%0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 11 %P e13306 %T Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: Qualitative Study %A Shen,Nelson %A Sequeira,Lydia %A Silver,Michelle Pannor %A Carter-Langford,Abigail %A Strauss,John %A Wiljer,David %+ Centre for Addiction and Mental Health, Bell Gateway Building, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 30132, nelson.shen@mail.utoronto.ca %K privacy %K health information exchange %K health information technology %K attitude to health %K trust %D 2019 %7 13.11.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: The privacy of patients with mental health conditions is prominent in health information exchange (HIE) discussions, given that their potentially sensitive personal health information (PHI) may be electronically shared for various health care purposes. Currently, the patient privacy perspective in the mental health context is not well understood because of the paucity of in-depth patient privacy research; however, the evidence suggests that patient privacy perspectives are more nuanced than what has been assumed in the academic and health care community. Objective: This study aimed to generate an understanding on how patients with mental health conditions feel about privacy in the context of HIE in Canada. This study also sought to identify the factors underpinning their privacy perspectives and explored how their perspectives influenced their attitudes toward HIE. Methods: Semistructured interviews were conducted with patients at a Canadian academic hospital for addictions and mental health. Guided by the Antecedent-Privacy Concern-Outcome macro-model, interview transcripts underwent deductive and inductive thematic analyses. Results: We interviewed 14 participants. Their privacy concerns varied, depending on the participant’s privacy experiences and health care perceptions. Media reports of privacy breaches and hackers had little impact on participants’ privacy concerns because of a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in health care settings caused concern. Decisions to trust others with PHI depended on past experiences with the individual (or institution) and health care needs. Participants had little knowledge of patient privacy rights and legislation but were willing to participate in HIE because of perceived individual and societal benefits. Conclusions: This study introduces evidence that patients with mental health conditions would support HIE. Participants were pragmatic, supporting HIE because they wanted the best care possible. They also understood that their PHI was critical in supporting the single-payer Canadian health care system. Participant health care experiences informed their privacy perspectives, trust, and PHI sharing attitudes—all accentuating the importance of the patient experience in building trust in HIE. Their lack of knowledge about patient rights and PHI uses highlights the degree of trust they have in the health care system to protect their privacy. These findings suggest that the patient privacy discourse should extend beyond the oft-cited barrier of patient privacy concerns to include discussions about building trust, communicating the benefits of HIE, and improving patient experiences. Although our findings are in the Canadian context, this study highlights the importance of engaging patients in privacy policy discussions, regardless of jurisdiction, to ensure their nuanced perspectives are reflected in policy decisions on their PHI. %M 31719029 %R 10.2196/13306 %U https://mental.jmir.org/2019/11/e13306 %U https://doi.org/10.2196/13306 %U http://www.ncbi.nlm.nih.gov/pubmed/31719029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14366 %T Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study %A Allan,Stephanie %A Bradstreet,Simon %A Mcleod,Hamish %A Farhall,John %A Lambrou,Maria %A Gleeson,John %A Clark,Andrea %A , %A Gumley,Andrew %+ Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Fleming Pavilion, West of Scotland Science Park, Glasgow, G20 0XA, United Kingdom, 44 01412113939, andrew.gumley@glasgow.ac.uk %K psychosis %K self-management %K implementation science %D 2019 %7 24.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective: Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods: To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration: ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 %M 31651400 %R 10.2196/14366 %U https://www.jmir.org/2019/10/e14366 %U https://doi.org/10.2196/14366 %U http://www.ncbi.nlm.nih.gov/pubmed/31651400 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e13189 %T Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial %A Sanci,Lena %A Kauer,Sylvia %A Thuraisingam,Sharmala %A Davidson,Sandra %A Duncan,Ann-Maree %A Chondros,Patty %A Mihalopoulos,Cathrine %A Buhagiar,Kerrie %+ Department of General Practice, University of Melbourne, 780 Elizabeth St, Parkville, 3052, Australia, 61 3 8344 6152, l.sanci@unimelb.edu.au %K adolescent %K young adult %K internet %K web archives as topic %K mental health %K mental disorders %K help-seeking behavior %K mental health services %K affect %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. Objective: The study aimed to investigate the effect of Link on young people’s positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. Methods: Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). Results: In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. Conclusions: The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731 %M 31625945 %R 10.2196/13189 %U https://mental.jmir.org/2019/10/e13189 %U https://doi.org/10.2196/13189 %U http://www.ncbi.nlm.nih.gov/pubmed/31625945 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e11665 %T Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study %A Morgiève,Margot %A Sebbane,Déborah %A De Rosario,Bianca %A Demassiet,Vincent %A Kabbaj,Soraya %A Briffault,Xavier %A Roelandt,Jean-Luc %+ World Health Organization Collaborating Centre for Research and Training in Mental Health, Établissement Public de Santé Mentale Lille Metropole, 211 rue Roger Salengro, 59260, Lille-Hellemmes, France, 33 620578776, deborah.sebbane6@gmail.com %K ehealth %K mental health %K psychiatry %K social representations %K focus group %K users %K caregivers %K qualitative analysis %K digital tools. %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: For the World Health Organization, electronic health (eHealth) is seen as an effective way to improve therapeutic practices and disease prevention in health. Digital tools lead to major changes in the field of mental medicine, but specific analyses are required to understand and accompany these changes. Objective: Our objective was to highlight the positions of the different stakeholders of the mental health care system on eHealth services and tools, as well as to establish professional and user group profiles of these positions and the uses of these services. Methods: In order to acquire the opinions and expectations of different categories of people, we carried out a qualitative study based on 10 focus groups (n=70, from 3-12 people per group) composed of: general practitioners, psychiatrists, psychologists, social workers, occupational therapists, nurses, caregivers, mental health services users, user representatives, and the general public. The analyses of focus group discussions were performed independently by four investigators through a common analysis grid. The constant comparative method was adopted within this framework. Results: The interviewees expressed different problems that new technologies engender in the field of mental health. What was previously strictly under the jurisdiction of physicians now tends to be fragmented and distributed over different groups and locations. New technologies reposition care in the field of domestic, rather than therapeutic, activities, and thus the conception of care as an autonomous activity in the subject’s life is questioned. The ideal of social autonomy through technology is part of the new logic of health democracy and empowerment, which is linked to a strong, contemporary aspiration to perform. Participants emphasized that there was the potential risk of a decrease in autonomy for the digitally engaged patient, while personal empowerment could become a set of obligations. Conclusions: This qualitative research highlights the heterogeneity of opinions among the groups and within each group. It suggests that opinions on electronic mental health devices are still far from being stabilized, and that a change management process should be set up to both regulate the development and facilitate the use of these tools. %M 31356151 %R 10.2196/11665 %U https://mental.jmir.org/2019/10/e11665 %U https://doi.org/10.2196/11665 %U http://www.ncbi.nlm.nih.gov/pubmed/31356151 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e14233 %T Curation of Mental Health Recovery Narrative Collections: Systematic Review and Qualitative Synthesis %A McGranahan,Rose %A Rennick-Egglestone,Stefan %A Ramsay,Amy %A Llewellyn-Beardsley,Joy %A Bradstreet,Simon %A Callard,Felicity %A Priebe,Stefan %A Slade,Mike %+ School of Health Sciences, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 82 30926, stefan.egglestone@nottingham.ac.uk %K mental health recovery %K narrative medicine %K culturally appropriate technology %D 2019 %7 4.10.2019 %9 Review %J JMIR Ment Health %G English %X Background: Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, which refer to events or actions over a period. They are readily available either individually or in collections of recovery narratives published in books, health service booklets, or on the Web. Collections of recovery narratives have been used in a range of mental health interventions, and organizations or individuals who curate collections can therefore influence how mental health problems are seen and understood. No systematic review has been conducted of research into curatorial decision making. Objective: This study aimed to produce a conceptual framework identifying and categorizing decisions made in the curation of mental health recovery narrative collections. Methods: A conceptual framework was produced through a systematic review and qualitative evidence synthesis. Research articles were identified through searching bibliographic databases (n=13), indexes of specific journals (n=3), and gray literature repositories (n=4). Informal documents presenting knowledge about curation were identified from editorial chapters of electronically available books (n=50), public documents provided by Web-based collections (n=50), and prefaces of health service booklets identified through expert consultation (n=3). Narrative summaries of included research articles were produced. A qualitative evidence synthesis was conducted on all included documents through an inductive thematic analysis. Subgroup analyses were conducted to identify differences in curatorial concerns between Web-based and printed collections. Results: A total of 5410 documents were screened, and 23 documents were included. These comprised 1 research publication and 22 informal documents. Moreover, 9 higher level themes were identified, which considered: the intended purpose and audience of the collection; how to support safety of narrators, recipients, and third parties; the processes of collecting, selecting, organizing, and presenting recovery narratives; ethical and legal issues around collections; and the societal positioning of the collection. Web-based collections placed more emphasis on providing benefits for narrators and providing safety for recipients. Printed collections placed more emphasis on the ordering of narrative within printed material and the political context. Conclusions: Only 1 research article was identified despite extensive searches, and hence this review has revealed a lack of peer-reviewed empirical research regarding the curation of recovery narrative collections. The conceptual framework can be used as a preliminary version of reporting guidelines for use when reporting on health care interventions that make use of narrative collections. It provides a theory base to inform the development of new narrative collections for use in complex mental health interventions. Collections can serve as a mechanism for supporting collective rather than individual discourses around mental health. %M 31588912 %R 10.2196/14233 %U https://mental.jmir.org/2019/10/e14233 %U https://doi.org/10.2196/14233 %U http://www.ncbi.nlm.nih.gov/pubmed/31588912 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 9 %P e13639 %T Evaluation of eMentalHealth.ca, a Canadian Mental Health Website Portal: Mixed Methods Assessment %A Jeong,Dahn %A Cheng,Michael %A St-Jean,Mireille %A Jalali,Alireza %+ Division of Clinical and Functional Anatomy, Faculty of Medicine, University of Ottawa, 2164, RGN, 451 Smyth Rd, Ottawa, ON, , Canada, 1 613 562 5800 ext 5782, ajalali@uottawa.ca %K e-mental health %K Canada %K online surveys %K website assessment %D 2019 %7 06.09.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many Canadians have mental health needs, and it can be challenging not knowing where to go for mental health information, services, and support. The website eMentalHealth.ca was created to facilitate and assist Canadians to (1) learn about mental health, (2) screen for common mental health issues, and (3) find mental health services and support. Objective: The aim of this study was to use multiple methods to learn about visitors of eMentalHealth.ca, their perceptions, and their satisfaction with the website. Methods: Website analytics (Google Analytics) provided information about the number of unique visits to the website and how the site was used. Web-based self-administered surveys were used to gather additional information on users’ characteristics and to assess their perception of the website and satisfaction with the website. Results: Web analytic results showed that from January 1 to December 31, 2017, there were 651,107 users, with 1.97 million page views. Users were more often female than male, and the majority of users were aged 35 years and older. Most users were located in Canada (612,806/651,107, 94.12%), and the most common city of origin of users was Toronto (101,473/651,107, 15.58%), followed by Ottawa (76,692/651,107, 11.78%), and Montreal (26,621/651,107, 4.09%). Web-based surveys were completed by a total of 370 respondents from June to December 2017. Overall, the majority of users were satisfied with the website (93.0%, 320 out of 344 responses). Positive feedback was related to the content of the website as a helpful resource, and negative feedback was related to technical difficulties as well as the design of the main page. This analysis will be used to help the team with ongoing improvements to the website, for example, improving technical issues and homepage usability. Conclusions: Most visitors reported satisfaction with their use of eMentalHealth.ca to learn about mental health as well as where to find help. Mental health websites such as eMentalHealth.ca are a low-cost way to increase public awareness about mental health. %M 31493328 %R 10.2196/13639 %U https://mental.jmir.org/2019/9/e13639/ %U https://doi.org/10.2196/13639 %U http://www.ncbi.nlm.nih.gov/pubmed/31493328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13382 %T Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians %A Hoffmann,Mariell %A Hartmann,Mechthild %A Wensing,Michel %A Friederich,Hans-Christoph %A Haun,Markus W %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, , Germany, 49 622156 ext 8774, markus.haun@med.uni-heidelberg.de %K video consultations %K videoconferencing %K integrated behavioral health %K primary care %K health services research %K mental health %D 2019 %7 19.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective: This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods: In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results: Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions: By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487 %M 31429419 %R 10.2196/13382 %U http://www.jmir.org/2019/8/e13382/ %U https://doi.org/10.2196/13382 %U http://www.ncbi.nlm.nih.gov/pubmed/31429419 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14318 %T Counseling With Guided Use of a Mobile Well-Being App for Students Experiencing Anxiety or Depression: Clinical Outcomes of a Feasibility Trial Embedded in a Student Counseling Service %A Broglia,Emma %A Millings,Abigail %A Barkham,Michael %+ Research Department, British Association for Counselling and Psychotherapy, 15 St John's Business Park, Lutterworth, Leicestershire,, United Kingdom, 44 1455 883318, emma.broglia@bacp.co.uk %K counseling %K students %K mental health %K mobile app %K feasibility studies %K outcome measures %K depressive symptoms %K generalized anxiety %K universities %D 2019 %7 15.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support with fewer resources to a growing student population. The convenience and availability of mobile phone apps offer innovative solutions to address therapeutic challenges and expand the reach of traditional support. Objective: The primary aim of this study was to establish the feasibility of a trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling. Methods: The feasibility trial used a two-arm, parallel nonrandomized design comparing counseling alone (treatment as usual, or TAU) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors evaluated include recruitment duration, treatment preference, randomization acceptability, and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3 and 6 months after recruitment. Results: Both groups demonstrated reduced clinical severity by the end of counseling. This was particularly noticeable for depression, social anxiety, and hostility, whereby clients moved from elevated clinical to low clinical or from low clinical to nonclinical by the end of the intervention. By the 6-month follow-up, TAU clients’ (n=18) anxiety had increased whereas intervention clients’ (n=20) anxiety continued to decrease, and this group difference was significant (Generalized Anxiety Disorder–7: t22=3.46, P=.002). This group difference was not replicated for levels of depression: students in both groups continued to decrease their levels of depression by a similar amount at the 6-month follow-up (Physical Health Questionnaire–9: t22=1.30, P=.21). Conclusion: Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. Trial registration: ISRCTN registry ISRCTN55102899; http://www.isrctn.com/ISRCTN55102899 %M 31418424 %R 10.2196/14318 %U http://mhealth.jmir.org/2019/8/e14318/ %U https://doi.org/10.2196/14318 %U http://www.ncbi.nlm.nih.gov/pubmed/31418424 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14127 %T Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study %A Ospina-Pinillos,Laura %A Davenport,Tracey %A Mendoza Diaz,Antonio %A Navarro-Mancilla,Alvaro %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, Shops 1-3, 66-70 Parramatta Road, Sydney, NSW, 2051, Australia, 61 028 627 6946, laura.ospinapinillos@sydney.edu.au %K telemedicine %K medical informatics %K eHealth %K mental health %K cultural characteristics %K cultural competency %K ethnic groups %K transients and migrants %K quality of health care %K international students %K Hispanics %K Latinos %K community-based participatory research %K primary health care %K patient participation %K patient preference %K patient satisfaction %K consumer health information %D 2019 %7 02.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries. %M 31376271 %R 10.2196/14127 %U https://www.jmir.org/2019/8/e14127/ %U https://doi.org/10.2196/14127 %U http://www.ncbi.nlm.nih.gov/pubmed/31376271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13065 %T The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial %A Le,Long Khanh-Dao %A Sanci,Lena %A Chatterton,Mary Lou %A Kauer,Sylvia %A Buhagiar,Kerrie %A Mihalopoulos,Cathrine %+ Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 392468383, long.le@deakin.edu.au %K economic evaluation %K cost effectiveness %K mental health %K help-seeking %K internet intervention %D 2019 %7 22.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. Objective: The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. Methods: A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life–4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. Results: Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus −$81 (Aus −$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. Conclusions: Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731 %M 31333199 %R 10.2196/13065 %U http://www.jmir.org/2019/7/e13065/ %U https://doi.org/10.2196/13065 %U http://www.ncbi.nlm.nih.gov/pubmed/31333199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e10838 %T A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial %A Hensel,Jennifer M %A Shaw,James %A Ivers,Noah M %A Desveaux,Laura %A Vigod,Simone N %A Cohen,Ashley %A Onabajo,Nike %A Agarwal,Payal %A Mukerji,Geetha %A Yang,Rebecca %A Nguyen,Megan %A Bouck,Zachary %A Wong,Ivy %A Jeffs,Lianne %A Jamieson,Trevor %A Bhatia,R Sacha %+ Women's College Institute for Health Systems Solutions and Virtual Care, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 5126, jennifer.hensel@wchospital.ca %K internet %K mental health %K anxiety %K depression %D 2019 %7 04.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support. Objective: The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care. Methods: A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers. Results: Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (−1.83 points, 95% CI −2.85 to −0.82) and GAD-7 score (−1.55 points, 95% CI −2.42 to −0.70). Follow-up was achieved for 55% (446/812) at 3 months, 48% (260/542) of ITG participants and 69% (186/270) of DTG participants. Only 58% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group. Conclusions: The Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions. Trial Registration: ClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO) %M 31165710 %R 10.2196/10838 %U https://www.jmir.org/2019/6/e10838/ %U https://doi.org/10.2196/10838 %U http://www.ncbi.nlm.nih.gov/pubmed/31165710 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e13955 %T Validation of the InnoWell Platform: Protocol for a Clinical Trial %A Davenport,Tracey A %A LaMonica,Haley M %A Whittle,Lisa %A English,Amelia %A Iorfino,Frank %A Cross,Shane %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 0404839897, tracey.davenport@sydney.edu.au %K clinical trial protocol %K mental health %K medical informatics %K suicide %D 2019 %7 31.