TY - JOUR AU - Au-Yeung, Christy AU - Thai, Helen AU - Best, Michael AU - Bowie, R. Christopher AU - Guimond, Synthia AU - Lavigne, M. Katie AU - Menon, Mahesh AU - Moritz, Steffen AU - Piat, Myra AU - Sauvé, Geneviève AU - Sousa, Elisa Ana AU - Thibaudeau, Elisabeth AU - Woodward, S. Todd AU - Lepage, Martin AU - Raucher-Chéné, Delphine PY - 2025/4/15 TI - iCogCA to Promote Cognitive Health Through Digital Group Interventions for Individuals Living With a Schizophrenia Spectrum Disorder: Protocol for a Nonrandomized Concurrent Controlled Trial JO - JMIR Res Protoc SP - e63269 VL - 14 KW - schizophrenia spectrum disorders KW - digital technology KW - cognitive health KW - cognitive remediation KW - metacognitive training KW - schizophrenia KW - digital group interventions N2 - Background: Cognitive impairments are a key aspect of schizophrenia spectrum disorders (SSDs), significantly affecting clinical and functional outcomes. The COVID-19 pandemic has heightened concerns about mental health services and cognitive stimulation opportunities. Despite evidence-based interventions like action-based cognitive remediation (ABCR) and metacognitive training (MCT), a research-to-practice gap exists in their application across mental health settings. Objective: The iCogCA study aims to address this gap by implementing digital ABCR and MCT through a national Canadian collaborative effort using digital psychological interventions to enhance cognitive health in SSDs. Methods: The study involves 5 Canadian sites, with mental health care practitioners trained digitally through the E-Cog platform, which was developed by our research group. Over 2.5 years, participants with SSDs will undergo pre- and postintervention assessments for clinical symptoms, cognition, and functioning. Each site will run groups annually for both ABCR and MCT, totaling ~390 participants. A nonrandomized concurrent controlled design will assess effectiveness design, in which one intervention (eg, ABCR) acts as the active control for the other (eg, MCT) and vice versa, comparing cognitive and clinical outcomes between the interventions using generalized linear mixed effect modeling. Implementation strategy evaluation will consider the digital platform?s efficacy for mental health care practitioners? training, contextual factors influencing implementation, and sustainability, using descriptive statistics for quantitative data and thematic analysis for qualitative data. Results: A pilot pragmatic trial has been conducted previously at the Montreal site, evaluating 3 early implementation outcomes: acceptability, feasibility, and engagement. Patient and therapist acceptability was deemed as high and feasible (21/28, 75% of recruited service users completed therapy, rated feasible by therapists). Technology did not appear to significantly impede program participation. Therapist-rated levels of engagement were also satisfactory. In the ongoing study, recruitment is underway (114 participants recruited as of winter 2024), and intervention groups have been conducted at all sites, with therapists receiving training via the E-Cog learning platform (32 enrolled as of winter 2024). Conclusions: At least 3 significant innovations will stem from this project. First, this national effort represents a catalyst for the use of digital technologies to increase the adoption of evidence-based interventions and will provide important results on the effectiveness of digitally delivered ABCR and MCT. Second, the results of the implementation component of this study will generate the expertise needed to inform the implementation of similar initiatives. Third, the proposed study will introduce and validate our platform to train and supervise mental health care practitioners to deliver these interventions, which will then be made accessible to the broader mental health community. Trial Registration: ClinicalTrials.gov NCT05661448; https://clinicaltrials.gov/study/NCT05661448 International Registered Report Identifier (IRRID): DERR1-10.2196/63269 UR - https://www.researchprotocols.org/2025/1/e63269 UR - http://dx.doi.org/10.2196/63269 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63269 ER - TY - JOUR AU - Schuler, R. Kaitlyn AU - Ong, Triton AU - Welch, M. Brandon AU - Craggs, G. Jason AU - Bunnell, E. Brian PY - 2025/4/10 TI - Examining a Telemedicine-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Protocol for a Feasibility Randomized Controlled Efficacy Trial JO - JMIR Res Protoc SP - e65770 VL - 14 KW - virtual reality KW - exposure therapy KW - phobias KW - telemedicine KW - telemental health KW - tele-VR KW - immersive simulations N2 - Background: Virtual reality (VR) has strong potential to enhance the effectiveness of telemental health care (TMH) by providing accessible, personalized treatment from home. While there is ample research supporting VR for in-person treatment, there is only preliminary data on the efficacy of telemedicine-based VR. Furthermore, the majority of VR apps used in therapy are not designed for mental health care. VR has the potential to enhance TMH through innovative technology solutions designed specifically for the enhancement of remotely delivered evidence-based practices. This feasibility randomized controlled efficacy trial aims to fill both of these gaps by piloting a novel telemedicine-based VR app (Doxy.me VR) equipped with animal phobia exposure stimuli. Objective: This is a feasibility randomized controlled efficacy trial comparing exposure therapy via a telemedicine-based VR clinic versus standard TMH with adults with an intense fear of dogs, snakes, or spiders. The primary objective is to assess the feasibility of a fully powered trial. The secondary objective is to conduct a preliminary examination of clinical outcomes (eg, specific phobia symptoms). Methods: This single-site trial will enroll a minimum of 30 and a maximum of 60 adults with self-reported fear of dogs, snakes, or spiders. Potential participants will be recruited through clinical trial and research recruitment websites and posting flyers. All self-report assessments and homework will be partially automated using REDCap (Research Electronic Data Capture; Vanderbilt University) forms and surveys, but the baseline assessment of phobia symptoms and exposure intervention will be administered by the study therapist. Results: The feasibility of the proposed trial methodology will be assessed using enrollment, retention, assessment completion, and treatment protocol fidelity benchmarks. Between-group differences in specific phobia, anxiety, and depression symptoms while covarying for pretreatment scores, will be conducted using repeated measures ANOVA along with differences in therapeutic alliance and presence. Data obtained from these analyses will inform power analyses for a fully powered efficacy trial. In total, 54 participants were randomized between October 25, 2023, and July 26, 2024 (Doxy.me VR n=28 and TMH n=26). Data analysis will be completed and submitted by the end of the second quarter of 2025. Conclusions: This feasibility randomized controlled trial comparing Doxy.me VR versus TMH aims to enhance the delivery of evidence-based treatments via telemedicine and reduce barriers to remotely delivered exposure therapy. This feasibility trial will be followed by a fully powered efficacy trial on telemedicine-based VR for animal phobias. Trial Registration: ClinicalTrials.gov NCT06302868; https://clinicaltrials.gov/study/NCT06302868 International Registered Report Identifier (IRRID): DERR1-10.2196/65770 UR - https://www.researchprotocols.org/2025/1/e65770 UR - http://dx.doi.org/10.2196/65770 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65770 ER - TY - JOUR AU - Oesterle, S. Tyler AU - Bormann, L. Nicholas AU - Paul, M. Margaret AU - Breitinger, A. Scott AU - Lai, Benjamin AU - Smith, L. Jamie AU - Stoppel, J. Cindy AU - Arndt, Stephan AU - Williams, D. Mark PY - 2025/3/26 TI - Treatment of Substance Use Disorders With a Mobile Phone App Within Rural Collaborative Care Management (Senyo Health): Protocol for a Mixed Methods Randomized Controlled Trial JO - JMIR Res Protoc SP - e65693 VL - 14 KW - substance-related disorders KW - mobile apps KW - primary care KW - clinical trial KW - substance use disorder KW - SUD KW - addiction treatment KW - telemedicine KW - telepsychiatry KW - care management KW - community-based care KW - behavioral health program N2 - Background: COVID-19 worsened an already existing problem in substance use disorder (SUD) treatment. However, it helped transform the use of telehealth, which particularly benefits rural America. The lack of specialty addiction treatment in rural areas places the onus on primary care providers. Screening, brief intervention, and referral to treatment (SBIRT) is an evidenced-based strategy commonly used in primary care settings to target SUD outcomes and related behaviors. The integration of telehealth tools within the SBIRT pathway may better sustain the program in primary care. Building on Mayo Clinic?s experience with collaborative care management (CoCM) for mental health treatment, we built a digitally native, integrated, behavioral health CoCM platform using a novel mobile app and web-based provider platform called Senyo Health. Objective: This protocol describes a novel use of the SBIRT pathway using Senyo Health to complement existing CoCM integration within primary care to deliver SUD treatment to rural patients lacking other access. We hypothesize that this approach will improve SUD-related outcomes within rural primary care clinics. Methods: Senyo Health is a digital tool to facilitate the use of SBIRT in primary care. It contains a web-based platform for clinician and staff use and a patient-facing mobile phone app. The app includes 16 learning modules along with data collection tools and a chat function for communicating directly with a licensed drug counselor. Beta-testing is currently underway to examine opportunities to improve Senyo Health prior to the start of the trial. We describe the development of Senyo Health and its therapeutic content and data collection instruments. We also describe our evaluation strategy including our measurement plan to assess implementation through a process guided by Consolidated Framework for Implementation Research methods and effectiveness through a waitlist control trial. A randomized controlled trial will occur where 30 participants are randomly assigned to immediately start the Senyo intervention compared to a waitlist control group of 30 participants who will start the active intervention after a 12-week delay. Results: The Senyo Health app was launched in May 2023, and the most recent update was in August 2024. Our funding period began in September 2023 and will conclude in July 2027. This protocol defines a novel implementation strategy for leveraging a digitally native, clinical platform that enables the delivery of CoCM to target an SUD-specific patient population. Our trial will begin in June 2025. Conclusions: We present a theory of change and study design to assess the impact of a novel and patient-centered mobile app to support the SBIRT approach to SUD in primary care settings. Trial Registration: ClinicalTrials.gov NCT06743282; http://clinicaltrials.gov/ct2/show/NCT06743282 International Registered Report Identifier (IRRID): PRR1-10.2196/65693 UR - https://www.researchprotocols.org/2025/1/e65693 UR - http://dx.doi.org/10.2196/65693 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65693 ER - TY - JOUR AU - Liu, Chang AU - Chamberlain, Samuel AU - Ioannidis, Konstantinos AU - Tiego, Jeggan AU - Grant, Jon AU - Yücel, Murat AU - Hellyer, Peter AU - Lochner, Christine AU - Hampshire, Adam AU - Albertella, Lucy PY - 2025/3/26 TI - Transdiagnostic Compulsivity Traits in Problematic Use of the Internet Among UK Residents: Cross-Sectional Network Analysis Study JO - J Med Internet Res SP - e66191 VL - 27 KW - compulsivity KW - problematic use of the internet KW - network analysis KW - perfectionism KW - reward drive KW - cognitive rigidity KW - transdiagnostic KW - PUI KW - mental health KW - intrapersonal factor KW - cognitive KW - internet use KW - network N2 - Background: The societal and public health costs of problematic use of the internet (PUI) are increasingly recognized as a concern across all age groups, presenting a growing challenge for mental health research. International scientific initiatives have emphasized the need to explore the potential roles of personality features in PUI. Compulsivity is a key personality trait associated with PUI and has been recognized by experts as a critical factor that should be prioritized in PUI research. Given that compulsivity is a multidimensional construct and PUI encompasses diverse symptoms, different underlying mechanisms are likely involved. However, the specific relationships between compulsivity dimensions and PUI symptoms remain unclear, limiting our understanding of compulsivity?s role in PUI. Objective: This study aimed to clarify the unique relationships among different dimensions of compulsivity, namely, perfectionism, reward drive, cognitive rigidity, and symptoms of PUI using a symptom-based network approach. Methods: A regularized partial-correlation network was fitted using a large-scale sample from the United Kingdom. Bridge centrality analysis was conducted to identify bridge nodes within the network. Node predictability analysis was performed to assess the self-determination and controllability of the nodes within the network. Results: The sample comprised 122,345 individuals from the United Kingdom (51.4% female, age: mean 43.7, SD 16.5, range 9-86 years). The analysis identified several strong mechanistic relationships. The strongest positive intracluster edge was between reward drive and PUI4 (financial consequences due to internet use; weight=0.11). Meanwhile, the strongest negative intracluster edge was between perfectionism and PUI4 (financial consequences due to internet use; weight=0.04). Cognitive rigidity showed strong relationships with PUI2 (internet use for distress relief; weight=0.06) and PUI3 (internet use for loneliness or boredom; weight=0.07). Notably, reward drive (bridge expected influence=0.32) and cognitive rigidity (bridge expected influence=0.16) were identified as key bridge nodes, positively associated with PUI symptoms. Meanwhile, perfectionism exhibited a negative association with PUI symptoms (bridge expected influence=?0.05). The network?s overall mean predictability was 0.37, with PUI6 (compulsion, predictability=0.55) showing the highest predictability. Conclusions: The findings reveal distinct relationships between different dimensions of compulsivity and individual PUI symptoms, supporting the importance of choosing targeted interventions based on individual symptom profiles. In addition, the identified bridge nodes, reward drive, and cognitive rigidity may represent promising targets for PUI prevention and intervention and warrant further investigation. UR - https://www.jmir.org/2025/1/e66191 UR - http://dx.doi.org/10.2196/66191 UR - http://www.ncbi.nlm.nih.gov/pubmed/40137076 ID - info:doi/10.2196/66191 ER - TY - JOUR AU - Saskovets, Marina AU - Saponkova, Irina AU - Liang, Zilu PY - 2025/3/24 TI - Effects of Sound Interventions on the Mental Stress Response in Adults: Scoping Review JO - JMIR Ment Health SP - e69120 VL - 12 KW - mental stress KW - anxiety KW - sound therapy KW - music therapy KW - psychoacoustics KW - expressive sounds KW - stress reduction KW - stress management KW - stress relief KW - stress markers KW - relaxation KW - personalized therapy KW - PRISMA N2 - Background: This scoping review examines the effects of various sound interventions, including music, natural sounds, and speech, on the stress response in adults. Objective: The review aims to identify key therapeutic factors, including sound type, individual listener characteristics, and environmental influences. It also synthesizes evidence on physiological responses to sound interventions and highlights current research gaps. Methods: We conducted a comprehensive search using databases such as PubMed, Web of Science, Scopus, and PsycINFO, focusing on studies from 1990 to 2024. Eligible studies included randomized controlled trials, clinical trials, and laboratory experiments that measured stress through physiological markers (eg, heart rate variability and cortisol) and self-reports. A total of 34 studies were included, and thematic analysis was conducted to identify recurring themes in the findings. Results: The findings suggest that music, especially classical and self-selected pieces, effectively reduces physiological stress markers, including cortisol levels, heart rate variability, and blood pressure. Nonmusical sounds, such as nature sounds and calming voices, also demonstrate potential for stress relief, although research in this area remains limited. While most sound interventions showed positive effects, some studies reported adverse effects, indicating that sound can both alleviate and induce stress. The outcomes were substantially affected by contextual factors such as personal preferences, delivery methods, cultural context, and emphasizing the importance of personalized interventions. Conclusions: Sound interventions offer promising, noninvasive methods for stress reduction. This review suggests that future research should address gaps in the study of nonmusical sound interventions and further investigate the neural mechanisms underlying stress responses to sound. International Registered Report Identifier (IRRID): RR2-10.2196/54030 UR - https://mental.jmir.org/2025/1/e69120 UR - http://dx.doi.org/10.2196/69120 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69120 ER - TY - JOUR AU - Nesbitt, Brittany AU - Virgadamo, Danielle AU - Aguirre, Carlos AU - DeCamp, Matthew AU - Dredze, Mark AU - Harrigian, Keith AU - Lhaksampa, Tenzin AU - Meuchel, M. Jennifer AU - Meyer, M. Aja AU - Walker, Alex AU - Zirikly, Ayah AU - Chisolm, S. Margaret AU - Zandi, P. Peter AU - Miller, Leslie PY - 2025/3/5 TI - Testing a Dashboard Intervention for Tracking Digital Social Media Activity in Clinical Care of Individuals With Mood and Anxiety Disorders: Protocol and Design Considerations for a Pragmatic Randomized Trial JO - JMIR Res Protoc SP - e63279 VL - 14 KW - digital mental health KW - mental health KW - dashboards KW - psychiatry KW - measurement-based care KW - electronic communication KW - social media KW - depression KW - anxiety KW - personal health information N2 - Background: Mood and anxiety disorders are prevalent mental health diagnoses. Numerous studies have shown that measurement-based care, which is used to monitor patient symptoms, functioning, and treatment progress and help guide clinical decisions and collaboration on treatment goals, can improve outcomes in patients with these disorders. Including digital information regarding patients? electronic communications and social media activity is an innovative approach to augmenting measurement-based care. Recent data indicate interest and willingness from both mental health clinicians and patients to share this type of digital information in treatment sessions. However, the clinical benefit of systematically doing this has been minimally evaluated. Objective: This study aims to develop an electronic dashboard for tracking patients? digital social activity and a protocol for a pragmatic randomized trial to test the feasibility and efficacy of using the dashboard in real-world clinical care of patients with depression or anxiety disorders. Methods: We developed a personalized electronic dashboard that tracks patients? electronic communications and social media activity, visualizes data on these interactions through key graphics and figures, and provides a tool that can be readily integrated into routine clinical care for use by clinicians and patients during treatment sessions. We then designed a randomized trial to evaluate the feasibility and effectiveness of using the electronic dashboard in real-world care compared to treatment as usual. The trial included patients aged ?12 years with a mood or anxiety disorder who were receiving treatment in outpatient psychiatry clinics in the Johns Hopkins Health System and the Kennedy Krieger Institute. The primary outcome includes changes in patient-rated depression symptoms. Secondary outcomes include changes in patient-rated anxiety symptoms and overall functioning. Exploratory analyses examine the impact of the intervention on measures of therapeutic alliance and the detection of clinically actionable targets. Results: We successfully developed an electronic dashboard for tracking patients? electronic communications and social media activity, and we implemented a protocol for evaluating the feasibility and efficacy of using the dashboard in routine care for mood or anxiety disorders. The protocol was approved by the Johns Hopkins University School of Medicine Institutional Review Board. In this study, we report the technological, ethical, and pragmatic considerations in developing the dashboard and testing it in a real-world setting. Conclusions: The integration of an electronic dashboard to monitor digital social activity in mental health care treatment is novel. This study examines the feasibility and effectiveness of the dashboard and the challenges in implementing this protocol. The lessons learned from developing and implementing the study will inform ongoing discussions about the value of gathering collateral information on patients? digital social activity and how to do so in a way that is acceptable and clinically effective. Trial Registration: ClinicalTrials.gov NCT03925038; https://clinicaltrials.gov/study/NCT03925038 International Registered Report Identifier (IRRID): DERR1-10.2196/63279 UR - https://www.researchprotocols.org/2025/1/e63279 UR - http://dx.doi.org/10.2196/63279 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053788 ID - info:doi/10.2196/63279 ER - TY - JOUR AU - Benjet, Corina AU - Zainal, Hani Nur AU - Albor, Yesica AU - Alvis-Barranco, Libia AU - Carrasco Tapia, Nayib AU - Contreras-Ibáñez, C. Carlos AU - Cortés-Morelos, Jacqueline AU - Cudris-Torres, Lorena AU - de la Peña, R. Francisco AU - González, Noé AU - Gutierrez-Garcia, A. Raúl AU - Vargas-Contreras, Eunice AU - Medina-Mora, Elena Maria AU - Patiño, Pamela AU - Gildea, M. Sarah AU - Kennedy, J. Chris AU - Luedtke, Alex AU - Sampson, A. Nancy AU - Petukhova, V. Maria AU - Zubizarreta, R. Jose AU - Cuijpers, Pim AU - Kazdin, E. Alan AU - Kessler, C. Ronald PY - 2025/2/28 TI - The Effect of Predicted Compliance With a Web-Based Intervention for Anxiety and Depression Among Latin American University Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e64251 VL - 12 KW - anxiety KW - depression KW - web-based cognitive behavioral therapy KW - compliance KW - randomized controlled trial N2 - Background: Web-based cognitive behavioral therapy (wb-CBT) is a scalable way to reach distressed university students. Guided wb-CBT is typically superior to self-guided wb-CBT over short follow-up periods, but evidence is less clear over longer periods. Objective: This study aimed to compare short-term (3 months) and longer-term (12 months) aggregate effects of guided and self-guided wb-CBT versus treatment as usual (TAU) in a randomized controlled trial of Colombian and Mexican university students and carry out an initially unplanned secondary analysis of the role of differential predicted compliance in explaining these differences. Methods: The 1319 participants, recruited either through email and social media outreach invitations or from waiting lists of campus mental health clinics, were undergraduates (1038/1319, 78.7% female) with clinically significant baseline anxiety (Generalized Anxiety Disorder?7 score?10) or depression (Patient Health Questionnaire?9 score?10). The intervention arms comprised guided wb-CBT with weekly asynchronous written human feedback, self-guided wb-CBT with the same content as the guided modality, and TAU as provided at each university. The prespecified primary outcome was joint remission (Generalized Anxiety Disorder?7 score=0-4 and Patient Health Questionnaire?9 score=0-4). The secondary outcome was joint symptom reduction (mean scores on the Patient Health Questionnaire Anxiety and Depression Scale) at 3 and 12 months after randomization. Results: As reported previously, 3-month outcomes were significantly better with guided wb-CBT than self-guided wb-CBT (P=.02) or TAU (P=.02). However, subsequent follow-up showed that 12-month joint remission (adjusted risk differences=6.0-6.5, SE 0.4-0.5, and P<.001 to P=.007; adjusted mean differences=2.70-2.69, SE 0.7-0.8, and P<.001 to P=.001) was significantly better with self-guided wb-CBT than with the other interventions. Participants randomly assigned to the guided wb-CBT arm spent twice as many minutes logged on as those in the self-guided wb-CBT arm in the first 12 weeks (mean 12.5, SD 36.9 vs 5.9, SD 27.7; ?21=107.1, P<.001), whereas participants in the self-guided wb-CBT arm spent twice as many minutes logged on as those in the guided wb-CBT arm in weeks 13 to 52 (mean 0.4, SD 7.5 vs 0.2, SD 4.4; ?21=10.5, P=.001). Subgroup analysis showed that this longer-term superiority of self-guided wb-CBT was confined to the 40% (528/1319) of participants with high predicted self-guided wb-CBT compliance beyond 3 months based on a counterfactual nested cross-validated machine learning model. The 12-month outcome differences were nonsignificant across arms among other participants (all P>.05). Conclusions: The results have important practical implications for precision intervention targeting to maximize longer-term wb-CBT benefits. Future research needs to investigate strategies to increase sustained guided wb-CBT use once guidance ends. Trial Registration: ClinicalTrials.gov NCT04780542; https://www.clinicaltrials.gov/study/NCT04780542 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06255-3 UR - https://mental.jmir.org/2025/1/e64251 UR - http://dx.doi.org/10.2196/64251 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053727 ID - info:doi/10.2196/64251 ER - TY - JOUR AU - Hopkin, Gareth AU - Coole, Holly AU - Edelmann, Francesca AU - Ayiku, Lynda AU - Branson, Richard AU - Campbell, Paul AU - Cooper, Sophie AU - Salmon, Mark PY - 2025/2/19 TI - Toward a New Conceptual Framework for Digital Mental Health Technologies: Scoping Review