan %A Rojas-Vargas,Jefferson %A Almeida,Guillermo %A Albitres-Flores,Leonardo %A Romero-Cabrera,Alejandra B %A Huarcaya-Victoria,Jeff %+ Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, Av Grau 800, Lima, 15001, Peru, 51 987382101, jeff.huarcaya@upsjb.edu.pe %K telemedicine %K digital health %K internet-based intervention %K mental health %K mental disorders %K systematic reviews %K qualitative research %K realist review %K mHealth %K eHealth %K telehealth %D 2022 %7 29.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. Objective: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. Methods: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. Results: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. Conclusions: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811 International Registered Report Identifier (IRRID): RR2-10.12688/f1000research.27150.2 %M 35348469 %R 10.2196/34760 %U https://mental.jmir.org/2022/3/e34760 %U https://doi.org/10.2196/34760 %U http://www.ncbi.nlm.nih.gov/pubmed/35348469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29114 %T Process and Outcome Evaluations of Smartphone Apps for Bipolar Disorder: Scoping Review %A Tatham,Iona %A Clarke,Ellisiv %A Grieve,Kelly Ann %A Kaushal,Pulkit %A Smeddinck,Jan %A Millar,Evelyn Barron %A Sharma,Aditya Narain %+ Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom, 44 1912875262, aditya.sharma@ncl.ac.uk %K child and adolescent mental health %K scoping review %K bipolar disorder %K mental health %D 2022 %7 23.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated. Objective: This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies. Methods: A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD. Results: Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD. Conclusions: Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD. %M 35319470 %R 10.2196/29114 %U https://www.jmir.org/2022/3/e29114 %U https://doi.org/10.2196/29114 %U http://www.ncbi.nlm.nih.gov/pubmed/35319470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33560 %T Use of Mobile and Wearable Artificial Intelligence in Child and Adolescent Psychiatry: Scoping Review %A Welch,Victoria %A Wy,Tom Joshua %A Ligezka,Anna %A Hassett,Leslie C %A Croarkin,Paul E %A Athreya,Arjun P %A Romanowicz,Magdalena %+ Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 5072556782, romanowicz.magdalena@mayo.edu %K mobile computing %K artificial intelligence %K wearable technologies %K child psychiatry %D 2022 %7 14.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Mental health disorders are a leading cause of medical disabilities across an individual’s lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising. Objective: This study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry. Methods: This scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus. Results: The initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals. Conclusions: Our scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials. %M 35285812 %R 10.2196/33560 %U https://www.jmir.org/2022/3/e33560 %U https://doi.org/10.2196/33560 %U http://www.ncbi.nlm.nih.gov/pubmed/35285812 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e31780 %T Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Greenwood,Hannah %A Krzyzaniak,Natalia %A Peiris,Ruwani %A Clark,Justin %A Scott,Anna Mae %A Cardona,Magnolia %A Griffith,Rebecca %A Glasziou,Paul %+ Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, 4226, Australia, 61 755955816 ext 55816, hgreenwo@bond.edu.au %K telemedicine %K psychology %K mental health %K psychotherapy %K primary health care %K behavioral sciences %K systematic review %D 2022 %7 11.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. Methods: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. Results: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI −0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI −0.40 to 0.39), function (SMD 0.13, 95% CI −0.16 to 0.42), working alliance client (SMD 0.11, 95% CI −0.34 to 0.57), working alliance therapist (SMD −0.16, 95% CI −0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI −0.30 to 0.53), or at any other time point (3, 6, and 12 months). Conclusions: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions. %M 35275081 %R 10.2196/31780 %U https://mental.jmir.org/2022/3/e31780 %U https://doi.org/10.2196/31780 %U http://www.ncbi.nlm.nih.gov/pubmed/35275081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e37440 %T Authors’ Reply to: Toward a Better Understanding of Quality Social Connections. Comment on “Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis” %A Dewa,Lindsay H %A Roberts,Lily %A Lawrance,Emma %A Ashrafian,Hutan %+ Institute of Global Health Innovation, Imperial College London, Reynolds Building, 3rd Floor, London, W6 8RP, United Kingdom, 44 02075940815, l.dewa@imperial.ac.uk %K mental health %K digital interventions %K young people %K quality social connection %K depression %K anxiety %K systematic review %K meta-analysis %K patient and public involvement %K mobile phone %D 2022 %7 11.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35275072 %R 10.2196/37440 %U https://www.jmir.org/2022/3/e37440 %U https://doi.org/10.2196/37440 %U http://www.ncbi.nlm.nih.gov/pubmed/35275072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e36739 %T Toward a Better Understanding of Quality Social Connections. Comment on “Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis” %A Deng,Huachu %A Qin,Xingan %+ Department of Gastrointestinal and Gland Surgery, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Qingxiu District, Nanning, 530000, China, 86 15277114948, drqinxingan@126.com %K mental health %K digital interventions %K young people %K quality social connection %K depression %K anxiety %K systematic review %K meta-analysis %K patient and public involvement %K mobile phone %D 2022 %7 11.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35275073 %R 10.2196/36739 %U https://www.jmir.org/2022/3/e36739 %U https://doi.org/10.2196/36739 %U http://www.ncbi.nlm.nih.gov/pubmed/35275073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28942 %T Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines %A Martinengo,Laura %A Stona,Anne-Claire %A Tudor Car,Lorainne %A Lee,Jimmy %A Griva,Konstadina %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047017, josip.car@ntu.edu.sg %K health literacy %K mental health literacy %K depression %K mobile apps %K apps %K telemedicine %K mHealth %K self-management %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non–evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user’s support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non–evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. %M 35262489 %R 10.2196/28942 %U https://www.jmir.org/2022/3/e28942 %U https://doi.org/10.2196/28942 %U http://www.ncbi.nlm.nih.gov/pubmed/35262489 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28301 %T Coaching to Support Mental Health Apps: Exploratory Narrative Review %A Meyer,Ashley %A Wisniewski,Hannah %A Torous,John %+ Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02115, United States, 1 6176676700, jtorous@bidmc.harvard.edu %K smartphone %K apps %K mental health %K coaching %K engagement %D 2022 %7 8.3.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The therapeutic alliance is crucial for the success of face-to-face therapies. Little is known about how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities such as smartphone apps. Objective: The aim of this paper was to assess how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities. Methods: We conducted a selected review to gather preliminary data about the role of coaching in mobile technology use for mental health care. We identified 26 trials using a 2019 review by Tønning et al and a 2021 scoping review by Tokgöz et al to assess how coaching is currently being used across different studies. Results: Our results showed a high level of heterogeneity as studies used varying types of coaching methods but provided little information about coaching protocols and training. Coaching was feasible by clinicians and nonclinicians, scheduled and on demand, and across all technologies ranging from phone calls to social media. Conclusions: Further research is required to better understand the effects of coaching in mobile mental health treatments, but examples offered from reviewed papers suggest several options to implement coaching today. Coaching based on replicable protocols that are verifiable for fidelity will enable the scaling of this model and a better exploration of the digital therapeutic alliance. %M 35258468 %R 10.2196/28301 %U https://humanfactors.jmir.org/2022/1/e28301 %U https://doi.org/10.2196/28301 %U http://www.ncbi.nlm.nih.gov/pubmed/35258468 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34221 %T Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review %A Thangavel,Gomathi %A Memedi,Mevludin %A Hedström,Karin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19 302471, gomathi.thangavel@oru.se %K social isolation %K loneliness %K review %K ICT %K older adults %K customization %K mobile phone %D 2022 %7 7.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77%) evaluated the usability and acceptance aspects, and few studies (11/39, 28%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. %M 35254273 %R 10.2196/34221 %U https://mental.jmir.org/2022/3/e34221 %U https://doi.org/10.2196/34221 %U http://www.ncbi.nlm.nih.gov/pubmed/35254273 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e27244 %T Detecting and Measuring Depression on Social Media Using a Machine Learning Approach: Systematic Review %A Liu,Danxia %A Feng,Xing Lin %A Ahmed,Farooq %A Shahid,Muhammad %A Guo,Jing %+ Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China, 86 18086471505, jing624218@bjmu.edu.cn %K depression %K machine learning %K social media %D 2022 %7 1.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Detection of depression gained prominence soon after this troublesome disease emerged as a serious public health concern worldwide. Objective: This systematic review aims to summarize the findings of previous studies concerning applying machine learning (ML) methods to text data from social media to detect depressive symptoms and to suggest directions for future research in this area. Methods: A bibliographic search was conducted for the period of January 1990 to December 2020 in Google Scholar, PubMed, Medline, ERIC, PsycINFO, and BioMed. Two reviewers retrieved and independently assessed the 418 studies consisting of 322 articles identified through database searching and 96 articles identified through other sources; 17 of the studies met the criteria for inclusion. Results: Of the 17 studies, 10 had identified depression based on researcher-inferred mental status, 5 had identified it based on users’ own descriptions of their mental status, and 2 were identified based on community membership. The ML approaches of 13 of the 17 studies were supervised learning approaches, while 3 used unsupervised learning approaches; the remaining 1 study did not describe its ML approach. Challenges in areas such as sampling, optimization of approaches to prediction and their features, generalizability, privacy, and other ethical issues call for further research. Conclusions: ML approaches applied to text data from users on social media can work effectively in depression detection and could serve as complementary tools in public mental health practice. %M 35230252 %R 10.2196/27244 %U https://mental.jmir.org/2022/3/e27244 %U https://doi.org/10.2196/27244 %U http://www.ncbi.nlm.nih.gov/pubmed/35230252 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33058 %T Methods and Applications of Social Media Monitoring of Mental Health During Disasters: Scoping Review %A Teague,Samantha J %A Shatte,Adrian B R %A Weller,Emmelyn %A Fuller-Tyszkiewicz,Matthew %A Hutchinson,Delyse M %+ Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 924 68440, sam.teague@deakin.edu.au %K social media %K SNS %K mental health %K disaster %K big data %K digital psychiatry %D 2022 %7 28.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: With the increasing frequency and magnitude of disasters internationally, there is growing research and clinical interest in the application of social media sites for disaster mental health surveillance. However, important questions remain regarding the extent to which unstructured social media data can be harnessed for clinically meaningful decision-making. Objective: This comprehensive scoping review synthesizes interdisciplinary literature with a particular focus on research methods and applications. Methods: A total of 6 health and computer science databases were searched for studies published before April 20, 2021, resulting in the identification of 47 studies. Included studies were published in peer-reviewed outlets and examined mental health during disasters or crises by using social media data. Results: Applications across 31 mental health issues were identified, which were grouped into the following three broader themes: estimating mental health burden, planning or evaluating interventions and policies, and knowledge discovery. Mental health assessments were completed by primarily using lexical dictionaries and human annotations. The analyses included a range of supervised and unsupervised machine learning, statistical modeling, and qualitative techniques. The overall reporting quality was poor, with key details such as the total number of users and data features often not being reported. Further, biases in sample selection and related limitations in generalizability were often overlooked. Conclusions: The application of social media monitoring has considerable potential for measuring mental health impacts on populations during disasters. Studies have primarily conceptualized mental health in broad terms, such as distress or negative affect, but greater focus is required on validating mental health assessments. There was little evidence for the clinical integration of social media–based disaster mental health monitoring, such as combining surveillance with social media–based interventions or developing and testing real-world disaster management tools. To address issues with study quality, a structured set of reporting guidelines is recommended to improve the methodological quality, replicability, and clinical relevance of future research on the social media monitoring of mental health during disasters. %M 35225815 %R 10.2196/33058 %U https://mental.jmir.org/2022/2/e33058 %U https://doi.org/10.2196/33058 %U http://www.ncbi.nlm.nih.gov/pubmed/35225815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33337 %T Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review %A Wan Mohd Yunus,Wan Mohd Azam %A Matinolli,Hanna-Maria %A Waris,Otto %A Upadhyaya,Subina %A Vuori,Miika %A Korpilahti-Leino,Tarja %A Ristkari,Terja %A Koffert,Tarja %A Sourander,Andre %+ Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, Turku, 20014, Finland, 358 503653447, andsou@utu.fi %K pregnancy %K antenatal depression %K systematic review %K cognitive behavior therapy %K digital interventions %K COVID-19 %D 2022 %7 23.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. Objective: Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. Methods: A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Results: The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. Conclusions: Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159 %M 35195532 %R 10.2196/33337 %U https://www.jmir.org/2022/2/e33337 %U https://doi.org/10.2196/33337 %U http://www.ncbi.nlm.nih.gov/pubmed/35195532 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31116 %T eHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis %A Silang,Katherine A %A Sohal,Pooja R %A Bright,Katherine S %A Leason,Jennifer %A Roos,Leslie %A Lebel,Catherine %A Giesbrecht,Gerald F %A Tomfohr-Madsen,Lianne M %+ Department of Psychology, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 2243, ltomfohr@ucalgary.ca %K eHealth %K pregnancy %K depression %K anxiety %K insomnia %K mobile phone %D 2022 %7 21.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. Objective: The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. Methods: A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. Results: In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. Conclusions: eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954 %M 35188471 %R 10.2196/31116 %U https://mental.jmir.org/2022/2/e31116 %U https://doi.org/10.2196/31116 %U http://www.ncbi.nlm.nih.gov/pubmed/35188471 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e28502 %T Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review %A Schroeder,Alexandra H %A Bogie,Bryce J M %A Rahman,Tabassum T %A Thérond,Alexandra %A Matheson,Hannah %A Guimond,Synthia %+ The Royal’s Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada, 1 (613) 722 6521 ext 6586, synthia.guimond@uqo.ca %K auditory verbal hallucinations %K cognitive remediation %K functional outcomes %K neurocognition %K paranoia %K psychosis %K schizophrenia %K social skills %K virtual reality (VR) %K vocational skills %D 2022 %7 18.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear. Objective: This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research. Methods: This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study. Results: A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance. Conclusions: VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life. %M 35179501 %R 10.2196/28502 %U https://mental.jmir.org/2022/2/e28502 %U https://doi.org/10.2196/28502 %U http://www.ncbi.nlm.nih.gov/pubmed/35179501 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e23700 %T The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis %A Wang,Hsin-Yi %A Cheng,Cecilia %+ Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong, Hong Kong, 852 39174224, ceci-cheng@hku.hk %K gaming motivation %K problematic gaming %K gaming disorder %K video gaming %K online gaming %K compulsive gaming %K escapism %K culture %K cross-cultural comparison, cultural individualism %D 2022 %7 17.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming. Objective: This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD. Methods: We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation. Results: The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions. Conclusions: This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations. %M 35175204 %R 10.2196/23700 %U https://mental.jmir.org/2022/2/e23700 %U https://doi.org/10.2196/23700 %U http://www.ncbi.nlm.nih.gov/pubmed/35175204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30810 %T Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review %A Moon,Khatiya %A Sobolev,Michael %A Kane,John M %+ Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 11004, United States, 1 718 470 4597, KMoon2@northwell.edu %K collaborative care %K integrated care %K augmented care %K digital health %K mobile health %K behavioral health %K review %D 2022 %7 16.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective: This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods: This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results: A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. Conclusions: The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials. %M 35171105 %R 10.2196/30810 %U https://mental.jmir.org/2022/2/e30810 %U https://doi.org/10.2196/30810 %U http://www.ncbi.nlm.nih.gov/pubmed/35171105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28093 %T Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis %A Evans,Kerry %A Rennick-Egglestone,Stefan %A Cox,Serena %A Kuipers,Yvonne %A Spiby,Helen %+ School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2HA, United Kingdom, 44 7596783920, kerry.evans1@nottingham.ac.uk %K anxiety %K pregnancy %K antenatal %K systematic review %K digital interventions %K eHealth %K remote interventions %K electronic health %K parenting %K remote delivery %K therapy %K CBT %K fear %K distress %K mobile phone %D 2022 %7 15.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. Objective: This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. Methods: This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women’s views, and opinions were included. Results: Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference −0.49, 95% CI −0.75 to −0.22; standardized mean difference −0.48, 95% CI −0.75 to −0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. Conclusions: There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms. %M 35166688 %R 10.2196/28093 %U https://www.jmir.org/2022/2/e28093 %U https://doi.org/10.2196/28093 %U http://www.ncbi.nlm.nih.gov/pubmed/35166688 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e29137 %T The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis %A Abd-alrazaq,Alaa %A Alajlani,Mohannad %A Alhuwail,Dari %A Schneider,Jens %A Akhu-Zaheya,Laila %A Ahmed,Arfan %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar, 974 55708566, mhouseh@hbku.edu.qa %K serious games %K exergames %K anxiety %K computerized cognitive behavioral therapy games %K biofeedback games %K systematic reviews %K meta-analysis %K mobile phone %D 2022 %7 14.2.2022 %9 Review %J JMIR Serious Games %G English %X Background: Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review. Methods: We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03). Conclusions: This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety. %M 35156932 %R 10.2196/29137 %U https://games.jmir.org/2022/1/e29137 %U https://doi.org/10.2196/29137 %U http://www.ncbi.nlm.nih.gov/pubmed/35156932 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28771 %T The Effect of Digital Health Interventions on Parents’ Mental Health Literacy and Help Seeking for Their Child’s Mental Health Problem: Systematic Review %A Peyton,Daniel %A Goods,Marquelle %A Hiscock,Harriet %+ Murdoch Children's Research Institute, 50 Flemington Road, Parkville, 3052, Australia, 61 93456910, harriet.hiscock@rch.org.au %K child %K mental health %K systematic review %K caregiver %K health literacy %K digital health %D 2022 %7 10.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Many children with mental health problems do not receive professional help. Despite the frequent use of digital health interventions (DHIs) such as websites or web-based service navigation platforms, their effects on parents’ mental health literacy, help seeking, or uptake of professional services are unclear. Objective: This study aims to provide a systematic review and narrative synthesis to describe whether DHIs improve the aforementioned parental outcomes. Methods: Databases, including CINAHL, Embase, MEDLINE OVID, PsycINFO, and PubMed (2000-2020), were accessed. Studies were included if they evaluated quantitative changes in mental health literacy, help seeking, or the uptake of services by parents of children with mental health problems. Theoretical frameworks, sample sizes, participant demographics, recruitment, interventions, DHI use, results, and health economic measures were used for data extraction. Results: Of the 11,379 search results, 5 (0.04%) studies met the inclusion criteria. One randomized controlled trial found the reduced uptake of services after using a DHI coupled with a telephone coach for a child’s behavioral problem. Of 3 studies, 2 (66.7%) found statistically significant improvement in mental health literacy for attention-deficit/hyperactivity disorder but had no control group. One study found nonsignificant improvement in mental health literacy and help-seeking attitudes toward anxiety and depression compared with those in active controls. All studies were rated as having a high or serious risk of bias. Search results were affected because of a single reviewer screening articles, overall low-quality studies, and a lack of consistent nomenclature. Conclusions: There is no high-quality evidence that DHIs can improve parents’ mental health literacy, help seeking, or uptake of services. More research is needed to evaluate DHIs by using rigorous study designs and consistent measures. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020130074; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020130074 %M 35142623 %R 10.2196/28771 %U https://www.jmir.org/2022/2/e28771 %U https://doi.org/10.2196/28771 %U http://www.ncbi.nlm.nih.gov/pubmed/35142623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e26736 %T The Effectiveness of Virtual Reality Exposure–Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis %A van Loenen,Inge %A Scholten,Willemijn %A Muntingh,Anna %A Smit,Johannes %A Batelaan,Neeltje %+ GGZ inGeest Specialized Mental Health Care, Oldenaller 1, Amsterdam, 1081HJ, Netherlands, 31 207884666, w.scholten@ggzingeest.nl %K anxiety disorders %K virtual reality %K virtual reality exposure therapy %K cognitive behavioral therapy %K meta-analysis %K mobile phone %D 2022 %7 10.2.2022 %9 Review %J J Med Internet Res %G English %X Background: In recent years, virtual reality exposure–based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders. Objective: The objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared. Methods: Studies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions. Results: A total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=−0.490, 95% CI −0.82 to −0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI −0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias. Conclusions: The results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings. %M 35142632 %R 10.2196/26736 %U https://www.jmir.org/2022/2/e26736 %U https://doi.org/10.2196/26736 %U http://www.ncbi.nlm.nih.gov/pubmed/35142632 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31018 %T Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review %A Skaczkowski,Gemma %A van der Kruk,Shannen %A Loxton,Sophie %A Hughes-Barton,Donna %A Howell,Cate %A Turnbull,Deborah %A Jensen,Neil %A Smout,Matthew %A Gunn,Kate %+ Department of Rural Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, 5001, Australia, 61 417852537, kate.gunn@unisa.edu.au %K web-based interventions %K depression %K anxiety %K suicide %K well-being %K mental health %K technology %K access to health care %D 2022 %7 8.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. Objective: This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. Results: Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%. Conclusions: There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist. %M 35133281 %R 10.2196/31018 %U https://mental.jmir.org/2022/2/e31018 %U https://doi.org/10.2196/31018 %U http://www.ncbi.nlm.nih.gov/pubmed/35133281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27388 %T Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores %A Leong,Qiao Ying %A Sridhar,Shreya %A Blasiak,Agata %A Tadeo,Xavier %A Yeo,GeckHong %A Remus,Alexandria %A Ho,Dean %+ N.1 Institute for Health, National University of Singapore, 28 Medical Drive, Singapore, 117456, Singapore, 65 86118796, bieamr@nus.edu.sg %K mHealth %K digital medicine %K anxiety %K depression %K systematic review %K mental health conditions %K mobile phone %D 2022 %7 4.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. Objective: The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. Methods: A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores—Google Play Store and Apple App Store—to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. Results: The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. Conclusions: A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality—utility, safety, and effectiveness—of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms. %M 35119370 %R 10.2196/27388 %U https://www.jmir.org/2022/2/e27388 %U https://doi.org/10.2196/27388 %U http://www.ncbi.nlm.nih.gov/pubmed/35119370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30359 %T Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review %A Kane,Hélène %A Gourret Baumgart,Jade %A El-Hage,Wissam %A Deloyer,Jocelyn %A Maes,Christine %A Lebas,Marie-Clotilde %A Marazziti,Donatella %A Thome,Johannes %A Fond-Harmant,Laurence %A Denis,Frédéric %+ Laboratoire Éducation, Éthique, Santé, Université de Tours, Boulevard Tonnellé, Tours, 37032, France, 33 279060019, helene.kane@gmail.com %K COVID-19 %K e–mental health %K professional practices %K quality of care %K telepsychiatry %K videoconferencing %D 2022 %7 4.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. %M 34736224 %R 10.2196/30359 %U https://humanfactors.jmir.org/2022/1/e30359 %U https://doi.org/10.2196/30359 %U http://www.ncbi.nlm.nih.gov/pubmed/34736224 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e29621 %T Impact of Smartphone App–Based Psychological Interventions for Reducing Depressive Symptoms in People With Depression: Systematic Literature Review and Meta-analysis of Randomized Controlled Trials %A Serrano-Ripoll,Maria J %A Zamanillo-Campos,Rocío %A Fiol-DeRoque,Maria A %A Castro,Adoración %A Ricci-Cabello,Ignacio %+ Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Escola Graduada, 3, Palma de Mallorca, 07002, Spain, 34 971175883, mjserranor@yahoo.es %K smartphone technology %K mental health interventions %K depression %K eHealth %K mHealth %K apps %K systematic review %K meta-analysis %K mobile phone %D 2022 %7 27.