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: New electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers and better support self-management of care. We developed a Web-based platform (the InnoWell Platform) that supports the prevention, early intervention, treatment, and continuous monitoring of mental health and maintenance of well-being in people aged 2 years and older. The platform is a customizable digital tool kit that operates through existing service providers who utilize the system to provide their consumers with access to evidence-based assessments and feedback, intervention options, and outcome monitoring. It does this by collecting, storing, and reporting personal and health information back to consumers and their health professionals to promote collaborative care partnerships that aim to improve the management of mental ill health and maintenance of well-being Objective: The aim of this study was to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or Web-based mental health service in which the InnoWell Platform is being offered as part of standard clinical care will be given the opportunity to use the platform. Methods: The Web-based platform is a configurable and customizable digital tool that assists in the assessment, monitoring and management of mental ill health, and maintenance of well-being. It does this by collecting, storing, and reporting health information back to the person and his or her clinician to enable transformation to person-centered care. The clinical trial will be conducted with individuals aged 2 years and older presenting to participating services for care, including persons from the veteran community, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, the lesbian, gay, bisexual, transgender, and intersex community, and those from broader education and workforce sectors, as well as people with disabilities, lived experience of comorbidity, complex disorders, and suicidality. Results: Project Synergy was funded in June 2017, and data collection began in November 2018 at a youth mental health service. At the time of this publication, 5 additional services have also begun recruitment, including 4 youth mental health services and a veteran’s service. The first results are expected to be submitted in 2020 for publication. Conclusions: This clinical trial will promote access to comprehensive, high-quality mental health care to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and reduce the rate of suicidal thoughts and/or behaviors and suicide by suggesting pathways to care that are appropriate for the identified level of need, while simultaneously enabling a timely service response. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12618001676202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374632 (Archived by WebCite at http://www.webcitation.org/78TOi5jwl) International Registered Report Identifier (IRRID): DERR1-10.2196/13955 %M 31152524 %R 10.2196/13955 %U http://www.researchprotocols.org/2019/5/e13955/ %U https://doi.org/10.2196/13955 %U http://www.ncbi.nlm.nih.gov/pubmed/31152524 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e12892 %T Evaluating a Web-Based Mental Health Service for Secondary School Students in Australia: Protocol for a Cluster Randomized Controlled Trial %A O'Dea,Bridianne %A King,Catherine %A Subotic-Kerry,Mirjana %A Anderson,Melissa %A Achilles,Melinda Rose %A Parker,Belinda %A Mackinnon,Andrew %A Anderson,Josey %A Cockayne,Nicole %A Christensen,Helen %+ Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, 2031, Australia, 61 0293828509, b.odea@blackdog.org.au %K schools %K adolescent %K mental health %K depression %K anxiety %K mental health services %K internet %D 2019 %7 17.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health problems are prevalent among Australian secondary school youth; however, help-seeking is low. Schools offer an ideal setting to address these concerns. The Black Dog Institute has developed a Web-based mental health service for secondary schools that is modeled on the principles of stepped care. The Smooth Sailing service aims to improve help-seeking and reduce anxiety and depressive symptoms in secondary school students. The acceptability of this service has been demonstrated in a pilot study. A full trial is now warranted. Objective: This study protocol for a cluster randomized controlled trial (RCT) aims to evaluate the effectiveness of the Smooth Sailing Web-based service for improving help-seeking intentions and behavior, and reducing depressive and anxiety symptoms, alongside other mental health outcomes, when compared with a school-as-usual control condition in secondary school youth. Methods: This RCT aims to recruit 1600 students from 16 secondary schools in regional and urban locations throughout New South Wales, Australia. Schools are randomly assigned to the intervention or school-as-usual control condition at the school level. Approximately 100 students from 1 or multiple grades are recruited from each participating school. Participants complete measures at 3 timepoints: baseline, 6 weeks post, and 12 weeks post, with the primary outcome assessed at 12 weeks posttest. Participants assigned to the intervention condition register to the Web-based service at baseline and receive care in accordance with the service model. Participants in the control condition receive school-as-usual. Results: The first baseline assessment occurred on February 22, 2018, with the 12-week endpoint assessments completed on Friday, June 29, 2018. Control schools are currently receiving the service, due for completion by June 30, 2019. The trial results are expected to demonstrate improved help-seeking intentions and behavior among students assigned to the intervention condition, alongside improvements in symptoms of depression, anxiety, distress, and other mental health outcomes when compared with students assigned to the control condition. Conclusions: To our knowledge, this is the first time that a Web-based mental health service based on the principles of stepped care will have been integrated into, and evaluated in, the Australian school context. The findings of this trial will have implications for the suitability of this type of service model in Australian schools and for the delivery of school-based mental health services more broadly. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001539224 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821&isReview=true (Archived by WebCite at http://www.webcitation.org/77N3MDGS6) International Registered Report Identifier (IRRID): DERR1-10.2196/12892 %M 31102370 %R 10.2196/12892 %U https://www.researchprotocols.org/2019/5/e12892/ %U https://doi.org/10.2196/12892 %U http://www.ncbi.nlm.nih.gov/pubmed/31102370 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12358 %T A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study %A McCreary,Michael %A Arevian,Armen C %A Brady,Madeline %A Mosqueda Chichits,Ana E %A Zhang,Lily %A Tang,Lingqi %A Zima,Bonnie %+ Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, 10920 Wilshire Blvd, Los Angeles, CA,, United States, 1 310 794 2400, mmccreary@mednet.ucla.edu %K integrated health care systems %K data collection methods %K community-based participatory research %K community mental health services %D 2019 %7 23.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. Objective: The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. Methods: Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. Results: A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. Conclusions: Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. Trial Registration: ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW) %M 31012861 %R 10.2196/12358 %U http://mental.jmir.org/2019/4/e12358/ %U https://doi.org/10.2196/12358 %U http://www.ncbi.nlm.nih.gov/pubmed/31012861 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11224 %T Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women %A Smail-Crevier,Rachel %A Powers,Gabrielle %A Noel,Chelsea %A Wang,JianLi %+ Work & Mental Health Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 613 722 6521 ext 6057, jianli.wang@theroyal.ca %K occupational health %K workplace %K mental health %K preventive health program %K depression %K internet %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers’ health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4%) and women (211/500, 42.2%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8%), women (408/479, 85.2%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9%), and to receive printed materials by mail (215/500, 43.4%). Men preferred to receive information in a video game format (156/511, 30.7%). Younger men (46/73, 63%) and younger women (49/60, 81%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. %M 30882361 %R 10.2196/11224 %U http://www.jmir.org/2019/3/e11224/ %U https://doi.org/10.2196/11224 %U http://www.ncbi.nlm.nih.gov/pubmed/30882361 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11198 %T The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study %A Laine,Anna %A Välimäki,Maritta %A Löyttyniemi,Eliisa %A Pekurinen,Virve %A Marttunen,Mauri %A Anttila,Minna %+ Department of Nursing Science, University of Turku, 20014 University of Turku, Turku,, Finland, 358 406890546, mava@utu.fi %K internet %K online education %K mental health %K continuing education %D 2019 %7 01.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments. Objective: We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described. Methods: The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course. Results: Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages. Conclusions: Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed. %M 30821697 %R 10.2196/11198 %U https://www.jmir.org/2019/3/e11198/ %U https://doi.org/10.2196/11198 %U http://www.ncbi.nlm.nih.gov/pubmed/30821697 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12376 %T Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals %A Vis,Christiaan %A Ruwaard,Jeroen %A Finch,Tracy %A Rapley,Tim %A de Beurs,Derek %A van Stel,Henk %A van Lettow,Britt %A Mol,Mayke %A Kleiboer,Annet %A Riper,Heleen %A Smit,Jan %+ Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 646098094, p.d.c.vis@vu.nl %K implementation science %K eHealth %K psychometrics %K eMental health %K normalization process theory %K implementation assessment %D 2019 %7 20.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective: The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods: Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results: A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62≤alpha≤.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, χ22=22.5, P≤.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (λCA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47≤r≤.54, P≤.05). Conclusions: NoMAD’s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices. %M 30785402 %R 10.2196/12376 %U http://www.jmir.org/2019/2/e12376/ %U https://doi.org/10.2196/12376 %U http://www.ncbi.nlm.nih.gov/pubmed/30785402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11694 %T Older Adults’ Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study %A Andrews,Jacob A %A Brown,Laura JE %A Hawley,Mark S %A Astell,Arlene J %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 1142220682, mark.hawley@sheffield.ac.uk %K mental health %K older adults %K technology %K digital technology %K Internet %K apps %D 2019 %7 13.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults’ attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults’ perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants’ immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. %M 30758292 %R 10.2196/11694 %U http://www.jmir.org/2019/2/e11694/ %U https://doi.org/10.2196/11694 %U http://www.ncbi.nlm.nih.gov/pubmed/30758292 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10240 %T Psychiatrists' Attitudes Toward Disruptive New Technologies: Mixed-Methods Study %A Bourla,Alexis %A Ferreri,Florian %A Ogorzelec,Laetitia %A Peretti,Charles-Siegfried %A Guinchard,Christian %A Mouchabac,Stephane %+ Department of Adult Psychiatry and Medical Psychology, Sorbonne Université, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, Paris, 75012, France, 33 149282628, alexis.bourla@aphp.fr %K acceptability %K clinical decision support systems %K computerized adaptive testing %K digital phenotype %K ecological momentary assessment %K machine learning %K mobile phone %K professional culture %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. Objective: The aim of this study was to explore psychiatrists’ perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. Methods: A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). Results: We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. Conclusions: This is the first study to assess psychiatrists’ views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies. %M 30552086 %R 10.2196/10240 %U http://mental.jmir.org/2018/4/e10240/ %U https://doi.org/10.2196/10240 %U http://www.ncbi.nlm.nih.gov/pubmed/30552086 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10224 %T Computer-Aided Telephone Support for Primary Care Patients with Common Mental Health Conditions: Randomized Controlled Trial %A Zaheer,Salaha %A Garofalo,Vanessa %A Rodie,David %A Perivolaris,Athina %A Chum,Jenny %A Crawford,Allison %A Geist,Rose %A Levinson,Andrea %A Mitchell,Brian %A Oslin,David %A Sunderji,Nadiya %A Mulsant,Benoit H %A , %+ Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, 250 College Street, Room 835, Toronto, ON, ON, M5T 1R8, Canada, 1 4165358501, benoit.mulsant@utoronto.ca %K telemedicine %K collaborative care %K depression %K anxiety %K at-risk drinking %K lay provider %K family medicine %K general practice %K primary care psychiatry %D 2018 %7 10.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone. Objective: This analysis assesses patient’s acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. Methods: The Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study is a randomized controlled trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for the treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion. Results: During the consent process, 17.1% (114/667) patients referred to the study declined to participate and 57.0% of them (65/114) attributed their refusal to research-related factors (ie, randomization and time commitment); a further 16.7% (19/114) declined owing to the telephone delivery of the intervention. Among the 377 participants who were randomized to the 1-year intervention, the overall retention rate was 82.8% (312/377). Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97% (38/39) of comments related to the telephone components were positive with key reported positive attributes being accessibility, convenience, and privacy. Conclusions: Our results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy. Trial Registration: ClinicalTrials.gov NCT02345122; https://clinicaltrials.gov/ct2/show/NCT02345122 (Archived by WebCite at http://www.webcitation.org/73R9Q2cle) %M 30530461 %R 10.2196/10224 %U http://mental.jmir.org/2018/4/e10224/ %U https://doi.org/10.2196/10224 %U http://www.ncbi.nlm.nih.gov/pubmed/30530461 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10129 %T An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration %A Miyoshi,Newton Shydeo Brandão %A Azevedo-Marques,João Mazzoncini De %A Alves,Domingos %A Azevedo-Marques,Paulo Mazzoncini De %+ Ribeirão Preto Medical School, University of São Paulo, Avenue Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Ribeirão Preto, 14049 900, Brazil, 55 33158594, newton.sbm@usp.br %K eHealth %K mental health %K health information exchange %K health information interoperability %K medical record linkage %K continuity of patient care %D 2018 %7 07.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries. Objective: The aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services. Methods: The proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution. Results: The eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients’ identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication. Conclusions: The proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care. %M 30530455 %R 10.2196/10129 %U http://mental.jmir.org/2018/4/e10129/ %U https://doi.org/10.2196/10129 %U http://www.ncbi.nlm.nih.gov/pubmed/30530455 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e4 %T Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey %A Cruickshank,Callum %A MacIntyre,Donald J %+ Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Old College, South Bridge, Edinburgh,, United Kingdom, 44 1316501000, callum.cruickshank@ed.ac.uk %K general psychiatry %K internet access %K memory assessment and treatment service %K mobile phone %K old age psychiatry %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Aging %G English %X Background: It has been suggested that improving access to mental health services, supporting self-management, and increasing clinical productivity can be achieved through the delivery of technology-enabled care by personal mobile-based and internet-based services. There is little evidence available about whether working-age and older adults with mental health problems or their caregivers have access to these technologies or their confidence with these technologies. Objective: This study aimed to ascertain the prevalence and range of devices used to access the internet in patients and caregivers attending general and older adult psychiatry outpatient services and their confidence in using these technologies. Methods: We conducted an anonymous survey of 77 patients and caregivers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology-enabled care. Results: We found high levels of internet access and confidence in using the internet in working-age adults, their caregivers, and older adult caregivers but not in older adult patients. The smartphone usage predominated in working-age adults and their caregivers. Older adult caregivers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor. Conclusions: Access rates and uptake of internet-based services have the potential to be high in working-age adults and their caregivers but are likely to be markedly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial. %M 31518247 %R 10.2196/aging.9130 %U http://aging.jmir.org/2018/2/e4/ %U https://doi.org/10.2196/aging.9130 %U http://www.ncbi.nlm.nih.gov/pubmed/31518247 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 11 %P e183 %T Clients’ Experiences With Internet-Based Psychological Treatments for Mental Disorders: Protocol for a Metasynthesis of Qualitative Studies %A Fernández-Álvarez,Javier %A Díaz-García,Amanda %A Vara,Mª Dolores %A Molinari,Guadalupe %A Colombo,Desirée %A Riva,Giuseppe %A Baños,Rosa M %A Botella,Cristina %+ Università Cattolica del Sacro Cuore, Largo A Gemelli 1, Milan, 20123, Italy, 39 3755680785, javier.fernandezkirszman@unicatt.it %K barriers %K clients’ experiences %K facilitators %K internet-based treatment %K metasynthesis %K qualitative %D 2018 %7 21.11.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients’ experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients’ perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. Objective: The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. Methods: Elliot and Timulak’s metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. Results: The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. Conclusions: We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training. Trial Registration: PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7). International Registered Report Identifier (IRRID): PRR1-10.2196/9722 %M 30463837 %R 10.2196/resprot.9722 %U https://www.researchprotocols.org/2018/11/e183/ %U https://doi.org/10.2196/resprot.9722 %U http://www.ncbi.nlm.nih.gov/pubmed/30463837 %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 %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10668 %T Impact of Internet-Based Interventions on Caregiver Mental Health: Systematic Review and Meta-Analysis %A Sherifali,Diana %A Ali,Muhammad Usman %A Ploeg,Jenny %A Markle-Reid,Maureen %A Valaitis,Ruta %A Bartholomew,Amy %A Fitzpatrick-Lewis,Donna %A McAiney,Carrie %+ School of Nursing, Faculty of Health Sciences, McMaster University, HSC 3N28F, 1280 Main Street West, Hamilton, ON,, Canada, 1 905 525 9140 ext 21435, dsherif@mcmaster.ca %K internet %K support %K education %K mental health %K caregivers %K chronic conditions %D 2018 %7 03.07.2018 %9 Review %J J Med Internet Res %G English %X Background: The health of informal caregivers of adults with chronic conditions is increasingly vital since caregivers comprise a large proportion of supportive care to family members living in the community. Due to efficiency and reach, internet-based interventions for informal caregivers have the potential to mitigate the negative mental health outcomes associated with caregiving. Objective: The objective of this systematic review and meta-analysis was to examine the impact of internet-based interventions on caregiver mental health outcomes and the impact of different types of internet-based intervention programs. Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, and AgeLine databases were searched for randomized controlled trials or controlled clinical trials published from January 1995 to April 2017 that compared internet-based intervention programs with no or minimal internet-based interventions for caregivers of adults with at least 1 chronic condition. The inclusion criteria were studies that included (1) adult informal caregivers (aged 18 years or older) of adults living in the community with a chronic condition; (2) an internet-based intervention program to deliver education, support, or monitoring to informal caregivers; and (3) outcomes of mental health. Title and abstract and full-text screening were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Where possible, data for mental health outcomes were meta-analyzed. Results: The search yielded 7923 unique citations of which 290 studies were screened at full-text. Of those, 13 studies met the inclusion criteria; 11 were randomized controlled trials, 1 study was a controlled clinical trial, and 1 study comprised both study designs. Beneficial effects of any internet-based intervention program resulted in a mean decrease of 0.48 points (95% CI –0.75 to –0.22) for stress and distress and a mean decrease of 0.40 points (95% CI –0.58 to –0.22) for anxiety among caregivers. For studies that examined internet-based information and education plus professional psychosocial support, the meta-analysis results showed small to medium beneficial effect sizes of the intervention for the mental health outcomes of depression (–0.34; 95% CI –0.63 to –0.05) and anxiety (–0.36; 95% CI –0.66 to –0.07). Some suggestion of a beneficial effect on overall health for the use of information and education plus combined peer and professional support was also shown (1.25; 95% CI 0.24 to 2.25). Overall, many studies were of poor quality and were rated at high risk of bias. Conclusions: The review found evidence for the benefit of internet-based intervention programs on mental health for caregivers of adults living with a chronic condition, particularly for the outcomes of caregiver depression, stress and distress, and anxiety. The types of interventions that predominated as efficacious included information and education with or without professional psychological support, and, to a lesser extent, with combined peer and psychological support. Further high-quality research is needed to inform the effectiveness of interactive, dynamic, and multicomponent internet-based interventions. Trial Registration: PROSPERO CRD42017075436; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=75436 (Archived by WebCite at http://www.webcitation.org/709M3tDvn) %M 29970358 %R 10.2196/10668 %U http://www.jmir.org/2018/7/e10668/ %U https://doi.org/10.2196/10668 %U http://www.ncbi.nlm.nih.gov/pubmed/29970358 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10148 %T Towards an Artificially Empathic Conversational Agent for Mental Health Applications: System Design and User Perceptions %A Morris,Robert R %A Kouddous,Kareem %A Kshirsagar,Rohan %A Schueller,Stephen M %+ Koko, 155 Rivington St, New York, NY, 10002, United States, 1 617 851 4967, rob@koko.ai %K conversational agents %K mental health %K empathy %K crowdsourcing %K peer support %D 2018 %7 26.