JO - JMIR Ment Health SP - e63484 VL - 12 KW - digital mental health KW - digital health KW - mental health KW - eHealth KW - categorization KW - conceptual KW - framework KW - regulation KW - synthesis KW - review methods KW - review methodology KW - systematic N2 - Background: Digital mental health technologies (DMHTs) are becoming more widely available and are seen as having the potential to improve the quality of mental health care. However, conversations around the potential impact of DMHTs can be impacted by a lack of focus on the types of technologies that are available. Several frameworks that could apply to DMHTs are available, but they have not been developed with comprehensive methods and have limitations. Objective: To address limitations with current frameworks, we aimed to identify existing literature on the categorization of DMHTs, to explore challenges with categorizing DMHTs for specific purposes, and to develop a new conceptual framework. Methods: We used an iterative approach to develop the framework. First, we completed a rapid review of the literature to identify studies that provided domains that could be used to categorize DMHTs. Second, findings from this review and associated issues were discussed by an expert working group, including professionals from a wide range of relevant settings. Third, we synthesized findings to develop a new conceptual framework. Results: The rapid review identified 3603 unique results, and hand searching identified another 3 potentially relevant papers. Of these, 24 papers were eligible for inclusion, which provided 10 domains to categorize DMHTs. The expert working group proposed a broad framework and based on the findings of the review and group discussions, we developed a new conceptual framework with 8 domains that represent important characteristics of DMHTs. These 8 domains are population, setting, platform or system, purpose, type of approach, human interaction, human responsiveness, and functionality. Conclusions: This conceptual framework provides a structure for various stakeholders to define the key characteristics of DMHTs. It has been developed with more comprehensive methods than previous attempts with similar aims. The framework can facilitate communication within the field and could undergo further iteration to ensure it is appropriate for specific purposes. UR - https://mental.jmir.org/2025/1/e63484 UR - http://dx.doi.org/10.2196/63484 ID - info:doi/10.2196/63484 ER - TY - JOUR AU - Loch, Andrade Alexandre AU - Kotov, Roman PY - 2025/2/18 TI - Promises and Pitfalls of Internet Search Data in Mental Health: Critical Review JO - JMIR Ment Health SP - e60754 VL - 12 KW - privacy KW - stigma KW - online KW - prevention KW - internet KW - search data KW - mental health KW - health care KW - clinical information KW - World Health Organization KW - WHO KW - digital health KW - mental illness KW - digital technologies KW - social network KW - mobile health KW - mHealth UR - https://mental.jmir.org/2025/1/e60754 UR - http://dx.doi.org/10.2196/60754 ID - info:doi/10.2196/60754 ER - TY - JOUR AU - Malouin-Lachance, Amylie AU - Capolupo, Julien AU - Laplante, Chloé AU - Hudon, Alexandre PY - 2025/2/7 TI - Does the Digital Therapeutic Alliance Exist? Integrative Review JO - JMIR Ment Health SP - e69294 VL - 12 KW - psychotherapy KW - mental health KW - psychiatry KW - artificial intelligence KW - therapeutic alliance KW - digital interventions KW - chatbot KW - psychology N2 - Background: Mental health disorders significantly impact global populations, prompting the rise of digital mental health interventions, such as artificial intelligence (AI)-powered chatbots, to address gaps in access to care. This review explores the potential for a ?digital therapeutic alliance (DTA),? emphasizing empathy, engagement, and alignment with traditional therapeutic principles to enhance user outcomes. Objective: The primary objective of this review was to identify key concepts underlying the DTA in AI-driven psychotherapeutic interventions for mental health. The secondary objective was to propose an initial definition of the DTA based on these identified concepts. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for scoping reviews and Tavares de Souza?s integrative review methodology were followed, encompassing systematic literature searches in Medline, Web of Science, PsycNet, and Google Scholar. Data from eligible studies were extracted and analyzed using Horvath et al?s conceptual framework on a therapeutic alliance, focusing on goal alignment, task agreement, and the therapeutic bond, with quality assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Results: A total of 28 studies were identified from an initial pool of 1294 articles after excluding duplicates and ineligible studies. These studies informed the development of a conceptual framework for a DTA, encompassing key elements such as goal alignment, task agreement, therapeutic bond, user engagement, and the facilitators and barriers affecting therapeutic outcomes. The interventions primarily focused on AI-powered chatbots, digital psychotherapy, and other digital tools. Conclusions: The findings of this integrative review provide a foundational framework for the concept of a DTA and report its potential to replicate key therapeutic mechanisms such as empathy, trust, and collaboration in AI-driven psychotherapeutic tools. While the DTA shows promise in enhancing accessibility and engagement in mental health care, further research and innovation are needed to address challenges such as personalization, ethical concerns, and long-term impact. UR - https://mental.jmir.org/2025/1/e69294 UR - http://dx.doi.org/10.2196/69294 ID - info:doi/10.2196/69294 ER - TY - JOUR AU - Jang, Byeul AU - Yuh, Chisung AU - Lee, Hyeri AU - Shin, Yu-Bin AU - Lee, Heon-Jeong AU - Kang, Kyoung Eun AU - Heo, Jeongyun AU - Cho, Chul-Hyun PY - 2025/2/5 TI - Exploring User Experience and the Therapeutic Relationship of Short-Term Avatar-Based Psychotherapy: Qualitative Pilot Study JO - JMIR Hum Factors SP - e66158 VL - 12 KW - avatar-based psychotherapy KW - telehealth KW - therapeutic relationship KW - user experience KW - anonymity KW - nonverbal communication KW - mental health KW - mobile phone N2 - Background: The rapid advancement of telehealth has led to the emergence of avatar-based psychotherapy (ABP), which combines the benefits of anonymity with nonverbal communication. With the adoption of remote mental health services, understanding the efficacy and user experience of ABP has become increasingly important. Objective: This study aimed to explore the user experience and therapeutic relationship formation in short-term ABP environments, focusing on psychological effects, user satisfaction, and critical factors for implementation. Methods: This qualitative study involved 18 adult participants (8 women and 10 men). Participants engaged in two short-term ABP sessions (approximately 50 minutes per session) over 2 weeks, using an ABP metaverse system prototype. Semistructured in-depth interviews were conducted with both the participants and therapists before and after the ABP sessions. The interviews were conducted via an online platform, with each interview lasting approximately 30 minutes. The key topics included the sense of intimacy, communication effectiveness of avatar expressions, emotions toward one?s avatar, concentration during sessions, and perceived important aspects of the ABP. Data were analyzed using thematic analysis. Results: The analysis revealed 3 main themes with 8 subthemes: (1) reduction of psychological barriers through avatar use (subthemes: anonymity, ease of access, self-objectification, and potential for self-disclosure); (2) importance of the avatar?self-connection in therapeutic relationship formation (subthemes: avatar self-relevance and avatar?self-connection fostering intimacy and trust); and (3) importance of nonverbal communication (subthemes: significance of nonverbal expressions and formation of empathy and trust through nonverbal expressions). Participants reported enhanced comfort and self-disclosure owing to the anonymity provided by avatars, while emphasizing the importance of avatar customization and the role of nonverbal cues in facilitating communication and building rapport. Conclusions: This pilot study provides valuable insights into the short-term ABP user experience and therapeutic relationship formation. Our findings suggest that ABP has the potential to reduce barriers to therapy through anonymity, ease of access, and potential for self-disclosure, while allowing for meaningful nonverbal communication. The avatar?self-connection emerged as a crucial factor in the effectiveness of ABP, highlighting the importance of avatar customization in enhancing user engagement and therapeutic outcomes. Future research and development in ABP should focus on improving avatar customization options, enhancing the fidelity of nonverbal cues, and investigating the long-term effectiveness of ABP compared with traditional face-to-face therapy. Trial Registration: CRIS KCT0009695; https://tinyurl.com/2a48s7dh UR - https://humanfactors.jmir.org/2025/1/e66158 UR - http://dx.doi.org/10.2196/66158 ID - info:doi/10.2196/66158 ER - TY - JOUR AU - de Graaff, Marijn Anne AU - Habashneh, Rand AU - Fanatseh, Sarah AU - Keyan, Dharani AU - Akhtar, Aemal AU - Abualhaija, Adnan AU - Faroun, Muhannad AU - Aqel, Said Ibrahim AU - Dardas, Latefa AU - Servili, Chiara AU - van Ommeren, Mark AU - Bryant, Richard AU - Carswell, Kenneth PY - 2025/2/5 TI - Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial JO - JMIR Ment Health SP - e63515 VL - 12 KW - chatbot KW - youth KW - depression KW - anxiety KW - feasibility study KW - randomized controlled trial KW - mental health KW - evaluation KW - Jordan KW - CBT KW - psychological treatment KW - digital intervention KW - health intervention KW - mood disorder KW - digital health N2 - Background: Depression and anxiety are a leading cause of disability worldwide and often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organization (WHO) developed a guided, nonartificial intelligence chatbot intervention called Scalable Technology for Adolescents and youth to Reduce Stress (STARS) to reduce symptoms of depression and anxiety among young people affected by adversity. Objective: The objective of this study was to evaluate the feasibility of the STARS intervention and study procedures among young people in Jordan. Methods: A 2-arm, single-blind, feasibility randomized controlled trial was conducted among 60 young people aged 18 years to 21 years living in Jordan with self-reported elevated levels of psychological distress. Immediately after baseline, participants were randomized 1:1 into the STARS intervention or enhanced care as usual (ECAU). STARS consisted of 10 lessons in which participants interacted with a chatbot and learned several cognitive behavioral therapy strategies, with optional guidance by a trained e-helper through 5 weekly phone calls. ECAU consisted of a static web page providing basic psychoeducation. Online questionnaires were administered at baseline (week 0) and postassessment (week 8) to assess depression (Hopkins Symptom Checklist-25 [HSCL-25]), anxiety (HSCL-25), functional impairment (WHO Disability Assessment Schedule [WHODAS] 2.0), psychological well-being (WHO-Five Well-Being Index [WHO-5]), and agency (State Hope Scale). Process evaluation interviews with stakeholders were conducted after the postassessment. Results: Participants were recruited in December 2022 and January 2023. Of 700 screening website visits, 160 participants were eligible, and 60 participants (mean age 19.7, SD 1.16 years; 49/60, 82% female) continued to baseline and were randomized into STARS (n=30) or ECAU (n=30). Of those who received STARS, 37% (11/30) completed at least 8 chatbot lessons, and 13% (4/30) completed all 5 support calls. The research protocol functioned well in terms of balanced randomization, high retention at postassessment (48/60, 80%), and good psychometric properties of the online questionnaires. Process evaluation interviews with STARS participants, ECAU participants, e-helpers, and the clinical supervisor indicated the acceptability of the study procedures and the STARS and ECAU conditions and highlighted several aspects that could be improved, including the e-helper support and features of the STARS chatbot. Conclusions: This study demonstrated the feasibility and acceptability of the STARS intervention and research procedures. A fully powered, definitive randomized controlled trial will be conducted to evaluate the effectiveness of STARS. Trial Registration: ISRCTN ISRCTN19217696; https://doi.org/10.1186/ISRCTN19217696 UR - https://mental.jmir.org/2025/1/e63515 UR - http://dx.doi.org/10.2196/63515 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63515 ER - TY - JOUR AU - Macrynikola, Natalia AU - Chen, Kelly AU - Lane, Erlend AU - Nguyen, Nic AU - Pinto, Jennifer AU - Yen, Shirley AU - Torous, John PY - 2025/1/29 TI - Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic JO - JMIR Ment Health SP - e65222 VL - 12 KW - digital interventions KW - transdiagnostic treatment KW - evidence-based treatment KW - digital navigator KW - access to care KW - mobile phone N2 - Background: Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services. Objective: To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity. Methods: Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants? app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing. Results: Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission. Conclusions: Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care. UR - https://mental.jmir.org/2025/1/e65222 UR - http://dx.doi.org/10.2196/65222 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65222 ER - TY - JOUR AU - Cameron, Gillian AU - Mulvenna, Maurice AU - Ennis, Edel AU - O'Neill, Siobhan AU - Bond, Raymond AU - Cameron, David AU - Bunting, Alex PY - 2025/1/24 TI - Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews JO - JMIR Ment Health SP - e67785 VL - 12 KW - digital interventions for mental health KW - workplace wellbeing KW - stress KW - anxiety KW - depression KW - burnout KW - CBT KW - umbrella review KW - digital mental health KW - evaluation KW - psychological KW - databases KW - Pubmed KW - Web of Science KW - Medline KW - Cochrane Library KW - PRISMA N2 - Background: There is potential for digital mental health interventions to provide affordable, efficient, and scalable support to individuals. Digital interventions, including cognitive behavioral therapy, stress management, and mindfulness programs, have shown promise when applied in workplace settings. Objective: The aim of this study is to conduct an umbrella review of systematic reviews in order to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Methods: A systematic search was conducted to identify systematic reviews relating to digital interventions for the workplace, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The review protocol was registered in the Open Science Framework. The following databases were searched: PubMed, Web of Science, MEDLINE, PsycINFO, and Cochrane Library. Data were extracted using a predefined extraction table. To assess the methodological quality of a study, the AMSTAR-2 tool was used to critically appraise systematic reviews of health care interventions. Results: The literature search resulted in 11,875 records, which was reduced to 14 full-text systematic literature reviews with the use of Covidence to remove duplicates and screen titles and abstracts. The 14 included reviews were published between 2014 and 2023, comprising 9 systematic reviews and 5 systematic reviews and meta-analyses. AMSTAR-2 was used to complete a quality assessment of the reviews, and the results were critically low for 7 literature reviews and low for the other 7 literature reviews. The most common types of digital intervention studied were cognitive behavioral therapy, mindfulness/meditation, and stress management followed by other self-help interventions. Effectiveness of digital interventions was found for many mental health symptoms and conditions in employee populations, such as stress, anxiety, depression, burnout, and psychological well-being. Factors such as type of technology, guidance, recruitment, tailoring, and demographics were found to impact effectiveness. Conclusions: This umbrella review aimed to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Despite the low quality of the reviews, best practice guidelines can be derived from factors that impact the effectiveness of digital interventions in the workplace. Trial Registration: OSF Registries osf.io/rc6ds; https://doi.org/10.17605/OSF.IO/RC6DS UR - https://mental.jmir.org/2025/1/e67785 UR - http://dx.doi.org/10.2196/67785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67785 ER - TY - JOUR AU - Asman, Oren AU - Torous, John AU - Tal, Amir PY - 2025/1/20 TI - Responsible Design, Integration, and Use of Generative AI in Mental Health JO - JMIR Ment Health SP - e70439 VL - 12 KW - responsible AI in medicine KW - AI ethics KW - digital mental health ethics KW - artificial intelligence KW - large language model KW - model alignment UR - https://mental.jmir.org/2025/1/e70439 UR - http://dx.doi.org/10.2196/70439 ID - info:doi/10.2196/70439 ER - TY - JOUR AU - Sanchez Ortuño, Montserrat María AU - Pecune, Florian AU - Coelho, Julien AU - Micoulaud-Franchi, Arthur Jean AU - Salles, Nathalie AU - Auriacombe, Marc AU - Serre, Fuschia AU - Levavasseur, Yannick AU - De Sevin, Etienne AU - Sagaspe, Patricia AU - Philip, Pierre PY - 2025/1/15 TI - Determinants of Dropout From a Virtual Agent?Based App for Insomnia Management in a Self-Selected Sample of Users With Insomnia Symptoms: Longitudinal Study JO - JMIR Ment Health SP - e51022 VL - 12 KW - insomnia KW - digital behavioral therapy KW - mobile health KW - dropout KW - virtual agent?based app KW - virtual agent KW - user KW - digital intervention KW - smartphone KW - mental health KW - implementation KW - cognitive behavioral therapy KW - CBT N2 - Background: Fully automated digital interventions delivered via smartphone apps have proven efficacious for a wide variety of mental health outcomes. An important aspect is that they are accessible at a low cost, thereby increasing their potential public impact and reducing disparities. However, a major challenge to their successful implementation is the phenomenon of users dropping out early. Objective: The purpose of this study was to pinpoint the factors influencing early dropout in a sample of self-selected users of a virtual agent (VA)?based behavioral intervention for managing insomnia, named KANOPEE, which is freely available in France. Methods: From January 2021 to December 2022, of the 9657 individuals, aged 18 years or older, who downloaded and completed the KANOPEE screening interview and had either subclinical or clinical insomnia symptoms, 4295 (44.5%) dropped out (ie, did not return to the app to continue filling in subsequent assessments). The primary outcome was a binary variable: having dropped out after completing the screening assessment (early dropout) or having completed all the treatment phases (n=551). Multivariable logistic regression analysis was used to identify predictors of dropout among a set of sociodemographic, clinical, and sleep diary variables, and users? perceptions of the treatment program, collected during the screening interview. Results: The users? mean age was 47.95 (SD 15.21) years. Of those who dropped out early and those who completed the treatment, 65.1% (3153/4846) were women and 34.9% (1693/4846) were men. Younger age (adjusted odds ratio [AOR] 0.98, 95% CI 0.97?0.99), lower education level (compared to middle school; high school: AOR 0.56, 95% CI 0.35?0.90; bachelor?s degree: AOR 0.35, 95% CI 0.23?0.52; master?s degree or higher: AOR 0.35, 95% CI 0.22?0.55), poorer nocturnal sleep (sleep efficiency: AOR 0.64, 95% CI 0.42?0.96; number of nocturnal awakenings: AOR 1.13, 95% CI 1.04?1.23), and more severe depression symptoms (AOR 1.12, 95% CI 1.04?1.21) were significant predictors of dropping out. When measures of perceptions of the app were included in the model, perceived benevolence and credibility of the VA decreased the odds of dropout (AOR 0.91, 95%?CI 0.85?0.97). Conclusions: As in traditional face-to-face cognitive behavioral therapy for insomnia, the presence of significant depression symptoms plays an important role in treatment dropout. This variable represents an important target to address to increase early engagement with fully automated insomnia management programs. Furthermore, our results support the contention that a VA can provide relevant user stimulation that will eventually pay out in terms of user engagement. Trial Registration: ClinicalTrials.gov NCT05074901; https://clinicaltrials.gov/study/NCT05074901?a=1 UR - https://mental.jmir.org/2025/1/e51022 UR - http://dx.doi.org/10.2196/51022 ID - info:doi/10.2196/51022 ER - TY - JOUR AU - Namatovu, Kasujja Hasifah AU - Magumba, Abraham Mark AU - Akena, Dickens PY - 2025/1/14 TI - E-Screening for Prenatal Depression in Kampala, Uganda Using the Edinburgh Postnatal Depression Scale: Survey Results JO - Online J Public Health Inform SP - e51602 VL - 17 KW - perinatal KW - prenatal KW - antenatal KW - antepartum KW - depression KW - Edinburgh Postnatal Depression Scale N2 - Background: Perinatal depression remains a substantial public health challenge, often overlooked or incorrectly diagnosed in numerous low-income nations. Objective: The goal of this study was to establish statistical baselines for the prevalence of perinatal depression in Kampala and understand its relationship with key demographic variables. Methods: We employed an Android-based implementation of the Edinburgh Postnatal Depression Scale (EPDS) to survey 12,913 women recruited from 7 government health facilities located in Kampala, Uganda. We used the standard EPDS cutoff, which classifies women with total scores above 13 as possibly depressed and those below 13 as not depressed. The ?2 test of independence was used to determine the most influential categorical variables. We further analyzed the most influential categorical variable using odds ratios. For continuous variables such as age and the weeks of gestation, we performed a simple correlation analysis. Results: We found that 21.5% (2783/12,913, 95% CI 20.8%?22.3%) were possibly depressed. Respondents? relationship category was found to be the most influential variable (?21=806.9, P<.001; Cramer?s V=0.25), indicating a small effect size. Among quantitative variables, we found a weak negative correlation between respondents? age and the total EPDS score (r=?0.11, P<.001). Similarly, a weak negative correlation was also observed between the total EPDS score and the number of previous children of the respondent (r=?0.07, P<.001). Moreover, a weak positive correlation was noted between weeks of gestation and the total EPDS score (r=0.02, P=.05) Conclusions: This study shows that demographic factors such as spousal employment category, age, and relationship status have an influence on the respondents? EPDS scores. These variables may serve as proxies for latent factors such as financial stability and emotional support. UR - https://ojphi.jmir.org/2025/1/e51602 UR - http://dx.doi.org/10.2196/51602 ID - info:doi/10.2196/51602 ER - TY - JOUR AU - Hossain, Tasnim Aniqa AU - Rahman, Hafizur Md AU - Manna, Maher Ridwana AU - Akter, Ema AU - Islam, Hasibul S. M. AU - Hossain, Alamgir Md AU - Ara, Tasnu AU - Usmani, Ghani Nasimul AU - Chandra, Pradip AU - Khan, Ahmed Maruf AU - Rahman, Mustafizur S. M. AU - Ahmed, Uddin Helal AU - Mozumder, Kamruzzaman Muhammad AU - Juthi, Mahmuda Jesmin AU - Shahrin, Fatema AU - Shams, Afrose Sadia AU - Afroze, Fahmida AU - Banu, Jahan Mukta AU - Ameen, Shafiqul AU - Jabeen, Sabrina AU - Ahmed, Anisuddin AU - Amin, Robed Mohammad AU - Arifeen, El Shams AU - Shomik, Sohel Mohammad AU - Rahman, Ehsanur Ahmed PY - 2025/1/3 TI - Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research JO - JMIR Pediatr Parent SP - e65912 VL - 8 KW - Wellbeing Centers KW - antepartum KW - postpartum KW - depression KW - anxiety KW - implementation N2 - Background: Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh?s Non-Communicable Disease Control program initiated ?Wellbeing Centers,? telemental health services in selected public hospitals. Objective: This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods: Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization?s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results: Almost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers? services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions: To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. UR - https://pediatrics.jmir.org/2025/1/e65912 UR - http://dx.doi.org/10.2196/65912 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65912 ER - TY - JOUR AU - Kang, Boyoung AU - Hong, Munpyo PY - 2025/1/3 TI - Development and Evaluation of a Mental Health Chatbot Using ChatGPT 4.0: Mixed Methods User Experience Study With Korean Users JO - JMIR Med Inform SP - e63538 VL - 13 KW - mental health chatbot KW - Dr. CareSam KW - HoMemeTown KW - ChatGPT 4.0 KW - large language model KW - LLM KW - cross-lingual KW - pilot testing KW - cultural sensitivity KW - localization KW - Korean students N2 - Background: Mental health chatbots have emerged as a promising tool for providing accessible and convenient support to individuals in need. Building on our previous research on digital interventions for loneliness and depression among Korean college students, this study addresses the limitations identified and explores more advanced artificial intelligence?driven solutions. Objective: This study aimed to develop and evaluate the performance of HoMemeTown Dr. CareSam, an advanced cross-lingual chatbot using ChatGPT 4.0 (OpenAI) to provide seamless support in both English and Korean contexts. The chatbot was designed to address the need for more personalized and culturally sensitive mental health support identified in our previous work while providing an accessible and user-friendly interface for Korean young adults. Methods: We conducted a mixed methods pilot study with 20 Korean young adults aged 18 to 27 (mean 23.3, SD 1.96) years. The HoMemeTown Dr CareSam chatbot was developed using the GPT application programming interface, incorporating features such as a gratitude journal and risk detection. User satisfaction and chatbot performance were evaluated using quantitative surveys and qualitative feedback, with triangulation used to ensure the validity and robustness of findings through cross-verification of data sources. Comparative analyses were conducted with other large language models chatbots and existing digital therapy tools (Woebot [Woebot Health Inc] and Happify [Twill Inc]). Results: Users generally expressed positive views towards the chatbot, with positivity and support receiving the highest score on a 10-point scale (mean 9.0, SD 1.2), followed by empathy (mean 8.7, SD 1.6) and active listening (mean 8.0, SD 1.8). However, areas for improvement were noted in professionalism (mean 7.0, SD 2.0), complexity of content (mean 7.4, SD 2.0), and personalization (mean 7.4, SD 2.4). The chatbot demonstrated statistically significant performance differences compared with other large language models chatbots (F=3.27; P=.047), with more pronounced differences compared with Woebot and Happify (F=12.94; P<.001). Qualitative feedback highlighted the chatbot?s strengths in providing empathetic responses and a user-friendly interface, while areas for improvement included response speed and the naturalness of Korean language responses. Conclusions: The HoMemeTown Dr CareSam chatbot shows potential as a cross-lingual mental health support tool, achieving high user satisfaction and demonstrating comparative advantages over existing digital interventions. However, the study?s limited sample size and short-term nature necessitate further research. Future studies should include larger-scale clinical trials, enhanced risk detection features, and integration with existing health care systems to fully realize its potential in supporting mental well-being across different linguistic and cultural contexts. UR - https://medinform.jmir.org/2025/1/e63538 UR - http://dx.doi.org/10.2196/63538 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63538 ER - TY - JOUR AU - Crawford, Allison AU - Kirvan, Anne AU - Sanches, Marcos AU - Gambin, Amanda AU - Canso, Denise AU - Serhal, Eva PY - 2025/1/3 TI - The Virtual Client Experience Survey for Mental Health and Addictions: Revalidation of a Survey to Measure Client and Family Experiences of Virtual Care JO - J Med Internet Res SP - e49844 VL - 27 KW - virtual care KW - digital health KW - mental health KW - client satisfaction KW - health care quality KW - Virtual Client Experience Survey KW - telehealth KW - telemedicine KW - eHealth N2 - Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients? perspectives on virtual mental health care quality will be critical to informing future policies and practices. Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care. Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach ? coefficient. Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an ? lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001). Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances. UR - https://www.jmir.org/2025/1/e49844 UR - http://dx.doi.org/10.2196/49844 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752192 ID - info:doi/10.2196/49844 ER - TY - JOUR AU - Cheung, Gar-Mun Lauryn AU - Thomas, Carien Pamela AU - Brvar, Eva AU - Rowe, Sarah PY - 2025/1/3 TI - User Experiences of and Preferences for Self-Guided Digital Interventions for the Treatment of Mild to Moderate Eating Disorders: Systematic Review and Metasynthesis JO - JMIR Ment Health SP - e57795 VL - 12 KW - eating disorders KW - anorexia KW - bulimia KW - binge eating KW - other specified feeding or eating disorder KW - OSFED KW - intervention KW - digital intervention KW - self-help KW - systematic review N2 - Background: Digital interventions typically involve using smartphones or PCs to access online or downloadable self-help and may offer a more accessible and convenient option than face-to-face interventions for some people with mild to moderate eating disorders. They have been shown to substantially reduce eating disorder symptoms, but treatment dropout rates are higher than for face-to-face interventions. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centered digital interventions that are engaging and meet users? needs. Objective: This study aims to understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a metasynthesis of qualitative studies. We searched 6 databases for published and unpublished literature from 2013 to 2024. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: A total of 8 studies were included after screening 3695 search results. Overall, 7 metathemes were identified. The identified metathemes included the appeal of digital interventions, role of digital interventions in treatment, value of support in treatment, communication at the right level, importance of engagement, shaping knowledge to improve eating disorder behaviors, and design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible and that they fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviors. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalized content and functions. Conclusions: Users found digital interventions for eating disorders practical and effective but stressed the need for interventions to address the full range of symptoms, severity, and individual needs. Future digital interventions should be cocreated with users and offer more personalization. Further research is needed to determine the appropriate balance of professional and peer support and whether these interventions should serve as the first step in the stepped care model. Trial Registration: PROSPERO CRD42023426932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426932 UR - https://mental.jmir.org/2025/1/e57795 UR - http://dx.doi.org/10.2196/57795 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752210 ID - info:doi/10.2196/57795 ER - TY - JOUR AU - Larsson, Anna AU - Weineland, Sandra AU - Nissling, Linnea AU - Lilja, L. Josefine PY - 2025/1/3 TI - The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study JO - JMIR Pediatr Parent SP - e59489 VL - 8 KW - adolescents KW - parental support KW - anxiety KW - depression KW - primary care KW - mental health KW - ACT KW - acceptance and commitment therapy KW - iACT KW - internet-delivered acceptance and commitment therapy N2 - Background: Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support. Objective: This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning. Methods: Adolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children?s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children?s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution. Results: The iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children?s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: ?2.94; P=.003; r=?0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: ?2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children?s Global Assessment Scale were found. Conclusions: The results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study. UR - https://pediatrics.jmir.org/2025/1/e59489 UR - http://dx.doi.org/10.2196/59489 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752209 ID - info:doi/10.2196/59489 ER - TY - JOUR AU - Benouis, Mohamed AU - Andre, Elisabeth AU - Can, Said Yekta PY - 2024/12/23 TI - Balancing Between Privacy and Utility for Affect Recognition Using Multitask Learning in Differential Privacy?Added Federated Learning Settings: Quantitative Study JO - JMIR Ment Health SP - e60003 VL - 11 KW - privacy preservation KW - multitask learning KW - federated learning KW - privacy KW - physiological signals KW - affective computing KW - wearable sensors KW - sensitive data KW - empathetic sensors KW - data privacy KW - digital mental health KW - wearables KW - ethics KW - emotional well-being N2 - Background: The rise of wearable sensors marks a significant development in the era of affective computing. Their popularity is continuously increasing, and they have the potential to improve our understanding of human stress. A fundamental aspect within this domain is the ability to recognize perceived stress through these unobtrusive devices. Objective: This study aims to enhance the performance of emotion recognition using multitask learning (MTL), a technique extensively explored across various machine learning tasks, including affective computing. By leveraging the shared information among related tasks, we seek to augment the accuracy of emotion recognition while confronting the privacy threats inherent in the physiological data captured by these sensors. Methods: To address the privacy concerns associated with the sensitive data collected by wearable sensors, we proposed a novel framework that integrates differential privacy and federated learning approaches with MTL. This framework was designed to efficiently identify mental stress while preserving private identity information. Through this approach, we aimed to enhance the performance of emotion recognition tasks while preserving user privacy. Results: Comprehensive evaluations of our framework were conducted using 2 prominent public datasets. The results demonstrate a significant improvement in emotion recognition accuracy, achieving a rate of 90%. Furthermore, our approach effectively mitigates privacy risks, as evidenced by limiting reidentification accuracies to 47%. Conclusions: This study presents a promising approach to advancing emotion recognition capabilities while addressing privacy concerns in the context of empathetic sensors. By integrating MTL with differential privacy and federated learning, we have demonstrated the potential to achieve high levels of accuracy in emotion recognition while ensuring the protection of user privacy. This research contributes to the ongoing efforts to use affective computing in a privacy-aware and ethical manner. UR - https://mental.jmir.org/2024/1/e60003 UR - http://dx.doi.org/10.2196/60003 ID - info:doi/10.2196/60003 ER - TY - JOUR AU - Bur, Thomas Oliver AU - Berger, Thomas PY - 2024/12/16 TI - Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study JO - JMIR Form Res SP - e46860 VL - 8 KW - internet intervention KW - depression KW - guidance KW - contact behavior KW - messages KW - adherence KW - online KW - intervention KW - digital health KW - therapy KW - participant N2 - Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes. Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome. Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively. Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants? messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=?2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=?2.62, P=.004) and group 2 (Z=?2.47, P=.007). All other group comparisons did not yield significant differences. Conclusion: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies. Trial Registration: ClinicalTrials.gov NCT04318236; https://www.clinicaltrials.gov/study/NCT04318236 UR - https://formative.jmir.org/2024/1/e46860 UR - http://dx.doi.org/10.2196/46860 ID - info:doi/10.2196/46860 ER - TY - JOUR AU - Southwick, Lauren AU - Sharma, Meghana AU - Rai, Sunny AU - Beidas, S. Rinad AU - Mandell, S. David AU - Asch, A. David AU - Curtis, Brenda AU - Guntuku, Chandra Sharath AU - Merchant, M. Raina PY - 2024/12/16 TI - Integrating Patient-Generated Digital Data Into Mental Health Therapy: Mixed Methods Analysis of User Experience JO - JMIR Ment Health SP - e59785 VL - 11 KW - digital data KW - social media KW - psychotherapy KW - latent Dirichlet allocation KW - LDA KW - mobile phone N2 - Background: Therapists and their patients increasingly discuss digital data from social media, smartphone sensors, and other online engagements within the context of psychotherapy. Objective: We examined patients? and mental health therapists? experiences and perceptions following a randomized controlled trial in which they both received regular summaries of patients? digital data (eg, dashboard) to review and discuss in session. The dashboard included data that patients consented to share from their social media posts, phone usage, and online searches. Methods: Following the randomized controlled trial, patient (n=56) and therapist (n=44) participants completed a debriefing survey after their study completion (from December 2021 to January 2022). Participants were asked about their experience receiving a digital data dashboard in psychotherapy via closed- and open-ended questions. We calculated descriptive statistics for closed-ended questions and conducted qualitative coding via NVivo (version 10; Lumivero) and natural language processing using the machine learning tool latent Dirichlet allocation to analyze open-ended questions. Results: Of 100 participants, nearly half (n=48, 49%) described their experience with the dashboard as ?positive,? while the other half noted a ?neutral? experience. Responses to the open-ended questions resulted in three thematic areas (nine subcategories): (1) dashboard experience (positive, neutral or negative, and comfortable); (2) perception of the dashboard?s impact on enhancing therapy (accountability, increased awareness over time, and objectivity); and (3) dashboard refinements (additional sources, tailored content, and privacy). Conclusions: Patients reported that receiving their digital data helped them stay ?accountable,? while therapists indicated that the dashboard helped ?tailor treatment plans.? Patient and therapist surveys provided important feedback on their experience regularly discussing dashboards in psychotherapy. Trial Registration: ClinicalTrials.gov NCT04011540; https://clinicaltrials.gov/study/NCT04011540 UR - https://mental.jmir.org/2024/1/e59785 UR - http://dx.doi.org/10.2196/59785 ID - info:doi/10.2196/59785 ER - TY - JOUR AU - Giguere, Sabrina AU - Beaudoin, Mélissa AU - Dellazizzo, Laura AU - Phraxayavong, Kingsada AU - Potvin, Stéphane AU - Dumais, Alexandre PY - 2024/11/27 TI - Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial JO - JMIR Ment Health SP - e58499 VL - 11 KW - cannabis use disorder KW - cannabis use KW - virtual reality therapy KW - virtual reality KW - addiction intervention KW - relational therapy KW - avatar KW - digital mental health N2 - Background: The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. Objective: This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD. Methods: Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model. Results: Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. Conclusions: Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention. Trial Registration: ClinicalTrials.gov NCT05726617; https://clinicaltrials.gov/study/NCT05726617 UR - https://mental.jmir.org/2024/1/e58499 UR - http://dx.doi.org/10.2196/58499 ID - info:doi/10.2196/58499 ER - TY - JOUR AU - Malandrone, Francesca AU - Urru, Sara AU - Berchialla, Paola AU - Rossini, Gilbert Pierre AU - Oliva, Francesco AU - Bianchi, Silvia AU - Ottaviano, Manuel AU - Gonzalez-Martinez, Sergio AU - Carli, Vladimir AU - Valenza, Gaetano AU - Scilingo, Pasquale Enzo AU - Carletto, Sara AU - Ostacoli, Luca PY - 2024/11/21 TI - Exploring the Effects of Variety and Amount of Mindfulness Practices on Depression, Anxiety, and Stress Symptoms: Longitudinal Study on a Mental Health?Focused eHealth System for Patients With Breast or Prostate Cancer JO - JMIR Ment Health SP - e57415 VL - 11 KW - depression KW - anxiety KW - stress KW - internet-based KW - mental health KW - mindfulness KW - breast cancer KW - prostate cancer KW - cancer-related mental distress KW - emotional distress KW - psychological distress KW - mindfulness-based interventions KW - MBI KW - e-MBI KW - dispositional mindfulness KW - self-compassion KW - mental wellbeing KW - mobile phone N2 - Background: Patients with cancer often face depression and anxiety, and mindfulness-based interventions, including internet-based versions, can effectively reduce these symptoms and improve their quality of life. This study aims to investigate the impact of internet-based mindfulness-based interventions (e-MBIs) on anxiety, depression, and stress symptoms in patients with prostate or breast cancer. Objective: The primary aims are to assess the association between the amount and variety of e-MBI practices and symptom reduction. Second, this study aims to examine how baseline information such as sociodemographic characteristics, dispositional mindfulness (DM), and dispositional self-compassion (DSC) correlate with both app usage and symptom reduction. Methods: Participants included 107 patients with cancer (68 women with breast cancer and 38 men with prostate cancer) enrolled in a hospital setting. They were assigned to the intervention group of the NEVERMIND project, using the e-BMI module via the NEVERMIND app. A longitudinal design involved Pearson correlation analysis to determine the relationship between the amount and duration of e-MBI practices. Linear regression analysis was conducted to gauge the dose-response effect, evaluating the impact of DM and DSC on depression, anxiety, and stress. Negative binomial regression was conudcted to study sociodemographic factors? influence on the amount of practice in e-MBIs. Results: The participants with more diverse and sustained mindfulness practices experienced significant reductions in depression, anxiety, and stress. A high correlation (0.94) between e-MBI practices and symptom reduction was also highlighted. Male, married, and highly educated patients were more likely to engage in mindfulness. Even if DM and DSC did not impact the amount or variety of practices correlated, they were correlated with symptom reduction, showing that higher levels were associated with significant reductions in depression, anxiety, and stress. Conclusions: While more e-MBI practice is linked to reduced anxiety, depression, and stress, this study emphasizes the crucial role of variety of practice over amount. DM and DSC are key in shaping intervention effectiveness and may act as protectors against psychological distress. Using app log data, our research provides a unique perspective on e-MBI impact, contributing to cancer care understanding and guiding future studies. UR - https://mental.jmir.org/2024/1/e57415 UR - http://dx.doi.org/10.2196/57415 ID - info:doi/10.2196/57415 ER - TY - JOUR AU - Gorban, Carla AU - McKenna, Sarah AU - Chong, K. Min AU - Capon, William AU - Battisti, Robert AU - Crowley, Alison AU - Whitwell, Bradley AU - Ottavio, Antonia AU - Scott, M. Elizabeth AU - Hickie, B. Ian AU - Iorfino, Frank PY - 2024/11/6 TI - Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study JO - JMIR Ment Health SP - e58068 VL - 11 KW - digital navigator KW - digital coach KW - clinical technology specialist KW - mental health services KW - shared decision-making KW - lived experience KW - implementation KW - poor engagement KW - decision-making KW - mental health KW - digital mental health KW - digital mental health technology UR - https://mental.jmir.org/2024/1/e58068 UR - http://dx.doi.org/10.2196/58068 ID - info:doi/10.2196/58068 ER - TY - JOUR AU - Beele, Gesa AU - Liesong, Paula AU - Bojanowski, Sabine AU - Hildebrand, Kristian AU - Weingart, Malte AU - Asbrand, Julia AU - Correll, U. Christoph AU - Morina, Nexhmedin AU - Uhlhaas, J. Peter PY - 2024/11/5 TI - Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study JO - JMIR Ment Health SP - e56235 VL - 11 KW - virtual reality exposure therapy KW - VRET KW - school anxiety KW - social anxiety KW - adolescents KW - virtual reality KW - VR KW - autonomic arousal KW - exposure therapy KW - posttreatment KW - digital health KW - simulation N2 - Background: Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking. Objective: A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of ?being there,? during VR exposure with anxiety measures and treatment response was examined. Methods: In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured. Results: The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (?2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response. Conclusions: Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents. UR - https://mental.jmir.org/2024/1/e56235 UR - http://dx.doi.org/10.2196/56235 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56235 ER - TY - JOUR AU - Bouguettaya, Ayoub AU - Aboujaoude, Elias PY - 2024/11/4 TI - Using Extended Reality to Enhance Effectiveness and Group Identification in Remote Group Therapy for Anxiety Disorders: A Critical Analysis JO - JMIR Form Res SP - e64494 VL - 8 KW - group therapy KW - psychotherapy KW - telepsychiatry KW - mental health KW - extended reality KW - augmented reality KW - virtual reality therapy KW - anxiety KW - cognitive behavioral therapy UR - https://formative.jmir.org/2024/1/e64494 UR - http://dx.doi.org/10.2196/64494 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64494 ER - TY - JOUR AU - Bennett, E. Sarah AU - Johnston, H. Milly AU - Treneman-Evans, Georgia AU - Denison-Day, James AU - Duffy, Anthony AU - Brigden, Amberly AU - Kuberka, Paula AU - Christoforou, Nicholas AU - Ritterband, Lee AU - Koh, Jewel AU - Meadows, Robert AU - Alamoudi, Doaa AU - Nabney, Ian AU - Yardley, Lucy PY - 2024/10/31 TI - Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study JO - JMIR Hum Factors SP - e63341 VL - 11 KW - behavior change KW - digital intervention KW - insomnia KW - depression KW - anxiety KW - sleep KW - qualitative research KW - mobile phone N2 - Background: Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Methods: Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. Results: A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported ?prefer not to say.? Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Conclusions: Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout. UR - https://humanfactors.jmir.org/2024/1/e63341 UR - http://dx.doi.org/10.2196/63341 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63341 ER - TY - JOUR AU - Ramirez, Ana AU - Kramer, Justin AU - Hazim, Katrina AU - Roberge, Jason PY - 2024/10/31 TI - Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation JO - JMIR Form Res SP - e60317 VL - 8 KW - telemedicine KW - telepsychiatry KW - adolescents KW - mental health KW - psychiatry KW - coaching KW - qualitative assessment KW - patient satisfaction KW - family engagement KW - depression KW - anxiety KW - suicidal ideation N2 - Background: Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management (?Youth and Family Engagement? [YFE] program). Objective: This study aims to explore patients? and parents? perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Methods: Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants? preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. Results: The YFE program?s structure was often mentioned as promoting engagement, with telephone appointments and health coaches? ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents? nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches? ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Conclusions: Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach?participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement. UR - https://formative.jmir.org/2024/1/e60317 UR - http://dx.doi.org/10.2196/60317 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60317 ER - TY - JOUR AU - Coppersmith, DL Daniel AU - Bentley, H. Kate AU - Kleiman, M. Evan AU - Jaroszewski, C. Adam AU - Daniel, Merryn AU - Nock, K. Matthew PY - 2024/10/31 TI - Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study JO - JMIR Ment Health SP - e58409 VL - 11 KW - suicidal thoughts KW - suicidal behaviors KW - ecological momentary assessment KW - crisis resources KW - real-time tool KW - self-report KW - psychoeducation KW - app N2 - Background: Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. Objective: The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. Methods: ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. Results: ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one?s own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). Conclusions: This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work. UR - https://mental.jmir.org/2024/1/e58409 UR - http://dx.doi.org/10.2196/58409 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58409 ER - TY - JOUR AU - Nordberg, S. Samuel AU - Jaso-Yim, A. Brittany AU - Sah, Pratha AU - Schuler, Keke AU - Eyllon, Mara AU - Pennine, Mariesa AU - Hoyler, H. Georgia AU - Barnes, Ben J. AU - Murillo, Hong Lily AU - O'Dea, Heather AU - Orth, Laura AU - Rogers, Elizabeth AU - Welch, George AU - Peloquin, Gabrielle AU - Youn, Jeong Soo PY - 2024/10/30 TI - Evaluating the Implementation and Clinical Effectiveness of an Innovative Digital First Care Model for Behavioral Health Using the RE-AIM Framework: Quantitative Evaluation JO - J Med Internet Res SP - e54528 VL - 26 KW - digital mental health interventions KW - implementation KW - clinical effectiveness KW - practice-oriented research KW - access to care N2 - Background: In the United States, innovation is needed to address the increasing need for mental health care services and widen the patient-to-provider ratio. Despite the benefits of digital mental health interventions (DMHIs), they have not been effective in addressing patients? behavioral health challenges as stand-alone treatments. Objective: This study evaluates the implementation and effectiveness of precision behavioral health (PBH), a digital-first behavioral health care model embedded within routine primary care that refers patients to an ecosystem of evidence-based DMHIs with strategically placed human support. Methods: Patient demographic information, triage visit outcomes, multidimensional patient-reported outcome measure, enrollment, and engagement with the DMHIs were analyzed using data from the electronic health record and vendor-reported data files. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate the implementation and clinical effectiveness outcomes of PBH. Results: PBH had a 47.58% reach rate, defined as patients accepting the PBH referral from their behavioral health integrated clinician. PBH patients had high DMHI registration rates (79.62%), high activation rates (76.54%), and high retention rates at 15 days (57.69%) and 30 days (44.58%) compared to literature benchmarks. In total, 74.01% (n=168) of patients showed clinical improvement, 22.47% (n=51) showed no clinical change, and 3.52% (n=8) showed clinical deterioration in symptoms. PBH had high adoption rates, with behavioral health integrated clinicians referring on average 4.35 (SD 0.46) patients to PBH per month and 90%-100% of clinicians (n=12) consistently referring at least 1 patient to PBH each month. A third (32%, n=1114) of patients were offered PBH as a treatment option during their triage visit. Conclusions: PBH as a care model with evidence-based DMHIs, human support for patients, and integration within routine settings offers a credible service to support patients with mild to moderate mental health challenges. This type of model has the potential to address real-life access to care problems faced by health care settings. UR - https://www.jmir.org/2024/1/e54528 UR - http://dx.doi.org/10.2196/54528 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54528 ER - TY - JOUR AU - Hernandez, Belinda AU - Shegog, Ross AU - Markham, Christine AU - Emery, Susan AU - Baumler, Elizabeth AU - Thormaehlen, Laura AU - Andina Teixeira, Rejane AU - Rivera, Yanneth AU - Pertuit, Olive AU - Kanipe, Chelsey AU - Witherspoon, Iraina AU - Doss, Janis AU - Jones, Victor AU - Peskin, Melissa PY - 2024/10/29 TI - Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study JO - JMIR Form Res SP - e64412 VL - 8 KW - sexual assault prevention KW - sexual harassment prevention KW - healthy relationships KW - military KW - technology-based interventions KW - intervention mapping N2 - Background: Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program?s goal is to increase Airmen?s knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen?s overall well-being and mission readiness. Objective: This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Methods: Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. Results: After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. Conclusions: The findings from this study demonstrate X-CoRe?s effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe?s impact on SH and SA victimization and the long-term impact on associated psychosocial determinants. UR - https://formative.jmir.org/2024/1/e64412 UR - http://dx.doi.org/10.2196/64412 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64412 ER - TY - JOUR AU - Wani, Carolina AU - McCann, Lisa AU - Lennon, Marilyn AU - Radu, Caterina PY - 2024/10/29 TI - Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review JO - J Med Internet Res SP - e51376 VL - 26 KW - adolescents KW - mental health KW - low- and middle-income countries KW - LMICs KW - digital mental health interventions KW - DMHIs KW - cultural appropriateness KW - implementation KW - design KW - evaluation KW - mobile phone N2 - Background: Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations? Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. Objective: This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. Methods: The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population "adolescents," concept "digital mental health interventions," and context "LMICs." We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. Results: We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. Conclusions: While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this. UR - https://www.jmir.org/2024/1/e51376 UR - http://dx.doi.org/10.2196/51376 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51376 ER - TY - JOUR AU - Liu, Qimin AU - Ning, Emma AU - Ross, K. Mindy AU - Cladek, Andrea AU - Kabir, Sarah AU - Barve, Amruta AU - Kennelly, Ellyn AU - Hussain, Faraz AU - Duffecy, Jennifer AU - Langenecker, A. Scott AU - Nguyen, M. Theresa AU - Tulabandhula, Theja AU - Zulueta, John AU - Demos, P. Alexander AU - Leow, Alex AU - Ajilore, Olusola PY - 2024/10/29 TI - Digital Phenotypes of Mobile Keyboard Backspace Rates and Their Associations With Symptoms of Mood Disorder: Algorithm Development and Validation JO - J Med Internet Res SP - e51269 VL - 26 KW - keyboard typing KW - passive sensing KW - digital phenotyping KW - mood disorder KW - mixture model KW - phenotypes KW - mobile keyboard KW - smartphone KW - keyboard data KW - monitoring KW - clinical decision-making KW - depression KW - mania, mobile phone N2 - Background: Passive sensing through smartphone keyboard data can be used to identify and monitor symptoms of mood disorders with low participant burden. Behavioral phenotyping based on mobile keystroke data can aid in clinical decision-making and provide insights into the individual symptoms of mood disorders. Objective: This study aims to derive digital phenotypes based on smartphone keyboard backspace use among 128 community adults across 2948 observations using a Bayesian mixture model. Methods: Eligible study participants completed a virtual screening visit where all eligible participants were instructed to download the custom-built BiAffect smartphone keyboard (University of Illinois). The BiAffect keyboard unobtrusively captures keystroke dynamics. All eligible and consenting participants were instructed to use this keyboard exclusively for up to 4 weeks of the study in real life, and participants? compliance was checked at the 2 follow-up visits at week 2 and week 4. As part of the research protocol, every study participant underwent evaluations by a study psychiatrist during each visit. Results: We found that derived phenotypes were associated with not only the diagnoses and severity of depression and mania but also specific individual symptoms. Using a linear mixed-effects model with random intercepts accounting for the nested data structure from daily data, the backspace rates on the continuous scale did not differ between participants in the healthy control and in the mood disorders groups (P=.11). The 3-class model had mean backspace rates of 0.112, 0.180, and 0.268, respectively, with a SD of 0.048. In total, 3 classes, respectively, were estimated to comprise 37.5% (n=47), 54.4% (n=72), and 8.1% (n=9) of the sample. We grouped individuals into Low, Medium, and High backspace rate groups. Individuals with unipolar mood disorder were predominantly in the Medium group (n=54), with some in the Low group (n=27) and a few in the High group (n=6). The Medium group, compared with the Low group, had significantly higher ratings of depression (b=2.32, P=.008). The High group was not associated with ratings of depression with (P=.88) or without (P=.27) adjustment for medication and diagnoses. The High group, compared with the Low group, was associated with both nonzero ratings (b=1.91, P=.02) and higher ratings of mania (b=1.46, P<.001). The High group, compared with the Low group, showed significantly higher odds of elevated mood (P=.03), motor activity (P=.04), and irritability (P<.05). Conclusions: This study demonstrates the promise of mobile typing kinematics in mood disorder research and practice. Monitoring a single mobile typing kinematic feature, that is, backspace rates, through passive sensing imposes a low burden on the participants. Based on real-life keystroke data, our derived digital phenotypes from this single feature can be useful for researchers and practitioners to distinguish between individuals with and those without mood disorder symptoms. UR - https://www.jmir.org/2024/1/e51269 UR - http://dx.doi.org/10.2196/51269 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51269 ER - TY - JOUR AU - Ferrao Nunes-Zlotkowski, Kelly AU - Shepherd, L. Heather AU - Beatty, Lisa AU - Butow, Phyllis AU - Shaw, Margaret Joanne PY - 2024/10/29 TI - Blended Psychological Therapy for the Treatment of Psychological Disorders in Adult Patients: Systematic Review and Meta-Analysis JO - Interact J Med Res SP - e49660 VL - 13 KW - systematic review KW - blended psychological therapy KW - blended care KW - face-to-face KW - online KW - psychological intervention KW - intervention design KW - digital care KW - digital mental health KW - psychological disorder N2 - Background: Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models. Objective: We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure. Methods: PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=?1.1, 95% CI ?0.6 to ?1.6, P<.001, and z score=?4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=?0.1, 95% CI ?0.3 to 0.05, P=.17, and z score=?1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=?0.75, 95% CI ?0.56 to ?0.95; anxiety: n=8, Cohen d=?0.9, 95% CI ?0.6 to ?1.2); fewer (?6) face-to-face sessions (depression: n=9, Cohen d=?0.7, 95% CI ?0.5 to ?0.9; anxiety: n=7, Cohen d=?0.8, 95% CI ?0.3 to ?1.3); and a lower ratio (?50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=?0.8, 95% CI ?0.6 to ?1.1; anxiety: n=4, Cohen d=?0.8, 95% CI 0.006 to ?1.6). Conclusions: This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required. Trial Registration: PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258977 UR - https://www.i-jmr.org/2024/1/e49660 UR - http://dx.doi.org/10.2196/49660 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470720 ID - info:doi/10.2196/49660 ER - TY - JOUR AU - Ramsey, Maya AU - Oberman, Nina AU - Quesenberry Jr, P. Charles AU - Kurtovich, Elaine AU - Gomez Chavez, Lizeth AU - Chess, Aaloni AU - Brown, Denise Susan AU - Albright, L. Cheryl AU - Bhalala, Mibhali AU - Badon, E. Sylvia AU - Avalos, A. Lyndsay PY - 2024/10/29 TI - A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression?the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e56882 VL - 13 KW - postpartum depression KW - depression KW - eHealth KW - online workout videos KW - exercise videos KW - physical activity KW - wellness KW - health promotion KW - digital interventions N2 - Background: Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. Objective: This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)?an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. Methods: This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. Results: The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ?66% for questionnaires and ?48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. Conclusions: The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. Trial Registration: ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696 International Registered Report Identifier (IRRID): DERR1-10.2196/56882 UR - https://www.researchprotocols.org/2024/1/e56882 UR - http://dx.doi.org/10.2196/56882 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470705 ID - info:doi/10.2196/56882 ER - TY - JOUR AU - So, Jae-hee AU - Chang, Joonhwan AU - Kim, Eunji AU - Na, Junho AU - Choi, JiYeon AU - Sohn, Jy-yong AU - Kim, Byung-Hoon AU - Chu, Hui Sang PY - 2024/10/24 TI - Aligning Large Language Models for Enhancing Psychiatric Interviews Through Symptom Delineation and Summarization: Pilot Study JO - JMIR Form Res SP - e58418 VL - 8 KW - large language model KW - psychiatric interview KW - interview summarization KW - symptom delineation N2 - Background: Recent advancements in large language models (LLMs) have accelerated their use across various domains. Psychiatric interviews, which are goal-oriented and structured, represent a significantly underexplored area where LLMs can provide substantial value. In this study, we explore the application of LLMs to enhance psychiatric interviews by analyzing counseling data from North Korean defectors who have experienced traumatic events and mental health issues. Objective: This study aims to investigate whether LLMs can (1) delineate parts of the conversation that suggest psychiatric symptoms and identify those symptoms, and (2) summarize stressors and symptoms based on the interview dialogue transcript. Methods: Given the interview transcripts, we align the LLMs to perform 3 tasks: (1) extracting stressors from the transcripts, (2) delineating symptoms and their indicative sections, and (3) summarizing the patients based on the extracted stressors and symptoms. These 3 tasks address the 2 objectives, where delineating symptoms is based on the output from the second task, and generating the summary of the interview incorporates the outputs from all 3 tasks. In this context, the transcript data were labeled by mental health experts for the training and evaluation of the LLMs. Results: First, we present the performance of LLMs in estimating (1) the transcript sections related to psychiatric symptoms and (2) the names of the corresponding symptoms. In the zero-shot inference setting using the GPT-4 Turbo model, 73 out of 102 transcript segments demonstrated a recall mid-token distance d<20 for estimating the sections associated with the symptoms. For evaluating the names of the corresponding symptoms, the fine-tuning method demonstrates a performance advantage over the zero-shot inference setting of the GPT-4 Turbo model. On average, the fine-tuning method achieves an accuracy of 0.82, a precision of 0.83, a recall of 0.82, and an F1-score of 0.82. Second, the transcripts are used to generate summaries for each interviewee using LLMs. This generative task was evaluated using metrics such as Generative Evaluation (G-Eval) and Bidirectional Encoder Representations from Transformers Score (BERTScore). The summaries generated by the GPT-4 Turbo model, utilizing both symptom and stressor information, achieve high average G-Eval scores: coherence of 4.66, consistency of 4.73, fluency of 2.16, and relevance of 4.67. Furthermore, it is noted that the use of retrieval-augmented generation did not lead to a significant improvement in performance. Conclusions: LLMs, using either (1) appropriate prompting techniques or (2) fine-tuning methods with data labeled by mental health experts, achieved an accuracy of over 0.8 for the symptom delineation task when measured across all segments in the transcript. Additionally, they attained a G-Eval score of over 4.6 for coherence in the summarization task. This research contributes to the emerging field of applying LLMs in psychiatric interviews and demonstrates their potential effectiveness in assisting mental health practitioners. UR - https://formative.jmir.org/2024/1/e58418 UR - http://dx.doi.org/10.2196/58418 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58418 ER - TY - JOUR AU - Pearson, Rahel AU - Beevers, G. Christopher AU - Mignogna, Joseph AU - Benzer, Justin AU - Pfeiffer, N. Paul AU - Post, Edward AU - Creech, K. Suzannah PY - 2024/10/24 TI - The Evaluation of a Web-Based Intervention (Deprexis) to Decrease Depression and Restore Functioning in Veterans: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e59119 VL - 13 KW - depression KW - eHealth KW - mental health KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Depressive symptoms are common in veterans, and the presence of these symptoms increases disability as well as suicidal thoughts and behaviors. However, there is evidence that these symptoms often go untreated. Intervening before symptoms become severe and entrenched is related to better long-term outcomes, including improved functioning and less disease chronicity. Computer-delivered interventions may be especially appropriate for those veterans with mild to moderate depressive symptoms, because these interventions can require fewer resources and have lower barriers to access and thus have potential for wider reach. Despite this potential, there is a dearth of research examining computerized interventions for depressive symptoms in veteran samples. Objective: The aim of this study is to evaluate the efficacy of Deprexis (GAIA AG), a computerized intervention for depressive symptoms and related functional impairment. Methods: Veterans will be recruited through the US Department of Veterans Affairs electronic medical record and through primary care and specialty clinics. First, qualitative interviews will be completed with a small subset of veterans (n=16-20) to assess the acceptability of treatment procedures. Next, veterans (n=132) with mild to moderate depressive symptoms will be randomly assigned to the fully automated Deprexis intervention or a treatment-as-usual control group. The primary outcomes will be self-reported depressive symptoms and various dimensions of psychosocial functioning. Results: This project was funded in May 2024, and data collection will be conducted between October 2024 and April 2029. Overall, 4 participants have been recruited as of the submission of the manuscript, and data analysis is expected in June 2029, with initial results expected in November 2029. Conclusions: This study will provide initial evidence for the efficacy of self-guided, computerized interventions for depressive symptoms and functional impairment in veterans. If effective, these types of interventions could improve veteran access to low-resource psychosocial treatments. Trial Registration: ClinicalTrials.gov NCT06217198; https://www.clinicaltrials.gov/study/NCT06217198 International Registered Report Identifier (IRRID): PRR1-10.2196/59119 UR - https://www.researchprotocols.org/2024/1/e59119 UR - http://dx.doi.org/10.2196/59119 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446432 ID - info:doi/10.2196/59119 ER - TY - JOUR AU - Tarp, Kristine AU - Christiansen, Regina AU - Bilberg, Randi AU - Borkner, Simone AU - Dalsgaard, Caroline AU - Paldam Folker, Marie AU - Søgaard Nielsen, Anette PY - 2024/10/23 TI - Patient Perspectives on Blended Internet-Based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study JO - J Med Internet Res SP - e47083 VL - 26 KW - internet-based KW - alcohol use disorder treatment KW - user perspective KW - qualitative KW - blended treatment KW - blended learning KW - cognitive behavioral therapy KW - alcoholism KW - alcohol use disorder KW - treatment KW - barriers KW - patient perspectives KW - rehabilitation N2 - Background: Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD. Objective: This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format. Methods: A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored. Results: We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments. Conclusions: Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions. Trial Registration: ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258 UR - https://www.jmir.org/2024/1/e47083 UR - http://dx.doi.org/10.2196/47083 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441642 ID - info:doi/10.2196/47083 ER - TY - JOUR AU - Kumar, Komal AU - Childs, W. Amber AU - Kohlmeier, Jonathan AU - Kroll, Elizabeth AU - Zant, Izabella AU - Stolzenbach, Stephanie AU - Fenkel, Caroline PY - 2024/10/23 TI - Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative JO - JMIR Form Res SP - e58994 VL - 8 KW - measurement-based care KW - MBC KW - remote KW - intensive outpatient program KW - IOP KW - mental health KW - implementation N2 - Background: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. Objective: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. Methods: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. Results: The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Conclusions: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings. UR - https://formative.jmir.org/2024/1/e58994 UR - http://dx.doi.org/10.2196/58994 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441653 ID - info:doi/10.2196/58994 ER - TY - JOUR AU - Gee, Brioney AU - Teague, Bonnie AU - Laphan, Andrew AU - Clarke, Tim AU - Coote, Georgianna AU - Garner, Jessica AU - Wilson, Jon PY - 2024/10/22 TI - Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation JO - JMIR Ment Health SP - e52866 VL - 11 KW - anxiety KW - children KW - young people KW - exposure therapy KW - graded exposures KW - cognitive behavioural therapy KW - digital intervention KW - mobile app KW - gaming KW - real-world evaluation KW - gaming technology KW - real-world implementation N2 - Background: Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7?12 years through a mobile app incorporating immersive gaming technology. Objective: We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service?funded mental health services. Methods: We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7?12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of ?challenges? completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Results: Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3?12) and the median time spent engaging with the intervention was 42 (IQR 15?79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25?0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27?0.65) between the first and last data points. Two in 5 young people?s scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. Conclusions: This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7?12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn. UR - https://mental.jmir.org/2024/1/e52866 UR - http://dx.doi.org/10.2196/52866 ID - info:doi/10.2196/52866 ER - TY - JOUR AU - Ernst, Mathias AU - Bouchard, Stéphane AU - Andersen, Tonny AU - Orskov, Trads Per AU - Tarp, Kristine AU - Lichtenstein, Beck Mia PY - 2024/10/21 TI - Virtual Reality?Based Exposure With 360° Environments for Social Anxiety Disorder: Usability and Feasibility Study JO - JMIR Form Res SP - e55679 VL - 8 KW - anxiety KW - exposure therapy KW - social anxiety disorder KW - virtual reality KW - 360° KW - mixed methods KW - interactive N2 - Background: Social anxiety disorder (SAD) is a long-term and overwhelming fear of social situations that can affect work, school, and other daily activities. Although cognitive behavioral therapy is effective, few seek treatment, and many who do start often drop out. This may be due to the component of exposure inherent to cognitive behavioral therapy, where the patient confronts feared stimuli outside the therapist?s office, which they otherwise try to avoid. As an alternative, research has explored the effectiveness of virtual reality (VR)?based exposure therapy with promising results. However, few studies have investigated the feasibility of VR tools using mixed methodologies before assessing their efficacy. Objective: This study aims to assess the usability, feasibility, and presence of four 360° virtual environments and whether these were able to evoke anxiety in patients with SAD. Methods: A total of 10 adult participants with SAD and 10 healthy controls were recruited for 1 experimental session (age range 21-32 y; 12/20, 60% male participants). Questionnaire and interview data were collected and analyzed. A mixed methods triangulation design was applied to analyze and compare the data. Results: Participants with SAD experienced increased anxiety when exposed to VR, and environments were considered relevant and useful as an exposure tool. Participants with SAD reported significantly higher average anxiety levels (P=.01) and peak anxiety levels (P=.01) compared with controls during exposure; however, significant differences in anxiety when accounting for baseline anxiety levels were only found in 2 of 4 environments (P=.01, P=.01, P=.07, and P=.06). While presence scores were acceptable in both groups, participants with SAD scored significantly lower than controls. Qualitative analyses highlight this finding within the SAD group, where some participants experienced presence reduction due to being observed while in VR and in situations with reduced interaction in VR. Conclusions: VR exposure with 360° videos seems to be useful as a first step of exposure therapy for patients with SAD. Future exploration in the clinical application of VR-based exposure for SAD, as well as means of increasing presence within the virtual environments, may be useful. UR - https://formative.jmir.org/2024/1/e55679 UR - http://dx.doi.org/10.2196/55679 UR - http://www.ncbi.nlm.nih.gov/pubmed/39432344 ID - info:doi/10.2196/55679 ER - TY - JOUR AU - Rachmayanti, D. Riris AU - Dewi, Tetra Fatwa Sari AU - Setiyawati, Diana AU - Megatsari, Hario AU - Diana, Rian AU - Vinarti, Retno PY - 2024/10/16 TI - Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e58681 VL - 13 KW - adolescents KW - digital media KW - mental health KW - resilience KW - scoping review N2 - Background: Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems. Objective: This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths. Methods: The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted. Results: The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education. Conclusions: The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents? resilience skills. International Registered Report Identifier (IRRID): DERR1-10.2196/58681 UR - https://www.researchprotocols.org/2024/1/e58681 UR - http://dx.doi.org/10.2196/58681 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58681 ER - TY - JOUR AU - Debrot, Anik AU - Efinger, Liliane AU - Kheyar, Maya AU - Pomini, Valentino AU - Berthoud, Laurent PY - 2024/10/16 TI - A French-Language Web-Based Intervention Targeting Prolonged Grief Symptoms in People Who Are Bereaved and Separated: Randomized Controlled Trial JO - JMIR Form Res SP - e57294 VL - 8 KW - web-based interventions KW - randomized controlled trial KW - grief KW - bereavement KW - separation KW - guidance N2 - Background: Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms. Objective: This study aimed to compare the efficacy and adherence rates of 2 WBIs for prolonged grief symptoms following the loss of a loved one through death or romantic separation. Methods: LIVIA 2.0 was developed relying on theoretical and empirical findings on bereavement processes and WBIs, and is compared with LIVIA 1, which has already demonstrated its efficacy. We conducted a randomized controlled trial and provided on-demand guidance to participants. Outcomes were assessed through web-based questionnaires before the intervention, after the intervention (12 weeks later), and at follow-up (24 weeks later). Primary outcomes were grief symptoms, depressive symptoms, and well-being. Secondary outcomes were anxiety symptoms, grief coping strategies, aspects related to self-identity, and program satisfaction. Results: In total, 62 participants were randomized (intent-to-treat [ITT] sample), 29 (47%) in LIVIA 2.0 (active arm) and 33 (53%) in LIVIA 1 (control arm). The dropout rate was 40% (37/62), and 10 participants were removed due to exclusion criteria, leading to a final per-protocol sample of 27 (44%) completers who differed from noncompleters only based on reporting fewer anxiety symptoms (t60=3.03; P=.004). Participants who are separated reported more grief symptoms (t60=2.22; P=.03) and attachment anxiety (t60=2.26; P=.03), compared to participants who are bereaved. There were pre-post within-group differences for both programs in the ITT sample, with significant reductions in grief (Cohen d=?0.90), depressive symptoms (Cohen d=?0.31), and centrality of the loss (Cohen d=?0.45). The same pattern was observed in the per-protocol sample, with the exception that anxiety symptoms also significantly diminished (Cohen d=?0.45). No difference was found in efficacy between the 2 programs (all P>.33). Participants (ITT sample) reported overall high levels of program satisfaction (mean 3.18, SD 0.54; over a maximum of 4). Effect stability was confirmed at the 6-month follow-up for all outcomes, with an improvement in self-concept clarity. Conclusions: The 2 grief-related WBIs were effective in reducing grief, depressive and anxiety symptoms for participants who are bereaved or separated. The analyses did not reveal any pre-post between-group differences, suggesting that the innovations brought to LIVIA 2.0 did not significantly affect the outcome. However, caution is warranted with the interpretation of the results given the limited power of the sample, which only allows the detection of medium effect sizes. Trial Registration: ClinicalTrials.gov NCT05219760; https://clinicaltrials.gov/study/NCT05219760 International Registered Report Identifier (IRRID): RR2-10.2196/39026 UR - https://formative.jmir.org/2024/1/e57294 UR - http://dx.doi.org/10.2196/57294 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412869 ID - info:doi/10.2196/57294 ER - TY - JOUR AU - Frischholz, Katja AU - Tanaka, Hiroki AU - Shidara, Kazuhiro AU - Onishi, Kazuyo AU - Nakamura, Satoshi PY - 2024/10/15 TI - Examining the Effects of Cognitive Behavioral Therapy With a Virtual Agent on User Motivation and Improvement in Psychological Distress and Anxiety: Two-Session Experimental Study JO - JMIR Form Res SP - e55234 VL - 8 KW - cognitive behavioral therapy KW - cognitive restructuring KW - motivation KW - virtual agent KW - automatic negative thoughts N2 - Background: Cognitive behavioral therapy (CBT) is a valuable treatment for mood disorders and anxiety. CBT methods, such as cognitive restructuring, are employed to change automatic negative thoughts to more realistic ones. Objective: This study extends on previous research conducted by the authors, focused on the process of correcting automatic negative thoughts to realistic ones and reducing distress and anxiety via CBT with a virtual agent. It was aimed to investigate whether the previously applied virtual agent would achieve changes in automatic negative thoughts when modifications to the previous experimental paradigm are applied and when user motivation is taken into consideration. Furthermore, the potential effects of existing participant knowledge concerning CBT or automatic thoughts were explored. Methods: A single-group, 2-session experiment was conducted using a within-group design. The study recruited 35 participants from May 15, 2023, to June 2, 2023, via Inter Group Corporation, with data collection following from June 5 to June 20, 2023, at Nara Institute of Science and Technology, Japan. There were 19 male and 16 female participants (age range: 18-50 years; mean 33.66, SD 10.77 years). Participants answered multiple questionnaires covering depressive symptomatology and other cognitive variables before and after a CBT session. CBT was carried out using a virtual agent, who participants conversed with using a CBT dialogue scenario on the topic of automatic negative thoughts. Session 2 of the experiment took place 1 week after session 1. Changes in distress and state anxiety were analyzed using a Wilcoxon signed-rank test and t-test for paired samples. The relationships of motivation with cognitive changes and distress or anxiety changes were investigated via correlation analysis. Multiple linear regression was used to analyze the potential predictive qualities of previous knowledge of CBT and automatic negative thoughts regarding outcome measures. Results: Significant reductions in distress (all P<.001) and state anxiety (all P<.003) emerged throughout the first and second experimental sessions. The CBT intervention increased participants? recognition of their negative thinking and their intention to change it, namely their motivation to change it. However, no clear correlations of motivation with changes in distress or anxiety were found (all P>.04). Participants reported moderate subjective changes in their cognition, which were in part positively correlated with their motivation (all P<.007). Lastly, existing knowledge of CBT did not predict reductions in distress during the first session of the experiment (P=.02). Conclusions: CBT using a virtual agent and a CBT dialogue scenario was successful in reducing distress and anxiety when talking about automatic negative thoughts. The promotion of client motivation needs to be critically considered when designing interventions using CBT with a virtual agent, and further experimental investigations on the causal influences between motivation and outcome measures need to be conducted. UR - https://formative.jmir.org/2024/1/e55234 UR - http://dx.doi.org/10.2196/55234 UR - http://www.ncbi.nlm.nih.gov/pubmed/39405101 ID - info:doi/10.2196/55234 ER - TY - JOUR AU - Folk, B. Johanna AU - Valencia-Ayala, Cynthia AU - Holloway, D. Evan AU - Anvar, Sarah AU - Czopp, Alison AU - Tolou-Shams, Marina PY - 2024/10/15 TI - Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation JO - JMIR Form Res SP - e57939 VL - 8 KW - family-based intervention KW - affect management KW - child welfare system KW - telehealth KW - formative evaluation KW - trauma exposure KW - substance misuse KW - adverse childhood experiences KW - trauma-informed care KW - adolescent health N2 - Background: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. Objective: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Methods: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Results: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. Conclusions: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. Trial Registration: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523 UR - https://formative.jmir.org/2024/1/e57939 UR - http://dx.doi.org/10.2196/57939 UR - http://www.ncbi.nlm.nih.gov/pubmed/39405104 ID - info:doi/10.2196/57939 ER - TY - JOUR AU - Feng, Xiandong AU - Hu, Yinhuan AU - Pfaff, Holger AU - Liu, Sha AU - Xie, Jinzhu AU - Zhang, Zemiao PY - 2024/10/10 TI - Exploring Client Preferences for Psychological Counselors in a Chinese Online Health Community: Longitudinal Study JO - J Med Internet Res SP - e58428 VL - 26 KW - signaling theory KW - psychological counselor KW - online health communities KW - clients? choice N2 - Background: Although online health communities are acknowledged for their role in bridging the supply-demand gap in mental health services, the client decision-making process in these environments remains underexplored. Objective: This study aimed to explore the impact of different signals presented on psychological counselors? home pages on clients? choices. Methods: Adopting signaling theory as the framework, this study classified information into online and offline signals and developed a theoretical model to examine client choice behaviors. We collected data from 487 psychological counselors in a leading Chinese online mental health community during March, June, September, and December 2023. Based on these data, we constructed a 4-period balanced panel dataset. A fixed effects model was used to analyze which signals influence clients? choices of psychological counselors. Results: Regarding online signals, the service price (?=0.186, P<.001) and online reputation (?=0.489, P=.002) of psychological counselors positively influence clients? choices. Concerning offline signals, psychological counselors? practical experience (?=0.007, P<.001) is positively related to clients? choices. Moreover, the results indicate that the relationship between a counselor?s prosocial behavior and clients? choices is not linear but rather exhibits an inverted U-shape. Conclusions: This study reveals that the varied information provided by psychological counselors has distinct impacts on clients? choices in online health communities. It broadens the application of signaling theory to online behaviors and emphasizes the importance of both online and offline signals. These insights offer strategic guidance for counselors and online platforms to better meet potential clients? needs by optimizing the information presented on psychological counselors? home pages. UR - https://www.jmir.org/2024/1/e58428 UR - http://dx.doi.org/10.2196/58428 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58428 ER - TY - JOUR AU - Held, Philip AU - Pridgen, A. Sarah AU - Chen, Yaozhong AU - Akhtar, Zuhaib AU - Amin, Darpan AU - Pohorence, Sean PY - 2024/10/10 TI - A Novel Cognitive Behavioral Therapy?Based Generative AI Tool (Socrates 2.0) to Facilitate Socratic Dialogue: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e58195 VL - 13 KW - generative artificial intelligence KW - mental health KW - feasibility KW - cognitive restructuring KW - Socratic dialogue KW - mobile phone N2 - Background: Digital mental health tools, designed to augment traditional mental health treatments, are becoming increasingly important due to a wide range of barriers to accessing mental health care, including a growing shortage of clinicians. Most existing tools use rule-based algorithms, often leading to interactions that feel unnatural compared with human therapists. Large language models (LLMs) offer a solution for the development of more natural, engaging digital tools. In this paper, we detail the development of Socrates 2.0, which was designed to engage users in Socratic dialogue surrounding unrealistic or unhelpful beliefs, a core technique in cognitive behavioral therapies. The multiagent LLM-based tool features an artificial intelligence (AI) therapist, Socrates, which receives automated feedback from an AI supervisor and an AI rater. The combination of multiple agents appeared to help address common LLM issues such as looping, and it improved the overall dialogue experience. Initial user feedback from individuals with lived experiences of mental health problems as well as cognitive behavioral therapists has been positive. Moreover, tests in approximately 500 scenarios showed that Socrates 2.0 engaged in harmful responses in under 1% of cases, with the AI supervisor promptly correcting the dialogue each time. However, formal feasibility studies with potential end users are needed. Objective: This mixed methods study examines the feasibility of Socrates 2.0. Methods: On the basis of the initial data, we devised a formal feasibility study of Socrates 2.0 to gather qualitative and quantitative data about users? and clinicians? experience of interacting with the tool. Using a mixed method approach, the goal is to gather feasibility and acceptability data from 100 users and 50 clinicians to inform the eventual implementation of generative AI tools, such as Socrates 2.0, in mental health treatment. We designed this study to better understand how users and clinicians interact with the tool, including the frequency, length, and time of interactions, users? satisfaction with the tool overall, quality of each dialogue and individual responses, as well as ways in which the tool should be improved before it is used in efficacy trials. Descriptive and inferential analyses will be performed on data from validated usability measures. Thematic analysis will be performed on the qualitative data. Results: Recruitment will begin in February 2024 and is expected to conclude by February 2025. As of September 25, 2024, overall, 55 participants have been recruited. Conclusions: The development of Socrates 2.0 and the outlined feasibility study are important first steps in applying generative AI to mental health treatment delivery and lay the foundation for formal feasibility studies. International Registered Report Identifier (IRRID): DERR1-10.2196/58195 UR - https://www.researchprotocols.org/2024/1/e58195 UR - http://dx.doi.org/10.2196/58195 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58195 ER - TY - JOUR AU - Pagnini, Francesco PY - 2024/10/9 TI - Supporting the Mind in Space: Psychological Tools for Long-Duration Missions JO - Interact J Med Res SP - e66626 VL - 13 KW - space psychology KW - astronauts KW - psychotherapy KW - isolated and confined environment KW - mindfulness KW - relaxation KW - mind-body UR - https://www.i-jmr.org/2024/1/e66626 UR - http://dx.doi.org/10.2196/66626 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382951 ID - info:doi/10.2196/66626 ER - TY - JOUR AU - Collins, C. Amanda AU - Bhattacharya, Sukanya AU - Oh, Y. Jenny AU - Salzhauer, Abigail AU - Taylor, T. Charles AU - Wolitzky-Taylor, Kate AU - Aupperle, L. Robin AU - Budney, J. Alan AU - Jacobson, C. Nicholas PY - 2024/10/7 TI - Inclusion of Individuals With Lived Experiences in the Development of a Digital Intervention for Co-Occurring Depression and Cannabis Use: Mixed Methods Investigation JO - JMIR Form Res SP - e54751 VL - 8 KW - digital intervention KW - depression KW - cannabis use KW - positive affect KW - formative research KW - app development N2 - Background: Existing interventions for co-occurring depression and cannabis use often do not treat both disorders simultaneously and can result in higher rates of symptom relapse. Traditional in-person interventions are often difficult to obtain due to financial and time limitations, which may further prevent individuals with co-occurring depression and cannabis use from receiving adequate treatment. Digital interventions can increase the scalability and accessibility for these individuals, but few digital interventions exist to treat both disorders simultaneously. Targeting transdiagnostic processes of these disorders with a digital intervention?specifically positive valence system dysfunction?may yield improved access and outcomes. Objective: Recent research has highlighted a need for the inclusion of individuals with lived experiences to assist in the co-design of interventions to enhance scalability and relevance of an intervention. Thus, the purpose of this study is to describe the process of eliciting feedback from individuals with elevated depressed symptoms and cannabis use and co-designing a digital intervention, Amplification of Positivity?Cannabis Use Disorder (AMP-C), focused on improving positive valence system dysfunction in these disorders. Methods: Ten individuals who endorsed moderate to severe depressive symptoms and regular cannabis use (2-3×/week) were recruited online via Meta ads. Using a mixed methods approach, participants completed a 1-hour mixed methods interview over Zoom (Zoom Technologies Inc) where they gave their feedback and suggestions for the development of a mental health app, based on an existing treatment targeting positive valence system dysfunction, for depressive symptoms and cannabis use. The qualitative approach allowed for a broader investigation of participants? wants and needs regarding the engagement and scalability of AMP-C, and the quantitative approach allowed for specific ratings of intervention components to be potentially included. Results: Participants perceived the 13 different components of AMP-C as overall helpful (mean 3.9-4.4, SD 0.5-1.1) and interesting (mean 4.0-4.9, SD 0.3-1.1) on a scale from 1 (not at all) to 5 (extremely). They gave qualitative feedback for increasing engagement in the app, including adding a social component, using notifications, and being able to track their symptoms and progress over time. Conclusions: This study highlights the importance of including individuals with lived experiences in the development of interventions, including digital interventions. This inclusion resulted in valuable feedback and suggestions for improving the proposed digital intervention targeting the positive valence system, AMP-C, to better match the wants and needs of individuals with depressive symptoms and cannabis use. UR - https://formative.jmir.org/2024/1/e54751 UR - http://dx.doi.org/10.2196/54751 UR - http://www.ncbi.nlm.nih.gov/pubmed/39374076 ID - info:doi/10.2196/54751 ER - TY - JOUR AU - Vomhof, Markus AU - Bau, Tabea Jessica AU - Hüter, Pia AU - Stehl, Stefan AU - Haastert, Burkhard AU - Loerbroks, Adrian AU - Icks, Andrea AU - Calo, Teresa Stella AU - Schuster, Luca AU - Pischke, R. Claudia AU - Kairies-Schwarz, Nadja AU - Angerer, Peter AU - Apolinário-Hagen, Jennifer PY - 2024/10/4 TI - Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment JO - JMIR Form Res SP - e55921 VL - 8 KW - preferences KW - digital mental health KW - medical students KW - innovation diffusion KW - technology acceptance KW - health information N2 - Background: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students? information preferences regarding DMHIs. Objective: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. Methods: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. Results: Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. Conclusions: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students? interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step. UR - https://formative.jmir.org/2024/1/e55921 UR - http://dx.doi.org/10.2196/55921 UR - http://www.ncbi.nlm.nih.gov/pubmed/39365652 ID - info:doi/10.2196/55921 ER - TY - JOUR AU - Horita, Hideki AU - Seki, Yoichi AU - Yamaguchi, Takumi AU - Shiko, Yuki AU - Kawasaki, Yohei AU - Shimizu, Eiji PY - 2024/10/3 TI - Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e60604 VL - 7 KW - internet addiction KW - adolescents KW - parents KW - cognitive behavioral therapy KW - digital health N2 - Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent?s problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents? hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 UR - https://pediatrics.jmir.org/2024/1/e60604 UR - http://dx.doi.org/10.2196/60604 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361415 ID - info:doi/10.2196/60604 ER - TY - JOUR AU - Ong, E. Laura AU - Speicher, Sarah AU - Villasenor, Diana AU - Kim, Jamie AU - Jacobs, Adam AU - Macia, S. Kathryn AU - Cloitre, Marylene PY - 2024/10/2 TI - Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial JO - J Med Internet Res SP - e52130 VL - 26 KW - posttraumatic stress disorder KW - PTSD KW - depression KW - depressive symptoms KW - veterans KW - veterans health KW - mHealth KW - mobile health KW - peer support KW - peer-to-peer KW - transdiagnostic KW - mental health KW - mental health services KW - community KW - emotion regulation KW - interpersonal regulation KW - mHealth program N2 - Background: Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning. Objective: This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression. Methods: A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. Results: Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes. Conclusions: BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes. Trial Registration: ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165 UR - https://www.jmir.org/2024/1/e52130 UR - http://dx.doi.org/10.2196/52130 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012722 ID - info:doi/10.2196/52130 ER - TY - JOUR AU - Liu, Yuhan AU - Fang, Anna AU - Moriarty, Glen AU - Firman, Cristopher AU - Kraut, E. Robert AU - Zhu, Haiyi PY - 2024/10/1 TI - Exploring Trade-Offs for Online Mental Health Matching: Agent-Based Modeling Study JO - JMIR Form Res SP - e58241 VL - 8 KW - agent-based modeling KW - mental health KW - algorithmic matching KW - social computing KW - online communities N2 - Background: Online mental health communities (OMHCs) are an effective and accessible channel to give and receive social support for individuals with mental and emotional issues. However, a key challenge on these platforms is finding suitable partners to interact with given that mechanisms to match users are currently underdeveloped or highly naive. Objective: In this study, we collaborated with one of the world?s largest OMHCs; our contribution is to show the application of agent-based modeling for the design of online community matching algorithms. We developed an agent-based simulation framework and showcased how it can uncover trade-offs in different matching algorithms between people seeking support and volunteer counselors. Methods: We used a comprehensive data set spanning January 2020 to April 2022 to create a simulation framework based on agent-based modeling that replicates the current matching mechanisms of our research site. After validating the accuracy of this simulated replication, we used this simulation framework as a ?sandbox? to test different matching algorithms based on the deferred acceptance algorithm. We compared trade-offs among these different matching algorithms based on various metrics of interest, such as chat ratings and matching success rates. Results: Our study suggests that various tensions emerge through different algorithmic choices for these communities. For example, our simulation uncovered that increased waiting time for support seekers was an inherent consequence on these sites when intelligent matching was used to find more suitable matches. Our simulation also verified some intuitive effects, such as that the greatest number of support seeker?counselor matches occurred using a ?first come, first served? protocol, whereas relatively fewer matches occurred using a ?last come, first served? protocol. We also discuss practical findings regarding matching for vulnerable versus overall populations. Results by demographic group revealed disparities?underaged and gender minority groups had lower average chat ratings and higher blocking rates on the site when compared to their majority counterparts, indicating the potential benefits of algorithmically matching them. We found that some protocols, such as a ?filter?-based approach that matched vulnerable support seekers only with a counselor of their same demographic, led to improvements for these groups but resulted in lower satisfaction (?12%) among the overall population. However, this trade-off between minority and majority groups was not observed when using ?topic? as a matching criterion. Topic-based matching actually outperformed the filter-based protocol among underaged people and led to significant improvements over the status quo among all minority and majority groups?specifically, a 6% average chat rating improvement and a decrease in blocking incidents from 5.86% to 4.26%. Conclusions: Agent-based modeling can reveal significant design considerations in the OMHC context, including trade-offs in various outcome metrics and the potential benefits of algorithmic matching for marginalized communities. UR - https://formative.jmir.org/2024/1/e58241 UR - http://dx.doi.org/10.2196/58241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58241 ER - TY - JOUR AU - Dominguez-Rodriguez, Alejandro AU - Sanz-Gomez, Sergio AU - González Ramírez, Patricia Leivy AU - Herdoiza-Arroyo, Erika Paulina AU - Trevino Garcia, Edith Lorena AU - de la Rosa-Gómez, Anabel AU - González-Cantero, Omar Joel AU - Macias-Aguinaga, Valeria AU - Arenas Landgrave, Paulina AU - Chávez-Valdez, Margarita Sarah PY - 2024/9/30 TI - Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial JO - JMIR Form Res SP - e53767 VL - 8 KW - self-guided web-based intervention KW - chat support KW - depression KW - anxiety KW - COVID-19 KW - opinion KW - usability KW - randomized control trial N2 - Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants? symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants? satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention?s usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users? perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 UR - https://formative.jmir.org/2024/1/e53767 UR - http://dx.doi.org/10.2196/53767 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53767 ER - TY - JOUR AU - D'Arcey, Jessica AU - Torous, John AU - Asuncion, Toni-Rose AU - Tackaberry-Giddens, Leah AU - Zahid, Aqsa AU - Ishak, Mira AU - Foussias, George AU - Kidd, Sean PY - 2024/9/30 TI - Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review JO - JMIR Ment Health SP - e57150 VL - 11 KW - schizophrenia KW - digital mental health KW - personal technology KW - access to specialized resources KW - mental health KW - scoping review KW - mental health care KW - feasibility KW - efficacy KW - clinical integration KW - support KW - specialized care KW - care KW - database KW - schizophrenia spectrum disorder KW - text messaging KW - text KW - user feedback KW - usability KW - acceptability KW - satisfaction KW - engagement KW - digital health KW - technology KW - health technology KW - mood disorder KW - mood disorders KW - neurodevelopment KW - eHealth KW - mobile phone N2 - Background: Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown. Objective: This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care. Methods: Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes. Conclusions: Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review. UR - https://mental.jmir.org/2024/1/e57150 UR - http://dx.doi.org/10.2196/57150 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348196 ID - info:doi/10.2196/57150 ER - TY - JOUR AU - Omylinska-Thurston, Joanna AU - Aithal, Supritha AU - Liverpool, Shaun AU - Clark, Rebecca AU - Moula, Zoe AU - Wood, January AU - Viliardos, Laura AU - Rodríguez-Dorans, Edgar AU - Farish-Edwards, Fleur AU - Parsons, Ailsa AU - Eisenstadt, Mia AU - Bull, Marcus AU - Dubrow-Marshall, Linda AU - Thurston, Scott AU - Karkou, Vicky PY - 2024/9/30 TI - Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e55500 VL - 11 KW - digital psychotherapies KW - depression KW - adults KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Depression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives. Objective: This review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients? and practitioners? perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression. Methods: A mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients? and therapists? perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups. Results: Of 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included ?stand-alone? or non?human contact interventions (58/160, 36.2%), ?human contact? interventions (11/160, 6.8%), and ?blended? including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=?0.61, 95% CI ?0.75 to ?0.47; Z=?8.58; P<.001). Subgroup analyses of the studies with different intervention delivery formats and session frequency did not have a statistically significant effect on the results (P=.48 and P=.97, respectively). However, blended approaches revealed a large effect size (Hedges g=?0.793), while interventions involving human contact (Hedges g=?0.42) or no human contact (Hedges g=?0.40) had slightly smaller effect sizes. Conclusions: Digital interventions for depression were found to be effective regardless of format and frequency. Blended interventions have larger effect size than those involving human contact or no human contact. Digital interventions were helpful especially for diverse ethnic groups and young women. Future research should focus on understanding the sources of heterogeneity based on intervention and population characteristics. Trial Registration: PROSPERO CRD42021238462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238462 UR - https://mental.jmir.org/2024/1/e55500 UR - http://dx.doi.org/10.2196/55500 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348177 ID - info:doi/10.2196/55500 ER - TY - JOUR AU - Fonseca, Olivia Ana AU - Gomes, Silveira July AU - Novaes, Barros Rafael Angulo Condoretti AU - Dias, Lopes Cíntia AU - Rodrigues, Alves Maria Eva de Miranda AU - Gadelha, Ary AU - Noto, Cristiano PY - 2024/9/6 TI - Feuerstein Instrumental Enrichment Program for People With Schizophrenia After the First Episode of Psychosis: Protocol for an Open-Label Intervention Study JO - JMIR Res Protoc SP - e57031 VL - 13 KW - schizophrenia KW - Feuerstein Instrumental Enrichment program KW - cognitive intervention KW - functionality KW - first-episode psychosis KW - early stages KW - Feuerstein Instrumental Enrichment KW - FIE KW - psychotic disorder KW - psychotic disorders KW - neurocognitive deficits KW - economic burden KW - cognitive rehabilitation KW - quality of life KW - daily living KW - cognitive assessment KW - maze task KW - mental disorder KW - cognitive deficits KW - mental health KW - psychosis N2 - Background: Schizophrenia is a disorder associated with neurocognitive deficits that adversely affect daily functioning and impose an economic burden. Cognitive rehabilitation interventions, particularly during the early phases of illness, have been shown to improve cognition, functionality, and quality of life. The Feuerstein Instrumental Enrichment (FIE) program, based on the Mediated Learning Experience and the Structural Cognitive Modifiability theory, has been applied in various disorders, but its applicability in schizophrenia has not yet been clarified. Objective: This study aims to investigate the effects of the FIE program on the functionality of patients with first-episode schizophrenia. Methods: In total, 17 patients will be recruited for an open-label intervention consisting of twice-weekly sessions for 10 weeks. The primary outcome measure will be changes in the Goal Achievement Scale score. Maze task performance from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery will serve as a secondary outcome measure. At the same time, changes in Positive and Negative Syndrome Scale scores and other MATRICS domains will be analyzed as exploratory outcomes. Assessments will be administered before and after the intervention, with a follow-up period of 6 months. Results: This trial was preregistered in The Brazilian Registry of Clinical Trials (RBR-4gzhy4s). By February 2024, 11 participants were enrolled in the training. Recruitment is expected to be completed by May 2024. Data analysis will be conducted between May and September 2024. The results are expected to be published in January 2025. Conclusions: This study may establish a protocol for the FIE program that uses mediation techniques for individuals in the early stages of schizophrenia. The results will add to the knowledge about strategies to promote cognitive skills and functional impairment in daily life. International Registered Report Identifier (IRRID): DERR1-10.2196/57031 UR - https://www.researchprotocols.org/2024/1/e57031 UR - http://dx.doi.org/10.2196/57031 UR - http://www.ncbi.nlm.nih.gov/pubmed/39240685 ID - info:doi/10.2196/57031 ER - TY - JOUR AU - Poteat, C. Tonia AU - Reisner, L. Sari AU - Wirtz, L. Andrea AU - Mayo-Wilson, Jennings Larissa AU - Brown, Carter AU - Kornbluh, Wiley AU - Humphrey, Ash AU - Perrin, Nancy PY - 2024/8/26 TI - A Microfinance Intervention With or Without Peer Support to Improve Mental Health Among Transgender and Nonbinary Adults (the Creating Access to Resources and Economic Support Study): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e63656 VL - 13 KW - clinical trial KW - depression KW - anxiety KW - peer support KW - minority stress KW - cash transfer KW - COVID-19 N2 - Background: Transgender and nonbinary (TNB) people experience economic and psychosocial inequities that make them more likely to be subject to financial and mental health harms exacerbated by the COVID-19 pandemic. Sustainable, multilevel interventions are needed to address these harms. The onset of the COVID-19 pandemic galvanized many TNB-led organizations to provide emergency financial and peer support for TNB people negatively impacted by the pandemic. However, the efficacy of these interventions has not been evaluated. The Creating Access to Resources and Economic Support (CARES) study seeks to assess the efficacy of feasible, acceptable, and community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of the COVID-19 pandemic. Objective: The study aims to (1) compare the efficacy of microgrants with peer mentoring with that of microgrants without peer mentoring in reducing psychological distress, (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress, and (3) explore participants? intervention experiences and perceived efficacy. Methods: We will enroll 360 TNB adults into an embedded, mixed methods, 3-arm, and 12-month randomized controlled trial. Participants will be randomized 1:1:1 to arm A (enhanced usual care), which will receive a single microgrant plus monthly financial literacy education, arm B (extended microgrants), which will receive enhanced usual care plus monthly microgrants, or arm C (peer mentoring), which will receive extended microgrants combined with peer mentoring. All intervention arms last for 6 months, and participants complete semiannual, web-based surveys at 0, 6, and 12 months as well as brief process measures at 3 and 6 months. A subset of 36 participants, 12 (33%) per arm, will complete longitudinal in-depth interviews at 3 and 9 months. Results: Full recruitment began on January 8, 2024, and, as of July 26, 2024, a total of 138 participants have enrolled. Recruitment is expected to be completed no later than March 31, 2025, and the final study visit will take place in March 2026. Conclusions: This national, web-based study will demonstrate whether an intervention tailored to reduce material hardship and improve peer support among TNB adults will reduce psychological distress. Its equitable, community-academic partnership will ensure the rapid dissemination of study findings. Trial Registration: ClinicalTrials.gov NCT05971160; https://clinicaltrials.gov/study/NCT05971160 International Registered Report Identifier (IRRID): DERR1-10.2196/63656 UR - https://www.researchprotocols.org/2024/1/e63656 UR - http://dx.doi.org/10.2196/63656 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63656 ER - TY - JOUR AU - Villarreal-Zegarra, David AU - Reategui-Rivera, Mahony C. AU - García-Serna, Jackeline AU - Quispe-Callo, Gleni AU - Lázaro-Cruz, Gabriel AU - Centeno-Terrazas, Gianfranco AU - Galvez-Arevalo, Ricardo AU - Escobar-Agreda, Stefan AU - Dominguez-Rodriguez, Alejandro AU - Finkelstein, Joseph PY - 2024/8/21 TI - Self-Administered Interventions Based on Natural Language Processing Models for Reducing Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e59560 VL - 11 KW - natural language processing KW - depression KW - anxiety KW - systematic review KW - artificial intelligence KW - AI N2 - Background: The introduction of natural language processing (NLP) technologies has significantly enhanced the potential of self-administered interventions for treating anxiety and depression by improving human-computer interactions. Although these advances, particularly in complex models such as generative artificial intelligence (AI), are highly promising, robust evidence validating the effectiveness of the interventions remains sparse. Objective: The aim of this study was to determine whether self-administered interventions based on NLP models can reduce depressive and anxiety symptoms. Methods: We conducted a systematic review and meta-analysis. We searched Web of Science, Scopus, MEDLINE, PsycINFO, IEEE Xplore, Embase, and Cochrane Library from inception to November 3, 2023. We included studies with participants of any age diagnosed with depression or anxiety through professional consultation or validated psychometric instruments. Interventions had to be self-administered and based on NLP models, with passive or active comparators. Outcomes measured included depressive and anxiety symptom scores. We included randomized controlled trials and quasi-experimental studies but excluded narrative, systematic, and scoping reviews. Data extraction was performed independently by pairs of authors using a predefined form. Meta-analysis was conducted using standardized mean differences (SMDs) and random effects models to account for heterogeneity. Results: In all, 21 articles were selected for review, of which 76% (16/21) were included in the meta-analysis for each outcome. Most of the studies (16/21, 76%) were recent (2020-2023), with interventions being mostly AI-based NLP models (11/21, 52%); most (19/21, 90%) delivered some form of therapy (primarily cognitive behavioral therapy: 16/19, 84%). The overall meta-analysis showed that self-administered interventions based on NLP models were significantly more effective in reducing both depressive (SMD 0.819, 95% CI 0.389-1.250; P<.001) and anxiety (SMD 0.272, 95% CI 0.116-0.428; P=.001) symptoms compared to various control conditions. Subgroup analysis indicated that AI-based NLP models were effective in reducing depressive symptoms (SMD 0.821, 95% CI 0.207-1.436; P<.001) compared to pooled control conditions. Rule-based NLP models showed effectiveness in reducing both depressive (SMD 0.854, 95% CI 0.172-1.537; P=.01) and anxiety (SMD 0.347, 95% CI 0.116-0.578; P=.003) symptoms. The meta-regression showed no significant association between participants? mean age and treatment outcomes (all P>.05). Although the findings were positive, the overall certainty of evidence was very low, mainly due to a high risk of bias, heterogeneity, and potential publication bias. Conclusions: Our findings support the effectiveness of self-administered NLP-based interventions in alleviating depressive and anxiety symptoms, highlighting their potential to increase accessibility to, and reduce costs in, mental health care. Although the results were encouraging, the certainty of evidence was low, underscoring the need for further high-quality randomized controlled trials and studies examining implementation and usability. These interventions could become valuable components of public health strategies to address mental health issues. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023472120; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023472120 UR - https://mental.jmir.org/2024/1/e59560 UR - http://dx.doi.org/10.2196/59560 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59560 ER - TY - JOUR AU - Perrin, B. Paul AU - Haun, N. Jolie AU - Klyce, W. Daniel AU - Melillo, Christine AU - Nakase-Richardson, Risa AU - Seel, T. Ronald AU - Martindale-Adams, Jennifer AU - Nichols, O. Linda AU - Perera, A. Robert AU - Xia, Bridget AU - Hahm, Bridget AU - Zuber, Jeffrey PY - 2024/8/15 TI - Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury JO - JMIR Res Protoc SP - e57692 VL - 13 KW - traumatic brain injury KW - telehealth KW - caregiver KW - methodology KW - veterans KW - service members N2 - Background: The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. Objective: This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, ?Resources for Enhancing All Caregivers? Health? (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. Methods: This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. Results: This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. Conclusions: If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. International Registered Report Identifier (IRRID): PRR1-10.2196/57692 UR - https://www.researchprotocols.org/2024/1/e57692 UR - http://dx.doi.org/10.2196/57692 UR - http://www.ncbi.nlm.nih.gov/pubmed/39145996 ID - info:doi/10.2196/57692 ER - TY - JOUR AU - Farrer, M. Louise AU - Jackson, M. Hayley AU - Gulliver, Amelia AU - Calear, L. Alison AU - Leach, Liana AU - Hasking, Penelope AU - Katruss, Natasha AU - Batterham, J. Philip PY - 2024/8/13 TI - A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial JO - J Med Internet Res SP - e53598 VL - 26 KW - university students KW - internet-based intervention KW - randomized controlled trial KW - mental health KW - transdiagnostic N2 - Background: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. Objective: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. Methods: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. Results: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ?15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. Conclusions: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146 UR - https://www.jmir.org/2024/1/e53598 UR - http://dx.doi.org/10.2196/53598 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137012 ID - info:doi/10.2196/53598 ER - TY - JOUR AU - Omisore, Mumini Olatunji AU - Odenigbo, Ifeanyi AU - Orji, Joseph AU - Beltran, Hernandez Amelia Itzel AU - Meier, Sandra AU - Baghaei, Nilufar AU - Orji, Rita PY - 2024/7/24 TI - Extended Reality for Mental Health Evaluation: Scoping Review JO - JMIR Serious Games SP - e38413 VL - 12 KW - extended reality KW - mental disorder KW - depression KW - anxiety KW - exposure therapy N2 - Background: Mental health disorders are the leading cause of health-related problems worldwide. It is projected that mental health disorders will be the leading cause of morbidity among adults as the incidence rates of anxiety and depression grow worldwide. Recently, ?extended reality? (XR), a general term covering virtual reality (VR), augmented reality (AR), and mixed reality (MR), is paving the way for the delivery of mental health care. Objective: We aimed to investigate the adoption and implementation of XR technology used in interventions for mental disorders and to provide statistical analyses of the design, usage, and effectiveness of XR technology for mental health interventions with a worldwide demographic focus. Methods: In this paper, we conducted a scoping review of the development and application of XR in the area of mental disorders. We performed a database search to identify relevant studies indexed in Google Scholar, PubMed, and the ACM Digital Library. A search period between August 2016 and December 2023 was defined to select papers related to the usage of VR, AR, and MR in a mental health context. The database search was performed with predefined queries, and a total of 831 papers were identified. Ten papers were identified through professional recommendation. Inclusion and exclusion criteria were designed and applied to ensure that only relevant studies were included in the literature review. Results: We identified a total of 85 studies from 27 countries worldwide that used different types of VR, AR, and MR techniques for managing 14 types of mental disorders. By performing data analysis, we found that most of the studies focused on high-income countries, such as the United States (n=14, 16.47%) and Germany (n=12, 14.12%). None of the studies were for African countries. The majority of papers reported that XR techniques lead to a significant reduction in symptoms of anxiety or depression. The majority of studies were published in 2021 (n=26, 30.59%). This could indicate that mental disorder intervention received higher attention when COVID-19 emerged. Most studies (n=65, 76.47%) focused on a population in the age range of 18-65 years, while few studies (n=2, 3.35%) focused on teenagers (ie, subjects in the age range of 10-19 years). In addition, more studies were conducted experimentally (n=67, 78.82%) rather than by using analytical and modeling approaches (n=8, 9.41%). This shows that there is a rapid development of XR technology for mental health care. Furthermore, these studies showed that XR technology can effectively be used for evaluating mental disorders in a similar or better way that conventional approaches. Conclusions: In this scoping review, we studied the adoption and implementation of XR technology for mental disorder care. Our review shows that XR treatment yields high patient satisfaction, and follow-up assessments show significant improvement with large effect sizes. Moreover, the studies adopted unique designs that were set up to record and analyze the symptoms reported by their participants. This review may aid future research and development of various XR mechanisms for differentiated mental disorder procedures. UR - https://games.jmir.org/2024/1/e38413 UR - http://dx.doi.org/10.2196/38413 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/38413 ER - TY - JOUR AU - Storman, Dawid AU - Jemio?o, Pawe? AU - Sawiec, Zuzanna AU - Swierz, Jan Mateusz AU - Antonowicz, Ewa AU - Bala, M. Malgorzata AU - Prokop-Dorner, Anna PY - 2024/7/12 TI - Needs Expressed in Peer-to-Peer Web-Based Interactions Among People With Depression and Anxiety Disorders Hospitalized in a Mental Health Facility: Mixed Methods Study JO - J Med Internet Res SP - e51506 VL - 26 KW - anxiety disorders KW - depression KW - peer-to-peer web-based interactions KW - needs KW - psychiatric hospitalization N2 - Background: Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery. Objective: Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers. Methods: We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson ?2 test, and ? coefficient was used to evaluate the posts. Results: The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization. Conclusions: Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support. UR - https://www.jmir.org/2024/1/e51506 UR - http://dx.doi.org/10.2196/51506 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51506 ER - TY - JOUR AU - Saskovets, Marina AU - Liang, Zilu AU - Piumarta, Ian AU - Saponkova, Irina PY - 2024/6/27 TI - Effects of Sound Interventions on the Mental Stress Response in Adults: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e54030 VL - 13 KW - mental stress KW - anxiety KW - sound therapy KW - music therapy KW - voice-guided relaxation KW - voice-guided meditation KW - prosody KW - paralanguage KW - expressive sounds KW - psychoacoustics N2 - Background: Sound therapy methods have seen a surge in popularity, with a predominant focus on music among all types of sound stimulation. There is substantial evidence documenting the integrative impact of music therapy on psycho-emotional and physiological outcomes, rendering it beneficial for addressing stress-related conditions such as pain syndromes, depression, and anxiety. Despite these advancements, the therapeutic aspects of sound, as well as the mechanisms underlying its efficacy, remain incompletely understood. Existing research on music as a holistic cultural phenomenon often overlooks crucial aspects of sound therapy mechanisms, particularly those related to speech acoustics or the so-called ?music of speech.? Objective: This study aims to provide an overview of empirical research on sound interventions to elucidate the mechanism underlying their positive effects. Specifically, we will focus on identifying therapeutic factors and mechanisms of change associated with sound interventions. Our analysis will compare the most prevalent types of sound interventions reported in clinical studies and experiments. Moreover, we will explore the therapeutic effects of sound beyond music, encompassing natural human speech and intermediate forms such as traditional poetry performances. Methods: This review adheres to the methodological guidance of the Joanna Briggs Institute and follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for reporting review studies, which is adapted from the Arksey and O?Malley framework. Our search strategy encompasses PubMed, Web of Science, Scopus, and PsycINFO or EBSCOhost, covering literature from 1990 to the present. Among the different study types, randomized controlled trials, clinical trials, laboratory experiments, and field experiments were included. Results: Data collection began in October 2022. We found a total of 2027 items. Our initial search uncovered an asymmetry in the distribution of studies, with a larger number focused on music therapy compared with those exploring prosody in spoken interventions such as guided meditation or hypnosis. We extracted and selected papers using Rayyan software (Rayyan) and identified 41 eligible papers after title and abstract screening. The completion of the scoping review is anticipated by October 2024, with key steps comprising the analysis of findings by May 2024, drafting and revising the study by July 2024, and submitting the paper for publication in October 2024. Conclusions: In the next step, we will conduct a quality evaluation of the papers and then chart and group the therapeutic factors extracted from them. This process aims to unveil conceptual gaps in existing studies. Gray literature sources, such as Google Scholar, ClinicalTrials.gov, nonindexed conferences, and reference list searches of retrieved studies, will be added to our search strategy to increase the number of relevant papers that we cover. International Registered Report Identifier (IRRID): DERR1-10.2196/54030 UR - https://www.researchprotocols.org/2024/1/e54030 UR - http://dx.doi.org/10.2196/54030 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54030 ER - TY - JOUR AU - Koelen, Jurrijn AU - Klein, Anke AU - Wolters, Nine AU - Bol, Eline AU - De Koning, Lisa AU - Roetink, Samantha AU - Van Blom, Jorien AU - Boutin, Bruno AU - Schaaf, Jessica AU - Grasman, Raoul AU - Van der Heijde, Maria Claudia AU - Salemink, Elske AU - Riper, Heleen AU - Karyotaki, Eirini AU - Cuijpers, Pim AU - Schneider, Silvia AU - Rapee, Ronald AU - Vonk, Peter AU - Wiers, Reinout PY - 2024/6/19 TI - Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial JO - JMIR Ment Health SP - e50503 VL - 11 KW - internet-based cognitive behavioral intervention KW - iCBT KW - university students KW - transdiagnostic KW - human guidance KW - technological guidance N2 - Background: Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. Objective: This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. Methods: A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use?related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test?10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. Results: In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). Conclusions: The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. Trial Registration: International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795 UR - https://mental.jmir.org/2024/1/e50503 UR - http://dx.doi.org/10.2196/50503 UR - http://www.ncbi.nlm.nih.gov/pubmed/38896474 ID - info:doi/10.2196/50503 ER - TY - JOUR AU - de Azevedo Cardoso, Taiane AU - Kochhar, Shruti AU - Torous, John AU - Morton, Emma PY - 2024/4/1 TI - Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions JO - JMIR Ment Health SP - e58631 VL - 11 KW - bipolar disorder KW - digital phenotyping KW - machine learning KW - mobile health interventions KW - mobile health KW - mHealth KW - apps UR - https://mental.jmir.org/2024/1/e58631 UR - http://dx.doi.org/10.2196/58631 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557724 ID - info:doi/10.2196/58631 ER - TY - JOUR AU - O'Sullivan, Shaunagh AU - McEnery, Carla AU - Cagliarini, Daniela AU - Hinton, X. Jordan D. AU - Valentine, Lee AU - Nicholas, Jennifer AU - Chen, A. Nicola AU - Castagnini, Emily AU - Lester, Jacqueline AU - Kanellopoulos, Esta AU - D'Alfonso, Simon AU - Gleeson, F. John AU - Alvarez-Jimenez, Mario PY - 2024/4/1 TI - A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study JO - JMIR Ment Health SP - e49217 VL - 11 KW - digital intervention KW - blended care KW - youth mental health KW - transdiagnostic intervention KW - psychotic disorders KW - borderline personality disorder KW - digital health KW - mobile phone N2 - Background: Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people?s preferences and calls for integration of these services, current mental health services rarely offer blended models of care. Objective: This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. Methods: A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. Results: eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians? competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. Conclusions: eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services. UR - https://mental.jmir.org/2024/1/e49217 UR - http://dx.doi.org/10.2196/49217 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557432 ID - info:doi/10.2196/49217 ER - TY - JOUR AU - Smith, Helm Ashley AU - Touchett, Hilary AU - Chen, Patricia AU - Fletcher, Terri AU - Arney, Jennifer AU - Hogan, Julianna AU - Wassef, Miryam AU - Cloitre, Marylene AU - Lindsay, A. Jan PY - 2024/2/2 TI - Patient Satisfaction With a Coach-Guided, Technology-Based Mental Health Treatment: Qualitative Interview Study and Theme Analysis JO - JMIR Ment Health SP - e50977 VL - 11 KW - coaching KW - digital treatment KW - interview KW - mental health KW - patient satisfaction KW - PTSD KW - qualitative assessment KW - qualitative methods KW - sentiment analysis KW - technology-based KW - telehealth KW - trauma KW - veterans KW - video telehealth KW - web-based treatment N2 - Background: Technology-based mental health interventions address barriers rural veterans face in accessing care, including provider scarcity and distance from the hospital or clinic. webSTAIR is a 10-module, web-based treatment based on Skills Training in Affective and Interpersonal Regulation, designed to treat posttraumatic stress disorder and depression in individuals exposed to trauma. Previous work has demonstrated that webSTAIR is acceptable to participants and effective at reducing symptoms of posttraumatic stress disorder and depression when delivered synchronously or asynchronously (over 5 or 10 sessions). Objective: This study explored factors that lead to greater patient satisfaction with webSTAIR, a web-based, coach-guided intervention. Methods: We analyzed qualitative interview data to identify themes related to patient satisfaction with webSTAIR delivered with synchronous video-based coaching. Results: Four themes emerged from the data: (1) coaching provides accountability and support, (2) self-pacing offers value that meets individual needs, (3) participants like the comfort and convenience of the web-based format, and (4) technical issues were common but not insurmountable. Conclusions: We conclude that participants valued the accountability, flexibility, and convenience of tech-based interventions with video-delivered coaching. UR - https://mental.jmir.org/2024/1/e50977 UR - http://dx.doi.org/10.2196/50977 UR - http://www.ncbi.nlm.nih.gov/pubmed/38306167 ID - info:doi/10.2196/50977 ER - TY - JOUR AU - van Doorn, Marilon AU - Monsanto, Anne AU - Wang, Lu Chen AU - Verfaillie, J. Sander C. AU - van Amelsvoort, J. Thérèse A. M. AU - Popma, Arne AU - Jaspers, M. Monique W. AU - Öry, Ferko AU - Alvarez-Jimenez, Mario AU - Gleeson, F. John AU - Nieman, H. Dorien PY - 2023/12/13 TI - The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study JO - JMIR Mhealth Uhealth SP - e50636 VL - 11 KW - indicative prevention KW - youth mental health KW - Moderated Online Social Therapy KW - MOST+ KW - eHealth KW - well-being KW - early detection and intervention KW - Engage Young People Early KW - ENYOY N2 - Background: To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. Objective: This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. Methods: Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54% and the dropout rate 62.6% (82/131). Results: The primary analysis (77/131, 58.8%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; ?p2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; ?p2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P?.