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Depression is a serious, disabling mental disorder that severely affects quality of life. Patients with depression often do not receive adequate treatment. App-based psychotherapy is considered to have great potential to treat depression owing to its reach and easy accessibility. Objective: We aim to analyze the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Methods: We conducted a systematic literature review and meta-analysis. We searched Medline, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials from inception to December 23, 2020. We selected randomized controlled trials to examine the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Study selection, data extraction, and critical appraisal (using the Cochrane Risk of Bias tool for randomized studies and the ROBINS-I tool for nonrandomized studies) were conducted independently by 2 reviewers. Where possible, we pooled data using random effects meta-analyses to obtain estimates of the effect size of the intervention. We conducted post hoc meta-regression analyses to explore the factors associated with intervention success. Results: After screening 3468 unique references retrieved from bibliographic searches and assessing the eligibility of 79 full texts, we identified 12 trials (2859 participants) evaluating 14 different interventions. Of 14 trials, 7 (58%) were conducted in the United States; 3 (25%) trials, in Asia (Japan, South Korea, and China); 1 (8%) trial, in Australia; and 1 (8%) trial, in Germany. Of the 12 trials, 5 (42%) trials presented a low risk of bias. The mean duration of the interventions was 6.6 (SD 2.8) weeks. Two-thirds of the interventions were based on cognitive behavioral therapy alone or included it in combination with cognitive control therapy, positive psychology, brief behavioral activation, or mindfulness- and acceptance-based therapy. With no evidence of publication bias, a pooled analysis of 83% (10/12) of the trials and 86% (12/14) of the interventions showed that app-based interventions, compared with a control group receiving usual care or minimal intervention, produced a moderate reduction in depressive symptoms (standardized mean difference [SMD] −0.51, 95% CI −0.69 to −0.33; 2018/2859, 70.58% of the participants; I2=70%). Our meta-regression analyses indicated that there was a greater reduction in symptoms of depression (P=.04) in trials that included participants with moderate to severe depression (SMD −0.67, 95% CI −0.79 to −0.55), compared with trials with participants exhibiting mild to moderate depression (SMD −0.15, 95% CI −0.43 to −0.12). Conclusions: App-based interventions targeted at people with depression produce moderate reductions in the symptoms of depression. More methodologically robust trials are needed to confirm our findings, determine which intervention features are associated with greater improvements, and identify those populations most likely to benefit from this type of intervention. Trial Registration: PROSPERO CRD42019145689; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145689 %M 35084346 %R 10.2196/29621 %U https://mhealth.jmir.org/2022/1/e29621 %U https://doi.org/10.2196/29621 %U http://www.ncbi.nlm.nih.gov/pubmed/35084346 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26453 %T Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation %A Voth,Melissa %A Chisholm,Shannon %A Sollid,Hannah %A Jones,Chelsea %A Smith-MacDonald,Lorraine %A Brémault-Phillips,Suzette %+ Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street Edmonton, Edmonton, AB, T6G 2G4, Canada, 1 7804920404, cweiman@ualberta.ca %K occupational stress injury %K trauma %K mHealth %K resilience %K mental health %K military %K veteran %K public safety personnel %K OSI %K PTSD %K mental health intervention %K mobile phone %D 2022 %7 19.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. Objective: This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. Methods: The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. Results: In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. Conclusions: The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process. %M 35044307 %R 10.2196/26453 %U https://mhealth.jmir.org/2022/1/e26453 %U https://doi.org/10.2196/26453 %U http://www.ncbi.nlm.nih.gov/pubmed/35044307 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32331 %T The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis %A Abd-Alrazaq,Alaa %A Al-Jafar,Eiman %A Alajlani,Mohannad %A Toro,Carla %A Alhuwail,Dari %A Ahmed,Arfan %A Reagu,Shuja Mohd %A Al-Shorbaji,Najeeb %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, PO Box 34110, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K serious games %K exergames %K depression %K cognitive behavioral therapy %K systematic reviews %K meta-analysis %D 2022 %7 14.1.2022 %9 Review %J JMIR Serious Games %G English %X Background: Depression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings. Objective: This study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies. Methods: A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games). Results: From an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (P=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (P=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=.003). Conclusions: Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969 %M 35029530 %R 10.2196/32331 %U https://games.jmir.org/2022/1/e32331 %U https://doi.org/10.2196/32331 %U http://www.ncbi.nlm.nih.gov/pubmed/35029530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27939 %T Effectiveness of Live Health Professional–Led Group eHealth Interventions for Adult Mental Health: Systematic Review of Randomized Controlled Trials %A Currie,Cheryl L %A Larouche,Richard %A Voss,M Lauren %A Trottier,Maegan %A Spiwak,Rae %A Higa,Erin %A Scott,David R %A Tallow,Treena %+ Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada, 1 4033324060, cheryl.currie@uleth.ca %K systematic review %K telemedicine %K eHealth %K mHealth %K e-therapy %K mobile interventions %K internet %K adult %K mental health %K anxiety %K depression %K substance use %K bereavement %K physical activity %K CBT %K psychotherapy %K group %K synchronous %K videoconference %K teleconference %D 2022 %7 11.1.2022 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. Objective: This systematic review aims to assess experimental evidence for the effectiveness of live health professional–led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. Methods: Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. Results: Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional–led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional–led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. Conclusions: Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. Trial Registration: PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551 International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01479-3 %M 34878409 %R 10.2196/27939 %U https://www.jmir.org/2022/1/e27939 %U https://doi.org/10.2196/27939 %U http://www.ncbi.nlm.nih.gov/pubmed/34878409 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30286 %T Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review %A Ademiluyi,Adesoji %A Li,Chuqin %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte Charlotte, Woodward 310H, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 704 687 8668, apark11@uncc.edu %K cyberbullying %K cybervictimization %K cyberaggression %K bullying %K mental health %K social isolation %K social media %K mobile phone %D 2022 %7 4.1.2022 %9 Review %J JMIR Form Res %G English %X Background: The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors. Objective: This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions. Methods: Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research. Results: Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents. Conclusions: Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention. %M 34982712 %R 10.2196/30286 %U https://formative.jmir.org/2022/1/e30286 %U https://doi.org/10.2196/30286 %U http://www.ncbi.nlm.nih.gov/pubmed/34982712 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e27991 %T The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review %A Majid,Shazmin %A Reeves,Stuart %A Figueredo,Grazziela %A Brown,Susan %A Lang,Alexandra %A Moore,Matthew %A Morriss,Richard %+ School of Computer Science, Horizon Centre for Doctoral Training, University of Nottingham, Computer Science Building, Wollaton Rd, Nottingham, NG8 1BB, United Kingdom, 44 7713508981, shazmin.majid1@nottingham.ac.uk %K user-centered design %K participatory design %K human-computer interaction %K patient and public involvement %K self-monitoring technology %K bipolar disorder %K mobile phone %D 2021 %7 20.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9%) self-monitoring app was classified as having low user involvement, 4 (36%) self-monitoring apps were classified as having medium user involvement, and 2 (18%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care–based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. %M 34931992 %R 10.2196/27991 %U https://mental.jmir.org/2021/12/e27991 %U https://doi.org/10.2196/27991 %U http://www.ncbi.nlm.nih.gov/pubmed/34931992 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30000 %T Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review %A Saleem,Maham %A Kühne,Lisa %A De Santis,Karina Karolina %A Christianson,Lara %A Brand,Tilman %A Busse,Heide %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 42121856 ext 923, saleem@leibniz-bips.de %K digital interventions %K mental health promotion %K engagement %K scoping review %K mobile phone %D 2021 %7 20.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Digital interventions offer a solution to address the high demand for mental health promotion, especially when facing physical contact restrictions or lacking accessibility. Engagement with digital interventions is critical for their effectiveness; however, retaining users’ engagement throughout the intervention is challenging. It remains unclear what strategies facilitate engagement with digital interventions that target mental health promotion. Objective: Our aim is to conduct a scoping review to investigate user engagement strategies and methods to evaluate engagement with digital interventions that target mental health promotion in adults. Methods: This scoping review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. The search was conducted in 7 electronic databases from inception to April 2020. The inclusion criteria for studies were as follows: adult (aged ≥18 years) users of digital interventions for mental health promotion from the general population; any digital intervention for mental health promotion; and user engagement strategies described in the intervention design. We extracted the following data items: study characteristics, digital intervention (type and engagement strategy), evaluation of engagement strategy (method and result specifying whether the strategy was effective at facilitating engagement), and features of engagement (extent of use and subjective experience of users). Results: A total of 2766 studies were identified, of which 16 (0.58%) met the inclusion criteria. The 16 studies included randomized controlled trials (6/16, 37%), studies analyzing process data (5/16, 31%), observational studies (3/16, 19%), and qualitative studies (2/16, 13%). The digital interventions for mental health promotion were either web based (12/16, 75%) or mobile app based (4/16, 25%). The engagement strategies included personalized feedback about intervention content or users’ mental health status; guidance regarding content and progress through e-coaching; social forums, and interactivity with peers; content gamification; reminders; and flexibility and ease of use. These engagement strategies were deemed effective based on qualitative user feedback or responses on questionnaires or tools (4/16, 25%), usability data (5/16, 31%), or both (7/16, 44%). Most studies identified personalized support in the form of e-coaching, peer support through a social platform, personalized feedback, or joint videoconference sessions as an engaging feature. Conclusions: Personalized support during the intervention, access to social support, and personalized feedback seem to promote engagement with digital interventions for mental health promotion. These findings need to be interpreted with caution because the included studies were heterogeneous, had small sample sizes, and typically did not address engagement as the primary outcome. Despite the importance of user engagement for the effectiveness of digital interventions, this field has not yet received much attention. Further research is needed on the effectiveness of different strategies required to facilitate user engagement in digital interventions for mental health promotion. %M 34931995 %R 10.2196/30000 %U https://mental.jmir.org/2021/12/e30000 %U https://doi.org/10.2196/30000 %U http://www.ncbi.nlm.nih.gov/pubmed/34931995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26584 %T Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis %A Dewa,Lindsay H %A Lawrance,Emma %A Roberts,Lily %A Brooks-Hall,Ellie %A Ashrafian,Hutan %A Fontana,Gianluca %A Aylin,Paul %+ Institute of Global Health Innovation, Imperial College London, Reynolds Building, 3rd Floor, London, W6 8RP, United Kingdom, 44 020 7594 0815, l.dewa@imperial.ac.uk %K mental health %K digital interventions %K young people %K quality social connection %K depression %K anxiety %K systematic review %K meta-analysis %K patient and public involvement %K mobile phone %D 2021 %7 17.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. Objective: The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. Methods: A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. Results: Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (–25.6%, 95% CI –0.352 to –0.160; P<.001) and anxiety (–15.1%, 95% CI –0.251 to –0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. Conclusions: D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations. %M 34927592 %R 10.2196/26584 %U https://www.jmir.org/2021/12/e26584 %U https://doi.org/10.2196/26584 %U http://www.ncbi.nlm.nih.gov/pubmed/34927592 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30482 %T Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review %A Martinez,Kim %A Menéndez-Menéndez,Maria Isabel %A Bustillo,Andres %+ Department of History, Geography and Communication, University of Burgos, Don Juan de Austria, Burgos, 09001, Spain, 34 947 49 91 12, kmartinez@ubu.es %K serious games %K depression %K anxiety %K children %K adolescents %K virtual reality %K mental health %K detection %K awareness %K prevention %K therapy %D 2021 %7 16.12.2021 %9 Review %J JMIR Serious Games %G English %X Background: Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. Objective: This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. Methods: The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. Results: A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. Conclusions: The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology. %M 34927589 %R 10.2196/30482 %U https://games.jmir.org/2021/4/e30482 %U https://doi.org/10.2196/30482 %U http://www.ncbi.nlm.nih.gov/pubmed/34927589 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e34170 %T Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review %A Schwarz,Julian %A Bärkås,Annika %A Blease,Charlotte %A Collins,Lorna %A Hägglund,Maria %A Markham,Sarah %A Hochwarter,Stefan %+ Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 17622652628, julian.schwarz@mhb-fontane.de %K electronic health record %K open notes %K user involvement %K patient advocacy %K patient portal %K patient rights %K collaborative health care %K participation %K coproduction %K system transformation %K health care reform %D 2021 %7 14.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)—often referred to as open notes—have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective: This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders’ perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods: A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results: Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members’ mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions: PAEHRs in MHC may strengthen user involvement, patients’ autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention. %M 34904956 %R 10.2196/34170 %U https://mental.jmir.org/2021/12/e34170 %U https://doi.org/10.2196/34170 %U http://www.ncbi.nlm.nih.gov/pubmed/34904956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31293 %T Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review %A Matsumoto,Kazuki %A Hamatani,Sayo %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo-ku,, Chiba, Japan, 81 43 226 2975, axpa0219@chiba-u.jp %K videoconference-delivered cognitive behavioral therapy %K depression %K anxiety %K psychiatric disorders %K systematic review %K meta-analysis %K digital health %K mental health %K cognitive therapy %K internet-based therapy %K cognition %K neurodevelopment %K communication technology %K health technology %K psychological disorders %K anxiety disorder %D 2021 %7 13.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective: This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods: A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results: The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of −0.49 (95% CI –0.68 to –0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions: While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832 %M 34898445 %R 10.2196/31293 %U https://www.jmir.org/2021/12/e31293 %U https://doi.org/10.2196/31293 %U http://www.ncbi.nlm.nih.gov/pubmed/34898445 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31746 %T Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review %A Appleton,Rebecca %A Williams,Julie %A Vera San Juan,Norha %A Needle,Justin J %A Schlief,Merle %A Jordan,Harriet %A Sheridan Rains,Luke %A Goulding,Lucy %A Badhan,Monika %A Roxburgh,Emily %A Barnett,Phoebe %A Spyridonidis,Spyros %A Tomaskova,Magdalena %A Mo,Jiping %A Harju-Seppänen,Jasmine %A Haime,Zoë %A Casetta,Cecilia %A Papamichail,Alexandra %A Lloyd-Evans,Brynmor %A Simpson,Alan %A Sevdalis,Nick %A Gaughran,Fiona %A Johnson,Sonia %+ NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872554, r.appleton@ucl.ac.uk %K telemental health %K COVID-19 %K remote care %K telemedicine %K mental health %K systematic review, implementation science %D 2021 %7 9.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 %M 34709179 %R 10.2196/31746 %U https://www.jmir.org/2021/12/e31746 %U https://doi.org/10.2196/31746 %U http://www.ncbi.nlm.nih.gov/pubmed/34709179 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e29661 %T Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis %A Zuelke,Andrea E %A Luppa,Melanie %A Löbner,Margrit %A Pabst,Alexander %A Schlapke,Christine %A Stein,Janine %A Riedel-Heller,Steffi G %+ Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Germany, 49 3419715483, andrea.zuelke@medizin.uni-leipzig.de %K grief %K systematic review %K meta-analysis %K internet-based %K online therapy %D 2021 %7 8.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. Objective: We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. Methods: We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. Results: In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. Conclusions: Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428 %M 34889769 %R 10.2196/29661 %U https://mental.jmir.org/2021/12/e29661 %U https://doi.org/10.2196/29661 %U http://www.ncbi.nlm.nih.gov/pubmed/34889769 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e32948 %T The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis %A Ellis,Louise A %A Meulenbroeks,Isabelle %A Churruca,Kate %A Pomare,Chiara %A Hatem,Sarah %A Harrison,Reema %A Zurynski,Yvonne %A Braithwaite,Jeffrey %+ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, NSW 2113, Australia, 61 9850 2484, louise.ellis@mq.edu.au %K e-mental health %K mental health %K COVID-19 %K bibliometrics %K health systems %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” Objective: The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. Methods: We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. Results: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. Conclusions: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. %M 34666306 %R 10.2196/32948 %U https://mental.jmir.org/2021/12/e32948 %U https://doi.org/10.2196/32948 %U http://www.ncbi.nlm.nih.gov/pubmed/34666306 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30439 %T Language, Speech, and Facial Expression Features for Artificial Intelligence–Based Detection of Cancer Survivors’ Depression: Scoping Meta-Review %A Smrke,Urška %A Mlakar,Izidor %A Lin,Simon %A Musil,Bojan %A Plohl,Nejc %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, 2000, Slovenia, 386 31262861, urska.smrke@um.si %K artificial intelligence %K cancer %K depression %K facial expression %K language %K oncology %K review %K screening %K speech %K symptom %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Cancer survivors often experience disorders from the depressive spectrum that remain largely unrecognized and overlooked. Even though screening for depression is recognized as essential, several barriers prevent its successful implementation. It is possible that better screening options can be developed. New possibilities have been opening up with advances in artificial intelligence and increasing knowledge on the connection of observable cues and psychological states. Objective: The aim of this scoping meta-review was to identify observable features of depression that can be intercepted using artificial intelligence in order to provide a stepping stone toward better recognition of depression among cancer survivors. Methods: We followed a methodological framework for scoping reviews. We searched SCOPUS and Web of Science for relevant papers on the topic, and data were extracted from the papers that met inclusion criteria. We used thematic analysis within 3 predefined categories of depression cues (ie, language, speech, and facial expression cues) to analyze the papers. Results: The search yielded 1023 papers, of which 9 met the inclusion criteria. Analysis of their findings resulted in several well-supported cues of depression in language, speech, and facial expression domains, which provides a comprehensive list of observable features that are potentially suited to be intercepted by artificial intelligence for early detection of depression. Conclusions: This review provides a synthesis of behavioral features of depression while translating this knowledge into the context of artificial intelligence–supported screening for depression in cancer survivors. %M 34874883 %R 10.2196/30439 %U https://mental.jmir.org/2021/12/e30439 %U https://doi.org/10.2196/30439 %U http://www.ncbi.nlm.nih.gov/pubmed/34874883 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32199 %T Examining the Effectiveness of Gamification in Mental Health Apps for Depression: Systematic Review and Meta-analysis %A Six,Stephanie G %A Byrne,Kaileigh A %A Tibbett,Thomas P %A Pericot-Valverde,Irene %+ Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC, 29634, United States, 1 864 656 3935, kaileib@clemson.edu %K depression %K reward %K gamification %K mental health apps %K apps %D 2021 %7 29.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Previous research showed that computerized cognitive behavioral therapy can effectively reduce depressive symptoms. Some mental health apps incorporate gamification into their app design, yet it is unclear whether features differ in their effectiveness to reduce depressive symptoms over and above mental health apps without gamification. Objective: The aim of this study was to determine whether mental health apps with gamification elements differ in their effectiveness to reduce depressive symptoms when compared to those that lack these elements. Methods: A meta-analysis of studies that examined the effect of app-based therapy, including cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness, on depressive symptoms was performed. A total of 5597 articles were identified via five databases. After screening, 38 studies (n=8110 participants) remained for data extraction. From these studies, 50 total comparisons between postintervention mental health app intervention groups and control groups were included in the meta-analysis. Results: A random effects model was performed to examine the effect of mental health apps on depressive symptoms compared to controls. The number of gamification elements within the apps was included as a moderator. Results indicated a small to moderate effect size across all mental health apps in which the mental health app intervention effectively reduced depressive symptoms compared to controls (Hedges g=–0.27, 95% CI –0.36 to –0.17; P<.001). The gamification moderator was not a significant predictor of depressive symptoms (β=–0.03, SE=0.03; P=.38), demonstrating no significant difference in effectiveness between mental health apps with and without gamification features. A separate meta-regression also did not show an effect of gamification elements on intervention adherence (β=–1.93, SE=2.28; P=.40). Conclusions: The results show that both mental health apps with and without gamification elements were effective in reducing depressive symptoms. There was no significant difference in the effectiveness of mental health apps with gamification elements on depressive symptoms or adherence. This research has important clinical implications for understanding how gamification elements influence the effectiveness of mental health apps on depressive symptoms. %M 34847058 %R 10.2196/32199 %U https://mental.jmir.org/2021/11/e32199 %U https://doi.org/10.2196/32199 %U http://www.ncbi.nlm.nih.gov/pubmed/34847058 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29742 %T Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review %A Domhardt,Matthias %A Engler,Sophie %A Nowak,Hannah %A Lutsch,Arne %A Baumel,Amit %A Baumeister,Harald %+ Department of Clinical Psychology and Psychotherapy, Ulm University, Lise-Meitner-Str. 16, Ulm, D-89081, Germany, 49 73150 32803, matthias.domhardt@uni-ulm.de %K children and adolescents %K mental disorders %K mediator %K mechanisms of change %K digital health intervention %K psychotherapy %K mobile phone %D 2021 %7 26.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective: This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods: A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results: A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions: The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future. %M 34842543 %R 10.2196/29742 %U https://www.jmir.org/2021/11/e29742 %U https://doi.org/10.2196/29742 %U http://www.ncbi.nlm.nih.gov/pubmed/34842543 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e27404 %T Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review %A Saad,Anthony %A Bruno,Deanna %A Camara,Bettina %A D’Agostino,Josephine %A Bolea-Alamanac,Blanca %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 6473312707, Blanca.BoleaAlamanac@wchospital.ca %K digital therapeutics %K self-directed %K mental health %K telehealth %K technology %K mobile applications %K telemedicine %K internet %K mobile phone %D 2021 %7 26.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. Objective: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient’s or at the technology’s end), so the patients can implement them without any support. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. Results: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. Conclusions: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates. %M 34842556 %R 10.2196/27404 %U https://mental.jmir.org/2021/11/e27404 %U https://doi.org/10.2196/27404 %U http://www.ncbi.nlm.nih.gov/pubmed/34842556 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29487 %T Studies of Depression and Anxiety Using Reddit as a Data Source: Scoping Review %A Boettcher,Nick %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 (403) 220 4286, nkboettc@ucalgary.ca %K depression %K anxiety %K mental health %K Reddit %K social media %K review %D 2021 %7 25.