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Conversational agents cannot yet express empathy in nuanced ways that account for the unique circumstances of the user. Agents that possess this faculty could be used to enhance digital mental health interventions. Objective: We sought to design a conversational agent that could express empathic support in ways that might approach, or even match, human capabilities. Another aim was to assess how users might appraise such a system. Methods: Our system used a corpus-based approach to simulate expressed empathy. Responses from an existing pool of online peer support data were repurposed by the agent and presented to the user. Information retrieval techniques and word embeddings were used to select historical responses that best matched a user’s concerns. We collected ratings from 37,169 users to evaluate the system. Additionally, we conducted a controlled experiment (N=1284) to test whether the alleged source of a response (human or machine) might change user perceptions. Results: The majority of responses created by the agent (2986/3770, 79.20%) were deemed acceptable by users. However, users significantly preferred the efforts of their peers (P<.001). This effect was maintained in a controlled study (P=.02), even when the only difference in responses was whether they were framed as coming from a human or a machine. Conclusions: Our system illustrates a novel way for machines to construct nuanced and personalized empathic utterances. However, the design had significant limitations and further research is needed to make this approach viable. Our controlled study suggests that even in ideal conditions, nonhuman agents may struggle to express empathy as well as humans. The ethical implications of empathic agents, as well as their potential iatrogenic effects, are also discussed. %M 29945856 %R 10.2196/10148 %U http://www.jmir.org/2018/6/e10148/ %U https://doi.org/10.2196/10148 %U http://www.ncbi.nlm.nih.gov/pubmed/29945856 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10521 %T Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals %A Petersson,Lena %A Erlingsdóttir,Gudbjörg %+ Department of Design Sciences, Faculty of Engineering, Lund University, Box 118, Lund, SE-22100, Sweden, 46 462220533, lena.petersson@design.lth.se %K electronic health records %K eHealth %K telemedicine %K postimplementation survey %K health care surveys %K mental health %K Open Notes %K psychiatry %K health professionals %D 2018 %7 21.06.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: This is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively. Objective: The objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Skåne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study. Methods: We distributed a full population Web-based questionnaire to psychiatric care professionals in Region Skåne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service. Results: A total of 41.5% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients’ questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62%) and doctors (36/94, 38%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40% of the health care professionals (239/650, 36.8%) reported that the Open Notes Service in psychiatry was a good idea. Conclusions: Most health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive. %M 29929946 %R 10.2196/10521 %U http://mental.jmir.org/2018/2/e10521/ %U https://doi.org/10.2196/10521 %U http://www.ncbi.nlm.nih.gov/pubmed/29929946 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e46 %T Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support %A Hatch,Ainslie %A Hoffman,Julia E %A Ross,Ruth %A Docherty,John P %+ Otsuka America Pharmaceutical, Inc, 508 Carnegie Center, Princeton, NJ, United States, 1 301 956 2702, ainslie.hatch@otsuka-us.com %K biomedical technology %K patient engagement %K severe mental disorders %D 2018 %7 12.06.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital technology is increasingly being used to enhance health care in various areas of medicine. In the area of serious mental illness, it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools, as well as the resources and training necessary for these patients to facilitate the use of this technology. Objective: The aim of this study was to conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and health care professionals), barriers and facilitators for appropriate use, and resources needed to optimize the use of digital health tools in patients with serious mental illness. Methods: A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey, rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across three ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the CI of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts’ responses to nine questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of digital health tools, (2) potential benefits or motivators and barriers or unintended consequences of digital health tool use, and (3) support and training for patients and health care professionals. Results: Among patient characteristics most likely to promote use of digital health tools, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain disease-associated signs and symptoms (eg, more severe symptoms, substance abuse problems, and a chaotic living situation) were considered likely to make it difficult for patients to use digital health tools. Enthusiasm among health care professionals for digital health tools and availability of staff and equipment to support their use were identified as variables to enable health care professionals to successfully incorporate digital health tools into their practices. The experts identified a number of potential benefits of and barriers to use of digital health tools by patients and health care professionals. Experts agreed that both health care professionals and patients would need to be trained in the use of these new technologies. Conclusions: These results provide guidance to the mental health field on how to optimize the development and deployment of digital health tools for patients with serious mental illness. %M 29895514 %R 10.2196/mental.9777 %U http://mental.jmir.org/2018/2/e46/ %U https://doi.org/10.2196/mental.9777 %U http://www.ncbi.nlm.nih.gov/pubmed/29895514 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e47 %T Predicting Caller Type From a Mental Health and Well-Being Helpline: Analysis of Call Log Data %A Grigorash,Alexander %A O'Neill,Siobhan %A Bond,Raymond %A Ramsey,Colette %A Armour,Cherie %A Mulvenna,Maurice D %+ School of Computing, Ulster University, Shore Road, Newtownabbey,, United Kingdom, 44 2890368602, md.mulvenna@ulster.ac.uk %K data mining %K machine learning %K clustering %K classification %K mental health %K suicide %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: This paper presents an analysis of call data records pertaining to a telephone helpline in Ireland among individuals seeking mental health and well-being support and among those who are in a suicidal crisis. Objective: The objective of our study was to examine whether rule sets generated from decision tree classification, trained using features derived from callers’ several initial calls, could be used to predict what caller type they would become. Methods: Machine learning techniques were applied to the call log data, and five distinct patterns of caller behaviors were revealed, each impacting the helpline capacity in different ways. Results: The primary findings of this study indicate that a significant model (P<.001) for predicting caller type from call log data obtained from the first 8 calls is possible. This indicates an association between callers’ behavior exhibited during initial calls and their behavior over the lifetime of using the service. Conclusions: These data-driven findings contribute to advanced workload forecasting for operational management of the telephone-based helpline and inform the literature on helpline caller behavior in general. %M 29891472 %R 10.2196/mental.9946 %U http://mental.jmir.org/2018/2/e47/ %U https://doi.org/10.2196/mental.9946 %U http://www.ncbi.nlm.nih.gov/pubmed/29891472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10386 %T Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists %A O'Connor,Marianne %A Morgan,Katy E %A Bailey-Straebler,Suzanne %A Fairburn,Christopher G %A Cooper,Zafra %+ Centre for Research on Dissemination at Oxford, Department of Psychiatry, University of Oxford, Warneford Lane, Headington, Oxford, OX3 7JX, United Kingdom, 44 2038094213, zafra.cooper@psych.ox.ac.uk %K internet %K web-centered %K eating disorders %K cognitive therapy %K effective treatment %D 2018 %7 08.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. Objective: The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit. Methods: A cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks. Results: A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95% CI 3.1-3.8; P<.001). After training, 52% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45% (95% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95% CI 1.2-4.1). Conclusions: Independent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments. %M 29884606 %R 10.2196/10386 %U http://www.jmir.org/2018/6/e10386/ %U https://doi.org/10.2196/10386 %U http://www.ncbi.nlm.nih.gov/pubmed/29884606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e188 %T Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies %A Ospina-Pinillos,Laura %A Davenport,Tracey A %A Ricci,Cristina S %A Milton,Alyssa C %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 0286276946, laura.ospinapinillos@sydney.edu.au %K mental health %K community-based participatory research %K eHealth %D 2018 %7 28.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available. %R 10.2196/jmir.9716 %U http://www.jmir.org/2018/5/e188/ %U https://doi.org/10.2196/jmir.9716 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e42 %T Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers %A Hermes,Eric %A Burrone,Laura %A Perez,Elliottnell %A Martino,Steve %A Rowe,Michael %+ VA Connecticut Healthcare System, Veterans Health Administration, 950 Campbell Ave, West Haven, CT, 06106, United States, 1 2039325711 ext 7422, eric.hermes@yale.edu %K cognitive behavioral therapy %K internet-based therapy %K health information technology %K behavioral intervention technology %K internet %K Veterans %D 2018 %7 18.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. Objective: The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. Methods: The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. Results: A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. Conclusions: This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings. %M 29776898 %R 10.2196/mental.9600 %U http://mental.jmir.org/2018/2/e42/ %U https://doi.org/10.2196/mental.9600 %U http://www.ncbi.nlm.nih.gov/pubmed/29776898 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10735 %T Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study %A Apolinário-Hagen,Jennifer %A Harrer,Mathias %A Kählke,Fanny %A Fritsche,Lara %A Salewski,Christel %A Ebert,David Daniel %+ Institute of Psychology, Department of Health Psychology, University of Hagen, Universitätsstraße 33, Hagen, 58097, Germany, 49 2331 987 2272, jennifer.apolinario-hagen@fernuni-hagen.de %K mental health %K eHealth %K attitude to computers %K patient preference %K cognitive therapy %K acceptability of health care %K stress, psychological %K object attachment %D 2018 %7 15.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet interventions have been proposed to improve the accessibility and use of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their use. Objective: This study aimed to (1) determine attitudes toward guided internet interventions, (2) assess its acceptability compared with other internet-based formats, and (3) explore predictors of acceptance. Methods: A convenience-sample Web-based survey (N=646) assessed attitudes toward guided internet therapies (ie, perceived usefulness and helpfulness, and advantage relative to face-to-face therapy), preferences for delivery modes (ie, e-preference: guided internet interventions, unguided internet interventions, or videoconferencing psychotherapy), and potential predictors of attitudes and preferences: sociodemographics, help-seeking–related variables, attachment style, and perceived stress. Results: Although most participants perceived internet interventions as useful or helpful (426/646, 65.9%), a few indicated their advantage relative to face-to-face therapy (56/646, 8.7%). Most participants preferred guided internet interventions (252/646, 39.0%) over videoconferencing psychotherapy (147/646, 22.8%), unguided internet interventions (124/646, 19.2%), and not using internet interventions (121/646, 18.8%; missing data: 1/646, 0.2%). Attachment avoidance and stress were related to e-preference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals who were aware of internet-based treatment (χ26=12.8; P=.046). Conclusions: Participants assessed therapist-guided internet interventions as helpful, but not equivalent to face-to-face therapies. The vast majority (523/646, 81.0%) of the participants were potentially willing to use internet-based approaches. In lieu of providing patients with only one specific low-intensity treatment, implementation concepts should offer several options, including guided internet interventions, but not limited to them. Conversely, our results also indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake. %M 29764797 %R 10.2196/10735 %U http://mental.jmir.org/2018/2/e10735/ %U https://doi.org/10.2196/10735 %U http://www.ncbi.nlm.nih.gov/pubmed/29764797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e153 %T Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model %A Feijt,Milou A %A de Kort,Yvonne AW %A Bongers,Inge MB %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, IPO Building, 2nd Floor, P.O. Box 513, Eindhoven, 5600 MB, Netherlands, 31 40 247 5391, m.a.feijt@tue.nl %K eHealth %K mental health %K psychology, clinical %K diffusion of innovation %K technology %D 2018 %7 24.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. Objective: The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. Methods: The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. Results: In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. Conclusions: The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options. %M 29691215 %R 10.2196/jmir.9485 %U http://www.jmir.org/2018/4/e153/ %U https://doi.org/10.2196/jmir.9485 %U http://www.ncbi.nlm.nih.gov/pubmed/29691215 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e27 %T Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis %A Booth,Richard G %A Allen,Britney N %A Bray Jenkyn,Krista M %A Li,Lihua %A Shariff,Salimah Z %+ Arthur Labatt Family School of Nursing, Western University, 1151 Richmond Street, FNB2333, London, ON, N6A 5B9, Canada, 1 5196612111 ext 86571, rbooth5@uwo.ca %K mental health %K youth %K adolescent %K social media %K population health %K mass media %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let’s Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can $0.05 for each interaction with a campaign-specific username (@Bell_LetsTalk). Objective: The intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada. Methods: Monthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health–related physician visit. Results: The inclusion of Twitter into the 2012 Bell Let’s Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P<.001), whereas males of the same age cohort experienced a monthly increase from 9.7/1000 to 9.8/1000 (slope change of 0.052 following campaign, P<.001). Outpatient psychiatric services visit rates also increased for both male and female adolescents aged 10 to 17 years post campaign (slope change of 0.005, P=.02; slope change of 0.003, P=.005, respectively). For young adults aged 18 to 24 years, females who used primary health care experienced the most significant increases in mental health visit rates from 26.5/1000 in April 2006 to 29.2/1000 in April 2015 (slope change of 0.17 following campaign, P<.001). Conclusions: The 2012 Bell Let’s Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services. %M 29625954 %R 10.2196/mental.8808 %U http://mental.jmir.org/2018/2/e27/ %U https://doi.org/10.2196/mental.8808 %U http://www.ncbi.nlm.nih.gov/pubmed/29625954 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e12 %T General Practitioners’ Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery %A Subotic-Kerry,Mirjana %A King,Catherine %A O'Moore,Kathleen %A Achilles,Melinda %A O'Dea,Bridianne %+ Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 2 9382 8509, m.subotic-kerry@blackdog.org.au %K anxiety %K depression %K adolescent %K general practitioners %K internet %D 2018 %7 23.03.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs’ views need to be measured. Objective: This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. Methods: GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. Results: A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. Conclusions: GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured. %M 29572203 %R 10.2196/humanfactors.8913 %U http://humanfactors.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/humanfactors.8913 %U http://www.ncbi.nlm.nih.gov/pubmed/29572203 %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 20 %N 3 %P e79 %T The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research %A VanHeerwaarden,Nicole %A Ferguson,Genevieve %A Abi-Jaoude,Alexxa %A Johnson,Andrew %A Hollenberg,Elisa %A Chaim,Gloria %A Cleverley,Kristin %A Eysenbach,Gunther %A Henderson,Joanna %A Levinson,Andrea %A Robb,Janine %A Sharpe,Sarah %A Voineskos,Aristotle %A Wiljer,David %+ Education, Technology & Innovation, University Health Network, 190 Elizabeth Street, R Fraser Elliott Building RFE 3S-411, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, david.wiljer@uhn.ca %K students %K transition-aged youth %K mental health %K substance use %K eHealth %K mobile apps %K participatory action research %K help-seeking %D 2018 %7 06.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings. Objective: The aim of this study was to describe the process of engaging with postsecondary students through the PDR approaches, with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with the PDR approaches, five student-led workshops, attended by 41 individuals, were facilitated to obtain feedback regarding the platform’s usability and functionality and its potential value in a postsecondary setting. Various creative engagement activities were delivered to gather experiences and opinions, including semistructured focus groups, questionnaires, personas, journey mapping, and a world café. Innovative technological features and refinements were also brainstormed during the workshops. Results: By using PDR methods of engagement, participants knew that their ideas and recommendations would be applied. There was also an overall sense of respect and care integrated into each group, which facilitated an exchange of ideas and suggestions. Conclusions: The process of engaging with students to redesign the Thought Spot platform through PDR has been effective. Findings from these workshops will significantly inform new technological features within the app to enable positive help-seeking behaviors among students. These behaviors will be further explored in the second phase that involves a randomized controlled trial. %M 29510970 %R 10.2196/jmir.8102 %U http://www.jmir.org/2018/3/e79/ %U https://doi.org/10.2196/jmir.8102 %U http://www.ncbi.nlm.nih.gov/pubmed/29510970 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e48 %T Implementation of the Enhanced Moderated Online Social Therapy (MOST+) Model Within a National Youth E-Mental Health Service (eheadspace): Protocol for a Single Group Pilot Study for Help-Seeking Young People %A Rice,Simon %A Gleeson,John %A Leicester,Steven %A Bendall,Sarah %A D'Alfonso,Simon %A Gilbertson,Tamsyn %A Killackey,Eoin %A Parker,Alexandra %A Lederman,Reeva %A Wadley,Greg %A Santesteban-Echarri,Olga %A Pryor,Ingrid %A Mawren,Daveena %A Ratheesh,Aswin %A Alvarez-Jimenez,Mario %+ Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, 3052, Australia, 61 03 9342 2800, simon.rice@orygen.org.au %K internet %K social networking %K young adult %K adolescent %K mental heath %D 2018 %7 22.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a substantial need for youth electronic mental health (e-mental health) services. In addressing this need, our team has developed a novel moderated online social therapy intervention called enhanced moderated online social therapy (MOST+). MOST+ integrates real-time, clinician-delivered Web chat counseling, interactive user-directed online therapy, expert and peer moderation, and private and secure peer-to-peer social networking. MOST+ has been designed to give young people immediate, 24-hour access to anonymous, evidence-based, and short-term mental health care. Objective: The primary aims of this pilot study were to determine the feasibility, acceptability, and safety of the intervention. Secondary aims were to assess prepost changes in key psychosocial outcomes and collect qualitative data for future intervention refinement. Methods: MOST+ will be embedded within eheadspace, an Australian youth e-mental health service, and will be evaluated via an uncontrolled single-group study. Approximately 250 help-seeking young people (16-25 years) will be progressively recruited to the intervention from the eheadspace home page over the first 4 weeks of an 8-week intervention period. All participants will have access to evidence-based therapeutic content and integrated Web chat counseling. Additional access to moderated peer-to-peer social networking will be granted to individuals for whom it is deemed safe and appropriate, through a three-tiered screening process. Participants will be enrolled in the MOST+ intervention for 1 week, with the option to renew their enrollment across the duration of the pilot. Participants will complete a survey at enrollment to assess psychological well-being and other mental health outcomes. Additional assessment will occur following account deactivation (ie, after participant has opted not to renew their enrollment, or at trial conclusion) and will include an online survey and telephone interview assessing psychological well-being and experience of using MOST+. Results: Recruitment for the study commenced in October 2017. We expect to have initial results in March 2018, with more detailed qualitative and quantitative analyses to follow. Conclusions: This is the first Australia-wide research trial to pilot an online social media platform merging real-time clinical support, expert and peer moderation, interactive online therapy, and peer-to-peer social networking. The importance of the project stems from the need to develop innovative new models for the efficient delivery of responsive evidence-based online support to help-seeking young people. If successful, this research stands to complement and enhance e-mental health services in Australia. %M 29472177 %R 10.2196/resprot.8813 %U http://www.researchprotocols.org/2018/2/e48/ %U https://doi.org/10.2196/resprot.8813 %U http://www.ncbi.nlm.nih.gov/pubmed/29472177 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e59 %T Attitudes Toward e-Mental Health Services in a Community Sample of Adults: Online Survey %A March,Sonja %A Day,Jamin %A Ritchie,Gabrielle %A Rowe,Arlen %A Gough,Jeffrey %A Hall,Tanya %A Yuen,Chin Yan Jackie %A Donovan,Caroline Leanne %A Ireland,Michael %+ Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland, Springfield Campus, Queensland, 4300, Australia, 61 734704434, Sonja.March@usq.edu.au %K eHealth %K mHealth %K consumer preference %K attitude %D 2018 %7 19.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite evidence that e-mental health services are effective, consumer preferences still appear to be in favor of face-to-face services. However, the theory of planned behavior (TPB) suggests that cognitive intentions are more proximal to behavior and thus may have a more direct influence on service use. Investigating individual characteristics that influence both preferences and intentions to use e-mental health services is important for better understanding factors that might impede or facilitate the use of these services. Objective: This study explores predictors of preferences and intentions to access e-mental health services relative to face-to-face services. Five domains were investigated (demographics, technology factors, personality, psychopathology, and beliefs), identified from previous studies and informed by the Internet interventions model. We expected that more participants would report intentions to use e-mental health services relative to reported preferences for this type of support and that these 5 domains would be significantly associated with both intentions and preferences toward online services. Methods: A mixed sample of 308 community members and university students was recruited through social media and the host institution in Australia. Ages ranged between 17 and 68 years, and 82.5% (254/308) were female. Respondents completed an online survey. Chi-square analysis and t tests were used to explore group differences, and logistic regression models were employed to explore factors predicting preferences and intentions. Results: Most respondents (85.7%, 264/308) preferred face-to-face services over e-mental health services. Relative to preferences, a larger proportion of respondents (39.6%, 122/308) endorsed intentions to use e-mental health services if experiencing mental health difficulties in the future. In terms of the 5 predictor domains, 95% CIs of odds ratios (OR) derived from bootstrapped standard errors suggested that prior experience with online services significantly predicted intentions to use self-help (95% CI 2.08-16.24) and therapist-assisted (95% CI 1.71-11.90) online services in future. Being older predicted increased intentions to use therapist-assisted online services in future (95% CI 1.01-1.06), as did more confidence using computers and the Internet (95% CI 1.06-2.69). Technology confidence was also found to predict greater preference for online services versus face-to-face options (95% CI 1.24-4.82), whereas higher doctor-related locus of control, or LOC (95% CI 0.76-0.95), and extraversion (95% CI 0.88-1.00) were predictive of lower likelihood of preferring online services relative to face-to-face services. Conclusions: Despite generally low reported preferences toward e-mental health services, intentions to access these services are higher, raising the question of how to best encourage translation of intentions into behavior (ie, actual use of programs). Strategies designed to ease people into new Internet-based mental health programs (to enhance confidence and familiarity) may be important for increasing the likelihood that they will return to such programs later. %M 29459357 %R 10.2196/jmir.9109 %U http://www.jmir.org/2018/2/e59/ %U https://doi.org/10.2196/jmir.9109 %U http://www.ncbi.nlm.nih.gov/pubmed/29459357 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e11 %T Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals %A Petersson,Lena %A Erlingsdóttir,Gudbjörg %+ Faculty of Engineering, Department of Design Sciences, Lund University, Box 118, Lund, SE-22100, Sweden, 46 462220533, Lena.Petersson@design.lth.se %K electronic health record %K eHealth %K baseline survey %K mental health %K open notes %K psychiatry %K health professionals %D 2018 %7 02.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. Objective: The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. Methods: A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. Results: The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. Conclusions: Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients. %M 29396386 %R 10.2196/mental.9140 %U http://mental.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/mental.9140 %U http://www.ncbi.nlm.nih.gov/pubmed/29396386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e38 %T Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial %A Martínez,Vania %A Rojas,Graciela %A Martínez,Pablo %A Zitko,Pedro %A Irarrázaval,Matías %A Luttges,Carolina %A Araya,Ricardo %+ Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago,, Chile, 56 229788601, graciela.rojas.castillo@gmail.com %K primary health care %K depression %K adolescents %K Internet %K telemedicine %K medically underserved area %D 2018 %7 31.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results: More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). Conclusions: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) %M 29386172 %R 10.2196/jmir.8021 %U https://www.jmir.org/2018/1/e38/ %U https://doi.org/10.2196/jmir.8021 %U http://www.ncbi.nlm.nih.gov/pubmed/29386172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e37 %T Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study %A Quanbeck,Andrew %A Gustafson,David H %A Marsch,Lisa A %A Chih,Ming-Yuan %A Kornfield,Rachel %A McTavish,Fiona %A Johnson,Roberta %A Brown,Randall T %A Mares,Marie-Louise %A Shah,Dhavan V %+ Department of Family Medicine and Community Health, University of Wisconsin - Madison, 1100 Delaplaine Ct, Madison, WI, 53715, United States, 1 608 263 4550, arquanbe@wisc.edu %K mobile health %K mHealth %K evidence-based practice %K behavioral medicine %D 2018 %7 30.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach—Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness—Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption—Patients sustained high levels of Seva use—between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation—At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance—Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. %M 29382624 %R 10.2196/jmir.8928 %U http://www.jmir.org/2018/1/e37/ %U https://doi.org/10.2196/jmir.8928 %U http://www.ncbi.nlm.nih.gov/pubmed/29382624 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e251 %T Implementing a Mental Health Care Program and Home-Based Training for Mothers of Children With Autism Spectrum Disorder in an Urban Population in Bangladesh: Protocol for a Feasibility Assessment Study %A Naheed,Aliya %A Koly,Kamrun Nahar %A Uddin Ahmed,Helal %A Akhter,Shaheen %A Uddin,MM Jalal %A Smith Fawzi,Mary C %A Chandir,Subhash %A Mannan,Muzharul %A Hossain,Saima %A Nelson,Charles %A Munir,Kerim %+ Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Dhaka-1212, Bangladesh, 880 1709 651 476, anaheed@icddrb.org %K depression %K psychosocial %K counseling %K autism spectrum disorder %K mothers %K training %D 2017 %7 14.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mothers of children with autism spectrum disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and developing countries. Mothers are the lifetime caregivers of children with ASD, and a high burden of depression can negatively impact their ability to provide care. However, access to mental health services in primary care is limited, given the scarcity of qualified providers in Bangladesh. Objective: We aim to pilot the feasibility of integrating mental health services for the mothers of children with ASD attending schools offering ASD care and improve skills of mothers for child care through a home-based training program. Methods: The study will be conducted in two selected schools in Dhaka in Bangladesh that have been offering services for ASD for more than 10 years. A female psychologist will be deployed at the schools to offer nonpharmacological services for all mothers having a depressive episode. Referral for pharmacological treatment will be made at the discretion of supervising psychiatrists. An ASD special educator will provide training to the mothers for enhancing their child care skills at home on a monthly basis. The proposed intervention package will be implemented over a period of 4-6 months, and the feasibility of the intervention will be assessed through a pre- and postintervention evaluation by obtaining the perspectives of various stakeholders involved in the implementation of mental health services and maternal training. The primary outcome will include assessment of acceptability, adaptability, demand, practicality, implementation, and integration of the package intervention in the school settings. The secondary outcomes will include assessment of: 1) the prevalence of maternal depression; 2) children’s behavioral, social, and communication skills; and 3) the intervention participation costs incurred by institutions and families. Results: Between February and March 2017, 188 mothers of children with ASD were screened for depression following a written informed consent. Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Structured Clinical Interview for the DSM-IV (SCID-1) was administered to 66 mothers. In-depth interviews were conducted with 10 mothers and 8 various stakeholders. Between January-June 2017, the team finalized a draft psychosocial counseling module and a maternal training module. Between April-May 2017, mental health services were provided by psychologists to 41 mothers who attended the counseling centers at each school. Three special educators have been trained in June 2017 to initiate training of the participating mothers. Conclusions: This is the first study of a mental health intervention for mothers of children with ASD to reduce their burden of depression and improve the outcomes of their children. The findings will inform the provision of services for children with ASD and their mothers in Bangladesh and similar settings. %M 29242177 %R 10.2196/resprot.8260 %U http://www.researchprotocols.org/2017/12/e251/ %U https://doi.org/10.2196/resprot.8260 %U http://www.ncbi.nlm.nih.gov/pubmed/29242177 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e55 %T School Counselors’ Perspectives of a Web-Based Stepped Care Mental Health Service for Schools: Cross-Sectional Online Survey %A O'Dea,Bridianne %A King,Catherine %A Subotic-Kerry,Mirjana %A O'Moore,Kathleen %A Christensen,Helen %+ Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 293828509, b.odea@blackdog.org.au %K secondary schools %K adolescent %K counseling %K internet %K depression %D 2017 %7 20.11.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health problems are common among youth in high school, and school counselors play a key role in the provision of school-based mental health care. However, school counselors occupy a multispecialist position that makes it difficult for them to provide care to all of those who are in need in a timely manner. A Web-based mental health service that offers screening, psychological therapy, and monitoring may help counselors manage time and provide additional oversight to students. However, for such a model to be implemented successfully, school counselors’ attitudes toward Web-based resources and services need to be measured. Objective: This study aimed to examine the acceptability of a proposed Web-based mental health service, the feasibility of providing this type of service in the school context, and the barriers and facilitators to implementation as perceived by school counselors in New South Wales (NSW), Australia. Methods: This study utilized an online cross-sectional survey to measure school counselors’ perspectives. Results: A total of 145 school counselors completed the survey. Overall, 82.1% (119/145) thought that the proposed service would be helpful to students. One-third reported that they would recommend the proposed model, with the remaining reporting potential concerns. Years of experience was the only background factor associated with a higher level of comfort with the proposed service (P=.048). Personal beliefs, knowledge and awareness, Internet accessibility, privacy, and confidentiality were found to influence, both positively and negatively, the likelihood of school counselors implementing a Web-based school mental health service. Conclusions: The findings of this study confirmed that greater support and resources are needed to facilitate what is already a challenging and emotionally demanding role for school counselors. Although the school counselors in this study were open to the proposed service model, successful implementation will require that the issues outlined are carefully addressed. %M 29158207 %R 10.2196/mental.8369 %U http://mental.jmir.org/2017/4/e55/ %U https://doi.org/10.2196/mental.8369 %U http://www.ncbi.nlm.nih.gov/pubmed/29158207 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e54 %T Exploring Working Relationships in Mental Health Care via an E-Recovery Portal: Qualitative Study on the Experiences of Service Users and Health Providers %A Strand,Monica %A Gammon,Deede %A Eng,Lillian Sofie %A Ruland,Cornelia %+ Centre for Shared Decision-Making and Collaborative Care Research, Oslo University Hospital, Sogn Arena Pb. 4950 Nydalen, N-0424 Oslo, Oslo,, Norway, 1 004790977963, deede.gammon@rr-research.no %K eHealth %K recovery %K mental health %K psychiatry %K user involvement %K empowerment %K working relationship %K secure email %K e-recovery %K participatory research %D 2017 %7 14.11.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: The quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood. Objective: The aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal. Methods: In this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user–generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed. Results: The thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users’ and health providers’ expectations for portal use were not aligned, and the consequences of not addressing these difficulties. Illustrative subthemes are initiative and responsibility, waiting for the other, feeling overwhelmed, and clarifications and agreements. Conclusions: The degree to which dyads benefited from using the e-recovery portal appeared to be mainly associated with the degree to which the dyads’ relations were open and flexible before the portal was introduced. For those who experienced frustrations, the portal may have both exposed and added to suboptimal working relationships. Use of the goal module appeared to strengthen the person-centered nature of collaboration. A key question is how health providers balance between enabling service users’ greater control over their care, without relinquishing responsibility for the quality of the working relationship, also when using an e-recovery portal. Implications for implementation are discussed. %M 29138127 %R 10.2196/mental.8491 %U http://mental.jmir.org/2017/4/e54/ %U https://doi.org/10.2196/mental.8491 %U http://www.ncbi.nlm.nih.gov/pubmed/29138127 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e49 %T Qualitative Exploration of the Potential for Adverse Events When Using an Online Peer Support Network for Mental Health: Cross-Sectional Survey %A Easton,Katherine %A Diggle,Jacob %A Ruethi-Davis,Mabel %A Holmes,Megan %A Byron-Parker,Darian %A Nuttall,Jessica %A Blackmore,Chris %+ Centre of Assistive Technology and Connected Healthcare, University of Sheffield, Innovtion Centre, 217 Portobello, Sheffield,, United Kingdom, 44 07969846886, k.a.easton@sheffield.ac.uk %K digital technology %K mental health %K online peer support %K adverse events %K online survey %D 2017 %7 30.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online peer support networks are a growing area of mental health support for offering social connection, identity, and support. However, it has been reported that not all individuals have a positive experience on such networks. The potential for adverse events within a moderated online peer support network is a new area of research exploration. Objective: The objective of the study was to determine if use of an online moderated peer networks leads to adverse events for users. Methods: Four biannual online surveys (October 2014 to March 2016) were conducted by a large national UK mental health charity, with users of their online peer support network exploring personal safety, moderation, experiences on the site, and how the site could be improved. Data were analyzed using thematic analysis by 2 independent researchers using a priori themes: negative experiences of moderation, social exclusion, contagion, negative interactions with other users, online relationships, co-rumination and collusion, and other. Results: In total, 2353 survey responses were logged with 197 (8.37%) documenting an adverse event of negative experience. A dominant theme of negative experiences of moderation emerged (73/197, 37.1%) with evidence of social exclusion (50/197, 25.4%). Reading user posts was shown to be a cause of worry and distress for a few users, and analysis highlighted several instances of depressogenic and emotional contagion as well as some limited evidence of behavioral contagion (46/197, 23.4%). Very limited evidence of co-rumination (1/197, 0.5%) and no evidence of collusion were identified. Conclusions: Evidence of adverse events was identified at low levels in the sample of respondents, although we have no comparison data to indicate if levels are low compared with comparable platforms. Not all users of online peer support networks find them wholly beneficial. Research must explore what works for whom. The next stage of service development should consider which users may be likely to receive no benefit, or even deteriorate, as a result of using the service. %M 29084710 %R 10.2196/mental.8168 %U http://mental.jmir.org/2017/4/e49/ %U https://doi.org/10.2196/mental.8168 %U http://www.ncbi.nlm.nih.gov/pubmed/29084710 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e46 %T Techniques for Improving Communication of Emotional Content in Text-Only Web-Based Therapeutic Communications: Systematic Review %A Paul,Christine Louise %A Cox,Martine Elizabeth %A Small,Hannah Julie %A Boyes,Allison W %A O'Brien,Lorna %A Rose,Shiho Karina %A Baker,Amanda L %A Henskens,Frans A %A Kirkwood,Hannah Naomi %A Roach,Della M %+ Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 4042 0659, chris.paul@newcastle.edu.au %K nonverbal communication %K Internet %K computer-assisted therapy %D 2017 %7 24.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based typed exchanges are increasingly used by professionals to provide emotional support to patients. Although some empirical evidence exists to suggest that various strategies may be used to convey emotion during Web-based text communication, there has been no critical review of these data in patients with chronic conditions. Objectives: The objective of this review was to identify the techniques used to convey emotion in written or typed Web-based communication and assess the empirical evidence regarding impact on communication and psychological outcomes. Methods: An electronic search of databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library was conducted to identify literature published from 1990 to 2016. Searches were also conducted using Google Scholar, manual searching of reference lists of identified papers and manual searching of tables of contents for selected relevant journals. Data extraction and coding were completed by 2 reviewers (10.00% [573/5731] of screened papers, at abstract/title screening stage; 10.0% of screened [69/694] papers, at full-text screening stage). Publications were assessed against the eligibility criteria and excluded if they were duplicates, were not published in English, were published before 1990, referenced animal or nonhuman subjects, did not describe original research, were not journal papers, or did not empirically test the effect of one or more nonverbal communication techniques (for eg, smileys, emoticons, emotional bracketing, voice accentuation, trailers [ellipsis], and pseudowords) as part of Web-based or typed communication on communication-related variables, including message interpretation, social presence, the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes, including depression, anxiety, and distress. Results: A total of 6902 unique publications were identified. Of these, six publications met the eligibility criteria and were included in a narrative synthesis. All six studies addressed the effect of smileys or emoticons on participant responses, message interpretation, or social presence of the writer. None of these studies specifically targeted chronic conditions. It was found that emoticons were more effective in influencing the emotional impact of a message than no cue and that smileys and emoticons were able to convey a limited amount of emotion. No studies addressed other techniques for conveying emotion in written communication. No studies addressed the effects of any techniques on the nature of the interaction (eg, therapeutic alliance), patient perceptions of the interaction (eg, participant satisfaction), or psychological outcomes (depression, anxiety, or distress). Conclusions: There is a need for greater empirical attention to the effects of the various proposed techniques for conveying emotion in Web-based typed communications to inform health service providers regarding best-practice communication skills in this setting. %M 29066426 %R 10.2196/mental.6707 %U http://mental.jmir.org/2017/4/e46/ %U https://doi.org/10.2196/mental.6707 %U http://www.ncbi.nlm.nih.gov/pubmed/29066426 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e42 %T Pregnant Women’s Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial %A Kingston,Dawn %A Biringer,Anne %A Veldhuyzen van Zanten,Sander %A Giallo,Rebecca %A McDonald,Sarah %A MacQueen,Glenda %A Vermeyden,Lydia %A Austin,Marie-Paule %+ University of Calgary, 2500 University Ave NW, Calgary, AB, T2N 1N4, Canada, 1 4032202634, dawn.kingston@ucalgary.ca %K pregnancy %K mental health %K screening %K prenatal care %K computers %D 2017 %7 20.