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: The study of depression and anxiety using publicly available social media data is a research activity that has grown considerably over the past decade. The discussion platform Reddit has become a popular social media data source in this nascent area of study, in part because of the unique ways in which the platform is facilitative of research. To date, no work has been done to synthesize existing studies on depression and anxiety using Reddit. Objective: The objective of this review is to understand the scope and nature of research using Reddit as a primary data source for studying depression and anxiety. Methods: A scoping review was conducted using the Arksey and O’Malley framework. MEDLINE, Embase, CINAHL, PsycINFO, PsycARTICLES, Scopus, ScienceDirect, IEEE Xplore, and ACM academic databases were searched. Inclusion criteria were developed using the participants, concept, and context framework outlined by the Joanna Briggs Institute Scoping Review Methodology Group. Eligible studies featured an analytic focus on depression or anxiety and used naturalistic written expressions from Reddit users as a primary data source. Results: A total of 54 studies were included in the review. Tables and corresponding analyses delineate the key methodological features, including a comparatively larger focus on depression versus anxiety, an even split of original and premade data sets, a widespread analytic focus on classifying the mental health states of Reddit users, and practical implications that often recommend new methods of professionally delivered monitoring and outreach for Reddit users. Conclusions: Studies of depression and anxiety using Reddit data are currently driven by a prevailing methodology that favors a technical, solution-based orientation. Researchers interested in advancing this research area will benefit from further consideration of conceptual issues surrounding the interpretation of Reddit data with the medical model of mental health. Further efforts are also needed to locate accountability and autonomy within practice implications, suggesting new forms of engagement with Reddit users. %M 34842560 %R 10.2196/29487 %U https://mental.jmir.org/2021/11/e29487 %U https://doi.org/10.2196/29487 %U http://www.ncbi.nlm.nih.gov/pubmed/34842560 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29838 %T Machine Learning Methods for Predicting Postpartum Depression: Scoping Review %A Saqib,Kiran %A Khan,Amber Fozia %A Butt,Zahid Ahmad %+ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 45107, zahid.butt@uwaterloo.ca %K machine learning %K postpartum depression %K big data %K mobile phone %D 2021 %7 24.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Machine learning (ML) offers vigorous statistical and probabilistic techniques that can successfully predict certain clinical conditions using large volumes of data. A review of ML and big data research analytics in maternal depression is pertinent and timely, given the rapid technological developments in recent years. Objective: This study aims to synthesize the literature on ML and big data analytics for maternal mental health, particularly the prediction of postpartum depression (PPD). Methods: We used a scoping review methodology using the Arksey and O’Malley framework to rapidly map research activity in ML for predicting PPD. Two independent researchers searched PsycINFO, PubMed, IEEE Xplore, and the ACM Digital Library in September 2020 to identify relevant publications in the past 12 years. Data were extracted from the articles’ ML model, data type, and study results. Results: A total of 14 studies were identified. All studies reported the use of supervised learning techniques to predict PPD. Support vector machine and random forest were the most commonly used algorithms in addition to Naive Bayes, regression, artificial neural network, decision trees, and XGBoost (Extreme Gradient Boosting). There was considerable heterogeneity in the best-performing ML algorithm across the selected studies. The area under the receiver operating characteristic curve values reported for different algorithms were support vector machine (range 0.78-0.86), random forest method (0.88), XGBoost (0.80), and logistic regression (0.93). Conclusions: ML algorithms can analyze larger data sets and perform more advanced computations, which can significantly improve the detection of PPD at an early stage. Further clinical research collaborations are required to fine-tune ML algorithms for prediction and treatment. ML might become part of evidence-based practice in addition to clinical knowledge and existing research evidence. %M 34822337 %R 10.2196/29838 %U https://mental.jmir.org/2021/11/e29838 %U https://doi.org/10.2196/29838 %U http://www.ncbi.nlm.nih.gov/pubmed/34822337 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30479 %T Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review %A Martel,Rhiannon %A Shepherd,Matthew %A Goodyear-Smith,Felicity %+ Department of General Practice & Primary Health Care, Faculty of Medical & Health Science, University of Auckland, 22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 99232357, f.goodyear-smith@auckland.ac.nz %K adolescent %K mental health %K risk behavior %K screening %K primary care %D 2021 %7 19.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases—MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews—were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. %M 34807833 %R 10.2196/30479 %U https://mental.jmir.org/2021/11/e30479 %U https://doi.org/10.2196/30479 %U http://www.ncbi.nlm.nih.gov/pubmed/34807833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27835 %T Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis %A Schenkel,Sandra K %A Jungmann,Stefanie M %A Gropalis,Maria %A Witthöft,Michael %+ Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Wallstraße 3, Mainz, 55122, Germany, 49 61313939202, s.schenkel@uni-mainz.de %K cyberchondria %K health anxiety %K online health information seeking %K anxiety %K systematic review %K meta-analysis %D 2021 %7 18.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Cyberchondria describes the detrimental effects of health-related internet use. Current conceptualizations agree that cyberchondria is associated with anxiety-related pathologies and may best be conceptualized as a safety behavior; however, little is known about its exact underlying mechanisms. Objective: This systematic review and meta-analysis aims to give an overview of the conceptualizations of cyberchondria and its relation to anxiety-related pathologies, quantify the strength of association to health anxiety by using meta-analyses, highlight gaps in the literature, and outline a hypothetical integrative cognitive-behavioral model of cyberchondria based on the available empirical evidence. Methods: A systematic literature search was conducted using PubMed, Web of Science, and PsycINFO electronic databases. A total of 25 studies were included for qualitative synthesis and 7 studies, comprising 3069 individuals, were included for quantitative synthesis. The meta-analysis revealed a strong association of cyberchondria (r=0.63) and its subfacets (r=0.24-0.66) with health anxiety. Results: The results indicate that cyberchondria is a distinct construct related to health anxiety, obsessive-compulsive symptoms, intolerance of uncertainty, and anxiety sensitivity. Further studies should distinguish between state and trait markers of anxiety-related pathologies and use experimental and naturalistic longitudinal designs to differentiate among risk factors, triggers, and consequences related to cyberchondria. Conclusions: Health-related internet use in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. Here, we present a corresponding integrative cognitive-behavioral model. %M 34792473 %R 10.2196/27835 %U https://www.jmir.org/2021/11/e27835 %U https://doi.org/10.2196/27835 %U http://www.ncbi.nlm.nih.gov/pubmed/34792473 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31170 %T Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis %A Eisenstadt,Mia %A Liverpool,Shaun %A Infanti,Elisa %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 7989165986, mia.eisenstadt@annafreud.org %K systematic review %K MHapp, mHealth %K mental health %K well-being %K emotion regulation %K mobile apps %K effectiveness %K monitoring %K management %K mental health app %D 2021 %7 8.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=–0.24, 95% CI –0.34 to –0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. %M 34747713 %R 10.2196/31170 %U https://mental.jmir.org/2021/11/e31170 %U https://doi.org/10.2196/31170 %U http://www.ncbi.nlm.nih.gov/pubmed/34747713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27676 %T Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis %A Hechinger,Mareike %A Fringer,André %+ Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8400, Switzerland, 41 58 934 64 79, andre.fringer@zhaw.ch %K nursing care %K health care professionals %K suicidal behavior %K suicidal inclinations %K suicidal ideation %K inpatient %K outpatient %K eHealth %K mHealth %K mental health %K suicide %K stress %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care. Objective: This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development. Methods: A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived. Results: In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life. Conclusions: The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care. %M 34709191 %R 10.2196/27676 %U https://formative.jmir.org/2021/10/e27676 %U https://doi.org/10.2196/27676 %U http://www.ncbi.nlm.nih.gov/pubmed/34709191 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e22651 %T Use of Automated Thematic Annotations for Small Data Sets in a Psychotherapeutic Context: Systematic Review of Machine Learning Algorithms %A Hudon,Alexandre %A Beaudoin,Mélissa %A Phraxayavong,Kingsada %A Dellazizzo,Laura %A Potvin,Stéphane %A Dumais,Alexandre %+ Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7331, rue Hochelaga, Montréal, QC, Canada, 1 (514) 251 4000, alexandre.dumais@umontreal.ca %K psychotherapy %K artificial intelligence %K automated text classification %K machine learning %K systematic review %D 2021 %7 22.10.2021 %9 Review %J JMIR Ment Health %G English %X Background: A growing body of literature has detailed the use of qualitative analyses to measure the therapeutic processes and intrinsic effectiveness of psychotherapies, which yield small databases. Nonetheless, these approaches have several limitations and machine learning algorithms are needed. Objective: The objective of this study is to conduct a systematic review of the use of machine learning for automated text classification for small data sets in the fields of psychiatry, psychology, and social sciences. This review will identify available algorithms and assess if automated classification of textual entities is comparable to the classification done by human evaluators. Methods: A systematic search was performed in the electronic databases of Medline, Web of Science, PsycNet (PsycINFO), and Google Scholar from their inception dates to 2021. The fields of psychiatry, psychology, and social sciences were selected as they include a vast array of textual entities in the domain of mental health that can be reviewed. Additional records identified through cross-referencing were used to find other studies. Results: This literature search identified 5442 articles that were eligible for our study after the removal of duplicates. Following abstract screening, 114 full articles were assessed in their entirety, of which 107 were excluded. The remaining 7 studies were analyzed. Classification algorithms such as naive Bayes, decision tree, and support vector machine classifiers were identified. Support vector machine is the most used algorithm and best performing as per the identified articles. Prediction classification scores for the identified algorithms ranged from 53%-91% for the classification of textual entities in 4-7 categories. In addition, 3 of the 7 studies reported an interjudge agreement statistic; these were consistent with agreement statistics for text classification done by human evaluators. Conclusions: A systematic review of available machine learning algorithms for automated text classification for small data sets in several fields (psychiatry, psychology, and social sciences) was conducted. We compared automated classification with classification done by human evaluators. Our results show that it is possible to automatically classify textual entities of a transcript based solely on small databases. Future studies are nevertheless needed to assess whether such algorithms can be implemented in the context of psychotherapies. %M 34677133 %R 10.2196/22651 %U https://mental.jmir.org/2021/10/e22651 %U https://doi.org/10.2196/22651 %U http://www.ncbi.nlm.nih.gov/pubmed/34677133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30491 %T Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study %A Kemp,Jessica %A Chorney,Jill %A Kassam,Iman %A MacDonald,Julie %A MacDonald,Tara %A Wozney,Lori %A Strudwick,Gillian %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K youth mental health %K digital mental health %K COVID-19 %K digital mental health interventions %K e-mental health %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. Objective: A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. Methods: The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content. Results: A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care. Conclusions: As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth. %M 34665141 %R 10.2196/30491 %U https://www.jmir.org/2021/10/e30491 %U https://doi.org/10.2196/30491 %U http://www.ncbi.nlm.nih.gov/pubmed/34665141 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e32544 %T Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis %A Zhao,Liuhong %A Chen,Jingfen %A Lan,Liuying %A Deng,Ni %A Liao,Yan %A Yue,Liqun %A Chen,Innie %A Wen,Shi Wu %A Xie,Ri-hua %+ Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Road, Lishui, Foshan, 528244, China, 86 189 2869 7126, xierihua928@hotmail.com %K telehealth %K postpartum depression %K anxiety %K meta-analysis %D 2021 %7 7.10.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Postpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that telehealth interventions for women with PPD result in increased accessibility and improved treatment effectiveness. However, no comprehensive synthesis of evidence from clinical trials by systematic review has been conducted. Objective: The aim of this study is to evaluate the effectiveness of telehealth interventions in reducing depressive symptoms and anxiety in women with PPD. To enhance the homogeneity and interpretability of the findings, this systematic review focuses on PPD measured by the Edinburgh Postnatal Depression Scale (EPDS). Methods: PubMed, The Cochrane Library, CINAHL, PsycINFO, CNKI, and Wanfang were electronically searched to identify randomized controlled trials (RCTs) on the effectiveness of telehealth interventions for women with PPD from inception to February 28, 2021. Data extraction and quality assessment were performed independently by two researchers. The quality of included studies was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using RevMan 5.4 software. Results: Following the search, 9 RCTs with a total of 1958 women with PPD were included. The EPDS (mean difference=–2.99, 95% CI –4.52 to –1.46; P<.001) and anxiety (standardized mean difference=–0.39, 95% CI –0.67 to –0.12; P=.005) scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time (P<.001). Conclusions: Telehealth interventions could effectively reduce the symptoms of depression and anxiety in women with PPD. However, better designed and more rigorous large-scale RCTs targeting specific therapies are needed to further explore the potential of telehealth interventions for PPD. Trial Registration: PROSPERO CRD42021258541; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258541 %M 34617909 %R 10.2196/32544 %U https://mhealth.jmir.org/2021/10/e32544 %U https://doi.org/10.2196/32544 %U http://www.ncbi.nlm.nih.gov/pubmed/34617909 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e20892 %T Effectiveness of Using Mobile Technology to Improve Cognitive and Social Skills Among Individuals With Autism Spectrum Disorder: Systematic Literature Review %A Leung,Phil Wai Shun %A Li,Shirley Xin %A Tsang,Carmen Sze Oi %A Chow,Bellavista Long Ching %A Wong,William Chi Wai %+ Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China (Hong Kong), 852 25185657, wongwcw@hku.hk %K autism spectrum disorder %K mobile devices %K systematic review %K randomized controlled trial %K social skills %K cognitive skills %D 2021 %7 28.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Mobile technology has become a necessity in the lives of people in many countries. Its characteristics and advantages also make it a potential medium of intervention for people with autism spectrum disorder (ASD). Objective: The objective of this review was to evaluate previous evidence, obtained in randomized controlled trials (RCTs), on the effectiveness of using mobile devices as the medium of intervention targeting social and cognitive skills among individuals with ASD. Methods: Literature search was conducted on electronic databases including Medline, PsycInfo, PsycArticles, Education Resources Information Centre, and Social Science Citation Index. Only RCTs published in English and after year 2000 were included for this review. Data extraction was carried out by 2 independent reviewers using constant comparative methods. Results: Totally 10 RCTs were identified. Most of the findings indicated that mobile devices could be an effective medium of intervention for people with ASD, among which 6 indicated significant intervention effects and 2 showed mixed findings. Effective intervention was more likely to be achieved in the studies that recruited older participants (aged over 9 years), targeting practical skills that could be readily applied in real life, or using pictures or materials that were highly relevant in daily life in the apps or mobile devices. Furthermore, the use of mobile devices was also reported to promote participation in the intervention among individuals with ASD. Conclusions: The results suggested that mobile devices could be a promising means for the delivery of interventions targeting people with ASD. Although including a small number of studies was a limitation of this review, the results provided useful implications for designing effective mobile technology–assisted interventions for the ASD population in future studies. %M 34581681 %R 10.2196/20892 %U https://mental.jmir.org/2021/9/e20892 %U https://doi.org/10.2196/20892 %U http://www.ncbi.nlm.nih.gov/pubmed/34581681 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e29681 %T Virtual Reality for Supporting the Treatment of Depression and Anxiety: Scoping Review %A Baghaei,Nilufar %A Chitale,Vibhav %A Hlasnik,Andrej %A Stemmet,Lehan %A Liang,Hai-Ning %A Porter,Richard %+ Department of Natural and Computational Sciences, Massey University, Oteha Rohe Albany Highway, Albany, Auckland, 0632, New Zealand, 64 800 627 739, n.baghaei@massey.ac.nz %K virtual reality %K mental health %K depression %K anxiety %K CBT %D 2021 %7 23.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Mental health conditions pose a major challenge to health care providers and society at large. The World Health Organization predicts that by 2030, mental health conditions will be the leading cause of disease burden worldwide. The current need for mental health care is overwhelming. In New Zealand, 1 in 6 adults has been diagnosed with common mental disorders, such as depression and anxiety disorders, according to a national survey. Cognitive behavioral therapy (CBT) has been shown to effectively help patients overcome a wide variety of mental health conditions. Virtual reality exposure therapy (VRET) might be one of the most exciting technologies emerging in the clinical setting for the treatment of anxiety and depression. Objective: This study aims to investigate the virtual reality (VR) technologies currently being used to help support the treatment of depression and anxiety. We also aim to investigate whether and how CBT is included as part of VRET and look at the VR technologies and interventions that have been used in recent studies on depression and anxiety. Methods: We performed a scoping review. To identify significant studies, we decided to use already aggregated sources from the Google Scholar database. Overall, the goal of our search strategy was to limit the number of initial results related to VR in mental health to only a relevant minimum. Results: Using our defined keywords, Google Scholar identified >17,300 articles. After applying all the inclusion and exclusion criteria, we identified a total of 369 articles for further processing. After manual evaluation, 34 articles were shortlisted; of the 34 articles, 9 (26%) reported the use of CBT with VR. All of the articles were published between 2017 and 2021. Out of the 9 studies, CBT was conducted within a VR environment in 5 (56%) studies, whereas in the remaining 4 (44%) studies, CBT was used as an addition to VRET. All 9 studies reported the use of CBT either in vivo or in a virtual environment to be effective in supporting the treatment of anxiety or depression. Conclusions: Most studies demonstrated the use of VR to be effective for supporting the treatment of anxiety or depression in a range of settings and recommended its potential as a tool for use in a clinical environment. Even though standalone headsets are much easier to work with and more suitable for home use, the shift from tethered VR headsets to standalone headsets in the mental health environment was not observed. All studies that looked at the use of CBT either in vivo or in a virtual environment found it to be effective in supporting the treatment of anxiety or depression. %M 34554097 %R 10.2196/29681 %U https://mental.jmir.org/2021/9/e29681 %U https://doi.org/10.2196/29681 %U http://www.ncbi.nlm.nih.gov/pubmed/34554097 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e29454 %T School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review %A Exner-Cortens,Deinera %A Baker,Elizabeth %A Gray,Shawna %A Fernandez Conde,Cristina %A Rivera,Rocio Ramirez %A Van Bavel,Marisa %A Vezina,Elisabeth %A Ambrose,Aleta %A Pawluk,Chris %A Schwartz,Kelly D %A Arnold,Paul D %+ Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada, 1 4032208871, deinera.exner2@ucalgary.ca %K suicide %K risk assessment %K youth %K eHealth %K school mental health %K mobile phone %D 2021 %7 21.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. %M 34546178 %R 10.2196/29454 %U https://mental.jmir.org/2021/9/e29454 %U https://doi.org/10.2196/29454 %U http://www.ncbi.nlm.nih.gov/pubmed/34546178 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30564 %T Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review %A Zurynski,Yvonne %A Ellis,Louise A %A Tong,Huong Ly %A Laranjo,Liliana %A Clay-Williams,Robyn %A Testa,Luke %A Meulenbroeks,Isabelle %A Turton,Charmaine %A Sara,Grant %+ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia, 61 9850 ext 2414, Yvonne.Zurynski@mq.edu.au %K electronic medical records %K health information technology %K implementation %K mental health %D 2021 %7 7.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: The success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field. Objective: We intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes. Methods: The scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Results: This review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed; the primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs. Conclusions: The body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps. %M 34491208 %R 10.2196/30564 %U https://mental.jmir.org/2021/9/e30564 %U https://doi.org/10.2196/30564 %U http://www.ncbi.nlm.nih.gov/pubmed/34491208 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e30098 %T Telemental Health For Youth With Chronic Illnesses: Systematic Review %A Lau,Nancy %A Colt,Susannah F %A Waldbaum,Shayna %A O'Daffer,Alison %A Fladeboe,Kaitlyn %A Yi-Frazier,Joyce P %A McCauley,Elizabeth %A Rosenberg,Abby R %+ Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 884 0569, nancy.lau@seattlechildrens.org %K telehealth care %K mental health %K psychosocial issues %K psychiatry %K psychology %K child %K chronic disease %D 2021 %7 27.8.2021 %9 Review %J JMIR Ment Health %G English %X Background: Children, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap. Objective: In this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ≤25 years with chronic illnesses. Methods: PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ≤25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals. Results: We screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis. Conclusions: The state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic. %M 34448724 %R 10.2196/30098 %U https://mental.jmir.org/2021/8/e30098 %U https://doi.org/10.2196/30098 %U http://www.ncbi.nlm.nih.gov/pubmed/34448724 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28150 %T Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review %A Pallavicini,Federica %A Pepe,Alessandro %A Mantovani,Fabrizia %+ Department of Human Sciences for Education “Riccardo Massa”, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy, 39 0264484903, federica.pallavicini@gmail.com %K commercial off-the-shelf video games %K video games %K stress %K anxiety %K relaxation %D 2021 %7 16.8.2021 %9 Review %J JMIR Ment Health %G English %X Background: Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games. Objective: The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play). Methods: A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [(“video game*”) OR (“computer game*”)] AND [(“stress”) OR (“anxiety”) OR (“relaxation”)] AND [(“study”) OR (“trial”) OR (“training”)]. Results: A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety. Conclusions: Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081 %M 34398795 %R 10.2196/28150 %U https://mental.jmir.org/2021/8/e28150 %U https://doi.org/10.2196/28150 %U http://www.ncbi.nlm.nih.gov/pubmed/34398795 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29159 %T Use of Telemedicine in Depression Care by Physicians: Scoping Review %A Echelard,Jean-François %+ Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada, 1 (514) 343 6111, jfechelard@hotmail.com %K telemedicine %K telepsychiatry %K depression %K mental health %K videoconferencing %D 2021 %7 26.7.2021 %9 Review %J JMIR Form Res %G English %X Background: Depression is a common disorder, and it creates burdens on people’s mental and physical health as well as societal costs. Although traditional in-person consultations are the usual mode of caring for patients with depression, telemedicine may be well suited to psychiatric assessment and management. Telepsychiatry can be defined as the use of information and communication technologies such as videoconferencing and telephone calls for the care of psychopathologies. Objective: This review aims to evaluate the extent and nature of the existing literature on the use of telemedicine for the care of depression by physicians. This review also aims to examine the effects and perceptions regarding this virtual care and determine how it compares to traditional in-person care. Methods: The Arksey and O’Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed. Relevant articles were identified through a search of three databases (MEDLINE, Cochrane Database of Systematic Reviews, and PsycArticles) on October 11, 2020. The search terms were “(virtual OR telemedicine OR teleconsultation* OR telehealth OR phone* OR webcam* OR telepsychiatry) AND (depress*)”. Eligibility criteria were applied to select studies about the use of telemedicine for the care of patients with depression specifically by physicians. An Excel file (Microsoft Corporation) was used to chart data from all included articles. Results: The search resulted in the identification of 28 articles, and all 13 nonreview studies were analyzed in detail. Most nonreview studies were conducted in the United States during the last decade. Most telemedicine programs were led by psychiatrists, and the average study population size was 135. In all applicable studies, telepsychiatry tended to perform at least as well as in-person care regarding improvement in depression severity, patient satisfaction, quality of life, functioning, cost-effectiveness, and most other perceptions and variables. Cultural sensitivity and collaborative care were part of the design of some telemedicine programs. Conclusions: Additional randomized, high-quality studies are recommended to evaluate various outcomes of the use of telemedicine for depression care, including depression variables, perceptions, health care outcomes and other outcomes. Studies should be conducted in various clinical contexts, including primary care. Telepsychiatry is a promising modality of care for patients suffering from depression. %M 34309571 %R 10.2196/29159 %U https://formative.jmir.org/2021/7/e29159 %U https://doi.org/10.2196/29159 %U http://www.ncbi.nlm.nih.gov/pubmed/34309571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e17874 %T The Efficacy of eHealth Interventions for the Treatment of Adults Diagnosed With Full or Subthreshold Binge Eating Disorder: Systematic Review and Meta-analysis %A Moghimi,Elnaz %A Davis,Caroline %A