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Pregnant women’s perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. Objective: The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women’s perceptions of risk and benefit of disclosure. Methods: Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women’s perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. Results: Of the 675 eligible women approached, 636 (94.2%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. Conclusions: Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women’s vulnerability throughout the screening process with strategies such as addressing women’s concerns, explaining the rationale for screening, and discussing how results will be used. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6tRKtGC4M) %M 29054833 %R 10.2196/mental.6888 %U http://mental.jmir.org/2017/4/e42/ %U https://doi.org/10.2196/mental.6888 %U http://www.ncbi.nlm.nih.gov/pubmed/29054833 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e47 %T A Transmedia Storytelling Intervention With Interactive Elements to Benefit Latinas’ Mental Health: Feasibility, Acceptability, and Efficacy %A Heilemann,MarySue V %A Soderlund,Patricia D %A Kehoe,Priscilla %A Brecht,Mary-Lynn %+ School of Nursing, University of California, Los Angeles, Factor Building, Room 5252, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K depression %K anxiety %K transmedia %K Internet %K mental health %K mood disorders %K smartphone %D 2017 %7 19.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Latinos report higher rates of depression and anxiety than US whites but are less likely to receive care. Transmedia storytelling interventions accessible on the Internet via smartphones, tablets, and computers hold promise for reducing reluctance to explore or get help for symptoms because they are private, convenient, and can reach large numbers of people, including Latinas with mental health needs. Objective: The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mental health transmedia intervention for Latinas with elevated symptoms of depression, anxiety, or both. Methods: A total of 28 symptomatic English-speaking Latina women aged 21 to 48 years participated in a 6-week study using a within-group design. All aspects of the study were completed via telephone or Internet. Participants used their personal devices to engage the Web-based transmedia intervention (in English) that included story-based videos, a data-informed psychotherapeutic video, an interactive video sequence, and a blog written from the point of view of one of the characters with links to mental health resources. Perceived confidence to get help and perceived importance for seeking immediate help were both measured using single-item questions. Participants completed surveys at baseline (via telephone) and 1 and 6 weeks after media engagement that measured various factors, including depression (Patient Health Questionnaire; PHQ-9 and PHQ-8) and anxiety (Generalized Anxiety Disorder scale; GAD-7). A telephone interview was conducted within 72 hours of media engagement. Action taken or intentions to get help (single-item question) and talking about the videos with others (single-item question) were measured 1 and 6 weeks after media engagement. Repeated measures analysis of variance was used to assess change in depression (PHQ-8) and anxiety (GAD-7) before transmedia engagement and 1 and 6 weeks after. Spearman correlations evaluated the association of confidence and importance of getting help with action taken, anxiety, and depression. Results: All 28 Latinas (English speakers) who engaged with the transmedia remained in the 6-week study. Within 1 week of transmedia engagement, 39% of women took action to get help, and 82% discussed the media with others. Symptoms of depression (F2,54=9.0, P<.001) and anxiety (F2,54=18.7, P<.001) significantly reduced across time. Higher levels of confidence were significantly associated with actions taken at 1 (P=.005) and 6 weeks (P=.04), and higher levels of importance were significantly associated with actions taken at 1 (P=.009) and 6 weeks (P=.003). Higher levels of confidence were associated with lower levels of depression (P=.04) and anxiety (P=.01) at 6 weeks. Conclusions: Preliminary findings indicate a culturally tailored mental health transmedia intervention is a feasible approach that holds promise for engaging large numbers of symptomatic English-speaking Latina women to begin the process of seeking help, as well as decreasing symptoms of anxiety and depression. %M 29051135 %R 10.2196/mental.8571 %U http://mental.jmir.org/2017/4/e47/ %U https://doi.org/10.2196/mental.8571 %U http://www.ncbi.nlm.nih.gov/pubmed/29051135 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e41 %T Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial %A Zwerenz,Rüdiger %A Becker,Jan %A Johansson,Robert %A Frederick,Ronald J %A Andersson,Gerhard %A Beutel,Manfred E %+ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, Mainz, 55131, Germany, 49 6131175981, ruediger.zwerenz@unimedizin-mainz.de %K psychoanalytic psychotherapy %K emotion-focused therapy %K inpatients %K aftercare %K Internet %K clinical trial %D 2017 %7 16.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions. Objective: The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders. Methods: A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT). Results: Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84%, 58/69), anxiety (68%, 47/69), personality disorder (38%, 26/69), and depersonalization-derealization disorder (22%, 15/69). A majority of the patients (86%, 36/42) logged into the program, of which 86% (31/36) completed the first unit. Satisfaction with the units mastered was rated as good (52%, 16/31) and very good (26%, 9/31). However, there was a steady decline of participation over the course of the program; only 36% of the participants (13/36) participated throughout the trial completing at least 50% of the sessions. According to the ITT analysis, participants improved statistically significantly and with moderate effect sizes (Cohen d) compared with the WLCG regarding depression (d=0.60), quality of life (d=0.53), and emotional competence (d=0.49). Effects were considerably stronger for the completers with respect to depression (d=1.33), quality of life (d=0.83), emotional competence (d=0.68), and general anxiety (d=0.62). Conclusions: Although overall program satisfaction and benefit of the program were favorable with respect to the indicators of emotional disorders, the rate of completion was low. Our findings point to the need to target the intervention more specifically to the needs and capabilities of participants and to the context of the intervention. Trial Registration: Clinicaltrials.gov NCT02671929; https://clinicaltrials.gov/ct2/show/NCT02671929 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb) %M 29038094 %R 10.2196/mental.7889 %U http://mental.jmir.org/2017/4/e41/ %U https://doi.org/10.2196/mental.7889 %U http://www.ncbi.nlm.nih.gov/pubmed/29038094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e152 %T Mobile Health Apps in OB-GYN-Embedded Psychiatric Care: Commentary %A Mehralizade,Aydan %A Schor,Shayna %A Coleman,Chad M %A Oppenheim,Claire E %A Denckla,Christy A %A Borba,Christina PC %A Henderson,David C %A Wolff,James %A Crane,Sarah %A Nettles-Gomez,Pamela %A Pal,Avik %A Milanovic,Snezana %+ Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118, Boston, MA,, United States, 1 617 414 1917, snezana.milanovic@bmc.org %K mHealth %K eHealth %K embedded psychiatric clinic %K postpartum depression %K mental health %K OB-GYN %K global health %K reproductive health %D 2017 %7 06.10.2017 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X This paper explores the potential benefits of the use of mobile health (mHealth) apps in obstetrician-gynecologist (OB-GYN)-embedded psychiatric clinics in the United States. First, we highlight the increasing trend of integrating mental health care within the OB-GYN context. Second, we provide examples of successful uses of mHealth in the global health context and highlight the dearth of available research in the United States. Finally, we provide a summary of the shortcomings of currently available apps and describe the upcoming trial of a novel app currently underway at the Mother-Child Wellness Clinical and Research Center at Boston Medical Center. %M 28986335 %R 10.2196/mhealth.7988 %U http://mhealth.jmir.org/2017/10/e152/ %U https://doi.org/10.2196/mhealth.7988 %U http://www.ncbi.nlm.nih.gov/pubmed/28986335 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e39 %T Development of a Questionnaire to Measure the Attitudes of Laypeople, Physicians, and Psychotherapists Toward Telemedicine in Mental Health %A Tonn,Peter %A Reuter,Silja Christin %A Kuchler,Isabelle %A Reinke,Britta %A Hinkelmann,Lena %A Stöckigt,Saskia %A Siemoneit,Hanna %A Schulze,Nina %+ Institute of Applied Research in Neuropsychiatry, Neuropsychiatric Center Hamburg-Altona, Stresemannstr. 23, Hamburg, 22769, Germany, +49 40 533 0 738 0, tonn@npz-hamburg.de %K screening %K questionnaire %K e-mental health %K remote consultation %K attitude to computers %K physician expectations %K telemedicine %K online-intervention %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the field of psychiatry and psychotherapy, there are now a growing number of Web-based interventions, mobile phone apps, or treatments that are available via remote transmission screen worldwide. Many of these interventions have been shown to be effective in studies but still find little use in everyday therapeutic work. However, it is important that attitude and expectation toward this treatment are generally examined, because these factors have an important effect on the efficacy of the treatment. To measure the general attitude of the users and prescribers toward telemedicine, which may include, for instance, Web-based interventions or interventions through mobile phone apps, there are a small number of extensive tests. The results of studies based on small groups of patients have been published too, but there is no useful short screening tool to give an insight into the general population’s attitude. We have developed a screening instrument that examines such attitude through a few graded questions. Objective: This study aimed to explore the Attitude toward Telemedicine in Psychiatry and Psychotherapy (ATiPP) and to evaluate the results of general population and some subgroups. Methods: In a three-step process, the questionnaire, which is available in three versions (laypeople, physicians, and psychologists), was developed. Afterwards, it was evaluated by four groups: population-representative laypeople, outpatients in different faculties, physicians, and psychotherapists. Results: The results were evaluated from a total of 1554 questionnaires. The sample population included 1000 laypeople, 455 outpatients, 62 physicians, and 37 psychotherapists. The reliability of all three versions of the questionnaire seemed good, as indicated by the Cronbach alpha values of .849 (the laypeople group), .80 (the outpatients’ group), .827 (the physicians’ group), and .855 (the psychotherapists’ group). Conclusions: The ATiPP was found to be useful and reliable for measuring the attitudes toward the Web-based interventions in psychiatry and psychotherapy and should be used in different studies in this field in the future to evaluate and reflect the attitude of the participants. %M 28974485 %R 10.2196/mental.6802 %U https://mental.jmir.org/2017/4/e39/ %U https://doi.org/10.2196/mental.6802 %U http://www.ncbi.nlm.nih.gov/pubmed/28974485 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e30 %T Web-Based Cognitive Remediation Improves Supported Employment Outcomes in Severe Mental Illness: Randomized Controlled Trial %A Harris,Anthony WF %A Kosic,Tanya %A Xu,Jean %A Walker,Chris %A Gye,William %A Redoblado Hodge,Antoinette %+ Westmead Institute for Medical Research, Brain Dynamics Centre, University of Sydney, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, 2145, Australia, 61 2 8627 3302, anthony.harris@sydney.edu.au %K severe mental disorders %K supported employment %K cognitive function %K cognitive remediation %K randomized controlled trial %D 2017 %7 20.09.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. Objective: The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. Methods: A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. Results: At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. Conclusions: This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos) %M 28931500 %R 10.2196/mental.6982 %U http://mental.jmir.org/2017/3/e30/ %U https://doi.org/10.2196/mental.6982 %U http://www.ncbi.nlm.nih.gov/pubmed/28931500 %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 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 %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e31 %T Development and Evaluation of Digital Game-Based Training for Managers to Promote Employee Mental Health and Reduce Mental Illness Stigma at Work: Quasi-Experimental Study of Program Effectiveness %A Hanisch,Sabine Elisabeth %A Birner,Ulrich Walter %A Oberhauser,Cornelia %A Nowak,Dennis %A Sabariego,Carla %+ Department of Medical Informatics, Biometry and Epidemiology, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University Munich, Ebene K U1, Marchioninistr. 17, Munich, 81377, Germany, 49 17677504067, bine.hanisch@gmail.com %K stigma %K mental health %K workplace %K prevention %K health promotion %K leadership %K eHealth %K Internet %D 2017 %7 04.08.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: To counteract the negative impact of mental health problems on business, organizations are increasingly investing in mental health intervention measures. However, those services are often underused, which, to a great extent, can be attributed to fear of stigmatization. Nevertheless, so far only a few workplace interventions have specifically targeted stigma, and evidence on their effectiveness is limited. Objective: The objective of this study was to develop and evaluate a digital game-based training program for managers to promote employee mental health and reduce mental illness stigma at work. Methods: We describe the empirical development of Leadership Training in Mental Health Promotion (LMHP), a digital game-based training program for leaders. A 1-group pre-post design and a 3-month follow-up were used for training evaluation. We applied multilevel growth models to investigate change over time in the dependent variables knowledge, attitudes, self-efficacy, and intentions to promote employee mental health in 48 managers of a global enterprise in the United Kingdom. Participants were mainly male (44/48, 92%) and ranged in age from 32 to 58 (mean 46.0, SD 7.2) years. Results: We found a positive impact of the Web-based training program on managers’ knowledge of mental health and mental illness (P<.001), on attitudes toward people with mental health problems (P<.01), and on their self-efficacy to deal with mental health situations at work (P<.001), with the exception of intentions to promote employee mental health, which was initially high. Conclusions: Results provide first evidence of the effectiveness of LMHP to positively affect managers’ skills to promote employee mental health at work. Furthermore, the high rate of participation in LMHP (48/54, 89%) supports the use of digital game-based interventions to increase user engagement and user experience in mental health programs at work. %M 28778839 %R 10.2196/mental.7600 %U http://mental.jmir.org/2017/3/e31/ %U https://doi.org/10.2196/mental.7600 %U http://www.ncbi.nlm.nih.gov/pubmed/28778839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e279 %T Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry %A Lowenstein,Margaret %A Bamgbose,Olusinmi %A Gleason,Nathaniel %A Feldman,Mitchell D %+ University of Pennsylvania Perelman School of Medicine, National Clinician Scholars Program, Blockley Hall, 423 Guardian Drive, Philadelphia, PA,, United States, 1 215 573 3977, margaw@mail.med.upenn.edu %K mental health %K primary care %K health care delivery %K teleconsultation %K telehealth %K Internet care delivery %D 2017 %7 04.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Objective: Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. Methods: We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Results: Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. Conclusions: For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. %M 28778852 %R 10.2196/jmir.7921 %U http://www.jmir.org/2017/8/e279/ %U https://doi.org/10.2196/jmir.7921 %U http://www.ncbi.nlm.nih.gov/pubmed/28778852 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e29 %T Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support %A Prescott,Julie %A Hanley,Terry %A Ujhelyi,Katalin %+ School of Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 0120490 ext 3676, j.prescott@bolton.ac.uk %K adolescence %K Internet %K social media, mental health %K qualitative research %D 2017 %7 02.08.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. Objective: The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). Methods: Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. Results: The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do. Conclusions: This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective). %M 28768607 %R 10.2196/mental.6921 %U http://mental.jmir.org/2017/3/e29/ %U https://doi.org/10.2196/mental.6921 %U http://www.ncbi.nlm.nih.gov/pubmed/28768607 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e26 %T Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey %A Batterham,Philip J %A Calear,Alison L %+ Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT, 2601, Australia, 61 61251031, philip.batterham@anu.edu.au %K Internet interventions %K mental health services %K preferences %K anxiety %K depression %D 2017 %7 30.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite extensive evidence that Internet interventions are effective in treating mental health problems, uptake of Internet programs is suboptimal. It may be possible to make Internet interventions more accessible and acceptable through better understanding of community preferences for delivery of online programs. Objective: This study aimed to assess community preferences for components, duration, frequency, modality, and setting of Internet interventions for mental health problems. Methods: A community-based online sample of 438 Australian adults was recruited using social media advertising and administered an online survey on preferences for delivery of Internet interventions, along with scales assessing potential correlates of these preferences. Results: Participants reported a preference for briefer sessions, although they recognized a trade-off between duration and frequency of delivery. No clear preference for the modality of delivery emerged, although a clear majority preferred tailored programs. Participants preferred to access programs through a computer rather than a mobile device. Although most participants reported that they would seek help for a mental health problem, more participants had a preference for face-to-face sources only than online programs only. Younger, female, and more educated participants were significantly more likely to prefer Internet delivery. Conclusions: Adults in the community have a preference for Internet interventions with short modules that are tailored to individual needs. Individuals who are reluctant to seek face-to-face help may also avoid Internet interventions, suggesting that better implementation of existing Internet programs requires increasing acceptance of Internet interventions and identifying specific subgroups who may be resistant to seeking help. %M 28666976 %R 10.2196/mental.7722 %U http://mental.jmir.org/2017/2/e26/ %U https://doi.org/10.2196/mental.7722 %U http://www.ncbi.nlm.nih.gov/pubmed/28666976 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e23 %T Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study %A Muñoz-Sánchez,Juan-Luis %A Delgado,Carmen %A Sánchez-Prada,Andrés %A Pérez-López,Mercedes %A Franco-Martín,Manuel A %+ Complejo Asistencial de Zamora, Department of Psychiatry, Av Hernán Cortés, 44, Zamora, 49021, Spain, 34 980548572, jlmusa@icloud.com %K suicide %K suicide attempt %K self-harm %K prevention %K new technologies %K Europe %D 2017 %7 27.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: New technologies are an integral component of today’s society and can complement existing suicide prevention programs. Here, we analyzed the use of new technologies in the prevention of suicide in 8 different European countries. Objective: The aim of this paper was to assess the opinions of professionals in incorporating such resources into the design of a suicide prevention program for the region of Zamora in Spain. This investigation, encompassed within the European project entitled European Regions Enforcing Actions against Suicide (EUREGENAS), includes 11 regions from 8 different countries and attempts to advance the field of suicide prevention in Europe. Methods: Using a specifically designed questionnaire, we assessed the opinions of 3 different groups of stakeholders regarding the use, frequency of use, facilitators, content, and format of new technologies for the prevention of suicide. The stakeholders were comprised of policy and public management professionals, professionals working in the area of mental health, and professionals related to the social area and non-governmental organizations (NGOs). A total of 416 participants were recruited in 11 regions from 8 different European countries. Results: The utility of the new technologies was valued positively in all 8 countries, despite these resources being seldom used in those countries. In all the countries, the factors that contributed most to facilitating the use of new technologies were accessibility and free of charge. Regarding the format of new technologies, the most widely preferred formats for use as a tool for the prevention of suicide were websites and email. The availability of information about signs of alarm and risk factors was the most relevant content for the prevention of suicide through the use of new technologies. The presence of a reference mental health professional (MHP) was also considered to be a key aspect. The countries differed in the evaluations given to the different formats suggesting that the cultural characteristics of the country should be taken into account. Conclusions: New technologies are much appreciated resources; however they are not often underused in the field of suicide prevention. The results of this exploratory study show that new technologies are indeed useful resources and should be incorporated into suicide prevention programs. %M 28655705 %R 10.2196/mental.7716 %U http://mental.jmir.org/2017/2/e23/ %U https://doi.org/10.2196/mental.7716 %U http://www.ncbi.nlm.nih.gov/pubmed/28655705 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e21 %T Perspectives of Family Members on Using Technology in Youth Mental Health Care: A Qualitative Study %A Lal,Shalini %A Daniel,Winnie %A Rivard,Lysanne %+ University of Montreal Hospital Research Center, University of Montreal, S-03-452, 850 St-Denis St, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 31676, shalini.lal@umontreal.ca %K family %K adolescent %K young adult %K technology %K telemedicine %K mental health services %K psychotic disorders %D 2017 %7 23.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Information and communication technologies (ICTs) are increasingly recognized as having an important role in the delivery of mental health services for youth. Recent studies have evaluated young people’s access and use of technology, as well as their perspectives on using technology to receive mental health information, services, and support; however, limited attention has been given to the perspectives of family members in this regard. Objective: The aim of this study was to explore the perspectives of family members on the use of ICTs to deliver mental health services to youth within the context of specialized early intervention for a first-episode psychosis (FEP). Methods: Six focus groups were conducted with family members recruited from an early intervention program for psychosis. Twelve family members participated in the study (target sample was 12-18, and recruitment efforts took place over the duration of 1 year). A 12-item semistructured focus group guide was developed to explore past experiences of technology and recommendations for the use of technology in youth mental health service delivery. A qualitative thematic analysis guided the identification and organization of common themes and patterns identified across the dataset. Results: Findings were organized by the following themes: access and use of technology, potential negative impacts of technology on youth in recovery, potential benefits of using technology to deliver mental health services to youth, and recommendations to use technology for (1) providing quality information in a manner that is accessible to individuals of diverse socioeconomic backgrounds, (2) facilitating communication with health care professionals and services, and (3) increasing access to peer support. Conclusions: To our knowledge, this is among the first (or the first) to explore the perspectives of family members of youth being treated for FEP on the use of technology for mental health care. Our results highlight the importance of considering diverse experiences and attitudes toward the role of technology in youth mental health, digital literacy skills, phases of recovery, and sociodemographic factors when engaging family members in technology-enabled youth mental health care research and practice. Innovative methods to recruit and elicit the perspectives of family members on this topic are warranted. It is also important to consider educational strategies to inform and empower family members on the role, benefits, and use of ICTs in relation to mental health care for FEP. %M 28645887 %R 10.2196/mental.7296 %U http://mental.jmir.org/2017/2/e21/ %U https://doi.org/10.2196/mental.7296 %U http://www.ncbi.nlm.nih.gov/pubmed/28645887 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e214 %T Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists %A Fairburn,Christopher G %A Allen,Elizabeth %A Bailey-Straebler,Suzanne %A O'Connor,Marianne E %A Cooper,Zafra %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford,, United Kingdom, 44 186 561 3199, credo@medsci.ox.ac.uk %K psychotherapy %K training %K dissemination %K Internet %K eating disorders %K cognitive behavior therapy %D 2017 %7 16.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl –6.62 to –5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. %M 28623184 %R 10.2196/jmir.7864 %U http://www.jmir.org/2017/6/e214/ %U https://doi.org/10.2196/jmir.7864 %U http://www.ncbi.nlm.nih.gov/pubmed/28623184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e208 %T A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship %A Denneson,Lauren M %A Cromer,Risa %A Williams,Holly B %A Pisciotta,Maura %A Dobscha,Steven K %+ VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, United States, 1 503 220 8262 ext 57351, denneson@ohsu.edu %K eHealth %K physician-patient relations %K mental health %K patient-centered care %D 2017 %7 14.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: As part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings. Objective: The aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care. Methods: We conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process. Results: OpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes. Conclusions: Our findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation. %M 28615152 %R 10.2196/jmir.6915 %U http://www.jmir.org/2017/6/e208/ %U https://doi.org/10.2196/jmir.6915 %U http://www.ncbi.nlm.nih.gov/pubmed/28615152 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e17 %T Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers %A Bird,Jennifer %A Rotumah,Darlene %A Bennett-Levy,James %A Singer,Judy %+ University Centre for Rural Health—North Coast, School of Rural Health, University of Sydney, PO Box 3074, Lismore, 2480, Australia, 61 266207570, james.bennett-levy@ucrh.edu.au %K eMental Health %K Aboriginal and Torres Strait Islanders %K social and emotional wellbeing %K health education %K health promotion %K mental health %K indigenous health services %K culturally appropriate technology %K internet %K implementation %K training %D 2017 %7 29.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: In Australia, mental health services are undergoing major systemic reform with eMental Health (eMH) embedded in proposed service models for all but those with severe mental illness. Aboriginal and Torres Strait Islander service providers have been targeted as a national priority for training and implementation of eMH into service delivery. Implementation studies on technology uptake in health workforces identify complex and interconnected variables that influence how individual practitioners integrate new technologies into their practice. To date there are only two implementation studies that focus on eMH and Aboriginal and Torres Strait Islander service providers. They suggest that the implementation of eMH in the context of Aboriginal and Torres Strait Islander populations may be different from the implementation of eMH with allied health professionals and mainstream health services. Objective: The objective of this study is to investigate how Aboriginal and Torres Strait Islander service providers in one regional area of Australia used eMH resources in their practice following an eMH training program and to determine what types of eMH resources they used. Methods: Individual semistructured qualitative interviews were conducted with a purposive sample of 16 Aboriginal and Torres Strait Islander service providers. Interviews were co-conducted by one indigenous and one non-indigenous interviewer. A sample of transcripts were coded and thematically analyzed by each interviewer and then peer reviewed. Consensus codes were then applied to all transcripts and themes identified. Results: It was found that 9 of the 16 service providers were implementing eMH resources into their routine practice. The findings demonstrate that participants used eMH resources for supporting social inclusion, informing and educating, assessment, case planning and management, referral, responding to crises, and self and family care. They chose a variety of types of eMH resources to use with their clients, both culturally specific and mainstream. While they referred clients to online treatment programs, they used only eMH resources designed for mobile devices in their face-to-face contact with clients. Conclusions: This paper provides Aboriginal and Torres Strait islander service providers and the eMH field with findings that may inform and guide the implementation of eMH resources. It may help policy developers locate this workforce within broader service provision planning for eMH. The findings could, with adaptation, have wider application to other workforces who work with Aboriginal and Torres Strait Islander clients. The findings highlight the importance of identifying and addressing the particular needs of minority groups for eMH services and resources. %M 28554880 %R 10.2196/mental.7878 %U http://mental.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/mental.7878 %U http://www.ncbi.nlm.nih.gov/pubmed/28554880 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e145 %T Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study %A Gammon,Deede %A Strand,Monica %A Eng,Lillian Sofie %A Børøsund,Elin %A Varsi,Cecilie %A Ruland,Cornelia %+ Center for Shared Decision-Making and Collaborative Care Research, Oslo University Hospital, Klaus Thorgårdsvei 3, 3rd Floor, Oslo, N-0377, Norway, 47 90977963, deede.gammon@rr-research.no %K recovery %K eHealth %K mental health %K psychiatry %K user involvement %K empowerment %K working relationships %K participatory research %K secure email %K e-recovery %D 2017 %7 02.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective: The aim was to illustrate uses and experiences with the secure e-recovery portal “ReConnect” as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods: ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results: Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users’ control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions: Regardless of providers’ portal use, service users’ control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users’ autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). %M 28465277 %R 10.2196/jmir.7524 %U http://www.jmir.org/2017/5/e145/ %U https://doi.org/10.2196/jmir.7524 %U http://www.ncbi.nlm.nih.gov/pubmed/28465277 %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 4 %N 1 %P e5 %T A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey %A Bernecker,Samantha L %A Banschback,Kaitlin %A Santorelli,Gennarina D %A Constantino,Michael J %+ Department of Psychological and Brain Sciences, University of Massachusetts, Tobin Hall, 135 Hicks Way, Amherst, MA, 01003, United States, 1 814 574 9625, samantha.bernecker@gmail.com %K computer-assisted instruction %K eHealth %K mental health %K self care %K self-help %K peer support %K social support %D 2017 %7 19.01.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-guided mental health interventions that are disseminated via the Web have the potential to circumvent barriers to treatment and improve public mental health. However, self-guided interventions often fail to attract consumers and suffer from user nonadherence. Uptake of novel interventions could be improved by consulting consumers from the beginning of the development process in order to assess their interest and their preferences. Interventions can then be tailored using this feedback to optimize appeal. Objective: The aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs. Methods: We surveyed consumers via Amazon’s Mechanical Turk to estimate interest in the self-help and peer support program. We assessed associations between demographic and clinical characteristics and interest in the program, and we obtained feedback on desired features of the program. Results: Overall, 63.9% (378/592) of respondents said that they would try the program; interest was lower but still substantial among those who were not willing or able to access traditional mental health services. Female gender, lower income, and openness to using psychotherapy were the most consistent predictors of interest in the program. The majority of respondents, although not all, preferred romantic partners or close friends as peer counselors and would be most likely to access the program if the training course were accessed on a stand-alone website. In general, respondents valued training in active listening skills. Conclusions: In light of the apparent public interest in this program, Web-disseminated self-help and peer support interventions have enormous potential to fill gaps in mental health care. The results of this survey can be used to inform the design of such interventions. %M 28104578 %R 10.2196/mental.4751 %U http://mental.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/mental.4751 %U http://www.ncbi.nlm.nih.gov/pubmed/28104578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e1 %T Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals? %A Bennett-Levy,James %A Singer,Judy %A DuBois,Simon %A Hyde,Kelly %+ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia, 61 266207570, james.bennett-levy@ucrh.edu.au %K e-mental health %K indigenous populations %K Aboriginal and Torres Strait Islander peoples %K professional supervision %K professional consultation %K service implementation %K health education %K mobile apps %D 2017 %7 11.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective: The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods: A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results: Uptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers’ lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions: A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH’s health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients. %M 28077347 %R 10.2196/jmir.6269 %U http://www.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/jmir.6269 %U http://www.ncbi.nlm.nih.gov/pubmed/28077347 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 1 %P e1 %T The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study %A Riahi,Sanaz %A Fischler,Ilan %A Stuckey,Melanie I %A Klassen,Philip E %A Chen,John %+ Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON,, Canada, 1 905 430 4055, riahis@ontarioshores.ca %K electronic health records %K health information management %K medical informatics %K mental health %K organizational innovation %K psychiatry %K quality improvement %D 2017 %7 05.01.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective: The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods: The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results: Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions: EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. %M 28057607 %R 10.2196/medinform.6512 %U http://medinform.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/medinform.6512 %U http://www.ncbi.nlm.nih.gov/pubmed/28057607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e309 %T Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up %A Robotham,Dan %A Satkunanathan,Safarina %A Doughty,Lisa %A Wykes,Til %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207848 ext 0219, dan.robotham@kcl.ac.uk %K digital divide %K socioeconomic factors %K technology %K mobile phone %K psychotic disorders %K distance counseling %D 2016 %7 22.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Nearly everyone in society uses the Internet in one form or another. The Internet is heralded as an efficient way of providing mental health treatments and services. However, some people are still excluded from using Internet-enabled technology through lack of resources, skills, and confidence. Objective: Five years ago, we showed that people with severe mental illness were at risk of digital exclusion, especially middle-aged patients with psychosis and/or people from black or minority ethnic groups with psychosis. An understanding of the breadth of potential digital exclusion is vital for the implementation of digital health services. The aim of this study is to understand the context of digital exclusion for people who experience mental illness. Methods: We conducted a survey involving people with a primary diagnosis of psychosis or depression in London, United Kingdom. A total of 241 participants were recruited: 121 with psychosis and 120 with depression. The majority of surveys were collected face-to-face (psychosis: n=109; depression: n=71). Participants answered questions regarding familiarity, access, use, motivation, and confidence with Internet-enabled technologies (ie, computers and mobile phones). Variables predicting digital exclusion were identified in regression analyses. The results were compared with the survey conducted in 2011. Results: Digital exclusion has declined since 2011. Online survey collection introduced biases into the sample, masking those who were likely to be excluded. Only 18.3% (20/109) of people with psychosis in our sample were digitally excluded, compared with 30% (28/93) in 2011 (χ21=3.8, P=.04). People with psychosis had less confidence in using the Internet than people with depression (χ21=7.4, P=.004). Only 9.9% (24/241) of participants in the total sample were digitally excluded, but the majority of these people had psychosis (n=20). Those with psychosis who were digitally excluded were significantly older than their included peers (t30=3.3, P=.002) and had used services for longer (t97=2.5, P=.02). Younger people were more likely to use mobile phones. Digitally excluded participants cited a lack of knowledge as a barrier to digital inclusion, and most wanted to use the Internet via computers (rather than mobile phones). Conclusions: Digital exclusion is lower, but some remain excluded. Facilitating inclusion among this population means helping them develop skills and confidence in using technology, and providing them with access. Providing mobile phones without basic information technology training may be counterproductive because excluded people may be excluded from mobile technology too. An evidence-based digital inclusion strategy is needed within the National Health Service to help digitally excluded populations access Internet-enabled services. %M 27876684 %R 10.2196/jmir.6511 %U http://www.jmir.org/2016/11/e309/ %U https://doi.org/10.2196/jmir.6511 %U http://www.ncbi.nlm.nih.gov/pubmed/27876684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e294 %T A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation %A Kipping,Sarah %A Stuckey,Melanie I %A Hernandez,Alexandra %A Nguyen,Tan %A Riahi,Sanaz %+ Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N5S9, Canada, 1 9054304055, kippings@ontarioshores.ca %K efficiency, organizational %K electronic health records %K mental health %K mental disorders %K patient activation %D 2016 %7 16.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Treatment for mental illness has shifted from focusing purely on treatment of symptoms to focusing on personal recovery. Patient activation is an important component of the recovery journey. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown. Objective: To conduct a benefits evaluation of a Web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on (1) patient activation, (2) recovery, (3) productivity, and (4) administrative efficiencies. Methods: All registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal and those who did not were designated as “users” and “nonusers,” respectively. All patients received usual treatment. Users had Web-based access to view parts of their electronic medical record, view upcoming appointments, and communicate with their health care provider. Users could attend portal training or support sessions led by either the engagement coordinator or peer support specialists. A subset of patients who created and utilized their portal account completed 2 Web-based surveys at baseline (just after enrollment; n=91) and at follow-up (6 and 10 months; n=65). The total score of the Mental Health Recovery Measure (MHRM) was a proxy for patient activation and the individual domains measured recovery. The System and Use Survey Tool (SUS) examined the use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and nonusers missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation. Results: A total of 461 patients (44.0% male, n=203) registered for the portal, which was used 4761 times over the 1-year follow-up period. The majority of uses (95.34%, 4539/4761) were for e-views. The overall MHRM score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at combined follow-up (P=.01). Of the 8 recovery domains, 7 were increased at follow-up (all P<.05). The odds of a portal user attending an appointment were 67% (CI 56%-79%) greater than that of nonusers over the follow-up period. Compared with 2014, over 2015 there was an 86% and 57% decrease in requests for information in users and nonusers, respectively. The SUS revealed that users felt an increased sense of autonomy and found the portal to be user-friendly, helpful, and efficient but felt that more information should be accessible. Conclusions: The benefits evaluation suggested that access to personal health records via patient portals may improve patient activation, recovery scores, and organizational efficiencies in a tertiary level mental health care facility. %M 27852556 %R 10.2196/jmir.6483 %U http://www.jmir.org/2016/11/e294/ %U https://doi.org/10.2196/jmir.6483 %U http://www.ncbi.nlm.nih.gov/pubmed/27852556 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e43 %T E-Mental Health Innovations for Aboriginal and Torres Strait Islander Australians: A Qualitative Study of Implementation Needs in Health Services %A Puszka,Stefanie %A Dingwall,Kylie M %A Sweet,Michelle %A Nagel,Tricia %+ Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina , NT, 0811, Australia, 61 08 8946 8422, Stefanie.Puszka@menzies.edu.au %K eHealth %K Indigenous health services %K mental health services %K diffusion of innovation %K culturally appropriate technology %D 2016 %7 19.09.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic mental health (e-mental health) interventions offer effective, easily accessible, and cost effective treatment and support for mental illness and well-being concerns. However, e-mental health approaches have not been well utilized by health services to date and little is known about their implementation in practice, particularly in diverse contexts and communities. Objective: This study aims to understand stakeholder perspectives on the requirements for implementing e-mental health approaches in regional and remote health services for Indigenous Australians. Methods: Qualitative interviews were conducted with 32 managers, directors, chief executive officers (CEOs), and senior practitioners of mental health, well-being, alcohol and other drug and chronic disease services. Results: The implementation of e-mental health approaches in this context is likely to be influenced by characteristics related to the adopter (practitioner skill and knowledge, client characteristics, communication barriers), the innovation (engaging and supportive approach, culturally appropriate design, evidence base, data capture, professional development opportunities), and organizational systems (innovation-systems fit, implementation planning, investment). Conclusions: There is potential for e-mental health approaches to address mental illness and poor social and emotional well-being amongst Indigenous people and to advance their quality of care. Health service stakeholders reported that e-mental health interventions are likely to be most effective when used to support or extend existing health services, including elements of client-driven and practitioner-supported use. Potential solutions to obstacles for integration of e-mental health approaches into practice were proposed including practitioner training, appropriate tool design using a consultative approach, internal organizational directives and support structures, adaptations to existing systems and policies, implementation planning and organizational and government investment. %M 27644259 %R 10.2196/mental.5837 %U http://mental.jmir.org/2016/3/e43/ %U https://doi.org/10.2196/mental.5837 %U http://www.ncbi.nlm.nih.gov/pubmed/27644259 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e40 %T Who Are the Young People Choosing Web-based Mental Health Support? Findings From the Implementation of Australia's National Web-based Youth Mental Health Service, eheadspace %A Rickwood,Debra %A Webb,Marianne %A Kennedy,Vanessa %A Telford,Nic %+ headspace National Youth Mental Health Foundation, Level 2, South Tower, 485 La Trobe Street, Melbourne, 3000, Australia, 61 3 9027 0141, vkennedy@headspace.org.au %K mental health %K adolescent %K help-seeking behavior %K telemedicine %K counseling %K Internet %D 2016 %7 25.