Rotondi,Michael %+ School of Kinesiology and Health Science, Faculty of Health, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 77239, elnazm@yorku.ca %K internet %K cognitive behavioral therapy %K guided self-help %K obesity %K weight loss %K eating disorder %K binge eating %K mobile phone %D 2021 %7 20.7.2021 %9 Review %J J Med Internet Res %G English %X Background: There has been a recent rise in the use of eHealth treatments for a variety of psychological disorders, including eating disorders. Objective: This meta-analysis of randomized controlled trials is the first to evaluate the efficacy of eHealth interventions specifically for the treatment of binge eating disorder (characterized by compulsive overconsumption of food, in a relatively short period, and without compensatory behaviors such as purging or fasting). Methods: A search on the electronic databases PubMed, Web of Science, Embase, MEDLINE, and CINAHL was conducted for randomized controlled trials that compared the efficacy of eHealth treatment interventions with waitlist controls. Results: From the databases searched, 3 studies (298 participants in total) met the inclusion criteria. All interventions were forms of internet-based guided cognitive behavioral therapy. The results of the analysis demonstrated that when compared with waitlist controls, individuals enrolled in eHealth interventions experienced a reduction in objective binge episodes (standardized mean difference [SMD] −0.77, 95% CI −1.38 to −0.16) and eating disorder psychopathology (SMD −0.71, 95% CI −1.20 to −0.22), which included shape (SMD −0.61, 95% CI −1.01 to −0.22) and weight concerns (SMD −0.91, 95% CI −1.33 to −0.48). There was no significant difference in BMI between the eHealth interventions and controls (SMD −0.01, 95% CI −0.40 to 0.39). Conclusions: These findings provide promising results for the use of internet-based cognitive behavioral therapy for binge eating disorder treatment and support the need for future research to explore the efficacy of these eHealth interventions. %M 34283028 %R 10.2196/17874 %U https://www.jmir.org/2021/7/e17874 %U https://doi.org/10.2196/17874 %U http://www.ncbi.nlm.nih.gov/pubmed/34283028 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e28168 %T New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials %A Sommers-Spijkerman,Marion %A Austin,Judith %A Bohlmeijer,Ernst %A Pots,Wendy %+ Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 652783025, m.p.j.spijkerman-6@umcutrecht.nl %K mindfulness %K mental health %K intervention %K online %K meta-analysis %K mobile phone %D 2021 %7 19.7.2021 %9 Review %J JMIR Ment Health %G English %X Background: There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. Objective: This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. Methods: We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. Results: The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. Conclusions: Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements. %M 34279240 %R 10.2196/28168 %U https://mental.jmir.org/2021/7/e28168 %U https://doi.org/10.2196/28168 %U http://www.ncbi.nlm.nih.gov/pubmed/34279240 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e23091 %T Acceptability of Computerized Cognitive Behavioral Therapy for Adults: Umbrella Review %A Treanor,Charlene J %A Kouvonen,Anne %A Lallukka,Tea %A Donnelly,Michael %+ Centre for Public Health, Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Grosvenor Road, Belfast, BT16 6BJ, United Kingdom, 44 28 90978993, michael.donnelly@qub.ac.uk %K computerized/internet cognitive behavioral therapy %K cCBT %K iCBT %K acceptability %K mental health %K umbrella review %D 2021 %7 6.7.2021 %9 Review %J JMIR Ment Health %G English %X Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34% of guided and 36% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8%-74% of the participants, while 94% completed one module and 67%-84% completed some modules. Unguided cCBT was completed in full by 16%-66% of participants, while 95% completed one module and 54%-93% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one’s own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users’ preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that “one size did not fit all” regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health. %M 34255714 %R 10.2196/23091 %U https://mental.jmir.org/2021/7/e23091 %U https://doi.org/10.2196/23091 %U http://www.ncbi.nlm.nih.gov/pubmed/34255714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24584 %T Effectiveness and Acceptance of Technology-Based Psychological Interventions for the Acute Treatment of Unipolar Depression: Systematic Review and Meta-analysis %A Köhnen,Moritz %A Kriston,Levente %A Härter,Martin %A Baumeister,Harald %A Liebherz,Sarah %+ Department of Medical Psychology, University Medical Center Hamburg–Eppendorf, Martinistr 52, Building West 26, Hamburg, , Germany, 49 40 7410 57705, m.koehnen@uke.de %K internet %K digital health %K digital mental health %K telephone %K psychotherapy %K depressive disorder %K systematic review %K meta-analysis %K technology-based psychological interventions %D 2021 %7 13.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective: The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods: Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results: Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P≥.09). Conclusions: We found that TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients, and the long-term effectiveness of TBIs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028042 %M 36260395 %R 10.2196/24584 %U https://www.jmir.org/2021/6/e24584/ %U https://doi.org/10.2196/24584 %U http://www.ncbi.nlm.nih.gov/pubmed/36260395 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e26448 %T Automation of Article Selection Process in Systematic Reviews Through Artificial Neural Network Modeling and Machine Learning: Protocol for an Article Selection Model %A Ferreira,Gabriel Ferraz %A Quiles,Marcos Gonçalves %A Nazaré,Tiago Santana %A Rezende,Solange Oliveira %A Demarzo,Marcelo %+ Department of Science and Technology, Universidade Federal de São Paulo, Avenida Padre José Maria, 545, São Paulo, CEP 04753-060, Brazil, 55 1135547084, demarzo@unifesp.br %K deep learning %K machine learning %K systematic review %K mindfulness %D 2021 %7 15.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A systematic review can be defined as a summary of the evidence found in the literature via a systematic search in the available scientific databases. One of the steps involved is article selection, which is typically a laborious task. Machine learning and artificial intelligence can be important tools in automating this step, thus aiding researchers. Objective: The aim of this study is to create models based on an artificial neural network system to automate the article selection process in systematic reviews related to “Mindfulness and Health Promotion.” Methods: The study will be performed using Python programming software. The system will consist of six main steps: (1) data import, (2) exclusion of duplicates, (3) exclusion of non-articles, (4) article reading and model creation using artificial neural network, (5) comparison of the models, and (6) system sharing. We will choose the 10 most relevant systematic reviews published in the fields of “Mindfulness and Health Promotion” and “Orthopedics” (control group) to serve as a test of the effectiveness of the article selection. Results: Data collection will begin in July 2021, with completion scheduled for December 2021, and final publication available in March 2022. Conclusions: An automated system with a modifiable sensitivity will be created to select scientific articles in systematic review that can be expanded to various fields. We will disseminate our results and models through the “Observatory of Evidence” in public health, an open and online platform that will assist researchers in systematic reviews. International Registered Report Identifier (IRRID): PRR1-10.2196/26448 %M 34128820 %R 10.2196/26448 %U https://www.researchprotocols.org/2021/6/e26448 %U https://doi.org/10.2196/26448 %U http://www.ncbi.nlm.nih.gov/pubmed/34128820 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e25952 %T Benefits of Digital Health Resources for Substance Use Concerns in Women: Scoping Review %A Quilty,Lena %A Agic,Branka %A Coombs,Michelle %A Kristy,Betty-Lou %A Shakespeare,Jill %A Spafford,Adrienne %A Besa,Reena %A Dematagoda,Shadini %A Patel,Alina %A Persaud,Rebecca %A Buckley,Leslie %+ Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada, 1 4165358501, Lena.Quilty@camh.ca %K women %K female %K gender-specific %K digital health %K internet %K mobile app %K technology %K technology interventions %K technology-based intervention %K web-based intervention %K substance use concerns %K trauma %D 2021 %7 7.6.2021 %9 Review %J JMIR Ment Health %G English %X Background: Digital health resources are being increasingly used to support women with substance use concerns. Although empirical research has demonstrated that these resources have promise, the available evidence for their benefit in women requires further investigation. Evidence supports the capacity of interventions that are sex-, gender-, and trauma-informed to improve treatment access and outcomes and to reduce health system challenges and disparities. Indeed, both sex- and gender-specific approaches are critical to improve health and gender equity. Violence and trauma are frequent among those with substance use concerns, but they disproportionately affect those who identify as female or women, further underscoring the need for trauma-informed care as well. Objective: The objective of this investigation was to evaluate the evidence supporting the efficacy or effectiveness of online or mobile interventions for risky or harmful substance use in adults who identify as female or women, or who report a history of trauma. Methods: This scoping review is based on an academic search in MEDLINE, APA PsycINFO, Embase, Cochrane Central, and CINAHL, as well as a grey literature search in US and Canadian government and funding agency websites. Of the 7807 records identified, 465 remained following title and abstract screening. Of these, 159 met all eligibility criteria and were reviewed and synthesized. Results: The 159 records reflected 141 distinct studies and 125 distinct interventions. Investigations and the interventions evaluated predominantly focused on alcohol use or general substance use. Evaluated digital health resources included multisession and brief-session interventions, with a wide range of therapeutic elements. Multisession online and mobile interventions exhibited beneficial effects in 86.1% (105/122) of studies. Single-session interventions similarly demonstrated beneficial effects in 64.2% (43/67) of study conditions. Most investigations did not assess gender identity or conduct sex- or gender-based analyses. Only 13 investigations that included trauma were identified. Conclusions: Despite the overall promise of digital health interventions for substance use concerns, direct or quantitative evidence on the efficacy or effectiveness of interventions in females or women specifically is weak. %M 34096879 %R 10.2196/25952 %U https://mental.jmir.org/2021/6/e25952 %U https://doi.org/10.2196/25952 %U http://www.ncbi.nlm.nih.gov/pubmed/34096879 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24712 %T Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis %A Shah,Syed Ghulam Sarwar %A Nogueras,David %A van Woerden,Hugo Cornelis %A Kiparoglou,Vasiliki %+ NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 1865221262, sarwar.shah@ouh.nhs.uk %K loneliness %K older people %K digital technology %K effectiveness %K efficacy %K evidence %K systematic review %K meta-analysis %D 2021 %7 4.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Loneliness is a serious public health issue, and its burden is increasing in many countries. Loneliness affects social, physical, and mental health, and it is associated with multimorbidity and premature mortality. In addition to social interventions, a range of digital technology interventions (DTIs) are being used to tackle loneliness. However, there is limited evidence on the effectiveness of DTIs in reducing loneliness, especially in adults. The effectiveness of DTIs in reducing loneliness needs to be systematically assessed. Objective: The objective of this study is to assess the effectiveness of DTIs in reducing loneliness in older adults. Methods: We conducted electronic searches in PubMed, MEDLINE, CINAHL, Embase, and Web of Science for empirical studies published in English from January 1, 2010, to July 31, 2019. The study selection criteria included interventional studies that used any type of DTIs to reduce loneliness in adults (aged ≥18 years) with a minimum intervention duration of 3 months and follow-up measurements at least 3 months after the intervention. Two researchers independently screened articles and extracted data using the PICO (participant, intervention, comparator, and outcome) framework. The primary outcome measure was loneliness. Loneliness scores in both the intervention and control groups at baseline and at follow-up at 3, 4, 6, and 12 months after the intervention were extracted. Data were analyzed via narrative synthesis and meta-analysis using RevMan (The Cochrane Collaboration) software. Results: A total of 6 studies were selected from 4939 screened articles. These studies included 1 before and after study and 5 clinical trials (4 randomized clinical trials and 1 quasi-experimental study). All of these studies enrolled a total of 646 participants (men: n=154, 23.8%; women: n=427, 66.1%; no gender information: n=65, 10.1%) with an average age of 73-78 years (SD 6-11). Five clinical trials were included in the meta-analysis, and by using the random effects model, standardized mean differences (SMDs) were calculated for each trial and pooled across studies at the 3-, 4-, and 6-month follow-ups. The overall effect estimates showed no statistically significant difference in the effectiveness of DTIs compared with that of usual care or non-DTIs at follow-up at 3 months (SMD 0.02; 95% CI −0.36 to 0.40; P=.92), 4 months (SMD −1.11; 95% CI −2.60 to 0.38; P=.14), and 6 months (SMD −0.11; 95% CI −0.54 to 0.32; P=.61). The quality of evidence was very low to moderate in these trials. Conclusions: Our meta-analysis shows no evidence supporting the effectiveness of DTIs in reducing loneliness in older adults. Future research may consider randomized controlled trials with larger sample sizes and longer durations for both the interventions and follow-ups. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-032455 %M 34085942 %R 10.2196/24712 %U https://www.jmir.org/2021/6/e24712 %U https://doi.org/10.2196/24712 %U http://www.ncbi.nlm.nih.gov/pubmed/34085942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25006 %T Chatbots to Support People With Dementia and Their Caregivers: Systematic Review of Functions and Quality %A Ruggiano,Nicole %A Brown,Ellen L %A Roberts,Lisa %A Framil Suarez,C Victoria %A Luo,Yan %A Hao,Zhichao %A Hristidis,Vagelis %+ Department of Computer Science and Engineering, University of California, Riverside, 317 Winston Chung Hall, 900 University Ave, Riverside, CA, 92521, United States, 1 951 827 2478, vagelis@cs.ucr.edu %K dementia %K caregivers %K chatbots %K conversation agents %K mobile apps %K mobile phone %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the past decade, there has been an increase in the use of information technologies to educate and support people with dementia and their family caregivers. At the same time, chatbot technologies have become increasingly popular for use by the public and have been identified as having benefits for health care delivery. However, little is known about how chatbot technologies may benefit people with dementia and their caregivers. Objective: This study aims to identify the types of current commercially available chatbots that are designed for use by people with dementia and their caregivers and to assess their quality in terms of features and content. Methods: Chatbots were identified through a systematic search on Google Play Store, Apple App Store, Alexa Skills, and the internet. An evidence-based assessment tool was used to evaluate the features and content of the identified apps. The assessment was conducted through interrater agreement among 4 separate reviewers. Results: Of the 505 initial chatbots identified, 6 were included in the review. The chatbots assessed varied significantly in terms of content and scope. Although the chatbots were generally found to be easy to use, some limitations were noted regarding their performance and programmed content for dialog. Conclusions: Although chatbot technologies are well established and commonly used by the public, their development for people with dementia and their caregivers is in its infancy. Given the successful use of chatbots in other health care settings and for other applications, there are opportunities to integrate this technology into dementia care. However, more evidence-based chatbots that have undergone end user evaluation are needed to evaluate their potential to adequately educate and support these populations. %M 34081019 %R 10.2196/25006 %U https://www.jmir.org/2021/6/e25006 %U https://doi.org/10.2196/25006 %U http://www.ncbi.nlm.nih.gov/pubmed/34081019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25140 %T mHealth Interventions for Self-Harm: Scoping Review %A Cliffe,Bethany %A Tingley,Jessica %A Greenhalgh,Isobel %A Stallard,Paul %+ Department for Health, University of Bath, Claverton Down, Bath, , United Kingdom, 44 01225 388388, bc731@bath.ac.uk %K mHealth %K self-harm %K digital interventions %K self-injury %K NSSI %K mobile phone %D 2021 %7 30.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective: This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods: A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results: A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions: Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm. %M 33929329 %R 10.2196/25140 %U https://www.jmir.org/2021/4/e25140 %U https://doi.org/10.2196/25140 %U http://www.ncbi.nlm.nih.gov/pubmed/33929329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26939 %T Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression %A McCall,Hugh C %A Hadjistavropoulos,Heather D %A Sundström,Christopher Richard Francis %+ Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada, 1 306 585 4111, hugh.c.mccall@gmail.com %K ICBT %K internet %K depression %K anxiety %K persuasive design %K eHealth %D 2021 %7 29.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17). Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT. %M 33913811 %R 10.2196/26939 %U https://www.jmir.org/2021/4/e26939 %U https://doi.org/10.2196/26939 %U http://www.ncbi.nlm.nih.gov/pubmed/33913811 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25847 %T Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview %A Lehtimaki,Susanna %A Martic,Jana %A Wahl,Brian %A Foster,Katherine T %A Schwalbe,Nina %+ Heilbrunn Department of Population and Family Health, Columbia Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, United States, 1 9172262645, nschwalbe@ssc.nyc %K digital health %K adolescent health %K young people %K mental health %K digital technologies %D 2021 %7 29.4.2021 %9 Review %J JMIR Ment Health %G English %X Background: An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective: This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods: We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results: In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions: Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care. %M 33913817 %R 10.2196/25847 %U https://mental.jmir.org/2021/4/e25847 %U https://doi.org/10.2196/25847 %U http://www.ncbi.nlm.nih.gov/pubmed/33913817 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e26268 %T Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review %A Tokgöz,Pinar %A Hrynyschyn,Robert %A Hafner,Jessica %A Schönfeld,Simone %A Dockweiler,Christoph %+ School of Public Health, Bielefeld University, Universitätsstraße 25, Bielefeld, 33615, Germany, 49 521 106 67136, pinar.tokgoez@uni-bielefeld.de %K digital health %K depression %K scoping review %K health care %D 2021 %7 16.4.2021 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. Objective: The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. Methods: A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. Results: In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. Conclusions: Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic. %M 33861201 %R 10.2196/26268 %U https://mental.jmir.org/2021/4/e26268 %U https://doi.org/10.2196/26268 %U http://www.ncbi.nlm.nih.gov/pubmed/33861201 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26474 %T Impact of the COVID-19 Pandemic on Older Adults: Rapid Review %A Lebrasseur,Audrey %A Fortin-Bédard,Noémie %A Lettre,Josiane %A Raymond,Emilie %A Bussières,Eve-Line %A Lapierre,Nolwenn %A Faieta,Julie %A Vincent,Claude %A Duchesne,Louise %A Ouellet,Marie-Christine %A Gagnon,Eric %A Tourigny,André %A Lamontagne,Marie-Ève %A Routhier,François %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525 Hamel est, Québec, QC, G1M 2S8, Canada, 1 4185299141 ext 6256, francois.routhier@rea.ulaval.ca %K COVID-19 %K impact %K rapid review %K older adults %K aged individuals %K review %D 2021 %7 12.4.2021 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. %M 33720839 %R 10.2196/26474 %U https://aging.jmir.org/2021/2/e26474 %U https://doi.org/10.2196/26474 %U http://www.ncbi.nlm.nih.gov/pubmed/33720839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25933 %T Voice-Based Conversational Agents for the Prevention and Management of Chronic and Mental Health Conditions: Systematic Literature Review %A Bérubé,Caterina %A Schachner,Theresa %A Keller,Roman %A Fleisch,Elgar %A v Wangenheim,Florian %A Barata,Filipe %A Kowatsch,Tobias %+ Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV G 214, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 633 8419, berubec@ethz.ch %K voice %K speech %K delivery of health care %K noncommunicable diseases %K conversational agents %K mobile phone %K smart speaker %K monitoring %K support %K chronic disease %K mental health %K systematic literature review %D 2021 %7 29.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Chronic and mental health conditions are increasingly prevalent worldwide. As devices in our everyday lives offer more and more voice-based self-service, voice-based conversational agents (VCAs) have the potential to support the prevention and management of these conditions in a scalable manner. However, evidence on VCAs dedicated to the prevention and management of chronic and mental health conditions is unclear. Objective: This study provides a better understanding of the current methods used in the evaluation of health interventions for the prevention and management of chronic and mental health conditions delivered through VCAs. Methods: We conducted a systematic literature review using PubMed MEDLINE, Embase, PsycINFO, Scopus, and Web of Science databases. We included primary research involving the prevention or management of chronic or mental health conditions through a VCA and reporting an empirical evaluation of the system either in terms of system accuracy, technology acceptance, or both. A total of 2 independent reviewers conducted the screening and data extraction, and agreement between them was measured using Cohen kappa. A narrative approach was used to synthesize the selected records. Results: Of 7170 prescreened papers, 12 met the inclusion criteria. All studies were nonexperimental. The VCAs provided behavioral support (n=5), health monitoring services (n=3), or both (n=4). The interventions were delivered via smartphones (n=5), tablets (n=2), or smart speakers (n=3). In 2 cases, no device was specified. A total of 3 VCAs targeted cancer, whereas 2 VCAs targeted diabetes and heart failure. The other VCAs targeted hearing impairment, asthma, Parkinson disease, dementia, autism, intellectual disability, and depression. The majority of the studies (n=7) assessed technology acceptance, but only few studies (n=3) used validated instruments. Half of the studies (n=6) reported either performance measures on speech recognition or on the ability of VCAs to respond to health-related queries. Only a minority of the studies (n=2) reported behavioral measures or a measure of attitudes toward intervention-targeted health behavior. Moreover, only a minority of studies (n=4) reported controlling for participants’ previous experience with technology. Finally, risk bias varied markedly. Conclusions: The heterogeneity in the methods, the limited number of studies identified, and the high risk of bias show that research on VCAs for chronic and mental health conditions is still in its infancy. Although the results of system accuracy and technology acceptance are encouraging, there is still a need to establish more conclusive evidence on the efficacy of VCAs for the prevention and management of chronic and mental health conditions, both in absolute terms and in comparison with standard health care. %M 33658174 %R 10.2196/25933 %U https://www.jmir.org/2021/3/e25933 %U https://doi.org/10.2196/25933 %U http://www.ncbi.nlm.nih.gov/pubmed/33658174 %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 3 %P e26550 %T Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review %A Strudwick,Gillian %A Sockalingam,Sanjeev %A Kassam,Iman %A Sequeira,Lydia %A Bonato,Sarah %A Youssef,Alaa %A Mehta,Rohan %A Green,Nadia %A Agic,Branka %A Soklaridis,Sophie %A Impey,Danielle %A Wiljer,David %A Crawford,Allison %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K digital health %K psychiatry %K mental health %K informatics %K pandemic %K COVID-19 %K telemedicine %K eHealth %K public health %K virtual care %K mobile apps %K population health %D 2021 %7 2.3.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada’s guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. %M 33650985 %R 10.2196/26550 %U https://mental.jmir.org/2021/3/e26550 %U https://doi.org/10.2196/26550 %U http://www.ncbi.nlm.nih.gov/pubmed/33650985 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e19478 %T Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review %A Dwyer,Anne %A de Almeida Neto,Abílio %A Estival,Dominique %A Li,Weicong %A Lam-Cassettari,Christa %A Antoniou,Mark %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 97726673, m.antoniou@westernsydney.edu.au %K mental health services %K text messaging %K counseling %K mobile health %K natural language processing %D 2021 %7 24.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. Objective: This scoping review maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm. Methods: We conducted a comprehensive electronic literature search of PsycINFO, PubMed, ERIC, and Web of Science databases for articles published in English through November 2020. Results: Of the 9134 articles screened, 70 met the eligibility criteria and were included in the review. There is preliminary evidence to suggest that text-based, real-time communication with a qualified therapist is an effective form of e-mental health service delivery, particularly for individuals concerned with stigma and confidentiality. There is also converging evidence that text-based communications that have been analyzed using computational linguistic techniques can be used to accurately predict progress during treatment and identify individuals at risk of serious mental health conditions and suicide. Conclusions: This review reveals a clear need for intensified research into the extent to which text-based counseling (and predictive models using modern computational linguistics tools) may help deliver mental health treatments to underserved groups such as regional communities, identify at-risk individuals for targeted intervention, and predict progress during treatment. Such approaches have implications for policy development to improve intervention accessibility in at-risk and underserved populations. %M 33625373 %R 10.2196/19478 %U https://mental.jmir.org/2021/2/e19478 %U https://doi.org/10.2196/19478 %U http://www.ncbi.nlm.nih.gov/pubmed/33625373 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e19004 %T A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review %A Cataldo,Francesco %A Chang,Shanton %A Mendoza,Antonette %A Buchanan,George %+ School of Computing and Information Systems, University Of Melbourne, Parkville, VIC, Melbourne, 3010, Australia, 61 444 574 920, fcataldo@student.unimelb.edu.au %K videoconference %K psychotherapy %K professional-patient relations %K client-psychologist relationships %K therapeutic alliance %K telehealth %K mobile phone %D 2021 %7 19.