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia’s national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type. Objective: The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center. Methods: Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015). Results: More eheadspace than headspace center clients were female (78.1% compared with 59.1%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6% compared with 73.2%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients. Conclusions: The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care. %M 27562729 %R 10.2196/mental.5988 %U http://mental.jmir.org/2016/3/e40/ %U https://doi.org/10.2196/mental.5988 %U http://www.ncbi.nlm.nih.gov/pubmed/27562729 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e36 %T Home-Based Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial %A Hungerbuehler,Ines %A Valiengo,Leandro %A Loch,Alexandre A %A Rössler,Wulf %A Gattaz,Wagner F %+ Laboratory of Neuroscience, Institute of Psychiatry, University of Sao Paulo, Rua Dr. Ovidio Pires de Campos 785, São Paulo, 05403-010, Brazil, 55 11 2661 8010, ines.hungerbuehler@gmail.com %K telemedicine %K telehealth %K eHealth, videoconferencing %K psychiatry %K outpatient %K home-care services %K mental health %K depression %D 2016 %7 03.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is a tremendous opportunity for innovative mental health care solutions such as psychiatric care through videoconferencing to increase the number of people who have access to quality care. However, studies are needed to generate empirical evidence on the use of psychiatric outpatient care via videoconferencing, particularly in low- and middle-income countries and clinically unsupervised settings. Objective: The objective of this study was to evaluate the effectiveness and feasibility of home-based treatment for mild depression through psychiatric consultations via videoconferencing. Methods: A randomized controlled trial with a 6- and 12-month follow-up including adults with mild depression treated in an ambulatory setting was conducted. In total, 107 participants were randomly allocated to the videoconferencing intervention group (n=53) or the face-to-face group (F2F; n=54). The groups did not differ with respect to demographic characteristics at baseline. The F2F group completed monthly follow-up consultations in person. The videoconferencing group received monthly follow-up consultations with a psychiatrist through videoconferencing at home. At baseline and after 6 and 12 months, in-person assessments were conducted with all participants. Clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence were assessed. Results: The severity of depression decreased significantly over the 12-month follow-up in both the groups. There was a significant difference between groups regarding treatment outcomes throughout the follow-up period, with better results in the videoconferencing group. There were 4 relapses in the F2F group and only 1 in the videoconferencing group. No significant differences between groups regarding mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence, or medication compliance were found. However, after 6 months, the rate of dropouts was significantly higher in the F2F group (18.5% vs 5.7% in the videoconferencing group, P<.05). Conclusions: Psychiatric treatment through videoconferencing in clinically unsupervised settings can be considered feasible and as effective as standard care (in-person treatment) for depressed outpatients with respect to clinical outcomes, patient satisfaction, therapeutic relationship, treatment adherence, and medication compliance. These results indicate the potential of telepsychiatry to extend access to psychiatric care to remote and underserved populations. ClinicalTrial: Clinicaltrials.gov NCT01901315; https://clinicaltrials.gov/ct2/show/NCT01901315 (Archived by WebCite at http://www.webcitation.org/6jBTrIVwg) %M 27489204 %R 10.2196/mental.5675 %U http://mental.jmir.org/2016/3/e36/ %U https://doi.org/10.2196/mental.5675 %U http://www.ncbi.nlm.nih.gov/pubmed/27489204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e35 %T Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study %A Rai,Minnie %A Vigod,Simone N %A Hensel,Jennifer M %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S1B2, Canada, 1 416 323 6400, jennifer.hensel@wchospital.ca %K e-communication %K mental health %K technology %K barriers %K social media %D 2016 %7 01.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. Objective: To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. Methods: We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Results: Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. Conclusions: A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services. %M 27480108 %R 10.2196/mental.6068 %U http://mental.jmir.org/2016/3/e35/ %U https://doi.org/10.2196/mental.6068 %U http://www.ncbi.nlm.nih.gov/pubmed/27480108 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e20 %T An Evaluation of Understandability of Patient Journey Models in Mental Health %A Percival,Jennifer %A McGregor,Carolyn %+ University of Ontario Institute of Technology, Faculty of Business and Information Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada, 1 905 721 8668 ext 2833, jennifer.percival@uoit.ca %K patient-journey modeling %K process modeling %K technology integration %K health information technology %D 2016 %7 28.07.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives: This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method: Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results: The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions: The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot case study to a more diversified group of clinicians and health care support workers. %M 27471006 %R 10.2196/humanfactors.5640 %U http://humanfactors.jmir.org/2016/2/e20/ %U https://doi.org/10.2196/humanfactors.5640 %U http://www.ncbi.nlm.nih.gov/pubmed/27471006 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e20 %T Community Structure of a Mental Health Internet Support Group: Modularity in User Thread Participation %A Carron-Arthur,Bradley %A Reynolds,Julia %A Bennett,Kylie %A Bennett,Anthony %A Cunningham,John Alastair %A Griffiths,Kathleen Margaret %+ National Institute for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston road, Acton, 2601, Australia, 61 2 6125 6825, Bradley.Carron-Arthur@anu.edu.au %K internet %K support group %K social network %K modularity %K mental health %K super user %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Little is known about the community structure of mental health Internet support groups, quantitatively. A greater understanding of the factors, which lead to user interaction, is needed to explain the design information of these services and future research concerning their utility. Objective: A study was conducted to determine the characteristics of users associated with the subgroup community structure of an Internet support group for mental health issues. Methods: A social network analysis of the Internet support group BlueBoard (blueboard.anu.edu.au) was performed to determine the modularity of the community using the Louvain method. Demographic characteristics age, gender, residential location, type of user (consumer, carer, or other), registration date, and posting frequency in subforums (depression, generalized anxiety, social anxiety, panic disorder, bipolar disorder, obsessive compulsive disorder, borderline personality disorder, eating disorders, carers, general (eg, “chit chat”), and suggestions box) of the BlueBoard users were assessed as potential predictors of the resulting subgroup structure. Results: The analysis of modularity identified five main subgroups in the BlueBoard community. Registration date was found to be the largest contributor to the modularity outcome as observed by multinomial logistic regression. The addition of this variable to the final model containing all other factors improved its classification accuracy by 46.3%, that is, from 37.9% to 84.2%. Further investigation of this variable revealed that the most active and central users registered significantly earlier than the median registration time in each group. Conclusions: The five subgroups resembled five generations of BlueBoard in distinct eras that transcended discussion about different mental health issues. This finding may be due to the activity of highly engaged and central users who communicate with many other users. Future research should seek to determine the generalizability of this finding and investigate the role that highly active and central users may play in the formation of this phenomenon. %M 27242012 %R 10.2196/mental.4961 %U http://mental.jmir.org/2016/2/e20/ %U https://doi.org/10.2196/mental.4961 %U http://www.ncbi.nlm.nih.gov/pubmed/27242012 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e22 %T Do Patients Look Up Their Therapists Online? An Exploratory Study Among Patients in Psychotherapy %A Eichenberg,Christiane %A Sawyer,Adam %+ Professorship of Clinical Psychology, Pychotherapy and Media, Department of Psychology, Sigmund Freud University Vienna, Freudplatz 1, Vienna, 1020, Austria, 43 660 1599154, christiane.eichenberg@sfu.ac.at %K therapist-targeted googling %K patient-targeted googling %K Internet %K patient-therapist relationship %D 2016 %7 26.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: The use of the Internet as a source of health information is growing among people who experience mental health difficulties. The increase in Internet use has led to questions about online information-seeking behaviors, for example, how psychotherapists and patients use the Internet to ascertain information about each other. The notion of psychotherapists seeking information about their patients online (patient-targeted googling, PTG) has been identified and explored. However, the idea of patients searching for information online about their psychotherapists (therapist-targeted googling, TTG) and the associated motives and effects on the therapeutic relationship remain unclear. Objective: This study investigated former and current German-speaking psychotherapy patients’ behavior and attitudes relating to TTG. In addition, patients’ methods of information gathering, motives, and success in searching for information were examined. Furthermore, patients’ experiences and perceptions of PTG were explored. Methods: Overall, 238 former and current psychotherapy patients responded to a new questionnaire specifically designed to assess the frequency, motives, use, and outcomes of TTG as well as experiences and perceptions of PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking therapy platforms and self-help forums. Results: Of the 238 former and current patients who responded, 106 (44.5%) had obtained information about their therapists; most of them (n=85, 80.2%) had used the Internet for this. Besides curiosity, motives behind information searches included the desire to get to know the therapist better by attempting to search for both professional and private information. TTG appeared to be associated with phases of therapy in which patients felt that progress was not being made. Patients being treated for personality disorders appear to engage more frequently in TTG (rphi = 0.21; P=.004). In general, however, information about therapists sought for online was often not found. Furthermore, most patients refrained from telling their therapist about their information searches. Conclusions: Patients appear to engage in TTG to obtain both professional and private information about their psychotherapists. TTG can be viewed as a form of client-initiated disclosure. It is therefore important to include TTG as a subject in therapists' education and also to raise awareness within patient education. This investigation provides the first findings into TTG to begin debate on this subject. %M 27230433 %R 10.2196/mental.5169 %U http://mental.jmir.org/2016/2/e22/ %U https://doi.org/10.2196/mental.5169 %U http://www.ncbi.nlm.nih.gov/pubmed/27230433 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e9 %T Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care %A Wentzel,Jobke %A van der Vaart,Rosalie %A Bohlmeijer,Ernst T %A van Gemert-Pijnen,Julia E W C %+ Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522NB, Netherlands, 31 534896050, j.vangemert-pijnen@utwente.nl %K blended care %K Internet-delivered cognitive behavior therapy %K mental health care %K online %K shared decision making %D 2016 %7 09.02.2016 %9 Viewpoint %J JMIR Mental Health %G English %X Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of “blend” works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The “Fit for Blended Care” instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) “blends” of online and face-to-face therapy becomes within reach. %M 26860537 %R 10.2196/mental.4534 %U http://mental.jmir.org/2016/1/e9/ %U https://doi.org/10.2196/mental.4534 %U http://www.ncbi.nlm.nih.gov/pubmed/26860537 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e22 %T Same-Day Counseling: Study Protocol for the Evaluation of a New Mental Health Service %A Ewen,Victoria %A Mushquash,Aislin R %A Bailey,Kathleen %A Haggarty,John M %A Dama,Sumeet %A Mushquash,Christopher J %+ St Joseph's Care Group, 710 Victoria Avenue East, Thunder Bay, ON, P7C 5P7, Canada, 1 8076243465, mushquaa@tbh.net %K single-session counseling %K mental health services %K outpatient %K program evaluation %K access %D 2016 %7 03.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Single-session counseling is being implemented across Canada to increase the accessibility and availability of mental health services. Despite increasing use, existing research on single-session counseling is sparse and has methodological limitations. In addition, some stakeholders are skeptical that this model of care can support meaningful change for clients. Objective: The aim of this study is to evaluate a new single-session counseling program (called Same-Day Counseling) offered in an outpatient community mental health clinic in Northwestern Ontario, Canada. Methods: Clients who attend Same-Day Counseling services will be given the opportunity to participate in the program evaluation. Those who consent will complete measures before their session, after their session, and at 1-month follow-up. Data will provide information on who accesses Same-Day Counseling (eg, typical presenting problems, symptom severity), client satisfaction with services, and whether clients benefit from the services (eg, improved functioning and reduced symptom severity). Results: Data collection is underway with 80 participants having completed baseline measures and 55 participants having completed follow-up measures. Data collection is expected to conclude in December 2015. Conclusions: This study is designed to contribute to the literature regarding the integration of single-session counseling into ongoing mental health services, with additional attention to methodological rigour. Our approach will help to address ongoing concerns regarding the implementation of single-session counseling, and inform health care providers and policy makers regarding the utility of this model for addressing the mental health care need of the community. %M 26842891 %R 10.2196/resprot.5206 %U http://www.researchprotocols.org/2016/1/e22/ %U https://doi.org/10.2196/resprot.5206 %U http://www.ncbi.nlm.nih.gov/pubmed/26842891 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e18 %T Increasing Access to Mental Health Care With Breathe, an Internet-Based Program for Anxious Adolescents: Study Protocol for a Pilot Randomized Controlled Trial %A Newton,Amanda S %A Wozney,Lori %A Bagnell,Alexa %A Fitzpatrick,Eleanor %A Curtis,Sarah %A Jabbour,Mona %A Johnson,David %A Rosychuk,Rhonda J %A Young,Michael %A Ohinmaa,Arto %A Joyce,Anthony %A McGrath,Patrick %+ University of Alberta, 3-526, Edmonton Clinic Health Academy, 11405-85 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7802485581, mandi.newton@ualberta.ca %K anxiety %K etherapy %K cognitive behavioral therapy %K adolescents %K mental health %K Internet %K intervention %K pilot %K randomized controlled trial %D 2016 %7 29.01.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a demand to make first-line treatments, including cognitive behavioural therapy (CBT) for adolescent anxiety disorders, more widely available. Internet-based CBT is proposed to circumvent access and availability barriers and reduce health care system costs. Recent reviews suggest more evidence is needed to establish the treatment effects of Internet-based CBT in children and adolescents and to determine related economic impacts. Objective: This pilot trial aims to collect the necessary data to inform the planning of a full-scale RCT to test the effectiveness of the Internet-based CBT program Breathe (Being Real, Easing Anxiety: Tools Helping Electronically). Methods: We are conducting a 27-month, 2-arm parallel-group, pilot randomized controlled trial (RCT). Outcomes will inform the planning of a full-scale RCT aimed to test the effectiveness of Internet-based CBT with a population of adolescents with moderate to mild anxiety problems. In the pilot RCT we will: (1) define a minimal clinically important difference (MCID) for the primary outcome measure (total anxiety score using the Multidimensional Anxiety Scale for Children); (2) determine a sample size for the full-scale RCT; (3) estimate recruitment and retention rates; (4) measure intervention acceptability to inform critical intervention changes; (5) determine the use of co-interventions; and (6) conduct a cost-consequence analysis to inform a cost-effectiveness analysis in the full-scale RCT. Adolescents aged 13-17 years seeking care for an anxiety complaint from a participating emergency department, mobile or school-based crisis team, or primary care clinic are being screened for interest and eligibility. Enrolled adolescents are being randomly allocated to either 8 weeks of Internet-based CBT with limited telephone and e-mail support, or a control group with access to a static webpage listing anxiety resources. Adolescents are randomly assigned using a computer generated allocation sequence. Data are being collected at baseline, treatment completion, and at a 3-month follow-up. Results: Currently, adolescents are being enrolled in the study. Enrolment is taking place between March 2014 and February 2016; data collection will conclude May 2016. We expect that analysis and results will be available by August 2016. Conclusions: In many communities, the resources available for front-line anxiety treatment are outweighed by the need for care. This pilot RCT is an essential step to designing a robust RCT to evaluate the effectiveness of an Internet-based CBT program for adolescents with moderate to mild anxiety problems. Trial Registration: Clinicaltrials.gov NCT02059226; http://clinicaltrials.gov/ct2/show/NCT02059226 (Archived by WebCite at http://www.webcitation.org/6epF8v7k4) %M 26825111 %R 10.2196/resprot.4428 %U http://www.researchprotocols.org/2016/1/e18/ %U https://doi.org/10.2196/resprot.4428 %U http://www.ncbi.nlm.nih.gov/pubmed/26825111 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e4 %T Mental Health Technologies: Designing With Consumers %A Orlowski,Simone %A Matthews,Ben %A Bidargaddi,Niranjan %A Jones,Gabrielle %A Lawn,Sharon %A Venning,Anthony %A Collin,Philippa %+ Flinders Human Behaviour & Health Research Unit, Department of Psychiatry, Flinders University, Margaret Tobin Centre, FMC, Sturt Road, Bedford Park, 5042, Australia, 61 8 8404 2615, simone.orlowski@flinders.edu.au %K design thinking %K participatory design %K mental health %K technology %D 2016 %7 28.01.2016 %9 Original Paper %J JMIR Human Factors %G English %X Despite growing interest in the promise of e-mental and well-being interventions, little supporting literature exists to guide their design and the evaluation of their effectiveness. Both participatory design (PD) and design thinking (DT) have emerged as approaches that hold significant potential for supporting design in this space. Each approach is difficult to definitively circumscribe, and as such has been enacted as a process, a mind-set, specific practices/techniques, or a combination thereof. At its core, however, PD is a design research tradition that emphasizes egalitarian partnerships with end users. In contrast, DT is in the process of becoming a management concept tied to innovation with strong roots in business and education. From a health researcher viewpoint, while PD can be reduced to a number of replicable stages that involve particular methods, techniques, and outputs, projects often take vastly different forms and effective PD projects and practice have traditionally required technology-specific (eg, computer science) and domain-specific (eg, an application domain, such as patient support services) knowledge. In contrast, DT offers a practical off-the-shelf toolkit of approaches that at face value have more potential to have a quick impact and be successfully applied by novice practitioners (and those looking to include a more human-centered focus in their work). Via 2 case studies we explore the continuum of similarities and differences between PD and DT in order to provide an initial recommendation for what health researchers might reasonably expect from each in terms of process and outcome in the design of e-mental health interventions. We suggest that the sensibilities that DT shares with PD (ie, deep engagement and collaboration with end users and an inclusive and multidisciplinary practice) are precisely the aspects of DT that must be emphasized in any application to mental health provision and that any technology development process must prioritize empathy and understanding over innovation for the successful uptake of technology in this space. %M 27026210 %R 10.2196/humanfactors.4336 %U http://humanfactors.jmir.org/2016/1/e4/ %U https://doi.org/10.2196/humanfactors.4336 %U http://www.ncbi.nlm.nih.gov/pubmed/27026210 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e10 %T Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research %A Meurk,Carla %A Leung,Janni %A Hall,Wayne %A Head,Brian W %A Whiteford,Harvey %+ School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Level 2, Public Health Building, Herston, 4006, Australia, 61 733655345, c.meurk@uq.edu.au %K telemedicine %K e-health %K e-mental health %K e-therapy %K Internet %K online %K cognitive behavioural therapy %K anxiety %K anxiety disorders %K depression %K depressive disorder %K Australia %K research translation %K evidence-informed policy %K implementation %D 2016 %7 13.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services. Objective: We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base. Methods: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance. Results: The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed. Conclusions: Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary. %M 26764181 %R 10.2196/jmir.4827 %U http://www.jmir.org/2016/1/e10/ %U https://doi.org/10.2196/jmir.4827 %U http://www.ncbi.nlm.nih.gov/pubmed/26764181 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e3 %T Do Therapists Google Their Patients? A Survey Among Psychotherapists %A Eichenberg,Christiane %A Herzberg,Philipp Y %+ Department of Psychology, Sigmund Freud University, Freudplatz 1, Vienna, 1020, Austria, 43 6601599154, christiane@rz-online.de %K patient-targeted googling (PTG) %K Internet %K patient-therapist relationship %K professional-patient relationship, professional guidelines %K educational curriculum %D 2016 %7 05.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing use of the Internet and its array of social networks brings new ways for psychotherapists to find out information about their patients, often referred to as patient-targeted googling (PTG). However, this topic has been subject to little empirical research; there has been hardly any attention given to it in Germany and the rest of Europe and it has not been included in ethical guidelines for psychotherapy despite the complex ethical issues it raises. Objective: This study explored German psychotherapists’ behavior and experiences related to PTG, investigated how these vary with sociodemographic factors and therapeutic background, and explored the circumstances in which psychotherapists considered PTG to be appropriate or not. Methods: A total of 207 psychotherapists responded to a newly developed questionnaire that assessed their experience of and views on PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking professional therapy platforms. Results: Most therapists (84.5%, 174/207) stated that they had not actively considered the topic of PTG. However, 39.6% (82/207) said that they had already looked for patient information online (eg, when they suspected a patient may have been lying) and 39.3% (81/207) knew colleagues or supervisors who had done so. Only 2.4% (5/207) of therapists had come across PTG during their education and training. Conclusions: It is essential to provide PTG as a part of therapists’ education and training. Furthermore, the complex problems concerning PTG should be introduced into codes of ethics to provide explicit guidance for psychotherapists in practice. This report provides initial suggestions to open up debate on this topic. %M 26733210 %R 10.2196/jmir.4306 %U http://www.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/jmir.4306 %U http://www.ncbi.nlm.nih.gov/pubmed/26733210 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e143 %T Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment %A Ruggiero,Kenneth J %A Bunnell,Brian E %A Andrews III,Arthur R %A Davidson,Tatiana M %A Hanson,Rochelle F %A Danielson,Carla Kmett %A Saunders,Benjamin E %A Soltis,Kathryn %A Yarian,Caleb %A Chu,Brian %A Adams,Zachary W %+ Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC, 29425, United States, 1 843 792 3687, ruggierk@musc.edu %K technology %K mobile health %K child mental health treatment %K feasibility test %K fidelity %K patient engagement %K traumatic stress %D 2015 %7 30.12.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Children need access to high quality mental health care. Effective treatments now exist for a wide range of mental health conditions. However, these interventions are delivered with variable effectiveness in traditional mental health service settings. Innovative solutions are needed to improve treatment delivery quality and effectiveness. Objective: The aim of this study was to develop a scalable, sustainable technology-based approach to improve the quality of care in child mental health treatment. Methods: A tablet-based resource was developed with input from mental health training experts, mental health providers, and patients. A series of qualitative data collection phases (ie, expert interviews, patient and provider focus groups, usability testing) guided the initial concept and design of the resource, and then its refinement. The result was an iPad-based “e-workbook” designed to improve child engagement and provider fidelity in implementation of a best-practice treatment. We are currently conducting a small scale randomized controlled trial to evaluate the feasibility of e-workbook facilitated child mental health treatment with 10 providers and 20 families recruited from 4 local community-based mental health clinics. Results: Usability and focus group testing yielded a number of strong, favorable reactions from providers and families. Recommendations for refining the e-workbook also were provided, and these guided several improvements to the resource prior to initiating the feasibility trial, which is currently underway. Conclusions: This study aimed to develop and preliminarily evaluate a tablet-based application to improve provider fidelity and child engagement in child mental health treatment. If successful, this approach may serve as a key step toward making best-practice treatment more accessible to children and families. As various technologies continue to increase in popularity worldwide and within the health care field more specifically, it is essential to rigorously test the usability, feasibility, acceptability, and effectiveness of novel health technology solutions. It is also essential to ensure that patients and providers drive decision making that supports the development of these resources to ensure that they can be seamlessly integrated into practice. Trial Registration: Clinicaltrials.gov NCT01915160; https://clinicaltrials.gov/ct2/show/NCT01915160 (Archived by WebCite at http://www.webcitation.org/6cPIiQDpu) %M 26717906 %R 10.2196/resprot.4416 %U http://www.researchprotocols.org/2015/4/e143/ %U https://doi.org/10.2196/resprot.4416 %U http://www.ncbi.nlm.nih.gov/pubmed/26717906 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e19 %T Online Peer-to-Peer Support for Young People With Mental Health Problems: A Systematic Review %A Ali,Kathina %A Farrer,Louise %A Gulliver,Amelia %A Griffiths,Kathleen M %+ National Institute for Mental Health Research, The Australian National University, Building 63, Eggleston Road, Canberra, , Australia, 61 261259155, kathina.ali@anu.edu.au %K mental health %K Internet %K young people %K peer-to-peer support %K Internet support groups %K technology %K systematic reviews %D 2015 %7 19.05.2015 %9 Review %J JMIR Mental Health %G English %X Background: Adolescence and early adulthood are critical periods for the development of mental disorders. Online peer-to-peer communication is popular among young people and may improve mental health by providing social support. Previous systematic reviews have targeted Internet support groups for adults with mental health problems, including depression. However, there have been no systematic reviews examining the effectiveness of online peer-to-peer support in improving the mental health of adolescents and young adults. Objective: The aim of this review was to systematically identify available evidence for the effectiveness of online peer-to peer support for young people with mental health problems. Methods: The PubMed, PsycInfo, and Cochrane databases were searched using keywords and Medical Subject Headings (MeSH) terms. Retrieved abstracts (n=3934) were double screened and coded. Studies were included if they (1) investigated an online peer-to-peer interaction, (2) the interaction discussed topics related to mental health, (3) the age range of the sample was between 12 to 25 years, and (4) the study evaluated the effectiveness of the peer-to-peer interaction. Results: Six studies satisfied the inclusion criteria for the current review. The studies targeted a range of mental health problems including depression and anxiety (n=2), general psychological problems (n=1), eating disorders (n=1), and substance use (tobacco) (n=2). The majority of studies investigated Internet support groups (n=4), and the remaining studies focused on virtual reality chat sessions (n=2). In almost all studies (n=5), the peer support intervention was moderated by health professionals, researchers or consumers. Studies employed a range of study designs including randomized controlled trials (n=3), pre-post studies (n=2) and one randomized trial. Overall, two of the randomized controlled trials were associated with a significant positive outcome in comparison to the control group at post-intervention. In the remaining four studies, peer-to-peer support was not found to be effective. Conclusions: This systematic review identified an overall lack of high-quality studies examining online peer-to-peer support for young people. Given that peer support is frequently used as an adjunct to Internet interventions for a variety of mental health conditions, there is an urgent need to determine the effectiveness of peer support alone as an active intervention. %M 26543923 %R 10.2196/mental.4418 %U http://mental.jmir.org/2015/2/e19/ %U https://doi.org/10.2196/mental.4418 %U http://www.ncbi.nlm.nih.gov/pubmed/26543923 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e123 %T E-Mental Health Care Among Young Adults and Help-Seeking Behaviors: A Transversal Study in a Community Sample %A Younes,Nadia %A Chollet,Aude %A Menard,Estelle %A Melchior,Maria %+ Centre Hospitalier de Versailles, 177, rue de Versailles, Le Chesnay, 78150, France, 33 0139639380, nyounes@ch-versailles.fr %K Internet %K mental health services %K young adult %K epidemiology %K health care disparities %D 2015 %7 15.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. Objective: In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Methods: Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen’s behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents’ income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Results: Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03). Conclusions: E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care. %M 25979680 %R 10.2196/jmir.4254 %U http://www.jmir.org/2015/5/e123/ %U https://doi.org/10.2196/jmir.4254 %U http://www.ncbi.nlm.nih.gov/pubmed/25979680 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e9 %T Privacy Issues in the Development of a Virtual Mental Health Clinic for University Students: A Qualitative Study %A Gulliver,Amelia %A Bennett,Kylie %A Bennett,Anthony %A Farrer,Louise M %A Reynolds,Julia %A Griffiths,Kathleen M %+ National Institute for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton, ACT, Canberra, , Australia, 61 02 6125 9472, amelia.gulliver@anu.edu.au %K university %K student %K mental health %K internet %K virtual clinic %K qualitative %D 2015 %7 31.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services. Objective: To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic. Methods: There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context. Results: The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic. Conclusions: Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences. %M 26543915 %R 10.2196/mental.4294 %U http://mental.jmir.org/2015/1/e9/ %U https://doi.org/10.2196/mental.4294 %U http://www.ncbi.nlm.nih.gov/pubmed/26543915 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e10 %T Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System %A East,Marlene Lynette %A Havard,Byron C %+ East Counseling Services, Inc., Private Counseling Practice, 6521 N Lagoon Dr., Panama City Beach, FL, 32408-3730, United States, 1 850 233 6623, marleneeast@yahoo.com %K clinical efficacy %K counselors %K ethical codes %K innovation diffusion %K instructional technology %K mental health %K mHealth %K mobile health %K smartphone %D 2015 %7 31.03.2015 %9 Viewpoint %J JMIR Mental Health %G English %X The roles of mental health educators and professionals in the diffusion of mental health mobile apps are addressed in this viewpoint article. Mental health mobile apps are emerging technologies that fit under the broad heading of mobile health (mHealth). mHealth, encompassed within electronic health (eHealth), reflects the use of mobile devices for the practice of public health. Well-designed mental health mobile apps that present content in interactive, engaging, and stimulating ways can promote cognitive learning, personal growth, and mental health enhancement. As key influencers in the mental health social system, counselor educators and professional associations may either help or hinder diffusion of beneficial mHealth technologies. As mental health mobile apps move towards ubiquity, research will continue to be conducted. The studies published thus far, combined with the potential of mental health mobile apps for learning and personal growth, offer enough evidence to compel mental health professionals to infuse these technologies into education and practice. Counselor educators and professional associations must use their influential leadership roles to train students and practitioners in how to research, evaluate, and integrate mental health mobile apps into practice. The objectives of this article are to (1) increase awareness of mHealth and mental health mobile apps, (2) demonstrate the potential for continued growth in mental health mobile apps based on technology use and acceptance theory, mHealth organizational initiatives, and evidence about how humans learn, (3) discuss evidence-based benefits of mental health mobile apps, (4) examine the current state of mHealth diffusion in the mental health profession, and (5) offer solutions for impelling innovation diffusion by infusing mental health mobile apps into education, training, and clinical settings. This discussion has implications for counselor educators, mental health practitioners, associations, continuing education providers, and app developers. %M 26543907 %R 10.2196/mental.3954 %U http://mental.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/mental.3954 %U http://www.ncbi.nlm.nih.gov/pubmed/26543907 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework %A Reynolds,Julia %A Griffiths,Kathleen M %A Cunningham,John A %A Bennett,Kylie %A Bennett,Anthony %+ National Institute for Mental Health Research, Research School of Population Health, Australian National University, Building 63, Eggleston Road, Canberra, 2601, Australia, 61 2 612 ext 57275, julia.reynolds@anu.edu.au %K translational medical research %K professional practice %K primary health care %K treatment of mental disorders %K Internet %K health care technology %K health promotion %K case management %K psychotherapy %D 2015 %7 23.03.2015 %9 Viewpoint %J JMIR Mental Health %G English %X Background: Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. Objective: The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. Methods: Information about service providers’ use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors’ experience of training primary care service providers. Results: Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers Conclusions: The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation. %M 26543912 %R 10.2196/mental.4200 %U http://mental.jmir.org/2015/1/e6/ %U https://doi.org/10.2196/mental.4200 %U http://www.ncbi.nlm.nih.gov/pubmed/26543912 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e2 %T A Virtual Mental Health Clinic for University Students: A Qualitative Study of End-User Service Needs and Priorities %A Farrer,Louise %A Gulliver,Amelia %A Chan,Jade KY %A Bennett,Kylie %A Griffiths,Kathleen M %+ National Institute for Mental Health Research, The Australian National University, 63 Eggleston Road, Acton, 2601, Australia, 61 02 6125 8859, louise.farrer@anu.edu.au %K university %K student %K mental health %K online %K qualitative %D 2015 %7 11.02.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Help seeking for mental health problems among university students is low, and Internet-based interventions such as virtual clinics have the potential to provide private, streamlined, and high quality care to this vulnerable group. Objective: The objective of this study was to conduct focus groups with university students to obtain input on potential functions and features of a university-specific virtual clinic for mental health. Methods: Participants were 19 undergraduate students from an Australian university between 19 and 24 years of age. Focus group discussion was structured by questions that addressed the following topics: (1) the utility and acceptability of a virtual mental health clinic for students, and (2) potential features of a virtual mental health clinic. Results: Participants viewed the concept of a virtual clinic for university students favorably, despite expressing concerns about privacy of personal information. Participants expressed a desire to connect with professionals through the virtual clinic, for the clinic to provide information tailored to issues faced by students, and for the clinic to enable peer-to-peer interaction. Conclusions: Overall, results of the study suggest the potential for virtual clinics to play a positive role in providing students with access to mental health support. %M 26543908 %R 10.2196/mental.3890 %U http://mental.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/mental.3890 %U http://www.ncbi.nlm.nih.gov/pubmed/26543908 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Client Perceptions of the Mental Health Engagement Network: A Secondary Analysis of an Intervention Using Smartphones and Desktop Devices for Individuals Experiencing Mood or Psychotic Disorders in Canada %A Forchuk,Cheryl %A Donelle,Lorie %A Ethridge,Paige %A Warner,Laura %+ Lawson Health Research Institute, Suite 102, 750 Baseline Road East, London, ON, N6C 2R5, Canada, 1 519 685 8500 ext 77034, cforchuk@uwo.ca %K mental health %K mobile health %K eHealth %K personal health records %K mood disorders %K psychotic disorders %K mental disorders %D 2015 %7 21.01.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: The use of innovative technologies in mental health care has the potential to improve system efficiency, enhance quality of care, and increase patient engagement. The Mental Health Engagement Network (MHEN) project developed, delivered, and evaluated an interactive Web-based personal health record, the Lawson SMART Record (LSR), to assist mental health clients in managing their care and connecting with their care providers. This paper presents a secondary analysis of data collected in the MHEN project regarding clients’ perceptions of technology and the use of these technologies in their care. Objective: We aimed to answer six questions: (1) What is the level of comfort with technology within a sample of individuals experiencing mood or psychotic disorders? (2) How easy to use and helpful are the MHEN technologies from the perspective of individuals experiencing a mental illness? (3) Are there differences in how helpful or useful individuals find the smartphone compared to the LSR? (4) Are there specific functions of MHEN technologies (eg, reminders for medications or appointments) that are more valued than others? (5) What are the other ways that individuals are using MHEN technologies in their daily lives? (6) How likely are individuals to be able to retain and maintain their smartphone? Methods: Mental health clients aged 18-80 (N=400) and diagnosed with a mood or psychotic disorder were provided with a smartphone (iPhone 4S) and participating care providers (n=52) were provided with a tablet (iPad) in order to access and engage with the LSR. A delayed implementation design with mixed methods was used. Survey and interview data were collected over the course of 18 months through semistructured interviews conducted by experienced research assistants every 6 months post-implementation of the intervention. Paired t tests were used to determine differences between 6 and 12-month data for perceptions of the MHEN technologies. A paired t test was used to examine whether differences existed between perceptions of the smartphone and the LSR at 12 months post-implementation. Results: Due to dropout or loss of contact, 394 out of 400 individuals completed the study. At the end of the study, 52 devices were lost or unusable. Prior to the intervention, participants reported being comfortable using technology. Perceptions of the MHEN technologies and their functions were generally positive. Positive perceptions of the smartphone increased over time (P=.002), while positive perceptions of the LSR decreased over time (P<.001). Conclusions: Quantitative and qualitative findings from this analysis demonstrated that these technologies positively impacted the lives of individuals experiencing severe mental illnesses and dispeled some of the myths regarding retention of technology among marginalized populations. This secondary analysis supported the acceptability of using mental health technologies within this population and provided considerations for future development. Trial Registration: ClinicalTrials.gov NCT01473550; http://clinicaltrials.gov/show/NCT01473550 (Archived by WebCite at http://www.webcitation.org/6SLNcoKb8). %M 26543906 %R 10.2196/mental.3926 %U http://mental.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/mental.3926 %U http://www.ncbi.nlm.nih.gov/pubmed/26543906 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e2 %T Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training – COGWEB Network %A Tedim Cruz,Vítor %A Pais,Joana %A Ruano,Luis %A Mateus,Cátia %A Colunas,Márcio %A Alves,Ivânia %A Barreto,Rui %A Conde,Eduardo %A Sousa,Andreia %A Araújo,Isabel %A Bento,Virgílio %A Coutinho,Paula %A Rocha,Nelson %A , %+ Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Neurology Department, Rua Dr. Cândido de Pinho, Santa Maria da Feira, 4520-211, Portugal, 351 936173516, vitor.cruz@chedv.min-saude.pt %K cognitive training %K neurorehabilitation %K eHealth systems %K memory clinic %K collaborative network %K stroke %K dementia %K schizophrenia %K mental health services %D 2014 %7 27.11.2014 %9 Original Paper %J JMIR Mental Health %G English %X Background: Cognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector. Objective: The objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB). Methods: The setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled. Results: The network included 68 professionals from 41 centers, (33/41) 80% clinical, (8/41) 19% nonclinical. A total of 298 patients received cognitive training; 45.3% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6%), (2) structural brain lesions (63/298, 21.1%), (3) autoimmune (40/298, 13.4%), (4) schizophrenia (30/298, 10.1%), and (5) others (50/298, 16.8%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education. Conclusions: Over its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden. %M 26543902 %R 10.2196/mental.3840 %U http://www.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/mental.3840 %U http://www.ncbi.nlm.nih.gov/pubmed/26543902