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. Objective: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. Methods: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. Results: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. Conclusions: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients. %M 33605891 %R 10.2196/19004 %U http://mental.jmir.org/2021/2/e19004/ %U https://doi.org/10.2196/19004 %U http://www.ncbi.nlm.nih.gov/pubmed/33605891 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24703 %T Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications %A Hrynyschyn,Robert %A Dockweiler,Christoph %+ Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Campus Virchow Klinikum, Berlin, 13353, Germany, 49 30 450 529 124, robert.hrynyschyn@charite.de %K mobile health %K depression %K cognitive behavioral therapy %K systematic review %K mobile phone %D 2021 %7 10.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. Objective: The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. Methods: A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. Results: The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. Conclusions: No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies. %M 33565989 %R 10.2196/24703 %U http://mhealth.jmir.org/2021/2/e24703/ %U https://doi.org/10.2196/24703 %U http://www.ncbi.nlm.nih.gov/pubmed/33565989 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e21700 %T Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review %A Köhnen,Moritz %A Dreier,Mareike %A Seeralan,Tharanya %A Kriston,Levente %A Härter,Martin %A Baumeister,Harald %A Liebherz,Sarah %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 407410 ext 57705, m.koehnen@uke.de %K internet %K telephone %K psychotherapy %K depression %K depressive disorder %K systematic review %K mobile phone %D 2021 %7 10.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. Objective: This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. Methods: Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. Results: Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. Conclusions: Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028042 %M 33565981 %R 10.2196/21700 %U https://mental.jmir.org/2021/2/e21700 %U https://doi.org/10.2196/21700 %U http://www.ncbi.nlm.nih.gov/pubmed/33565981 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e17828 %T Perceptions and Opinions of Patients About Mental Health Chatbots: Scoping Review %A Abd-Alrazaq,Alaa A %A Alajlani,Mohannad %A Ali,Nashva %A Denecke,Kerstin %A Bewick,Bridgette M %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, PO Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, RT542, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K chatbots %K conversational agents %K mental health %K mental disorders %K perceptions %K opinions %K mobile phone %D 2021 %7 13.1.2021 %9 Review %J J Med Internet Res %G English %X Background: Chatbots have been used in the last decade to improve access to mental health care services. Perceptions and opinions of patients influence the adoption of chatbots for health care. Many studies have been conducted to assess the perceptions and opinions of patients about mental health chatbots. To the best of our knowledge, there has been no review of the evidence surrounding perceptions and opinions of patients about mental health chatbots. Objective: This study aims to conduct a scoping review of the perceptions and opinions of patients about chatbots for mental health. Methods: The scoping review was carried out in line with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching 8 electronic databases (eg, MEDLINE and Embase) in addition to conducting backward and forward reference list checking of the included studies and relevant reviews. In total, 2 reviewers independently selected studies and extracted data from the included studies. Data were synthesized using thematic analysis. Results: Of 1072 citations retrieved, 37 unique studies were included in the review. The thematic analysis generated 10 themes from the findings of the studies: usefulness, ease of use, responsiveness, understandability, acceptability, attractiveness, trustworthiness, enjoyability, content, and comparisons. Conclusions: The results demonstrated overall positive perceptions and opinions of patients about chatbots for mental health. Important issues to be addressed in the future are the linguistic capabilities of the chatbots: they have to be able to deal adequately with unexpected user input, provide high-quality responses, and have to show high variability in responses. To be useful for clinical practice, we have to find ways to harmonize chatbot content with individual treatment recommendations, that is, a personalization of chatbot conversations is required. %M 33439133 %R 10.2196/17828 %U http://www.jmir.org/2021/1/e17828/ %U https://doi.org/10.2196/17828 %U http://www.ncbi.nlm.nih.gov/pubmed/33439133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e16490 %T Smartphone-Based Interventions and Internalizing Disorders in Youth: Systematic Review and Meta-analysis %A Buttazzoni,Adrian %A Brar,Keshbir %A Minaker,Leia %+ School of Planning, University of Waterloo, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 46564, anbuttazzoni@uwaterloo.ca %K mental health %K meta-analysis %K mobile phone %K smartphone %K systematic review %K youth %D 2021 %7 11.1.2021 %9 Review %J J Med Internet Res %G English %X Background: Mental health disorders in youth are a global issue that have important implications for the future quality of life and morbidity of affected individuals. In the context of public health initiatives, smartphone-based interventions have been suggested to hold the potential to be an effective strategy to reduce the symptoms of mental health disorders in youth; however, further evaluation is needed to confirm their effectiveness. This systematic review and meta-analysis documents and synthesizes existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Objective: This study aims to synthesize existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Methods: PubMed and SCOPUS were searched in 2019, and 4334 potentially relevant articles were found. A total of 12 studies were included in the final synthesis. We used the Hedges g meta-analysis approach and a random effects model for analysis. Results: The results of this review note that depression and anxiety are the most commonly targeted symptoms, and unlike other similar topics, most studies reviewed were linked to a proven treatment. The overall pooled effect from the meta-analysis showed small but significant effects (κ=12; N=1370; Hedges g=0.20; 95% CI 0.02-0.38) for interventions in reducing the symptoms of internalizing disorders. In total, 4 subgroup analyses examining specific symptoms and intervention styles found varied small significant and nonsignificant effects. Conclusions: Future research should focus on developing robust evaluative frameworks and examining interventions among more diverse populations and settings. More robust research is needed before smartphone-based interventions are scaled up and used at the population level to address youth internalizing disorders. %M 33427682 %R 10.2196/16490 %U http://www.jmir.org/2021/1/e16490/ %U https://doi.org/10.2196/16490 %U http://www.ncbi.nlm.nih.gov/pubmed/33427682 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e16508 %T Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review %A MacDougall,Sarah %A Jerrott,Susan %A Clark,Sharon %A Campbell,Leslie Anne %A Murphy,Andrea %A Wozney,Lori %+ Mental Health and Addictions, Policy and Planning, Nova Scotia Health, 200 Pleasant Street, Dartmouth, NS, B2Y 3S3, Canada, 1 (902) 471 5463, lori.wozney@nshealth.ca %K adolescent %K mental health %K eHealth %K text messaging %K SMS %K information science %K cell phone %K implementation %K review %D 2021 %7 8.1.2021 %9 Review %J JMIR Ment Health %G English %X Background: The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective: The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents. Methods: A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications. Results: We screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported. Conclusions: The use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone–based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required. %M 33416504 %R 10.2196/16508 %U https://mental.jmir.org/2021/1/e16508 %U https://doi.org/10.2196/16508 %U http://www.ncbi.nlm.nih.gov/pubmed/33416504 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25382 %T The Current State and Diagnostic Accuracy of Digital Mental Health Assessment Tools for Psychiatric Disorders: Protocol for a Systematic Review and Meta-analysis %A Martin-Key,Nayra A %A Schei,Thea S %A Barker,Eleanor J %A Spadaro,Benedetta %A Funnell,Erin %A Benacek,Jiri %A Tomasik,Jakub %A Bahn,Sabine %+ Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K diagnostic accuracy %K digital mental health %K digital questionnaire %K meta-analysis %K psychiatry %K systematic review %D 2021 %7 8.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the rapidly growing number of digital assessment tools for screening and diagnosing mental health disorders, little is known about their diagnostic accuracy. Objective: The purpose of this systematic review and meta-analysis is to establish the diagnostic accuracy of question- and answer-based digital assessment tools for diagnosing a range of highly prevalent psychiatric conditions in the adult population. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) will be used. The focus of the systematic review is guided by the population, intervention, comparator, and outcome framework (PICO). We will conduct a comprehensive systematic literature search of MEDLINE, PsychINFO, Embase, Web of Science Core Collection, Cochrane Library, Applied Social Sciences Index and Abstracts (ASSIA), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for appropriate articles published from January 1, 2005. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any inconsistencies will be discussed and resolved. The two authors will then extract data into a standardized form. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and a descriptive analysis and meta-analysis will summarize the diagnostic accuracy of the identified digital assessment tools. Results: The systematic review and meta-analysis commenced in November 2020, with findings expected by May 2021. Conclusions: This systematic review and meta-analysis will summarize the diagnostic accuracy of question- and answer-based digital assessment tools. It will identify implications for clinical practice, areas for improvement, and directions for future research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020214724; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020214724. International Registered Report Identifier (IRRID): DERR1-10.2196/25382 %M 33416508 %R 10.2196/25382 %U http://www.researchprotocols.org/2021/1/e25382/ %U https://doi.org/10.2196/25382 %U http://www.ncbi.nlm.nih.gov/pubmed/33416508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19836 %T Standalone Smartphone Cognitive Behavioral Therapy–Based Ecological Momentary Interventions to Increase Mental Health: Narrative Review %A Marciniak,Marta Anna %A Shanahan,Lilly %A Rohde,Judith %A Schulz,Ava %A Wackerhagen,Carolin %A Kobylińska,Dorota %A Tuescher,Oliver %A Binder,Harald %A Walter,Henrik %A Kalisch,Raffael %A Kleim,Birgit %+ University of Zurich, Psychiatric University Hospital, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 44 384 23 51, birgit.kleim@uzh.ch %K mHealth %K mobile app %K ecological momentary intervention %K EMI %K cognitive behavioral therapy %K CBT %K COVID-19 %K mobile phone %K smartphone %D 2020 %7 12.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. Objective: This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. Methods: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics. %M 33180027 %R 10.2196/19836 %U https://mhealth.jmir.org/2020/11/e19836 %U https://doi.org/10.2196/19836 %U http://www.ncbi.nlm.nih.gov/pubmed/33180027 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e17453 %T Smartphone-Based Self-Monitoring, Treatment, and Automatically Generated Data in Children, Adolescents, and Young Adults With Psychiatric Disorders: Systematic Review %A Melbye,Sigurd %A Kessing,Lars Vedel %A Bardram,Jakob Eyvind %A Faurholt-Jepsen,Maria %+ The Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Rigshospitalet, Blegdamsvej 9, København Ø, 2200, Denmark, 45 28966634, sigurd.arne.melbye@regionh.dk %K mHealth %K child and adolescent psychiatry %K eHealth %K systematic review %K psychiatry %K mobile phone %D 2020 %7 29.10.2020 %9 Review %J JMIR Ment Health %G English %X Background: Psychiatric disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning smartphone-based monitoring and treatment in this population has been published. Objective: This systematic review aims at describing the following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies. Methods: We conducted a systematic literature search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically assessed. Results: A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants’ adherence to self-monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials, the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas. Conclusions: Smartphones hold great potential as a modern, widely available technology platform to help diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses. %M 33118950 %R 10.2196/17453 %U http://mental.jmir.org/2020/10/e17453/ %U https://doi.org/10.2196/17453 %U http://www.ncbi.nlm.nih.gov/pubmed/33118950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20581 %T Digital Interventions for Screening and Treating Common Mental Disorders or Symptoms of Common Mental Illness in Adults: Systematic Review and Meta-analysis %A Sin,Jacqueline %A Galeazzi,Gian %A McGregor,Elicia %A Collom,Jennifer %A Taylor,Anna %A Barrett,Barbara %A Lawrence,Vanessa %A Henderson,Claire %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, Reading, RG6 6AL, United Kingdom, 44 7817027035, jacqueline.sin@reading.ac.uk %K eHealth %K mHealth %K psychiatric illness %K mental disorders %K common mental illness %K depression %K anxiety %K self-care %D 2020 %7 2.9.2020 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions targeting common mental disorders (CMDs) or symptoms of CMDs are growing rapidly and gaining popularity, probably in response to the increased prevalence of CMDs and better awareness of early help-seeking and self-care. However, no previous systematic reviews that focus on these novel interventions were found. Objective: This systematic review aims to scope entirely web-based interventions that provided screening and signposting for treatment, including self-management strategies, for people with CMDs or subthreshold symptoms. In addition, a meta-analysis was conducted to evaluate the effectiveness of these interventions for mental well-being and mental health outcomes. Methods: Ten electronic databases including MEDLINE, PsycINFO, and EMBASE were searched from January 1, 1999, to early April 2020. We included randomized controlled trials (RCTs) that evaluated a digital intervention (1) targeting adults with symptoms of CMDs, (2) providing both screening and signposting to other resources including self-care, and (3) delivered entirely through the internet. Intervention characteristics including target population, platform used, key design features, and outcome measure results were extracted and compared. Trial outcome results were included in a meta-analysis on the effectiveness of users’ well-being and mental health outcomes. We also rated the meta-analysis results with the Grading of Recommendations, Assessment, Development, and Evaluations approach to establish the quality of the evidence. Results: The electronic searches yielded 21 papers describing 16 discrete digital interventions. These interventions were investigated in 19 unique trials including 1 (5%) health economic study. Most studies were conducted in Australia and North America. The targeted populations varied from the general population to allied health professionals. All interventions offered algorithm-driven screening with measures to assess symptom levels and to assign treatment options including automatic web-based psychoeducation, self-care strategies, and signposting to existing services. A meta-analysis of usable trial data showed that digital interventions improved well-being (3 randomized controlled trials [RCTs]; n=1307; standardized mean difference [SMD] 0.40; 95% CI 0.29 to 0.51; I2=28%; fixed effect), symptoms of mental illness (6 RCTs; n=992; SMD −0.29; 95% CI −0.49 to −0.09; I2=51%; random effects), and work and social functioning (3 RCTs; n=795; SMD −0.16; 95% CI −0.30 to −0.02; I2=0%; fixed effect) compared with waitlist or attention control. However, some follow-up data failed to show any sustained effects beyond the post intervention time point. Data on mechanisms of change and cost-effectiveness were also lacking, precluding further analysis. Conclusions: Digital mental health interventions to assess and signpost people experiencing symptoms of CMDs appear to be acceptable to a sufficient number of people and appear to have enough evidence for effectiveness to warrant further study. We recommend that future studies incorporate economic analysis and process evaluation to assess the mechanisms of action and cost-effectiveness to aid scaling of the implementation. %M 32876577 %R 10.2196/20581 %U https://www.jmir.org/2020/9/e20581 %U https://doi.org/10.2196/20581 %U http://www.ncbi.nlm.nih.gov/pubmed/32876577 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e21108 %T COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians %A Smith,Katharine %A Ostinelli,Edoardo %A Macdonald,Orla %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 01865618228, andrea.cipriani@psych.ox.ac.uk %K digital mental health %K telepsychiatry %K evidence-based guidance %K systematic review %K mental health %K COVID-19 %D 2020 %7 28.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The coronavirus disease (COVID-19) presents unique challenges in health care, including mental health care provision. Telepsychiatry can provide an alternative to face-to-face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. Objective: The aim of this paper is to produce an open-access, easy-to-consult, and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach. Methods: We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre–COVID-19 guidelines and other digital mental health topics where relevant. We summarized the data we extracted as answers to specific clinical questions. Results: Findings from this study are presented as both a short practical checklist for clinicians and detailed textboxes with a full summary of all the guidelines. The summary textboxes are also available on an open-access webpage, which is regularly updated. These findings reflected the strong evidence base for the use of telepsychiatry and included guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance, and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focused on practical implementation and US guidelines more expansive and detailed. Guidelines on possible combinations with other digital technologies such as apps (eg, from the US Food and Drug Administration, the National Health Service Apps Library, and the National Institute for Health and Care Excellence) are less detailed. Several key areas were not represented. Although some special populations such as child and adolescent, and older adult, and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder, and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, the initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines. Conclusions: We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organizations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organizational change in the short- and long-term. Providing easily accessible guidance is a first step but will need cultural change to implement as clinicians start to view telepsychiatry not just as a replacement but as a parallel and complementary form of delivering therapy with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post–COVID-19, and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment. %M 32658857 %R 10.2196/21108 %U https://mental.jmir.org/2020/8/e21108 %U https://doi.org/10.2196/21108 %U http://www.ncbi.nlm.nih.gov/pubmed/32658857 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20889 %T Evidence on Virtual Reality–Based Therapies for Psychiatric Disorders: Meta-Review of Meta-Analyses %A Dellazizzo,Laura %A Potvin,Stéphane %A Luigi,Mimosa %A Dumais,Alexandre %+ Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada, 1 514 251 4000 ext 3925, alexandre.dumais@umontreal.ca %K systematic review %K virtual reality %K therapy %K mental disorders %K meta-analysis %D 2020 %7 19.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Among all diseases globally, mental illnesses are one of the major causes of burden. As many people are resistant to conventional evidence-based treatments, there is an unmet need for the implementation of novel mental health treatments. Efforts to increase the effectiveness and benefits of evidence-based psychotherapy in psychiatry have led to the emergence of virtual reality (VR)–based interventions. These interventions have shown a wide range of advantages over conventional psychotherapies. Currently, VR-based interventions have been developed mainly for anxiety-related disorders; however, they are also used for developmental disorders, severe mental disorders, and neurocognitive disorders. Objective: This meta-review aims to summarize the current state of evidence on the efficacy of VR-based interventions for various psychiatric disorders by evaluating the quality of evidence provided by meta-analytical studies. Methods: A systematic search was performed using the following electronic databases: PubMed, PsycINFO, Web of Science, and Google Scholar (any time until February 2020). Meta-analyses were included as long as they quantitatively examined the efficacy of VR-based interventions for symptoms of a psychiatric disorder. To avoid overlap among meta-analyses, for each subanalysis included within this meta-review, only one analysis provided from one meta-analysis was selected based on the best quality of evidence. Results: The search retrieved 11 eligible meta-analyses. The quality of evidence varied from very low to moderate quality. Several reasons account for the lower quality evidence, such as a limited number of randomized controlled trials, lack of follow-up analysis or control group, and the presence of heterogeneity and publication bias. Nonetheless, evidence has shown that VR-based interventions for anxiety-related disorders display overall medium-to-large effects when compared with inactive controls but no significant difference when compared with standard evidence-based approaches. Preliminary data have highlighted that such effects appear to be sustained in time, and subjects may fare better than active controls. Neurocognitive disorders also appear to improve with VR-based approaches, with small effects being found for various clinical outcomes (eg, cognition, emotion). Finally, there are insufficient data to classify VR-based interventions as an evidence-based practice for social skills training in neurodevelopmental disorders and compliance among patients with schizophrenia. Conclusions: VR provides unlimited opportunities by tailoring approaches to specific complex problems and individualizing the intervention. However, VR-based interventions have not shown superiority compared with usual evidence-based treatments. Future VR-based interventions should focus on developing innovative approaches for complex and treatment-resistant symptoms that are difficult to address with traditional treatments. Future research should also aim to gain a better understanding of the potential factors that may mediate VR outcomes to improve treatment. %M 32812889 %R 10.2196/20889 %U http://www.jmir.org/2020/8/e20889/ %U https://doi.org/10.2196/20889 %U http://www.ncbi.nlm.nih.gov/pubmed/32812889 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e16654 %T Toward a Taxonomy for Analyzing the Heart Rate as a Physiological Indicator of Posttraumatic Stress Disorder: Systematic Review and Development of a Framework %A Sadeghi,Mahnoosh %A Sasangohar,Farzan %A McDonald,Anthony D %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K heart rate %K statistics %K PTSD %K mental health %K physiology %D 2020 %7 22.7.2020 %9 Review %J JMIR Ment Health %G English %X Background: Posttraumatic stress disorder (PTSD) is a prevalent psychiatric condition that is associated with symptoms such as hyperarousal and overreactions. Treatments for PTSD are limited to medications and in-session therapies. Assessing the way the heart responds to PTSD has shown promise in detecting and understanding the onset of symptoms. Objective: This study aimed to extract statistical and mathematical approaches that researchers can use to analyze heart rate (HR) data to understand PTSD. Methods: A scoping literature review was conducted to extract HR models. A total of 5 databases including Medical Literature Analysis and Retrieval System Online (Medline) OVID, Medline EBSCO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Excerpta Medica Database (Embase) Ovid, and Google Scholar were searched. Non–English language studies, as well as studies that did not analyze human data, were excluded. A total of 54 studies that met the inclusion criteria were included in this review. Results: We identified 4 categories of models: descriptive time-independent output, descriptive and time-dependent output, predictive and time-independent output, and predictive and time-dependent output. Descriptive and time-independent output models include analysis of variance and first-order exponential; the descriptive time-dependent output model includes a classical time series analysis and mixed regression. Predictive time-independent output models include machine learning methods and analysis of the HR-based fluctuation-dissipation method. Finally, predictive time-dependent output models include the time-variant method and nonlinear dynamic modeling. Conclusions: All of the identified modeling categories have relevance in PTSD, although the modeling selection is dependent on the specific goals of the study. Descriptive models are well-founded for the inference of PTSD. However, there is a need for additional studies in this area that explore a broader set of predictive models and other factors (eg, activity level) that have not been analyzed with descriptive models. %M 32706710 %R 10.2196/16654 %U https://mental.jmir.org/2020/7/e16654 %U https://doi.org/10.2196/16654 %U http://www.ncbi.nlm.nih.gov/pubmed/32706710 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17195 %T Therapeutic Alliance in Technology-Based Interventions for the Treatment of Depression: Systematic Review %A Wehmann,Eileen %A Köhnen,Moritz %A Härter,Martin %A Liebherz,Sarah %+ Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany, 49 40 7410 57969, s.liebherz@uke.de %K therapeutic alliance %K depression %K technology-based intervention %K treatment %D 2020 %7 11.6.2020 %9 Review %J J Med Internet Res %G English %X Background: There is growing evidence that technology-based interventions (TBIs) are effective for the treatment of depression. As TBIs are gaining acceptance, a question arises whether good therapeutic alliance, considered a key aspect of psychotherapy, can be established without or with minimal face-to-face contact or rather changes if blended concepts are applied. While therapeutic alliance has been studied extensively in the context of face-to-face therapy, only few studies have reviewed evidence on alliance ratings in TBIs. Objective: The purpose of this study was to examine therapeutic alliance in technology-based psychological interventions for the treatment of depression. Methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PSYNDEX, CINAHL, clinical trial registers, and sources of grey literature for randomized controlled trials on TBIs in the treatment of adults with unipolar depression. All publications were selected according to prespecified criteria. Data were extracted by two independent reviewers. Results: A total of eight out of 98 studies (9.5%) included in the review on TBIs for depression considered therapeutic alliance as part of their evaluation. The available data covered eight different treatment conditions, including four stand-alone treatments (face-to-face psychotherapy, email, telephone, and internet program) and four combined treatments (face-to-face psychotherapy plus a smartphone app and an internet program combined with face-to-face psychotherapy, treatment as usual, or email/telephone). On average, patients rated the alliance positively across all groups. Importantly, no relevant group differences regarding therapeutic alliance sum scores were found in any of the studies. Five studies investigated the relationship between patients’ alliance ratings and treatment outcome, revealing mixed results. Conclusions: Our results suggest that it is possible to establish a positive therapeutic alliance across a variety of different TBIs for depression, but this is based on a small number of studies. Future research needs to determine on what basis therapeutic alliance is formed in settings that do not allow for additional nonverbal cues, perhaps with adapted instruments to measure therapeutic alliance. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413) International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028042 %M 32525484 %R 10.2196/17195 %U http://www.jmir.org/2020/6/e17195/ %U https://doi.org/10.2196/17195 %U http://www.ncbi.nlm.nih.gov/pubmed/32525484 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e16460 %T Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review %A Fortuna,Karen L %A Naslund,John A %A LaCroix,Jessica M %A Bianco,Cynthia L %A Brooks,Jessica M %A Zisman-Ilani,Yaara %A Muralidharan,Anjana %A Deegan,Patricia %+ Dartmouth College, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, United States, 1 6036533430, klfortuna@gmail.com %K peer support %K digital mental health %K recovery %D 2020 %7 3.4.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Peer support is recognized globally as an essential recovery service for people with mental health conditions. With the influx of digital mental health services changing the way mental health care is delivered, peer supporters are increasingly using technology to deliver peer support. In light of these technological advances, there is a need to review and synthesize the emergent evidence for peer-supported digital health interventions for adults with mental health conditions. Objective: The aim of this study was to identify and review the evidence of digital peer support interventions for people with a lived experience of a serious mental illness. Methods: This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures. The PubMed, Embase, Web of Science, Cochrane Central, CINAHL, and PsycINFO databases were searched for peer-reviewed articles published between 1946 and December 2018 that examined digital peer support interventions for people with a lived experience of a serious mental illness. Additional articles were found by searching the reference lists from the 27 articles that met the inclusion criteria and a Google Scholar search in June 2019. Participants, interventions, comparisons, outcomes, and study design (PICOS) criteria were used to assess study eligibility. Two authors independently screened titles and abstracts, and reviewed all full-text articles meeting the inclusion criteria. Discrepancies were discussed and resolved. All included studies were assessed for methodological quality using the Methodological Quality Rating Scale. Results: A total of 30 studies (11 randomized controlled trials, 2 quasiexperimental, 15 pre-post designs, and 2 qualitative studies) were included that reported on 24 interventions. Most of the studies demonstrated feasibility, acceptability, and preliminary effectiveness of peer-to-peer networks, peer-delivered interventions supported with technology, and use of asynchronous and synchronous technologies. Conclusions: Digital peer support interventions appear to be feasible and acceptable, with strong potential for clinical effectiveness. However, the field is in the early stages of development and requires well-powered efficacy and clinical effectiveness trials. Trial Registration: PROSPERO CRD42020139037; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID= 139037 %M 32243256 %R 10.2196/16460 %U https://mental.jmir.org/2020/4/e16460 %U https://doi.org/10.2196/16460 %U http://www.ncbi.nlm.nih.gov/pubmed/32243256 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e16993 %T The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review %A D'Arcey,Jessica %A Collaton,Joanna %A Kozloff,Nicole %A Voineskos,Aristotle N %A Kidd,Sean A %A Foussias,George %+ Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, 250 College St 738, Toronto, ON, M5T1R8, Canada, 1 4165358501 ext 34390, george.foussias@camh.ca %K SMS %K text messaging %K psychosis %K schizophrenia %K bipolar disorder %K engagement %K medication adherence %K attendance %K patient appointments %D 2020 %7 2.4.2020 %9 Review %J JMIR Ment Health %G English %X Background: Individuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis. Objective: This review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis. Methods: Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources. Results: Of the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received. Conclusions: Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation. %M 32238334 %R 10.2196/16993 %U https://mental.jmir.org/2020/4/e16993 %U https://doi.org/10.2196/16993 %U http://www.ncbi.nlm.nih.gov/pubmed/32238334 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 12 %P e11643 %T How New Technologies Can Improve Prediction, Assessment, and Intervention in Obsessive-Compulsive Disorder (e-OCD): Review %A Ferreri,Florian %A Bourla,Alexis %A Peretti,Charles-Siegfried %A Segawa,Tomoyuki %A Jaafari,Nemat %A Mouchabac,Stéphane %+ Sorbonne Université, Department of Adult Psychiatry and Medical Psychology, APHP, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France, 33 149282635, alexis.bourla@aphp.fr %K obsessive-compulsive disorder %K ecological momentary assessment %K biofeedback %K digital biomarkers %K digital phenotyping %K mobile health %K virtual reality %K machine learning %D 2019 %7 10.12.2019 %9 Review %J JMIR Ment Health %G English %X Background: New technologies are set to profoundly change the way we understand and manage psychiatric disorders, including obsessive-compulsive disorder (OCD). Developments in imaging and biomarkers, along with medical informatics, may well allow for better assessments and interventions in the future. Recent advances in the concept of digital phenotype, which involves using computerized measurement tools to capture the characteristics of a given psychiatric disorder, is one paradigmatic example. Objective: The impact of new technologies on health professionals’ practice in OCD care remains to be determined. Recent developments could disrupt not just their clinical practices, but also their beliefs, ethics, and representations, even going so far as to question their professional culture. This study aimed to conduct an extensive review of new technologies in OCD. Methods: We conducted the review by looking for titles in the PubMed database up to December 2017 that contained the following terms: [Obsessive] AND [Smartphone] OR [phone] OR [Internet] OR [Device] OR [Wearable] OR [Mobile] OR [Machine learning] OR [Artificial] OR [Biofeedback] OR [Neurofeedback] OR [Momentary] OR [Computerized] OR [Heart rate variability] OR [actigraphy] OR [actimetry] OR [digital] OR [virtual reality] OR [Tele] OR [video]. Results: We analyzed 364 articles, of which 62 were included. Our review was divided into 3 parts: prediction, assessment (including diagnosis, screening, and monitoring), and intervention. Conclusions: The review showed that the place of connected objects, machine learning, and remote monitoring has yet to be defined in OCD. Smartphone assessment apps and the Web Screening Questionnaire demonstrated good sensitivity and adequate specificity for detecting OCD symptoms when compared with a full-length structured clinical interview. The ecological momentary assessment procedure may also represent a worthy addition to the current suite of assessment tools. In the field of intervention, CBT supported by smartphone, internet, or computer may not be more effective than that delivered by a qualified practitioner, but it is easy to use, well accepted by patients, reproducible, and cost-effective. Finally, new technologies are enabling the development of new therapies, including biofeedback and virtual reality, which focus on the learning of coping skills. For them to be used, these tools must be properly explained and tailored to individual physician and patient profiles. %M 31821153 %R 10.2196/11643 %U https://mental.jmir.org/2019/12/e11643 %U https://doi.org/10.2196/11643 %U http://www.ncbi.nlm.nih.gov/pubmed/31821153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13873 %T Young People’s Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review %A Pretorius,Claudette %A Chambers,Derek %A Coyle,David %+ School of Computer Science, University College Dublin, Belfield, Dublin, Ireland, 353 017162818, claudette.pretorius@ucdconnect.ie %K internet %K help-seeking behavior %K youth %K mental health %K online behavior %K self-determination theory %K systematic review %D 2019 %7 19.11.2019 %9 Review %J J Med Internet Res %G English %X Background: Young people frequently make use of the internet as part of their day-to-day activities, and this has extended to their help-seeking behavior. Offline help-seeking is known to be impeded by a number of barriers including stigma and a preference for self-reliance. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties without being encumbered by these same barriers. Objective: The objective of this systematic literature review was to examine young peoples’ online help-seeking behaviors for mental health concerns. It aimed to summarize young peoples’ experiences and identify benefits and limitations of online help-seeking for this age group. It also examined the theoretical perspectives that have been applied to understand online help-seeking. Methods: A systematic review of peer-reviewed research papers from the following major electronic databases was conducted: PsycINFO, Cumulative Index of Nursing and Allied Health Literature, PubMed, Cochrane Library, Association for Computing Machinery Digital Library, and Institute of Electrical and Electronics Engineers Xplore. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search was conducted in August 2017. The narrative synthesis approach to reviews was used to analyze the existing evidence to answer the review questions. Results: Overall, 28 studies were included. The most common method of data collection was through the use of surveys. Study quality was moderate to strong. Text-based query via an internet search engine was the most commonly identified help-seeking approach. Social media, government or charity websites, live chat, instant messaging, and online communities were also used. Key benefits included anonymity and privacy, immediacy, ease of access, inclusivity, the ability to connect with others and share experiences, and a greater sense of control over the help-seeking journey. Online help-seeking has the potential to meet the needs of those with a preference for self-reliance or act as a gateway to further help-seeking. Barriers to help-seeking included a lack of mental health literacy, concerns about privacy and confidentiality, and uncertainty about the trustworthiness of online resources. Until now, there has been limited development and use of theoretical models to guide research on online help-seeking. Conclusions: Approaches to improving help-seeking by young people should consider the role of the internet and online resources as an adjunct to offline help-seeking. This review identifies opportunities and challenges in this space. It highlights the limited use of theoretical frameworks to help conceptualize online help-seeking. Self-determination theory and the help-seeking model provide promising starting points for the development of online help-seeking theories. This review discusses the use of these theories to conceptualize online help-seeking and identify key motivations and tensions that may arise when young people seek help online. %M 31742562 %R 10.2196/13873 %U http://www.jmir.org/2019/11/e13873/ %U https://doi.org/10.2196/13873 %U http://www.ncbi.nlm.nih.gov/pubmed/31742562 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13540 %T Qualitative Synthesis of Young People’s Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review %A McCashin,Darragh %A Coyle,David %A O'Reilly,Gary %+ School of Psychology, University College Dublin, Belfield, Dublin, Dublin 4, Ireland, 353 1718363, darragh.mccashin@ucd.ie %K cognitive behavioral therapy %K systematic review %K qualitative research %K children %K mental health %K technology %K mHealth %K eHealth %D 2019 %7 12.11.2019 %9 Review %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) for young people is increasingly being provided using technology-assisted formats. Although there is increasing evidence regarding the efficacy of such approaches, as illustrated by quantitative systematic reviews, the literature has also highlighted challenges with implementation factors, including high attrition rates and variable user engagement. Qualitative review methods can help to address the factors that impact young peoples’ experience of technology-assisted cognitive behavioral therapy (tech-assisted CBT) and, thus, enable us to better understand such implementation factors. To date, no such qualitative synthesis exists. Objective: The primary aim of this review was to systematically identify and synthesize the qualitative literature concerning the experiences of young people who have used tech-assisted CBT. Methods: This systematic review applied Thomas and Harden’s 2008 qualitative thematic synthesis approach. This involved line-by-line coding of the results sections of included studies and an inductive analysis on identified themes, followed by the generation of analytical themes through a process of iteration and interpretation of the descriptive themes. PsycINFO, ACM Digital Library, PubMed, EMBASE, and JMIR Publications databases were searched. The inclusion criteria were (1) studies involving school-aged young people over preschool age (6 years) but under the age of 18 years, (2) use of any form of tech-assisted CBT for any time period, (3) a stated focus of qualitative data to document the experiences of participants, and (4) studies published in English. The exclusion criteria were (1) interventions only provided face-to-face with no technological component, (2) only focused on the performance of the technology rather than participant experience, and (3) numerical data that sought to represent qualitative data. Results: A total of 14 studies were included in this review. Overall, these studies represented interventions for low mood and anxiety (n=10), trauma or self-harm (n=2), and physical difficulties (n=2). Overall, 5 analytical themes emerged on young people’s experiences with tech-assisted CBT: (1) helpfulness, (2) therapeutic process, (3) transferability, (4) gameplay experience, and (5) limitations. In addition, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face CBT, understanding of a CBT model, process of change, skills development, application to everyday life settings, parental involvement, character relatedness, playability, negative experiences, and broad content. Conclusions: Overall, young people’s experiences with tech-assisted CBT were mostly positive. The use of gaming environments, relatable characters, concrete metaphors, and age-appropriate narratives contributed to these positive experiences. Evidence suggests that technology can help to mediate face-to-face relationships with therapists and help young people to understand the CBT model. Clear barriers also emerged, including over-reliance on reading and writing skills and dissatisfaction with overly generalized content and comparison with commercial technologies. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018103388; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103388 %M 31714251 %R 10.2196/13540 %U http://www.jmir.org/2019/11/e13540/ %U https://doi.org/10.2196/13540 %U http://www.ncbi.nlm.nih.gov/pubmed/31714251 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e14166 %T Conversational Agents in the Treatment of Mental Health Problems: Mixed-Method Systematic Review %A Gaffney,Hannah %A Mansell,Warren %A Tai,Sara %+ , School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2nd Floor, Zochonis Building, Manchester, M13 9PL, United Kingdom, 44 161 306 0400, hannah.gaffney-2@postgrad.manchester.ac.uk %K artificial intelligence %K mental health %K stress, pychological %K psychiatry %K therapy, computer-assisted %K conversational agent %K chatbot %K digital health %D 2019 %7 18.10.2019 %9 Review %J JMIR Ment Health %G English %X Background: The use of conversational agent interventions (including chatbots and robots) in mental health is growing at a fast pace. Recent existing reviews have focused exclusively on a subset of embodied conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health. Objective: This study aimed to review the use of conversational agent interventions in the treatment of mental health problems. Methods: We performed a systematic search using relevant databases (MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane library). Studies that reported on an autonomous conversational agent that simulated conversation and reported on a mental health outcome were included. Results: A total of 13 studies were included in the review. Among them, 4 full-scale randomized controlled trials (RCTs) were included. The rest were feasibility, pilot RCTs and quasi-experimental studies. Interventions were diverse in design and targeted a range of mental health problems using a wide variety of therapeutic orientations. All included studies reported reductions in psychological distress postintervention. Furthermore, 5 controlled studies demonstrated significant reductions in psychological distress compared with inactive control groups. In addition, 3 controlled studies comparing interventions with active control groups failed to demonstrate superior effects. Broader utility in promoting well-being in nonclinical populations was unclear. Conclusions: The efficacy and acceptability of conversational agent interventions for mental health problems are promising. However, a more robust experimental design is required to demonstrate efficacy and efficiency. A focus on streamlining interventions, demonstrating equivalence to other treatment modalities, and elucidating mechanisms of action has the potential to increase acceptance by users and clinicians and maximize reach. %M 31628789 %R 10.2196/14166 %U https://mental.jmir.org/2019/10/e14166 %U https://doi.org/10.2196/14166 %U http://www.ncbi.nlm.nih.gov/pubmed/31628789 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13717 %T Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review %A Cheng,Vanessa Wan Sze %A Davenport,Tracey %A Johnson,Daniel %A Vella,Kellie %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney,, Australia, 61 286276941, vanessa.cheng@sydney.edu.au %K well-being %K video games %K gamification %K mental health %K health behavior %K systematic review %K eHealth %K mHealth %K health informatics %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. Objective: This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. Methods: We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. Results: The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. Conclusions: Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields. %M 31244479 %R 10.2196/13717 %U http://mental.jmir.org/2019/6/e13717/ %U https://doi.org/10.2196/13717 %U http://www.ncbi.nlm.nih.gov/pubmed/31244479 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 3 %P e12493 %T Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review %A Steinkamp,Jackson M %A Goldblatt,Nathaniel %A Borodovsky,Jacob T %A LaVertu,Amy %A Kronish,Ian M %A Marsch,Lisa A %A Schuman-Olivier,Zev %+ Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, 26 Central Street, Outpatient Addiction Services, Somerville, MA, 02143, United States, 1 617 591 6056, zschuman@cha.harvard.edu %K systematic review %K mental health %K substance-related disorders %K mHealth %K psychiatry %K medication adherence %K medication compliance %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. Objective: The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. Methods: This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. Results: The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. Conclusions: Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions. %M 30860493 %R 10.2196/12493 %U http://mental.jmir.org/2019/3/e12493/ %U https://doi.org/10.2196/12493 %U http://www.ncbi.nlm.nih.gov/pubmed/30860493 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 2 %P e9819 %T Mobile Phone and Wearable Sensor-Based mHealth Approaches for Psychiatric Disorders and Symptoms: Systematic Review %A Seppälä,Jussi %A De Vita,Ilaria %A Jämsä,Timo %A Miettunen,Jouko %A Isohanni,Matti %A Rubinstein,Katya %A Feldman,Yoram %A Grasa,Eva %A Corripio,Iluminada %A Berdun,Jesus %A D'Amico,Enrico %A , %A Bulgheroni,Maria %+ Ab.Acus srl, Via Francesco Caracciolo 77, Milano,, Italy, 39 89693979, mariabulgheroni@ab-acus.com %K sensors %K mobile phone %K m-RESIST %K ecological momentary assessment %K EMA %K psychiatric disorder %K schizophrenia %D 2019 %7 20.02.2019 %9 Review %J JMIR Ment Health %G English %X Background: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an innovative therapeutic program for treatment-resistant schizophrenia. The program exploits information from mobile phones and wearable sensors for behavioral tracking to support intervention administration. Objective: To systematically review original studies on sensor-based mHealth apps aimed at uncovering associations between sensor data and symptoms of psychiatric disorders in order to support the m-RESIST approach to assess effectiveness of behavioral monitoring in therapy. Methods: A systematic review of the English-language literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed through Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Studies published between September 1, 2009, and September 30, 2018, were selected. Boolean search operators with an iterative combination of search terms were applied. Results: Studies reporting quantitative information on data collected from mobile use and/or wearable sensors, and where that information was associated with clinical outcomes, were included. A total of 35 studies were identified; most of them investigated bipolar disorders, depression, depression symptoms, stress, and symptoms of stress, while only a few studies addressed persons with schizophrenia. The data from sensors were associated with symptoms of schizophrenia, bipolar disorders, and depression. Conclusions: Although the data from sensors demonstrated an association with the symptoms of schizophrenia, bipolar disorders, and depression, their usability in clinical settings to support therapeutic intervention is not yet fully assessed and needs to be scrutinized more thoroughly. %M 30785404 %R 10.2196/mental.9819 %U http://mental.jmir.org/2019/2/e9819/ %U https://doi.org/10.2196/mental.9819 %U http://www.ncbi.nlm.nih.gov/pubmed/30785404 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e62 %T Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review %A Lawes-Wickwar,Sadie %A McBain,Hayley %A Mulligan,Kathleen %+ Centre for Health Services Research, School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB, United Kingdom, 44 0207 040 0876, kathleen.mulligan.1@city.ac.uk %K severe mental disorders %K telehealth %K technology %K systematic review %K mobile phone %D 2018 %7 21.11.2018 %9 Review %J JMIR Ment Health %G English %X Background: People with severe mental illness (SMI) must receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly being used to assist in health care delivery using “telehealth,” which includes telephones and mobile phones, computers, remote sensors, the internet, and other devices, to provide immediate real-time information to service users to improve the management of chronic health conditions. Some initial findings have suggested that technology could improve the quality of life of people with SMI. Objective: In this systematic review, we aimed to identify the various uses and efficacy of telehealth technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Health Technology Assessment, CINAHL Plus, and NHS Economic Evaluations Database) to identify randomized controlled trials evaluating telehealth for adults with SMI published in English. Additional literature was identified through searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: Our search identified 31 articles describing 29 trials as eligible for the review. The included studies evaluated the use of computers to deliver cognitive rehabilitation (15 trials), patient education (3 trials), and Web-based self-management interventions (2 trials) and to support consultations (1 trial). Virtual reality was used to simulate work and social situations (2 trials) and to deliver cognitive training (1 trial). Telephones were used to prompt service users to take medications (3 trials) and to report symptoms to their health care team (1 trial). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective in improving medication adherence and reducing the severity of symptoms and inpatient days. Computer-assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. The results of this review should be taken in the context of varied quality in study design, with only 5 studies demonstrating a low risk of bias. Conclusions: A growing variety of telehealth technologies are being used to support the management of SMI. Specific technology types have been found to be effective for some outcomes (eg, telephone and remote medication monitoring for adherence to treatment), while other types of telehealth technologies (eg, delivery of patient education using computers) had no benefit over traditional nurse-based methods and were less acceptable to patients. Further research is warranted to establish the full potential benefits of telehealth for improving the quality of life in people with SMI, acceptability from the service user perspective, and cost-effectiveness. The findings of this review are limited by the poor quality of many of the studies reviewed. %M 30463836 %R 10.2196/mental.8816 %U http://mental.jmir.org/2018/4/e62/ %U https://doi.org/10.2196/mental.8816 %U http://www.ncbi.nlm.nih.gov/pubmed/30463836 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10278 %T Web-Based Mindfulness Interventions for Mental Health Treatment: Systematic Review and Meta-Analysis %A Sevilla-Llewellyn-Jones,Julia %A Santesteban-Echarri,Olga %A Pryor,Ingrid %A McGorry,Patrick %A Alvarez-Jimenez,Mario %+ Institute of Psychiatry and Mental Health, Health Research Institute (IdISSC). Hospital Clínico San Carlos, Av/ Prof Martin Lago s/n, Madrid, 28040, Spain, 34 651563055, juliasevill@gmail.com %K mindfulness %K anxiety disorder %K depressive disorder %K internetinternet-based %K treatment %K meta-analysis %K mental health. %K systematic review %D 2018 %7 25.9.2018 %9 Review %J JMIR Ment Health %G English %X Background: Web-based mindfulness interventions are increasingly delivered through the internet to treat mental health conditions. Objective: The objective of this study was to determine the effectiveness of web-based mindfulness interventions in clinical mental health populations. Secondary aims were to explore the impact of study variables on the effectiveness of web-based mindfulness interventions. Methods: We performed a systematic review and meta-analysis of studies investigating the effects of web-based mindfulness interventions on clinical populations. Results: The search strategy yielded 12 eligible studies. Web-based mindfulness interventions were effective in reducing depression in the total clinical sample (n=656 g=−0.609, P=.004) and in the anxiety disorder subgroup (n=313, g=−0.651, P<.001), but not in the depression disorder subgroup (n=251, P=.18). Similarly, web-based mindfulness interventions significantly reduced anxiety in the total clinical sample (n=756, g=−0.433, P=.004) and the anxiety disorder subgroup (n=413, g=−0.719, P<.001), but not in the depression disorder group (n=251, g=−0.213, P=.28). Finally, web-based mindfulness interventions improved quality of life and functioning in the total sample (n=591, g=0.362, P=.02) in the anxiety disorder subgroup (n=370, g=0.550, P=.02) and mindfulness skills in the total clinical sample (n=251, g=0.724, P<.001). Conclusions: Results support the effectiveness of web-based mindfulness interventions in reducing depression and anxiety and in enhancing quality of life and mindfulness skills, particularly in those with clinical anxiety. Results should be interpreted with caution given the high heterogeneity of web-based mindfulness interventions and the low number of studies included. %M 30274963 %R 10.2196/10278 %U http://mental.jmir.org/2018/3/e10278/ %U https://doi.org/10.2196/10278 %U http://www.ncbi.nlm.nih.gov/pubmed/30274963 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10496 %T For Better or for Worse? A Systematic Review of the Evidence on Social Media Use and Depression Among Lesbian, Gay, and Bisexual Minorities %A Escobar-Viera,César G %A Whitfield,Darren L %A Wessel,Charles B %A Shensa,Ariel %A Sidani,Jaime E %A Brown,Andre L %A Chandler,Cristian J %A Hoffman,Beth L %A Marshal,Michael P %A Primack,Brian A %+ Center for Research on Media, Technology, and Health, School of Medicine, University of Pittburgh, 230 McKee Place, Suite 600.11, Pittsburgh, PA, 15213, United States, 1 412 692 4297, escobar-viera@pitt.edu %K social media %K social networking sites %K sexual minorities %K lesbian %K gay %K bisexual %K depression %K systematic review %D 2018 %7 23.07.2018 %9 Review %J JMIR Ment Health %G English %X Background: Over 90% of adults in the United States have at least one social media account, and lesbian, gay, and bisexual (LGB) persons are more socially active on social media than heterosexuals. Rates of depression among LGB persons are between 1.5- and 2-fold higher than those among their heterosexual counterparts. Social media allows users to connect, interact, and express ideas, emotions, feelings, and thoughts. Thus, social media use might represent both a protective and a risk factor for depression among LGB persons. Studying the nature of the relationship between social media use and depression among LGB individuals is a necessary step to inform public health interventions for this population. Objective: The objective of this systematic review was to synthesize and critique the evidence on social media use and depression among LGB populations. Methods: We conducted a literature search for quantitative and qualitative studies published between January 2003 and June 2017 using 3 electronic databases. Articles were included if they were peer-reviewed, were in English, assessed social media use either quantitatively or qualitatively, measured depression, and focused on LGB populations. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed appropriate reporting of studies using the Strengthening the Reporting of Observational Studies in Epidemiology and the Consolidated Criteria for Reporting Qualitative Research for quantitative and qualitative studies, respectively. Results: We included 11 articles in the review; 9 studies were quantitative and cross-sectional and 2 were qualitative. Appropriate reporting of results varied greatly. Across quantitative studies, we found heterogeneity in how social media use was defined and measured. Cyberbullying was the most studied social media experience and was associated with depression and suicidality. Qualitative studies found that while social media provides a space to disclose minority experiences and share ways to cope and get support, constant surveillance of one’s social media profile can become a stressor, potentially leading to depression. In most studies, sexual minority participants were identified inconsistently. Conclusions: This review supports the need for research on the role of social media use on depression outcomes among LBG persons. Using social media may be both a protective and a risk factor for depression among LGB individuals. Support gained via social media may buffer the impact of geographic isolation and loneliness. Negative experiences such as cyberbullying and other patterns of use may be associated with depression. Future research would benefit from more consistent definitions of both social media use and study populations. Moreover, use of larger samples and accounting for patterns of use and individuals’ experiences on social media may help better understand the factors that impact LGB mental health disparities. %M 30037786 %R 10.2196/10496 %U http://mental.jmir.org/2018/3/e10496/ %U https://doi.org/10.2196/10496 %U http://www.ncbi.nlm.nih.gov/pubmed/30037786 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e48 %T eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes %A Wozney,Lori %A McGrath,Patrick J %A Gehring,Nicole D %A Bennett,Kathryn %A Huguet,Anna %A Hartling,Lisa %A Dyson,Michele P %A Soleimani,Amir %A Newton,Amanda S %+ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K eHealth %K mental health %K implementation science %K healthcare planning %K organizational innovation %K decision-making %K healthcare organizations %D 2018 %7 26.06.2018 %9 Review %J JMIR Ment Health %G English %X Background: Anxiety disorders and depression are frequent conditions in childhood and adolescence. eMental healthcare technologies may improve access to services, but their uptake within health systems is limited. Objective: The objective of this review was to examine and describe how the implementation of eMental healthcare technologies for anxiety disorders and depression in children and adolescents has been studied. Methods: We conducted a search of 5 electronic databases and gray literature. Eligible studies were those that assessed an eMental healthcare technology for treating or preventing anxiety or depression, included children or adolescents (<18 years), or their parents or healthcare providers and reported findings on technology implementation. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool. Outcomes of interest were based on 8 implementation outcomes: acceptability (satisfaction with a technology), adoption (technology uptake and utilization), appropriateness (“fitness for purpose”), cost (financial impact of technology implementation), feasibility (extent to which a technology was successfully used), fidelity (implementation as intended), penetration (“spread” or “reach” of the technology), and sustainability (maintenance or integration of a technology within a healthcare service). For extracted implementation outcome data, we coded favorable ratings on measurement scales as “positive results” and unfavorable ratings on measurement scales as “negative results.” Those studies that reported both positive and negative findings were coded as having “mixed results.” Results: A total of 46 studies met the inclusion criteria, the majority of which were rated as very good to excellent in methodological quality. These studies investigated eMental healthcare technologies for anxiety (n=23), depression (n=18), or both anxiety and depression (n=5). Studies of technologies for anxiety evaluated the following: (1) acceptability (78%) reported high levels of satisfaction, (2) adoption (43%) commonly reported positive results, and (3) feasibility (43%) reported mixed results. Studies of technologies for depression evaluated the following: (1) appropriateness (56%) reported moderate helpfulness and (2) acceptability (50%) described a mix of both positive and negative findings. Studies of technologies designed to aid anxiety and depression commonly reported mixed experiences with acceptability and adoption and positive findings for appropriateness of the technologies for treatment. Across all studies, cost, fidelity, and penetration and sustainability were the least measured implementation outcomes. Conclusions: Acceptability of eMental healthcare technology is high among users and is the most commonly investigated implementation outcome. Perceptions of the appropriateness and adoption of eMental healthcare technology were varied. Implementation research that identifies, evaluates, and reports on costs, sustainability, and fidelity to clinical guidelines is crucial for making high-quality eMental healthcare available to children and adolescents. %M 29945858 %R 10.2196/mental.9655 %U http://mental.jmir.org/2018/2/e48/ %U https://doi.org/10.2196/mental.9655 %U http://www.ncbi.nlm.nih.gov/pubmed/29945858 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e20 %T Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors %A Vis,Christiaan %A Mol,Mayke %A Kleiboer,Annet %A Bührmann,Leah %A Finch,Tracy %A Smit,Jan %A Riper,Heleen %+ Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 646098094, p.d.c.vis@vu.nl %K eMental health %K implementation %K routine practice %K determinants of practices %K RE-AIM %K barriers and facilitators %K mood disorders %K review %D 2018 %7 16.03.2018 %9 Review %J JMIR Ment Health %G English %X Background: Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective: This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods: A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results: A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH. Conclusions: Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients’ mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided. %M 29549072 %R 10.2196/mental.9769 %U http://mental.jmir.org/2018/1/e20/ %U https://doi.org/10.2196/mental.9769 %U http://www.ncbi.nlm.nih.gov/pubmed/29549072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e306 %T Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review %A Erbe,Doris %A Eichert,Hans-Christoph %A Riper,Heleen %A Ebert,David Daniel %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 9131 85 67566, david.ebert@fau.de %K mental health %K Internet %K psychotherapy %K blended treatment %D 2017 %7 15.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Many studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions). Objective: The aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness. Methods: Studies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions (“inpatient,” “outpatient,” “face-to-face,” or “residential treatment”), which were combined with terms indicating Internet treatment (“internet,” “online,” or “web”) and terms indicating mental disorders (“mental health,” “depression,” “anxiety,” or “substance abuse”). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse). Results: We identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions. Conclusions: Several studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary. %M 28916506 %R 10.2196/jmir.6588 %U http://www.jmir.org/2017/9/e306/ %U https://doi.org/10.2196/jmir.6588 %U http://www.ncbi.nlm.nih.gov/pubmed/28916506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e266 %T How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies %A Wozney,Lori %A Huguet,Anna %A Bennett,Kathryn %A Radomski,Ashley D %A Hartling,Lisa %A Dyson,Michele %A McGrath,Patrick J %A Newton,Amanda S %+ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K persuasive systems %K mental health %K Internet-based intervention %K review %K psychological therapy %D 2017 %7 09.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) have been delivered face-to-face. However, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based CBT and IPT involve therapeutic content, interaction between the user and the system, and different technological features embedded into the online program (eg, multimedia). Studies of Internet-based CBT and IPT for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the treatment conditions that influence therapy outcomes is important to designing and evaluating these novel therapies. Objective: Our aim was to examine the technological and program delivery features of Internet-based CBT and IPT for adolescent depression and to document their potential relation to treatment outcomes and program use. Methods: We performed a realist synthesis. We started with an extensive search of published and gray literature. We included intervention studies that evaluated Internet-based CBT or IPT for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the Mixed-Methods Appraisal Tool to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how Internet-based CBT and IPT, as technology-based systems, influence the attitudes and behaviors of system users. PSD components described for the therapies were linked to reported outcomes using a cross-case comparison method and thematic synthesis. Results: We identified 19 Internet-based CBT programs in 59 documents. Of those, 71% (42/59) were of moderate to high quality. The PSD features surface credibility (competent “look and feel”), dialogue support (online program + in-person support), liking and similarity (esthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction, and adherence, as well as symptom and functional impairments. Conclusions: When incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction, and depression-related outcomes. Testing of these features using hypothesis-driven dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness. %M 28793983 %R 10.2196/jmir.7573 %U http://www.jmir.org/2017/8/e266/ %U https://doi.org/10.2196/jmir.7573 %U http://www.ncbi.nlm.nih.gov/pubmed/28793983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e267 %T Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review %A Hoermann,Simon %A McCabe,Kathryn L %A Milne,David N %A Calvo,Rafael A %+ Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Building J03, Maze Crescent, Sydney, 2008, Australia, 61 2 9351 8171, rafael.calvo@sydney.edu.au %K chat %K dialog system %K remote psychotherapy %D 2017 %7 21.7.2017 %9 Review %J J Med Internet Res %G English %X Background: Synchronous written conversations (or “chats”) are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective: The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods: A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results: A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions: Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice. %M 28784594 %R 10.2196/jmir.7023 %U http://www.jmir.org/2017/8/e267/ %U https://doi.org/10.2196/jmir.7023 %U http://www.ncbi.nlm.nih.gov/pubmed/28784594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e191 %T Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis %A Wahle,Fabian %A Bollhalder,Lea %A Kowatsch,Tobias %A Fleisch,Elgar %+ Center for Digital Health Interventions, Institute of Technology Management, University of St Gallen, Dufourstrasse 40a, Büro 1-236, St Gallen, 9000, Switzerland, 41 712247244, tobias.kowatsch@unisg.ch %K literature review %K mental health %K design feature %K depression %K information systems %D 2017 %7 31.05.2017 %9 Review %J J Med Internet Res %G English %X Background: Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. Objective: This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. Methods: Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg’s test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. Results: Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD –0.58, 95% CI –0.71 to –0.45, P<.001). Heterogeneity was large (I2≥76). A total of 15 components were identified. Conclusions: Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders. %M 28566267 %R 10.2196/jmir.7381 %U http://www.jmir.org/2017/5/e191/ %U https://doi.org/10.2196/jmir.7381 %U http://www.ncbi.nlm.nih.gov/pubmed/28566267 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e176 %T Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review %A Grist,Rebecca %A Porter,Joanna %A Stallard,Paul %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 2253850 ext 86, r.grist@bath.ac.uk %K mobile apps %K smartphone apps %K mHealth %K mental health %K self-help %K child %K adolescent %K preadolescent %K review %D 2017 %7 25.05.2017 %9 Review %J J Med Internet Res %G English %X Background: There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years. Methods: The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years. Results: A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate. Conclusions: Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed. %M 28546138 %R 10.2196/jmir.7332 %U http://www.jmir.org/2017/5/e176/ %U https://doi.org/10.2196/jmir.7332 %U http://www.ncbi.nlm.nih.gov/pubmed/28546138 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e14 %T A Systematic Review and Meta-Analysis of e-Mental Health Interventions to Treat Symptoms of Posttraumatic Stress %A Simblett,Sara %A Birch,Jennifer %A Matcham,Faith %A Yaguez,Lidia %A Morris,Robin %+ Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207 848 0762, sara.simblett@kcl.ac.uk %K e-Mental Health %K PTSD %K psychological treatment %K systematic review %K meta-analysis %D 2017 %7 17.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Posttraumatic stress disorder (PTSD) is a stress disorder characterized by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyperarousal, avoidance, as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend health care have led to the creation of e-Mental Health interventions. Objective: Our aim was to assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD. Methods: The following databases were systematically searched to identify randomized controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardized and validated scales: the Cochrane Library, MEDLINE, EMBASE, and PsycINFO (in March 2015 and repeated in November 2016). Results: A total of 39 studies were found during the systematic review, and 33 (N=3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favor of the active intervention group (standardized mean difference=-0.35, 95% confidence interval -0.45 to -0.25, P<.001, I2=81%). Several sensitivity and subgroup analyses were performed suggesting that improvements in PTSD symptoms remained in favor of the active intervention group independent of the comparison condition, the type of cognitive behavioral therapy-based intervention, and the level of guidance provided. Conclusions: This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD. %M 28526672 %R 10.2196/mental.5558 %U http://mental.jmir.org/2017/2/e14/ %U https://doi.org/10.2196/mental.5558 %U http://www.ncbi.nlm.nih.gov/pubmed/28526672 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e10 %T Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review %A Apolinário-Hagen,Jennifer %A Kemper,Jessica %A Stürmer,Carolina %+ Institute for Psychology, Department of Health Psychology, University of Hagen, Bldg D, 1st Fl, Universitätsstr 33, Hagen, 58097, Germany, 49 2331 987 2272, jennifer.apolinario-hagen@fernuni-hagen.de %K mental health %K eHealth %K acceptability of healthcare %K public opinion %K attitude to computers %K patient preference %K diffusion of innovation %K cognitive therapy %K computer literacy %K review %D 2017 %7 03.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems. Objective: This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies. Methods: We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs. Results: The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or “e-awareness” and intentions to use e-mental health services were weak or inconsistent. Conclusions: Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care. %M 28373153 %R 10.2196/mental.6186 %U http://mental.jmir.org/2017/2/e10/ %U https://doi.org/10.2196/mental.6186 %U http://www.ncbi.nlm.nih.gov/pubmed/28373153 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 4 %P e50 %T Social Networking Sites, Depression, and Anxiety: A Systematic Review %A Seabrook,Elizabeth M %A Kern,Margaret L %A Rickard,Nikki S %+ Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Monash University, Clayton, 3800, Australia, 61 413170668, elizabeth.seabrook@monash.edu %K depression %K anxiety %K social media %K social networking %K review, systematic %K mental health %K well-being %D 2016 %7 23.11.2016 %9 Review %J JMIR Ment Health %G English %X Background: Social networking sites (SNSs) have become a pervasive part of modern culture, which may also affect mental health. Objective: The aim of this systematic review was to identify and summarize research examining depression and anxiety in the context of SNSs. It also aimed to identify studies that complement the assessment of mental illness with measures of well-being and examine moderators and mediators that add to the complexity of this environment. Methods: A multidatabase search was performed. Papers published between January 2005 and June 2016 relevant to mental illness (depression and anxiety only) were extracted and reviewed. Results: Positive interactions, social support, and social connectedness on SNSs were consistently related to lower levels of depression and anxiety, whereas negative interaction and social comparisons on SNSs were related to higher levels of depression and anxiety. SNS use related to less loneliness and greater self-esteem and life satisfaction. Findings were mixed for frequency of SNS use and number of SNS friends. Different patterns in the way individuals with depression and individuals with social anxiety engage with SNSs are beginning to emerge. Conclusions: The systematic review revealed many mixed findings between depression, anxiety, and SNS use. Methodology has predominantly focused on self-report cross-sectional approaches; future research will benefit from leveraging real-time SNS data over time. The evidence suggests that SNS use correlates with mental illness and well-being; however, whether this effect is beneficial or detrimental depends at least partly on the quality of social factors in the SNS environment. Understanding these relationships will lead to better utilization of SNSs in their potential to positively influence mental health. %M 27881357 %R 10.2196/mental.5842 %U http://mental.jmir.org/2016/4/e50/ %U https://doi.org/10.2196/mental.5842 %U http://www.ncbi.nlm.nih.gov/pubmed/27881357 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e44 %T Cultural Adaptation of Minimally Guided Interventions for Common Mental Disorders: A Systematic Review and Meta-Analysis %A Harper Shehadeh,Melissa %A Heim,Eva %A Chowdhary,Neerja %A Maercker,Andreas %A Albanese,Emiliano %+ Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech Building G6, 9 Chemin des Mines, Geneva, 1202, Switzerland, 41 797589701, Melissa.Harper@etu.unige.ch %K cultural adaptation %K depression %K anxiety %K self-help %K minimally guided intervention %K e-mental health %K bibliotherapy %D 2016 %7 26.09.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cultural adaptation of mental health care interventions is key, particularly when there is little or no therapist interaction. There is little published information on the methods of adaptation of bibliotherapy and e-mental health interventions. Objective: To systematically search for evidence of the effectiveness of minimally guided interventions for the treatment of common mental disorders among culturally diverse people with common mental disorders; to analyze the extent and effects of cultural adaptation of minimally guided interventions for the treatment of common mental disorders. Methods: We searched Embase, PubMed, the Cochrane Library, and PsycINFO for randomized controlled trials that tested the efficacy of minimally guided or self-help interventions for depression or anxiety among culturally diverse populations. We calculated pooled standardized mean differences using a random-effects model. In addition, we administered a questionnaire to the authors of primary studies to assess the cultural adaptation methods used in the included primary studies. We entered this information into a meta-regression to investigate effects of the extent of adaptation on intervention efficacy. Results: We included eight randomized controlled trials (RCTs) out of the 4911 potentially eligible records identified by the search: four on e-mental health and four on bibliotherapy. The extent of cultural adaptation varied across the studies, with language translation and use of metaphors being the most frequently applied elements of adaptation. The pooled standardized mean difference for primary outcome measures of depression and anxiety was -0.81 (95% CI -0.10 to -0.62). Higher cultural adaptation scores were significantly associated with greater effect sizes (P=.04). Conclusions: Our results support the results of previous systematic reviews on the cultural adaptation of face-to-face interventions: the extent of cultural adaptation has an effect on intervention efficacy. More research is warranted to explore how cultural adaptation may contribute to improve the acceptability and effectiveness of minimally guided psychological interventions for common mental disorders. %M 27670598 %R 10.2196/mental.5776 %U http://mental.jmir.org/2016/3/e44/ %U https://doi.org/10.2196/mental.5776 %U http://www.ncbi.nlm.nih.gov/pubmed/27670598 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e39 %T Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review %A Brown,Menna %A O'Neill,Noelle %A van Woerden,Hugo %A Eslambolchilar,Parisa %A Jones,Matt %A John,Ann %+ Swansea University, Medical School, ILS2, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 179260 ext 6312, menna.brown@swansea.ac.uk %K adherence %K Web-based mental health interventions %K well-being %K gamification %K engagement %K dropout %K patient compliance %K patient nonadherence %D 2016 %7 24.08.2016 %9 Review %J JMIR Ment Health %G English %X Background: Adherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains a critical issue, with clear potential to increase effectiveness. Continued identification and examination of “active” technological components within Web-based interventions has been called for. Gamification is the use of game design elements and features in nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort to encourage engagement and increase program adherence. The potential influence of gamification on program adherence has not been examined in the context of Web-based interventions designed to manage CMDs and well-being. Objective: This study seeks to review the literature to examine whether gaming features predict or influence reported rates of program adherence in Web-based interventions designed to manage CMDs and well-being. Methods: A systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs or well-being and incorporated gamification features. Seven electronic databases were searched. Results: A total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were designed to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in use. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly used feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of gamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in duration had higher mean adherence than those intended to be 6 or 8 weeks in duration. Conclusions: Gamification features have been incorporated into the design of interventions designed to treat CMD and well-being. Further research is needed to improve understanding of gamification features on adherence and engagement in order to inform the design of future Web-based health interventions in which adherence to treatment is of concern. Conclusions were limited by varied reporting of adherence and usage data. %M 27558893 %R 10.2196/mental.5710 %U http://mental.jmir.org/2016/3/e39/ %U https://doi.org/10.2196/mental.5710 %U http://www.ncbi.nlm.nih.gov/pubmed/27558893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e221 %T Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis %A Brown,Menna %A Glendenning,Alexander %A Hoon,Alice E %A John,Ann %+ Swansea University, Medical School, ILS2, Swansea, SA2 8PP, United Kingdom, 44 179260 ext 6213, menna.brown@swansea.ac.uk %K acceptance and commitment therapy %K systematic review %K meta-analysis %K depression %K anxiety %K quality of life %K Internet-based %K mobile-based %D 2016 %7 24.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. Objective: The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. Method: A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. Results: The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. Conclusions: ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public. %M 27558740 %R 10.2196/jmir.6200 %U http://www.jmir.org/2016/8/e221/ %U https://doi.org/10.2196/jmir.6200 %U http://www.ncbi.nlm.nih.gov/pubmed/27558740 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e38 %T Effectiveness of Internet-Based Interventions for the Prevention of Mental Disorders: A Systematic Review and Meta-Analysis %A Sander,Lasse %A Rausch,Leonie %A Baumeister,Harald %+ Institute of Psychology, Depatment of Rehabilitationpsychology and Psychotherapy, University of Freiburg, Engelberger Str. 41, Freiburg, 79085, Germany, +49 7612033049, lasse.sander@psychologie.uni-freiburg.de %K prevention %K systematic review %K meta-analysis %K mental disorders %K Internet and mobile-based %D 2016 %7 17.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders are highly prevalent and associated with considerable disease burden and personal and societal costs. However, they can be effectively reduced through prevention measures. The Internet as a medium appears to be an opportunity for scaling up preventive interventions to a population level. Objective: The aim of this study was to systematically summarize the current state of research on Internet-based interventions for the prevention of mental disorders to give a comprehensive overview of this fast-growing field. Methods: A systematic database search was conducted (CENTRAL, Medline, PsycINFO). Studies were selected according to defined eligibility criteria (adult population, Internet-based mental health intervention, including a control group, reporting onset or severity data, randomized controlled trial). Primary outcome was onset of mental disorder. Secondary outcome was symptom severity. Study quality was assessed using the Cochrane Risk of Bias Tool. Meta-analytical pooling of results took place if feasible. Results: After removing duplicates, 1169 studies were screened of which 17 were eligible for inclusion. Most studies examined prevention of eating disorders or depression or anxiety. Two studies on posttraumatic stress disorder and 1 on panic disorder were also included. Overall study quality was moderate. Only 5 studies reported incidence data assessed by means of standardized clinical interviews (eg, SCID). Three of them found significant differences in onset with a number needed to treat of 9.3-41.3. Eleven studies found significant improvements in symptom severity with small-to-medium effect sizes (d=0.11- d=0.76) in favor of the intervention groups. The meta-analysis conducted for depression severity revealed a posttreatment pooled effect size of standardized mean difference (SMD) =−0.35 (95% CI, −0.57 to −0.12) for short-term follow-up, SMD = −0.22 (95% CI, −0.37 to −0.07) for medium-term follow-up, and SMD = −0.14 (95% CI, -0.36 to 0.07) for long-term follow-up in favor of the Internet-based psychological interventions when compared with waitlist or care as usual. Conclusions: Internet-based interventions are a promising approach to prevention of mental disorders, enhancing existing methods. Study results are still limited due to inadequate diagnostic procedures. To be able to appropriately comment on effectiveness, future studies need to report incidence data assessed by means of standardized interviews. Public health policy should promote research to reduce health care costs over the long term, and health care providers should implement existing, demonstrably effective interventions into routine care. %M 27535468 %R 10.2196/mental.6061 %U http://mental.jmir.org/2016/3/e38/ %U https://doi.org/10.2196/mental.6061 %U http://www.ncbi.nlm.nih.gov/pubmed/27535468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e152 %T Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis %A Versluis,Anke %A Verkuil,Bart %A Spinhoven,Philip %A van der Ploeg,Melanie M %A Brosschot,Jos F %+ Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 715276343, a.versluis@fsw.leidenuniv.nl %K mHealth %K ecological momentary intervention %K mental health %K anxiety %K depression %K stress %K meta-analysis %K systematic review %D 2016 %7 27.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being. %M 27349305 %R 10.2196/jmir.5642 %U http://www.jmir.org/2016/6/e152/ %U https://doi.org/10.2196/jmir.5642 %U http://www.ncbi.nlm.nih.gov/pubmed/27349305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e165 %T Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review %A Brijnath,Bianca %A Protheroe,Joanne %A Mahtani,Kamal Ram %A Antoniades,Josefine %+ Curtin University, School of Occupational Therapy and Social Work, Building 401, Bentley Campus, Perth, 6152, Australia, 61 8 9266 5206, bianca.brijnath@curtin.edu.au %K health literacy %K health care seeking behavior %K Internet %K intervention study %K mental health %K social stigma %D 2016 %7 20.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated. Objective: Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness. Methods: We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings. Results: Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included “active ingredients” such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning. Conclusions: Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant improvements in health outcomes, especially for individuals with mild to moderate depression. The most promising interventions suited to this cohort appear to be MoodGYM and BluePages, 2 interventions from Australia. However, the relationship between MHL and formal and informal help seeking is less clear; self-stigma appears to be an important mediator with results showing that despite improvements in MHL and community attitudes to mental illness, individuals with mental illness still seek help at relatively low rates. Overall, the Internet is a viable method to improve MHL. Future studies could explore how new technology interfaces (eg, mobile phones vs computers) can help improve MHL, mental health outcomes, and reduce stigma. %M 27323907 %R 10.2196/jmir.5463 %U http://www.jmir.org/2016/6/e165/ %U https://doi.org/10.2196/jmir.5463 %U http://www.ncbi.nlm.nih.gov/pubmed/27323907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e157 %T Barriers and Facilitation Measures Related to People With Mental Disorders When Using the Web: A Systematic Review %A Bernard,Renaldo %A Sabariego,Carla %A Cieza,Alarcos %+ Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität München, Marchioninistraße 17, Munich, 81377, Germany, 49 89 2180 78229, renaldo.bernard@med.lmu.de %K World Wide Web %K mental disorders %K systematic review %K accessibility %K interaction design %K Web-based interaction %D 2016 %7 09.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders (MDs) affect almost 1 in 4 adults at some point during their lifetime, and coupled with substance use disorders are the fifth leading cause of disability adjusted life years worldwide. People with these disorders often use the Web as an informational resource, platform for convenient self-directed treatment, and a means for many other kinds of support. However, some features of the Web can potentially erect barriers for this group that limit their access to these benefits, and there is a lack of research looking into this eventuality. Therefore, it is important to identify gaps in knowledge about “what” barriers exist and “how” they could be addressed so that this knowledge can inform Web professionals who aim to ensure the Web is inclusive to this population. Objective: The objective of this study was to provide an overview of existing evidence regarding the barriers people with mental disorders experience when using the Web and the facilitation measures used to address such barriers. Methods: This study involved a systematic review of studies that have considered the difficulties people with mental disorders experience when using digital technologies. Digital technologies were included because knowledge about any barriers here would likely be also applicable to the Web. A synthesis was performed by categorizing data according to the 4 foundational principles of Web accessibility as proposed by the World Wide Web Consortium, which forms the necessary basis for anyone to gain adequate access to the Web. Facilitation measures recommended by studies were later summarized into a set of minimal recommendations. Results: A total of 16 publications were included in this review, comprising 13 studies and 3 international guidelines. Findings suggest that people with mental disorders experience barriers that limit how they perceive, understand, and operate websites. Identified facilitation measures target these barriers in addition to ensuring that Web content can be reliably interpreted by a wide range of user applications. Conclusions: People with mental disorders encounter barriers on the Web, and attempts have been made to remove or reduce these barriers. As forewarned by experts in the area, only a few studies investigating this issue were found. More rigorous research is needed to be exhaustive and to have a larger impact on improving the Web for people with mental disorders. %M 27282115 %R 10.2196/jmir.5442 %U http://www.jmir.org/2016/6/e157/ %U https://doi.org/10.2196/jmir.5442 %U http://www.ncbi.nlm.nih.gov/pubmed/27282115 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e14 %T Finding Web-Based Anxiety Interventions on the World Wide Web: A Scoping Review %A Ashford,Miriam Thiel %A Olander,Ellinor K %A Ayers,Susan %+ Centre for Maternal and Child Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, United Kingdom, 44 20 7040 ext 5775, miriam.ashford@city.ac.uk %K Anxiety %K mental health %K web-based interventions %K internet %K technology %K consumer %K access to health care %D 2016 %7 01.06.2016 %9 Review %J JMIR Ment Health %G English %X Background: One relatively new and increasingly popular approach of increasing access to treatment is Web-based intervention programs. The advantage of Web-based approaches is the accessibility, affordability, and anonymity of potentially evidence-based treatment. Despite much research evidence on the effectiveness of Web-based interventions for anxiety found in the literature, little is known about what is publically available for potential consumers on the Web. Objective: Our aim was to explore what a consumer searching the Web for Web-based intervention options for anxiety-related issues might find. The objectives were to identify currently publically available Web-based intervention programs for anxiety and to synthesize and review these in terms of (1) website characteristics such as credibility and accessibility; (2) intervention program characteristics such as intervention focus, design, and presentation modes; (3) therapeutic elements employed; and (4) published evidence of efficacy. Methods: Web keyword searches were carried out on three major search engines (Google, Bing, and Yahoo—UK platforms). For each search, the first 25 hyperlinks were screened for eligible programs. Included were programs that were designed for anxiety symptoms, currently publically accessible on the Web, had an online component, a structured treatment plan, and were available in English. Data were extracted for website characteristics, program characteristics, therapeutic characteristics, as well as empirical evidence. Programs were also evaluated using a 16-point rating tool. Results: The search resulted in 34 programs that were eligible for review. A wide variety of programs for anxiety, including specific anxiety disorders, and anxiety in combination with stress, depression, or anger were identified and based predominantly on cognitive behavioral therapy techniques. The majority of websites were rated as credible, secure, and free of advertisement. The majority required users to register and/or to pay a program access fee. Half of the programs offered some form of paid therapist or professional support. Programs varied in treatment length and number of modules and employed a variety of presentation modes. Relatively few programs had published research evidence of the intervention’s efficacy. Conclusions: This review represents a snapshot of available Web-based intervention programs for anxiety that could be found by consumers in March 2015. The consumer is confronted with a diversity of programs, which makes it difficult to identify an appropriate program. Limited reports and existence of empirical evidence for efficacy make it even more challenging to identify credible and reliable programs. This highlights the need for consistent guidelines and standards on developing, providing, and evaluating Web-based interventions and platforms with reliable up-to-date information for professionals and consumers about the characteristics, quality, and accessibility of Web-based interventions. %M 27251763 %R 10.2196/mental.5349 %U http://mental.jmir.org/2016/2/e14/ %U https://doi.org/10.2196/mental.5349 %U http://www.ncbi.nlm.nih.gov/pubmed/27251763 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e17 %T Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments %A Sansom-Daly,Ursula M %A Wakefield,Claire E %A McGill,Brittany C %A Wilson,Helen L %A Patterson,Pandora %+ Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Behavioural Sciences Unit, Kids Cancer Centre, Level 1 South Wing, Sydney Children's Hospital, High St, Randwick, 2031, Australia, 61 9382 3114, ursula@unsw.edu.au %K Internet %K videoconferencing %K Skype %K mental health %K cognitive therapy %K ethics, professional %K guidelines as topic %K professional practice %K societies %K standards %D 2016 %7 18.05.2016 %9 Review %J JMIR Mental Health %G English %X Background: Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. Objective: This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. Methods: This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations’ published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. Results: In the study, 19 guidelines were included, yielding 11 specific "firm" and a further 123 "tentative-level" recommendations regarding the appropriateness of e-mental health, competence, legal and regulatory issues, confidentiality, consent, professional boundaries, and crisis management. International consensus yielded firm guidance across almost all areas except professional boundaries and some aspects of determining the appropriateness of e-mental health. Few guidelines specifically addressed special populations. Overall guideline quality varied; however, 42% (8/19) of the guidelines scored at least 5 out of 7. Conclusions: This synthesis of guidelines provides a foundation for clinicians and researchers utilizing e-mental health worldwide. The lack of specific guidance relating to special populations is an area warranting further attention in order to strengthen mental health professionals’ and researchers’ capacity to ethically and effectively tailor e-mental health interventions to these groups. %M 27192931 %R 10.2196/mental.5481 %U http://mental.jmir.org/2016/2/e17/ %U https://doi.org/10.2196/mental.5481 %U http://www.ncbi.nlm.nih.gov/pubmed/27192931 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e3 %T Assessing the Evidence for e-Resources for Mental Health Self-Management: A Systematic Literature Review %A Karasouli,Eleni %A Adams,Ann %+ Institute of Digital Healthcare, International Digital Laboratory, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476 151404, e.karasouli@warwick.ac.uk %K self-management %K mental health %K depression %K bipolar disorder %K eHealth %K e-resources %K digital technology %K systematic review %D 2014 %7 08.12.2014 %9 Review %J JMIR Mental Health %G English %X Background: In a climate which recognizes mental health as a key health improvement target, but where mental health services are increasingly over-stretched, self-management e-resources can play a potentially important role in helping to ensure people get the care and support they need. They have the potential to enable individuals to learn more about, and to exercise active involvement in, their care, and thus we see a growing interest in this area for both research and practice. However, for e-resources to become important adjuncts to clinical care, it is necessary to understand if and how they impact on patients and care outcomes. Objective: The objective of this study was to review systematically the research evidence for theory-driven and evidence-based mental health self-management e-resources; and make recommendations about strengthening the future evidence base. Methods: A comprehensive literature search in MEDLINE, EMBASE, AMED, PsycINFO, Scopus, and Cochrane Library was conducted. No limits to study design were applied. We did not restrict the types of Web-based technologies included, such as websites and mobile applications, so long as they met the study inclusion criteria. A narrative synthesis of data was performed to elaborate both the development and effectiveness of online resources. Results: In total, 2969 abstracts were identified. Of those, 8 papers met the inclusion criteria. Only one randomized controlled trial was identified. The e-resources were aimed at self-management of bipolar disorder, depression, or general mental health problems. Some of the e-resources were intended to be used as prevention aids, whereas others were recovery orientated. Conclusions: Mental health self-management e-resources have the potential to be widely effective, but our review shows it is early days in terms of development of the evidence base for them. To build robust evidence, clear guidelines are needed on the development and reporting of e-resources, so that both developers and researchers maximize the potential of a new, but rapidly evolving area. %M 26543903 %R 10.2196/mental.3708 %U http://mental.jmir.org/2014/1/e3/ %U https://doi.org/10.2196/mental.3708 %U http://www.ncbi.nlm.nih.gov/pubmed/26543903 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e209 %T Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation %A Renton,Tian %A Tang,Herman %A Ennis,Naomi %A Cusimano,Michael D %A Bhalerao,Shree %A Schweizer,Tom A %A Topolovec-Vranic,Jane %+ Trauma and Neurosurgery Program, St Michael's Hospital, Bond 3-012, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 6060 ext 3421, topolovec-vranicj@smh.ca %K depression %K Web-based interventions %K interactive treatment %K health care access %K mental health %K technology %D 2014 %7 23.09.2014 %9 Review %J J Med Internet Res %G English %X Background: Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers. Objective: The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program? Methods: Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score. Results: The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms. Conclusions: There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool. %M 25249003 %R 10.2196/jmir.3147 %U http://www.jmir.org/2014/9/e209/ %U https://doi.org/10.2196/jmir.3147 %U http://www.ncbi.nlm.nih.gov/pubmed/25249003 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e206 %T Online and Social Networking Interventions for the Treatment of Depression in Young People: A Systematic Review %A Rice,Simon M %A Goodall,Joanne %A Hetrick,Sarah E %A Parker,Alexandra G %A Gilbertson,Tamsyn %A Amminger,G. Paul %A Davey,Christopher G %A McGorry,Patrick D %A Gleeson,John %A Alvarez-Jimenez,Mario %+ Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 419497599, simon.rice@unimelb.edu.au %K Internet %K depression %K young adult %K adolescent %K social networking %K support groups %K review %D 2014 %7 16.09.2014 %9 Review %J J Med Internet Res %G English %X Background: Major depression accounts for the greatest burden of all diseases globally. The peak onset of depression occurs between adolescence and young adulthood, and for many individuals, depression displays a relapse-remitting and increasingly severe course. Given this, the development of cost-effective, acceptable, and population-focused interventions for depression is critical. A number of online interventions (both prevention and acute phase) have been tested in young people with promising results. As these interventions differ in content, clinician input, and modality, it is important to identify key features (or unhelpful functions) associated with treatment outcomes. Objective: A systematic review of the research literature was undertaken. The review was designed to focus on two aspects of online intervention: (1) standard approaches evaluating online intervention content in randomized controlled designs (Section 1), and (2) second-generation online interventions and services using social networking (eg, social networking sites and online support groups) in any type of research design (Section 2). Methods: Two specific literature searches were undertaken. There was no date range specified. The Section 1 search, which focused on randomized controlled trials, included only young people (12-25 years) and yielded 101 study abstracts, of which 15 met the review inclusion criteria. The Section 2 search, which included all study design types and was not restricted in terms of age, yielded 358 abstracts, of which 22 studies met the inclusion criteria. Information about the studies and their findings were extracted and tabulated for review. Results: The 15 studies identified in Section 1 described 10 trials testing eight different online interventions, all of which were based on a cognitive behavioral framework. All but one of the eight identified studies reported positive results; however, only five of the 15 studies used blinded interviewer administered outcomes with most trials using self-report data. Studies varied significantly in presentation of intervention content, treatment dose, and dropout. Only two studies included moderator or clinician input. Results for Section 2 were less consistent. None of the Section 2 studies reported controlled or randomized designs. With the exception of four studies, all included participants were younger than 25 years of age. Eight of the 16 social networking studies reported positive results for depression-related outcomes. The remaining studies were either mixed or negative. Findings for online support groups tended to be more positive; however, noteworthy risks were identified. Conclusions: Online interventions with a broad cognitive behavioral focus appear to be promising in reducing depression symptomology in young people. Further research is required into the effectiveness of online interventions delivering cognitive behavioral subcomponents, such as problem-solving therapy. Evidence for the use of social networking is less compelling, although limited by a lack of well-designed studies and social networking interventions. A range of future social networking therapeutic opportunities are highlighted. %M 25226790 %R 10.2196/jmir.3304 %U http://www.jmir.org/2014/9/e206/ %U https://doi.org/10.2196/jmir.3304 %U http://www.ncbi.nlm.nih.gov/pubmed/25226790 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e130 %T Computer-Delivered and Web-Based Interventions to Improve Depression, Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis %A Davies,E Bethan %A Morriss,Richard %A Glazebrook,Cris %+ Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, The University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 74 84293, mcxebd@nottingham.ac.uk %K systematic review %K meta-analysis %K intervention %K universities %K students %K mental health %K depression %K anxiety %K health promotion %D 2014 %7 16.05.2014 %9 Review %J J Med Internet Res %G English %X Background: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. Objective: The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Methods: Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. Results: A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers’ analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] −0.56; 95% CI −0.77 to −0.35, P<.001), depression (pooled SMD −0.43; 95% CI −0.63 to −0.22, P<.001), and stress (pooled SMD −0.73; 95% CI −1.27 to −0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD −0.18; 95% CI −0.98 to 0.62, P=.66) or depression (pooled SMD −0.28; 95% CI −0.75 to −0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD −0.10; 95% CI −0.39 to 0.18, P=.48) or depression (pooled SMD −0.33; 95% CI −0.43 to 1.09, P=.40). Conclusions: The findings suggest Web-based and computer-delivered interventions can be effective in improving students’ depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data. %M 24836465 %R 10.2196/jmir.3142 %U http://www.jmir.org/2014/5/e130/ %U https://doi.org/10.2196/jmir.3142 %U http://www.ncbi.nlm.nih.gov/pubmed/24836465 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e66 %T Do Online Mental Health Services Improve Help-Seeking for Young People? A Systematic Review %A Kauer,Sylvia Deidre %A Mangan,Cheryl %A Sanci,Lena %+ Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, 3053, Australia, 61 390356097, sylvia.kauer@unimelb.edu.au %K adolescent %K young adult %K Internet %K medical informatics %K mental health %K mental disorders %K systematic review %K information seeking behavior %D 2014 %7 04.03.2014 %9 Review %J J Med Internet Res %G English %X Background: Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. Objective: This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. Results: Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. Conclusions: Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people. %M 24594922 %R 10.2196/jmir.3103 %U http://www.jmir.org/2014/3/e66/ %U https://doi.org/10.2196/jmir.3103 %U http://www.ncbi.nlm.nih.gov/pubmed/24594922 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e30 %T Caught in the Web: A Review of Web-Based Suicide Prevention %A Lai,Mee Huong %A Maniam,Thambu %A Chan,Lai Fong %A Ravindran,Arun V %+ Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia, 60 3 91455555 ext 6143, laifchan@gmail.com %K suicide prevention %K Web-based %K Internet %D 2014 %7 28.01.2014 %9 Review %J J Med Internet Res %G English %X Background: Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people’s lives, both negative and positive, including an impact on suicidal behaviors. Objective: Our aim was to perform a review of the published literature on Web-based suicide prevention strategies, focusing on their efficacy, benefits, and challenges. Methods: The EBSCOhost (Medline, PsycINFO, CINAHL), OvidSP, the Cochrane Library, and ScienceDirect databases were searched for literature regarding Web-based suicide prevention strategies from 1997 to 2013 according to the modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The selected articles were subjected to quality rating and data extraction. Results: Good quality literature was surprisingly sparse, with only 15 fulfilling criteria for inclusion in the review, and most were rated as being medium to low quality. Internet-based cognitive behavior therapy (iCBT) reduced suicidal ideation in the general population in two randomized controlled trial (effect sizes, d=0.04-0.45) and in a clinical audit of depressed primary care patients. Descriptive studies reported improved accessibility and reduced barriers to treatment with Internet among students. Besides automated iCBT, preventive strategies were mainly interactive (email communication, online individual or supervised group support) or information-based (website postings). The benefits and potential challenges of accessibility, anonymity, and text-based communication as key components for Web-based suicide prevention strategies were emphasized. Conclusions: There is preliminary evidence that suggests the probable benefit of Web-based strategies in suicide prevention. Future larger systematic research is needed to confirm the effectiveness and risk benefit ratio of such strategies. %M 24472876 %R 10.2196/jmir.2973 %U http://www.jmir.org/2014/1/e30/ %U https://doi.org/10.2196/jmir.2973 %U http://www.ncbi.nlm.nih.gov/pubmed/24472876 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e24 %T Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features %A Plaza,Inmaculada %A Demarzo,Marcelo Marcos Piva %A Herrera-Mercadal,Paola %A García-Campayo,Javier %+ Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, Universidad de Zaragoza, Avda Isabel La Católica 1, Zaragoza, 50009, Spain, 34 976253621, jgarcamp@gmail.com %K mobile health %K mHealth %K mindfulness %K social networks %K personalized education %K health informatics %K evidence-based medicine %D 2013 %7 01.11.2013 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce. Objective: Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting. Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature. Results: The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs. Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored. %M 25099314 %R 10.2196/mhealth.2733 %U http://mhealth.jmir.org/2013/2/e24/ %U https://doi.org/10.2196/mhealth.2733 %U http://www.ncbi.nlm.nih.gov/pubmed/25099314 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e101 %T Technology-Based Interventions for Mental Health in Tertiary Students: Systematic Review %A Farrer,Louise %A Gulliver,Amelia %A Chan,Jade KY %A Batterham,Philip J %A Reynolds,Julia %A Calear,Alison %A Tait,Robert %A Bennett,Kylie %A Griffiths,Kathleen M %+ Centre for Mental Health Research, The Australian National University, Building 63, Eggleston Road, The Australian National University, Canberra ACT, 0200, Australia, 61 2 6125 8859, louise.farrer@anu.edu.au %K systematic review %K technology %K intervention %K universities %K students %K mental health %D 2013 %7 27.05.2013 %9 Review %J J Med Internet Res %G English %X Background: Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed. Objective: To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders. Methods: The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder. Results: A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range –0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range –0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses. Conclusions: The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed. %M 23711740 %R 10.2196/jmir.2639 %U http://www.jmir.org/2013/5/e101/ %U https://doi.org/10.2196/jmir.2639 %U http://www.ncbi.nlm.nih.gov/pubmed/23711740 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e110 %T The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review %A Sucala,Madalina %A Schnur,Julie B %A Constantino,Michael J %A Miller,Sarah J %A Brackman,Emily H %A Montgomery,Guy H %+ Department of Oncological Sciences, Mount Sinai School of Medicine, Box 1130, 1425 Madison Avenue, New York, NY, 10029, United States, 1 212 659 5504 ext 85504, madalina.sucala@mssm.edu %K e-Therapy %K therapeutic relationship %K therapeutic alliance %K common factors in psychotherapy %D 2012 %7 02.08.2012 %9 Review %J J Med Internet Res %G English %X Background: E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective: Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods: We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results: From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions: Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments. %M 22858538 %R 10.2196/jmir.2084 %U http://www.jmir.org/2012/4/e110/ %U https://doi.org/10.2196/jmir.2084 %U http://www.ncbi.nlm.nih.gov/pubmed/22858538