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38% (39/102) of cases, no change in 54.9% (56/102) of cases, and worsening in 5.9% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50% (51/102), 43.1% (44/102), and 6.9% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5% (77/102) of cases for distress and 89.2% (91/102) for functioning. Conclusions: This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03315-x UR - https://mhealth.jmir.org/2023/1/e50636 UR - http://dx.doi.org/10.2196/50636 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090802 ID - info:doi/10.2196/50636 ER - TY - JOUR AU - Kerber, André AU - Beintner, Ina AU - Burchert, Sebastian AU - Knaevelsrud, Christine PY - 2023/11/6 TI - Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial JO - JMIR Ment Health SP - e45068 VL - 10 KW - patient empowerment KW - mental health?related self-management skills KW - help-seeking attitude KW - mental health literacy KW - internet-based interventions KW - unguided KW - self-guided KW - transdiagnostic mental health app N2 - Background: Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life. Objective: This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design. Methods: Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health?related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation. Results: We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity. Conclusions: A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability. Trial Registration: German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531 UR - https://mental.jmir.org/2023/1/e45068 UR - http://dx.doi.org/10.2196/45068 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930749 ID - info:doi/10.2196/45068 ER - TY - JOUR AU - Williams, Jess A. AU - Freed, Maureen AU - Theofanopoulou, Nikki AU - Daudén Roquet, Claudia AU - Klasnja, Predrag AU - Gross, James AU - Schleider, Jessica AU - Slovak, Petr PY - 2023/10/31 TI - Feasibility, Perceived Impact, and Acceptability of a Socially Assistive Robot to Support Emotion Regulation With Highly Anxious University Students: Mixed Methods Open Trial JO - JMIR Ment Health SP - e46826 VL - 10 KW - emotion regulation KW - students KW - anxiety KW - digital intervention KW - mixed-methods N2 - Background: Mental health difficulties among university students have been rising rapidly over the last decade, and the demand for university mental health services commonly far exceeds available resources. Digital interventions are seen as one potential solution to these challenges. However, as in other mental health contexts, digital programs often face low engagement and uptake, and the field lacks usable, engaging, evidence-supported mental health interventions that may be used flexibly when students need them most. Objective: The aim of this study is to investigate the feasibility and acceptability of a new, in situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in situ support for emotion regulation (ER)?a well-known transdiagnostic construct?directly in the moments when individuals are facing emotionally challenging situations. A secondary aim is to consider the perceived impact of Purrble on youth mental health, as reported by students over a 7-week deployment. Methods: A mixed methods open trial was conducted with 78 under- and postgraduate students at Oxford University. Participants were recruited based on moderate to high levels of anxiety measured by Generalized Anxiety Disorder-7 at baseline (mean 16.09, SD 3.03). All participants had access to Purrble for 7 weeks during the spring term with data on their perceived anxiety, emotion dysregulation, ER self-efficacy, and engagement with the intervention collected at baseline (pre), week 4 (mid), and week 8 (postintervention). Qualitative responses were also collected at the mid- and postintervention points. Results: The findings demonstrated a sustained engagement with Purrble over the 7-week period, with the acceptability further supported by the qualitative data indicating that students accepted Purrble and that Purrble was well-integrated into their daily routines. Exploratory quantitative data analysis indicated that Purrble was associated with reductions in student anxiety (dz=0.96, 95% CI 0.62-1.29) and emotion dysregulation (dz=0.69, 95% CI 0.38-0.99), and with an increase in ER self-efficacy (dz=?0.56, 95% CI ?0.86 to ?0.26). Conclusions: This is the first trial of a simple physical intervention that aims to provide ongoing ER support to university students. Both quantitative and qualitative data suggest that Purrble is an acceptable and feasible intervention among students, the engagement with which can be sustained at a stable level across a 7-week period while retaining a perceived benefit for those who use it (n=32, 61% of our sample). The consistency of use is particularly promising given that there was no clinician engagement or further support provided beyond Purrble being delivered to the students. These results show promise for an innovative intervention model, which could be complementary to the existing interventions. UR - https://mental.jmir.org/2023/1/e46826 UR - http://dx.doi.org/10.2196/46826 UR - http://www.ncbi.nlm.nih.gov/pubmed/37906230 ID - info:doi/10.2196/46826 ER - TY - JOUR AU - Lanssens, Dorien AU - Vandenberk, Thijs AU - Storms, Valerie AU - Thijs, Inge AU - Grieten, Lars AU - Bamelis, Lotte AU - Gyselaers, Wilfried AU - Tang, Eileen AU - Luyten, Patrick PY - 2023/9/6 TI - Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study JO - J Med Internet Res SP - e42686 VL - 25 KW - intrapersonal factors KW - peripartum period KW - pregnancy KW - pregnancy-induced hypertension KW - remote monitoring N2 - Background: The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one?s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). Objective: The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. Methods: We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. Results: Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. Conclusions: This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737 UR - https://www.jmir.org/2023/1/e42686 UR - http://dx.doi.org/10.2196/42686 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672324 ID - info:doi/10.2196/42686 ER - TY - JOUR AU - Sadeh-Sharvit, Shiri AU - Camp, Del T. AU - Horton, E. Sarah AU - Hefner, D. Jacob AU - Berry, M. Jennifer AU - Grossman, Eyal AU - Hollon, D. Steven PY - 2023/7/10 TI - Effects of an Artificial Intelligence Platform for Behavioral Interventions on Depression and Anxiety Symptoms: Randomized Clinical Trial JO - J Med Internet Res SP - e46781 VL - 25 KW - augmentation KW - anxiety KW - artificial intelligence KW - cognitive-behavioral therapy KW - community-based center KW - depression KW - evidence-based practices KW - health force burnout KW - depressive N2 - Background: The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral health care services by helping clinicians collect objective data on patients? progress, streamline their workflow, and automate administrative tasks. Objective: The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy. Methods: The study was conducted at a community-based clinic in the United States. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health was compared to a treatment-as-usual (TAU) approach during the first 2 months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the use of evidence-based practices, and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session?s progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on an intention-to-treat approach from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness. Results: A total of 72 patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34/47, 72% women and 13/47, 28% men; mean age 30.64, SD 11.02 years), with 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% (mean 5.24, SD 2.31) more sessions compared to those in TAU (mean 3.14, SD 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. Further, therapists using the AI platform submitted their progress notes, on average, 55 hours earlier than therapists in the TAU group (t=?0.73; P<.001). Conclusions: In this randomized controlled trial, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy. Trial Registration: ClinicalTrials.gov NCT05745103; https://classic.clinicaltrials.gov/ct2/show/NCT05745103 UR - https://www.jmir.org/2023/1/e46781 UR - http://dx.doi.org/10.2196/46781 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428547 ID - info:doi/10.2196/46781 ER - TY - JOUR AU - Obuobi-Donkor, Gloria AU - Eboreime, Ejemai AU - Shalaby, Reham AU - Agyapong, Belinda AU - Phung, Natalie AU - Eyben, Scarlett AU - Wells, Kristopher AU - Dias, Luz Raquel da AU - Hilario, Carla AU - Jones, Chelsea AU - Brémault-Phillips, Suzette AU - Zhang, Yanbo AU - Greenshaw, J. Andrew AU - Agyapong, Opoku Vincent Israel PY - 2023/6/23 TI - User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study JO - JMIR Form Res SP - e46431 VL - 7 KW - public safety personnel KW - Text4PTSI KW - text messaging KW - satisfaction KW - occupational health KW - work safety KW - public safety KW - digital health intervention KW - mental health service KW - user satisfaction N2 - Background: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. Objective: This study aims to evaluate users? satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)?based supportive SMS text messaging intervention (Text4PTSI). Methods: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral?based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents? perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. Results: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). Conclusions: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users. UR - https://formative.jmir.org/2023/1/e46431 UR - http://dx.doi.org/10.2196/46431 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351940 ID - info:doi/10.2196/46431 ER - TY - JOUR AU - Lauvsnes, Forsmo Anders Dahlen AU - Hansen, Ivar Tor AU - Ankill, Øiungen Sebastian AU - Bae, Won Sang AU - Gråwe, W. Rolf AU - Braund, A. Taylor AU - Larsen, Mark AU - Langaas, Mette PY - 2023/6/23 TI - Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study JO - JMIR Form Res SP - e45254 VL - 7 KW - executive functioning KW - substance use disorder KW - ecological momentary assessment KW - clinical inference KW - substance use KW - pilot study KW - mood KW - mental health KW - neurocognitive functioning KW - smartphone use KW - mobile sensor KW - sensor KW - decision support KW - mobile phone N2 - Background: Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. Objective: This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. Methods: In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone?s battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. Results: A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. Conclusions: This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes. UR - https://formative.jmir.org/2023/1/e45254 UR - http://dx.doi.org/10.2196/45254 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351934 ID - info:doi/10.2196/45254 ER - TY - JOUR AU - La Sala, Louise AU - Pirkis, Jane AU - Cooper, Charlie AU - Hill, M. Nicole T. AU - Lamblin, Michelle AU - Rajaram, Gowri AU - Rice, Simon AU - Teh, Zoe AU - Thorn, Pinar AU - Zahan, Rifat AU - Robinson, Jo PY - 2023/5/19 TI - Acceptability and Potential Impact of the #chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study JO - JMIR Hum Factors SP - e44535 VL - 10 KW - youth KW - suicide KW - social media KW - suicide postvention KW - suicide prevention KW - contagion KW - postvention N2 - Background: Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. Objective: This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. Methods: A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the #chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. Results: After the 6-week #chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the #chatsafe intervention via social media, and no iatrogenic effects were recorded. Conclusions: The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as #chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people. UR - https://humanfactors.jmir.org/2023/1/e44535 UR - http://dx.doi.org/10.2196/44535 UR - http://www.ncbi.nlm.nih.gov/pubmed/37204854 ID - info:doi/10.2196/44535 ER - TY - JOUR AU - Gutierrez, Gilmar AU - Stephenson, Callum AU - Eadie, Jazmin AU - Moghimi, Elnaz AU - Omrani, Mohsen AU - Groll, Dianne AU - Soares, N. Claudio AU - Milev, Roumen AU - Vazquez, Gustavo AU - Yang, Megan AU - Alavi, Nazanin PY - 2023/5/19 TI - Evaluating the Efficacy of Web-Based Cognitive Behavioral Therapy for the Treatment of Patients With Bipolar II Disorder and Residual Depressive Symptoms: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e46157 VL - 12 KW - bipolar disorder KW - cognitive behavioral therapy KW - depression KW - eHealth KW - electronic care KW - internet KW - mental health KW - psychotherapy KW - treatment KW - web-based therapy N2 - Background: Bipolar disorder (BD) is a highly prevalent psychiatric condition that can significantly impact every aspect of a person?s life if left untreated. A subtype of BD, bipolar disorder type II (BD-II), is characterized by long depressive episodes and residual depression symptoms, with short-lived hypomanic episodes. Medication and psychotherapy, such as cognitive behavioral therapy (CBT), are the main treatment options for BD-II. CBT specific for BD-II involves the recognition of warning signs, potentially triggering stimuli, and the development of coping skills to increase euthymic periods and improve global functioning. However, access to in-person CBT may be limited by several barriers, including low availability, high costs, and geographical limitations. Thus, web-based adaptations of CBT (e-CBT) have become a promising solution to address these treatment barriers. Nevertheless, e-CBT for the treatment of BD-II remains understudied. Objective: The proposed study aims to establish the first e-CBT program specific for the treatment of BD-II with residual depressive symptoms. The primary objective of this study will be to determine the effect of e-CBT in managing BD symptomatology. The secondary objective will be to assess the effects of this e-CBT program on quality of life and resilience. The tertiary objective will involve gathering user feedback using a posttreatment survey to support the continuous improvement and optimization of the proposed program. Methods: Adult participants (N=170) with a confirmed diagnosis of BD-II experiencing residual depressive symptoms will be randomly assigned to either the e-CBT and treatment as usual (TAU; n=85) group or the TAU (n=85) control group. Participants in the control group will be able to participate in the web-based program after the first 13 weeks. The e-CBT program will consist of 13 weekly web-based modules designed following a validated CBT framework. Participants will complete module-related homework and receive asynchronous personalized feedback from a therapist. TAU will consist of standard treatment services conducted outside of this research study. Depression and manic symptoms, quality of life, and resiliency will be assessed using clinically validated symptomatology questionnaires at baseline, week 6, and week 13. Results: The study received ethics approval in March 2020, and participant recruitment is expected to begin in February 2023 through targeted advertisements and physician referrals. Data collection and analysis are expected to conclude by December 2024. Linear and binomial regression (continuous and categorical outcomes, respectively) will be conducted along with qualitative interpretive methods. Conclusions: The findings will be the first on the effectiveness of delivering e-CBT for patients with BD-II with residual depressive symptoms. This approach can provide an innovative method to address barriers to in-person psychotherapy by increasing accessibility and decreasing costs. Trial Registration: ClinicalTrials.gov NCT04664257; https://clinicaltrials.gov/ct2/show/NCT04664257 International Registered Report Identifier (IRRID): PRR1-10.2196/46157 UR - https://www.researchprotocols.org/2023/1/e46157 UR - http://dx.doi.org/10.2196/46157 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140460 ID - info:doi/10.2196/46157 ER - TY - JOUR AU - Thomas, Kroska Emily Brenny AU - Sagorac Gruichich, Tijana AU - Maronge, M. Jacob AU - Hoel, Sydney AU - Victory, Amanda AU - Stowe, N. Zachary AU - Cochran, Amy PY - 2023/5/15 TI - Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial JO - JMIR Ment Health SP - e43065 VL - 10 KW - acceptance and commitment therapy KW - randomized controlled trials KW - mobile health KW - mHealth KW - first-generation college students KW - psychological flexibility KW - distress KW - depression N2 - Background: Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. Objective: This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. Methods: Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. Results: The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. Conclusions: An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. Trial Registration: ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662 International Registered Report Identifier (IRRID): RR2-10.2196/17086 UR - https://mental.jmir.org/2023/1/e43065 UR - http://dx.doi.org/10.2196/43065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184896 ID - info:doi/10.2196/43065 ER - TY - JOUR AU - Yoshinaga, Naoki AU - Thew, R. Graham AU - Hayashi, Yuta AU - Matsuoka, Jun AU - Tanoue, Hiroki AU - Takanashi, Rieko AU - Araki, Mutsumi AU - Kanai, Yoshihiro AU - Smith, Alisha AU - Grant, L. Sophie H. AU - Clark, M. David PY - 2023/5/5 TI - Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan JO - JMIR Form Res SP - e45136 VL - 7 KW - benchmarking KW - anxiety KW - social anxiety KW - social phobia KW - cognitive behavioral therapy KW - cognitive therapy KW - cross-cultural comparison KW - Japan KW - mental disorders KW - internet-based intervention KW - mobile phone N2 - Background: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. Objective: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. Methods: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety?related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants? feedback about their experience with the iCT-SAD. Results: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. Conclusions: Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly. UR - https://formative.jmir.org/2023/1/e45136 UR - http://dx.doi.org/10.2196/45136 UR - http://www.ncbi.nlm.nih.gov/pubmed/37145850 ID - info:doi/10.2196/45136 ER - TY - JOUR AU - Peynenburg, Vanessa AU - Sapkota, P. Ram AU - Lozinski, Tristen AU - Sundström, Christopher AU - Wilhelms, Andrew AU - Titov, Nickolai AU - Dear, Blake AU - Hadjistavropoulos, Heather PY - 2023/4/18 TI - The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study JO - JMIR Ment Health SP - e44722 VL - 10 KW - internet-delivered cognitive behavioral therapy KW - transdiagnostic KW - depression KW - anxiety KW - alcohol KW - drinking N2 - Background: Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. Objective: This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. Methods: All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients? use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients? alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. Results: During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, divorced, or widowed (P<.001). Reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) over time; in contrast, there was no change in clients? drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. Conclusions: Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource. UR - https://mental.jmir.org/2023/1/e44722 UR - http://dx.doi.org/10.2196/44722 UR - http://www.ncbi.nlm.nih.gov/pubmed/37071454 ID - info:doi/10.2196/44722 ER - TY - JOUR AU - Robinson, Jo AU - La Sala, Louise AU - Cooper, Charlie AU - Spittal, Matthew AU - Rice, Simon AU - Lamblin, Michelle AU - Brown, Ellie AU - Nolan, Hayley AU - Battersby-Coulter, Rikki AU - Rajaram, Gowri AU - Thorn, Pinar AU - Pirkis, Jane AU - May-Finlay, Summer AU - Silenzio, Vincent AU - Skehan, Jaelea AU - Krysinska, Karolina AU - Bellairs-Walsh, India PY - 2023/2/17 TI - Testing the Impact of the #chatsafe Intervention on Young People?s Ability to Communicate Safely About Suicide on Social Media: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e44300 VL - 12 KW - suicide KW - young people KW - social media KW - intervention, sexual health, randomized-controlled trial N2 - Background: Suicide is the leading cause of death among Australians. One commonly cited explanation is the impact of social media, in particular, the ways in which young people use social media to communicate about their own experiences and their exposure to suicide-related content posted by others. Guidelines designed to assist mainstream media to safely report about suicide are widespread. Until recently, no guidelines existed that targeted social media or young people. In response, we developed the #chatsafe guidelines and a supporting social media campaign, which together make up the #chatsafe intervention. The intervention was tested in a pilot study with positive results. However, the study was limited by the lack of a control group. Objective: The aim of this study is to assess the impact of the #chatsafe social media intervention on young people?s safety and confidence when communicating on the web about suicide. Methods: The study employs a pragmatic, parallel, superiority randomized controlled design. It will be conducted in accordance with the Consolidated Standards of Reporting Trials statement over 18 months. Participants will be 400 young people aged 16-25 years (200 per arm). Participants will be recruited via social media advertising and assessed at 3 time points: time 1?baseline; time 2?8-week postintervention commencement; and time 3?4-week postintervention. They will be asked to complete a weekly survey to monitor safety and evaluate each piece of social media content. The intervention comprises an 8-week social media campaign including social media posts shared on public Instagram profiles. The intervention group will receive the #chatsafe suicide prevention content and the control group will receive sexual health content. Both groups will receive 24 pieces of content delivered to their mobile phones via text message. The primary outcome is safety when communicating on the web about suicide, as measured via the purpose-designed #chatsafe online safety questionnaire. Additional outcomes include willingness to intervene against suicide, internet self-efficacy, safety, and acceptability. Results: The study was funded in November 2020, approved by the University of Melbourne Human Research Ethics Committee on October 7, 2022, and prospectively registered with the Australian New Zealand Clinical Trials registry. Trial recruitment began in November 2022 and study completion is anticipated by June 2024. Conclusions: This will be the first randomized controlled trial internationally to test the impact of a social media intervention designed to equip young people to communicate safely on the web about suicide. Given the rising rates of youth suicide in Australia and the acceptability of social media among young people, incorporating social media?based interventions into the suicide prevention landscape is an obvious next step. This intervention, if effective, could also be extended internationally, thereby improving web-based safety for young people not just in Australia but globally. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622001397707; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384318 International Registered Report Identifier (IRRID): DERR1-10.2196/44300 UR - https://www.researchprotocols.org/2023/1/e44300 UR - http://dx.doi.org/10.2196/44300 UR - http://www.ncbi.nlm.nih.gov/pubmed/36800220 ID - info:doi/10.2196/44300 ER - TY - JOUR AU - Brodbeck, Jeannette AU - Jacinto, Sofia AU - Gouveia, Afonso AU - Mendonça, Nuno AU - Madörin, Sarah AU - Brandl, Lena AU - Schokking, Lotte AU - Rodrigues, Maria Ana AU - Gonçalves, Judite AU - Mooser, Bettina AU - Marques, M. Marta AU - Isaac, Joana AU - Nogueira, Vasco AU - Matos Pires, Ana AU - van Velsen, Lex PY - 2022/11/30 TI - A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries JO - JMIR Res Protoc SP - e37827 VL - 11 IS - 11 KW - bereavement KW - cognitive behavioral therapy KW - CBT KW - cost-effectiveness KW - electronic mental health KW - grief KW - technology acceptance N2 - Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n?85), the Netherlands (n?40), and Portugal (n?80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention?s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20). Results: The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023. Conclusions: The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons. Trial Registration: Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346 International Registered Report Identifier (IRRID): PRR1-10.2196/37827 UR - https://www.researchprotocols.org/2022/11/e37827 UR - http://dx.doi.org/10.2196/37827 UR - http://www.ncbi.nlm.nih.gov/pubmed/36449341 ID - info:doi/10.2196/37827 ER - TY - JOUR AU - González-Robles, Alberto AU - Roca, Pablo AU - Díaz-García, Amanda AU - García-Palacios, Azucena AU - Botella, Cristina PY - 2022/10/31 TI - Long-term Effectiveness and Predictors of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Emotional Disorders in Specialized Care: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Ment Health SP - e40268 VL - 9 IS - 10 KW - transdiagnostic KW - anxiety KW - depression KW - long term KW - predictors N2 - Background: Transdiagnostic internet-delivered cognitive behavioral therapy (iCBT) for emotional disorders has been shown to be effective in specialized care in the short term. However, less is known about its long-term effects in this specific setting. In addition, predictors of long-term effectiveness may help to identify what treatments are more suitable for certain individuals. Objective: This study aimed to analyze the long-term effectiveness of transdiagnostic iCBT compared with that of treatment as usual (TAU) in specialized care and explore predictors of long-term effectiveness. Methods: Mixed models were performed to analyze the long-term effectiveness and predictors of transdiagnostic iCBT (n=99) versus TAU (n=101) in public specialized mental health care. Outcomes included symptoms of depression and anxiety, health-related quality of life (QoL), behavioral inhibition and behavioral activation, comorbidity, and diagnostic status (ie, loss of principal diagnosis) from baseline to 1-year follow-up. Sociodemographic characteristics (sex, age, and education) and clinical variables (principal diagnosis, comorbidity, and symptom severity at baseline) were selected as predictors of long-term changes. Results: Compared with baseline, transdiagnostic iCBT was more effective than TAU in improving symptoms of depression (b=?4.16, SE 1.80, 95% CI ?7.68 to ?0.67), health-related QoL (b=7.63, SE 3.41, 95% CI 1.00-14.28), diagnostic status (b=?0.24, SE 0.09, 95% CI ?1.00 to ?0.15), and comorbidity at 1-year follow-up (b=?0.58, SE 0.22, 95% CI ?1.00 to ?0.15). From pretreatment assessment to follow-up, anxiety symptoms improved in both transdiagnostic iCBT and TAU groups, but no significant differences were found between the groups. Regarding the predictors of the long-term effectiveness of transdiagnostic iCBT compared with that of TAU, higher health-related QoL at follow-up was predicted by a baseline diagnosis of anxiety, male sex, and the use of psychiatric medication; fewer comorbid disorders at follow-up were predicted by older age and higher baseline scores on health-related QoL; and fewer depressive symptoms at follow-up were predicted by baseline diagnosis of depression. However, this pattern was not observed for baseline anxiety diagnoses and anxiety symptoms. Conclusions: The results suggest that transdiagnostic iCBT is more effective than TAU to target depressive symptoms among patients with emotional disorders. Anxiety symptoms remained stable at 1-year follow-up, with no differences between the groups. Results on predictors suggest that some groups of patients may obtain specific gains after transdiagnostic iCBT. Specifically, and consistent with the literature, patients with baseline depression improved their depression scores at follow-up. However, this pattern was not found for baseline anxiety disorders. More studies on the predictor role of sociodemographic and clinical variables in long-term outcomes of transdiagnostic iCBT are warranted. Future studies should focus on studying the implementation of transdiagnostic iCBT in Spanish public specialized mental health care. Trial Registration: ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668 UR - https://mental.jmir.org/2022/10/e40268 UR - http://dx.doi.org/10.2196/40268 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315227 ID - info:doi/10.2196/40268 ER - TY - JOUR AU - Mehta, Meherwan Urvakhsh AU - Basavaraju, Rakshathi AU - Ramesh, Abhishek AU - Kesavan, Muralidharan AU - Thirthalli, Jagadisha PY - 2022/10/21 TI - Motor Resonance During Action Observation and Its Relevance to Virtual Clinical Consultations: Observational Study Using Transcranial Magnetic Stimulation JO - JMIR Ment Health SP - e40652 VL - 9 IS - 10 KW - mirror neuron activity KW - virtual interactions KW - digital psychiatry KW - telepsychiatry KW - virtual mental health interventions KW - motor resonance N2 - Background: Virtual clinical interactions have increased tremendously since the onset of the COVID-19 pandemic. While they certainly have their advantages, there also exist potential limitations, for example, in establishing a therapeutic alliance, discussing complex clinical scenarios, etc. This may be due to possible disruptions in the accurate activation of the human mirror neuron system (MNS), a posited physiological template for effective social communication. Objective: This study aimed to compare motor resonance, a putative marker of MNS activity, estimated using transcranial magnetic stimulation (TMS) elicited while viewing virtual (video-based) and actual or real (enacted by a person) actions in healthy individuals. We hypothesized that motor resonance will be greater during real compared to virtual action observation. Methods: We compared motor resonance or motor-evoked potential (MEP) facilitation during the observation of virtual (presented via videos) and real (enacted in person) actions, relative to static image observation in healthy individuals using TMS. The MEP recordings were obtained by 2 single-pulse (neuronal membrane excitability?driven) TMS paradigms of different intensities and 2 paired-pulse (cortical gamma-aminobutyric acid-interneuron?driven) TMS paradigms. Results: This study comprised 64 participants. Using the repeated measures ANOVA, we observed a significant time effect for MEP facilitation from static to virtual and real observation states when recorded using 3 of the 4 TMS paradigms. Post hoc pairwise comparisons with Benjamini-Hochberg false discovery rate correction revealed significant MEP facilitation in both virtual and real observation states relative to static image observation; however, we also observed a significant time effect between the 2 action observation states (real > virtual) with 2 of the 4 TMS paradigms. Conclusions: Our results indicate that visual cues expressed via both virtual (video) or real (in person) modes elicit physiological responses within the putative MNS, but this effect is more pronounced for actions presented in person. This has relevance to the appropriate implementation of digital health solutions, especially those pertaining to mental health. UR - https://mental.jmir.org/2022/10/e40652 UR - http://dx.doi.org/10.2196/40652 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269658 ID - info:doi/10.2196/40652 ER - TY - JOUR AU - Dambi, Jermaine AU - Norman, Clara AU - Doukani, Asmae AU - Potgieter, Stephan AU - Turner, Jean AU - Musesengwa, Rosemary AU - Verhey, Ruth AU - Chibanda, Dixon PY - 2022/10/7 TI - A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study JO - JMIR Ment Health SP - e37968 VL - 9 IS - 10 KW - acceptability KW - COVID-19 KW - feasibility KW - Friendship Bench KW - Inuka KW - pilot KW - task-shifting KW - Zimbabwe N2 - Background: Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web. Objective: We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka. Methods: Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis. Results: Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants? mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data, and power outages cited as potential barriers to scale up. Generally, there was a decline in CMDs (F2,73=2.63; P=.08), depression (F2,73=7.67; P<.001), and anxiety (F2,73=2.95; P=.06) and a corresponding increase in HRQoL (F2,73=7.287; P<.001) in both groups. Conclusions: Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app?s double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed. UR - https://mental.jmir.org/2022/10/e37968 UR - http://dx.doi.org/10.2196/37968 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960595 ID - info:doi/10.2196/37968 ER - TY - JOUR AU - Suchan, Victoria AU - Peynenburg, Vanessa AU - Thiessen, David AU - Nugent, Marcie AU - Dear, Blake AU - Titov, Nickolai AU - Hadjistavropoulos, Heather PY - 2022/9/6 TI - Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Symptoms of Postpartum Anxiety and Depression: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e37216 VL - 6 IS - 9 KW - postpartum depression KW - postpartum anxiety KW - internet-delivered cognitive behavioral therapy KW - transdiagnostic KW - therapist assistance N2 - Background: Postpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and are associated with significant personal and economic costs. Fewer than half of the mothers experiencing PPD or PPA symptoms receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behavioral therapy (ICBT). Objective: This pilot study aimed to examine the impact of a therapist-assisted, transdiagnostic ICBT program on symptoms of PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population, which did not include therapist assistance. Methods: Clients endorsing the symptoms of PPD or PPA (N=63) were randomized to an 8-week transdiagnostic ICBT course (Wellbeing Course for New Moms) or to treatment as usual (TAU). Clients completed measures of depression, anxiety, stress, postnatal bonding, and relationship satisfaction, as well as measures of treatment satisfaction and therapeutic alliance, before treatment, after treatment, and at the 1-month follow-up. Outcome measures were also completed at the 6-month follow-up for clients who completed the ICBT course. Results: Both the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements after treatment and at the 1-month follow-up on more measures than the TAU group, with medium between-group Cohen d effects on primary outcome measures for anxiety (Cohen d=0.65, 95% CI 0.13-1.17), PPD (Cohen d=0.52, 95% CI 0.01-1.04), and depression (Cohen d=0.56, 95% CI 0.05-1.08), and on secondary outcome measures of overall distress (Cohen d=0.69, 95% CI 0.17-1.21), anxiety (Cohen d=0.59, 95% CI 0.07-1.11), and stress (Cohen d=0.76, 95% CI 0.23-1.28). Time-by-group interactions for proportional reductions between groups over time were only significant after treatment and at the 1-month follow-up for the primary anxiety measure (P=.006). This study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible, and 95% (21/22) of the clients were satisfied with the treatment content and therapist support. Conclusions: Findings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD and PPA symptoms to improve access to psychological treatments. Trial Registration: ClinicalTrials.gov NCT04012580; https://clinicaltrials.gov/ct2/show/NCT04012580 UR - https://formative.jmir.org/2022/9/e37216 UR - http://dx.doi.org/10.2196/37216 UR - http://www.ncbi.nlm.nih.gov/pubmed/36066958 ID - info:doi/10.2196/37216 ER - TY - JOUR AU - Six, G. Stephanie AU - Byrne, A. Kaileigh AU - Aly, Heba AU - Harris, W. Maggie PY - 2022/8/9 TI - The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e39516 VL - 9 IS - 8 KW - depression KW - mental health apps KW - customization KW - personalization KW - cognitive behavioral therapy KW - avatars KW - mobile phone N2 - Background: Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. Objective: The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)?based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. Methods: College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one?s own preferences and use of one?s name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. Results: Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=?0.312, P=.02; connection: r=?0.305, P=.02; and lack of relatability: r=0.338, P=.01). Conclusions: These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. Trial Registration: Open Science Framework t28gm; https://osf.io/t28gm UR - https://mental.jmir.org/2022/8/e39516 UR - http://dx.doi.org/10.2196/39516 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943788 ID - info:doi/10.2196/39516 ER - TY - JOUR AU - Ma, S. Jennifer AU - O?Riordan, Megan AU - Mazzer, Kelly AU - Batterham, J. Philip AU - Bradford, Sally AU - Kõlves, Kairi AU - Titov, Nickolai AU - Klein, Britt AU - Rickwood, J. Debra PY - 2022/8/5 TI - Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study JO - JMIR Hum Factors SP - e34514 VL - 9 IS - 3 KW - consumer KW - community KW - help-seeker KW - perspective KW - technology KW - artificial intelligence KW - crisis KW - support KW - acceptability N2 - Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline?s crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline?s crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline?s crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline?s crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. UR - https://humanfactors.jmir.org/2022/3/e34514 UR - http://dx.doi.org/10.2196/34514 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930334 ID - info:doi/10.2196/34514 ER - TY - JOUR AU - Young, S. Alexander AU - Choi, Abigail AU - Cannedy, Shay AU - Hoffmann, Lauren AU - Levine, Lionel AU - Liang, Li-Jung AU - Medich, Melissa AU - Oberman, Rebecca AU - Olmos-Ochoa, T. Tanya PY - 2022/8/5 TI - Passive Mobile Self-tracking of Mental Health by Veterans With Serious Mental Illness: Protocol for a User-Centered Design and Prospective Cohort Study JO - JMIR Res Protoc SP - e39010 VL - 11 IS - 8 KW - serious mental illness KW - mobile health KW - mental health KW - passive sensing KW - health informatics KW - behavior KW - sensor KW - self-tracking KW - predict KW - assessment N2 - Background: Serious mental illnesses (SMI) are common, disabling, and challenging to treat, requiring years of monitoring and treatment adjustments. Stress or reduced medication adherence can lead to rapid worsening of symptoms and behaviors. Illness exacerbations and relapses generally occur with little or no clinician awareness in real time, leaving limited opportunity to modify treatments. Previous research suggests that passive mobile sensing may be beneficial for individuals with SMI by helping them monitor mental health status and behaviors, and quickly detect worsening mental health for prompt assessment and intervention. However, there is too little research on its feasibility and acceptability and the extent to which passive data can predict changes in behaviors or symptoms. Objective: The aim of this research is to study the feasibility, acceptability, and safety of passive mobile sensing for tracking behaviors and symptoms of patients in treatment for SMI, as well as developing analytics that use passive data to predict changes in behaviors and symptoms. Methods: A mobile app monitors and transmits passive mobile sensor and phone utilization data, which is used to track activity, sociability, and sleep in patients with SMI. The study consists of a user-centered design phase and a mobile sensing phase. In the design phase, focus groups, interviews, and usability testing inform further app development. In the mobile sensing phase, passive mobile sensing occurs with participants engaging in weekly assessments for 9 months. Three- and nine-month interviews study the perceptions of passive mobile sensing and ease of app use. Clinician interviews before and after the mobile sensing phase study the usefulness and feasibility of app utilization in clinical care. Predictive analytic models are built, trained, and selected, and make use of machine learning methods. Models use sensor and phone utilization data to predict behavioral changes and symptoms. Results: The study started in October 2020. It has received institutional review board approval. The user-centered design phase, consisting of focus groups, usability testing, and preintervention clinician interviews, was completed in June 2021. Recruitment and enrollment for the mobile sensing phase began in October 2021. Conclusions: Findings may inform the development of passive sensing apps and self-tracking in patients with SMI, and integration into care to improve assessment, treatment, and patient outcomes. Trial Registration: ClinicalTrials.gov NCT05023252; https://clinicaltrials.gov/ct2/show/NCT05023252 International Registered Report Identifier (IRRID): DERR1-10.2196/39010 UR - https://www.researchprotocols.org/2022/8/e39010 UR - http://dx.doi.org/10.2196/39010 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930336 ID - info:doi/10.2196/39010 ER - TY - JOUR AU - Michalak, E. Erin AU - Barnes, J. Steven AU - Morton, Emma AU - O'Brien, L. Heather AU - Murray, Greg AU - Hole, Rachelle AU - Meyer, Denny PY - 2022/8/4 TI - Supporting Self-management and Quality of Life in Bipolar Disorder With the PolarUs App (Alpha): Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e36213 VL - 11 IS - 8 KW - eHealth KW - mobile health KW - mHealth KW - bipolar disorder KW - self-management KW - engagement KW - mobile phone N2 - Background: Quality of life (QoL) is increasingly being recognized as a key outcome of interventions for bipolar disorder (BD). Mobile phone apps can increase access to evidence-based self-management strategies and provide real-time support. However, although individuals with lived experiences desire support with monitoring and improving broader health domains, existing BD apps largely target mood symptoms only. Further, evidence from the broader mobile health (mHealth) literature has shown that the desires and goals of end users are not adequately considered during app development, and as a result, engagement with mental health apps is suboptimal. To capitalize on the potential of apps to optimize wellness in BD, there is a need for interventions developed in consultation with real-world users designed to support QoL self-monitoring and self-management. Objective: This mixed methods pilot study was designed to evaluate the alpha version of the newly developed PolarUs app, developed to support QoL self-monitoring and self-management in people with BD. Co-designed using a community-based participatory research framework, the PolarUs app builds on the web-based adaptation of a BD-specific QoL self-assessment measure and integrates material from a web-based portal providing information on evidence-informed self-management strategies in BD. The primary objectives of this project were to evaluate PolarUs app feasibility (via behavioral use metrics), the impact of PolarUs (via the Brief Quality of Life in Bipolar Disorder scale, our primary outcome measure), and explore engagement with the PolarUs app (via quantitative and qualitative methods). Methods: Participants will be residents of North America (N=150), aged >18 years, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of BD type 1, BD type 2, or BD not otherwise specified as assessed by structured diagnostic interview. An embedded mixed methods research design will be adopted; qualitative interviews with a purposefully selected subsample (approximately, n=30) of participants will be conducted to explore in more depth feasibility, impact, and engagement with the PolarUs app over the 12-week study period. Results: At the time of publication of this protocol, the development of the alpha version of the PolarUs app was complete. Participant enrollment has begun in June 2022. Data collection is expected to be completed by December 2022. Conclusions: Beyond contributing knowledge on the feasibility and impact of a novel app to support QoL and self-management in BD, this study will also provide new insights related to engagement with mHealth apps. Furthermore, it will function as a case study of successful co-design between people with BD, health care providers, and BD researchers, providing a template for the future use of community-based participatory research frameworks in mHealth intervention development. The results will be used to further refine the PolarUs app and inform the design of a larger clinical trial. International Registered Report Identifier (IRRID): PRR1-10.2196/36213 UR - https://www.researchprotocols.org/2022/8/e36213 UR - http://dx.doi.org/10.2196/36213 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925666 ID - info:doi/10.2196/36213 ER - TY - JOUR AU - Petrovic, Milica AU - Bonanno, Silvia AU - Landoni, Marta AU - Ionio, Chiara AU - Hagedoorn, Mariët AU - Gaggioli, Andrea PY - 2022/8/2 TI - Using the Transformative Storytelling Technique to Generate Empowering Narratives for Informal Caregivers: Semistructured Interviews, Thematic Analysis, and Method Demonstration JO - JMIR Form Res SP - e36405 VL - 6 IS - 8 KW - informal care KW - story KW - storytelling KW - stories KW - patient narrative KW - digital narrative KW - informal caregiver KW - caregiver KW - caregiving KW - transformative storytelling technique KW - audio stories KW - audio story KW - digital health KW - eHealth KW - empower KW - fiction KW - life narrative KW - audio narrative KW - self-help KW - user-centered design KW - human-centered design KW - innovation in mental health KW - mental health KW - therapy N2 - Background: The transformative storytelling technique is an innovative top-down approach to narrative therapy that aims to provide building blocks for creating flourishing narratives for target groups or populations. This approach acts as a facilitator for implementing the human-centered design in developing digital self-help tools for larger samples or target groups. Objective: This study applied the transformative storytelling technique, as a new approach in mental health, to develop empowering audio narratives for informal caregivers. Methods: A narrative inquiry was conducted with 17 informal caregivers (16 women and 1 man) who completed a semistructured interview, ?Caregiver Life Story,? acquiring information about the beginning of the role, rising action, and critical point of the role. The participants? ages ranged from 41 to 84 years, with all participants providing care for at least a 6-month period. This inquiry was guided by the transformative storytelling technique, and aimed to collect data relevant to creating fictional stories based on real-life themes. Results: Twenty-five overall themes were distinguished across three a priori?set categories, providing narrative building blocks for the informal caregiver life stories. The final empowering caregiver life story was created as an example for this study, demonstrating the application of the transformative storytelling technique in an informal care context. Conclusions: The creation of empowering stories for populations or target groups in mental health care requires a unified and guided approach that will follow clear guidelines and storytelling principles. The transformative storytelling technique is a first of its kind in the mental health context, representing an initial step in enabling and supporting the creation of meaningful stories and the development of relatable, but productive, narratives. Such narratives have the potential to serve across media and digital platforms for supporting and improving well-being, and potentially triggering self-change in the target group or population. UR - https://formative.jmir.org/2022/8/e36405 UR - http://dx.doi.org/10.2196/36405 UR - http://www.ncbi.nlm.nih.gov/pubmed/35802492 ID - info:doi/10.2196/36405 ER - TY - JOUR AU - Carney, E. Colleen AU - Carmona, E. Nicole PY - 2022/6/13 TI - Authors? Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on ?Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study? JO - JMIR Form Res SP - e39198 VL - 6 IS - 6 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone KW - smartphone KW - polysomnography UR - https://formative.jmir.org/2022/6/e39198 UR - http://dx.doi.org/10.2196/39198 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699990 ID - info:doi/10.2196/39198 ER - TY - JOUR AU - Tsai, Wan-Tong AU - Liu, Tzung-Liang PY - 2022/6/13 TI - Additional Measurement Approaches for Sleep Disturbances. Comment on ?A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study? JO - JMIR Form Res SP - e35959 VL - 6 IS - 6 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone KW - smartphone KW - polysomnography UR - https://formative.jmir.org/2022/6/e35959 UR - http://dx.doi.org/10.2196/35959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700003 ID - info:doi/10.2196/35959 ER - TY - JOUR AU - Dewa, H. Lindsay AU - Pappa, Sofia AU - Greene, Talya AU - Cooke, James AU - Mitchell, Lizzie AU - Hadley, Molly AU - Di Simplicio, Martina AU - Woodcock, Thomas AU - Aylin, Paul PY - 2022/5/17 TI - The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e33817 VL - 11 IS - 5 KW - sleep KW - suicide KW - psychiatric inpatient KW - ecological momentary assessment KW - EMA KW - experience sampling KW - coproduction KW - sleep disturbance KW - discharge N2 - Background: Patients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge. Objective: Our study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients. Methods: Our study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality. Results: South Birmingham Research Ethics Committee (21/WM/0128) approved the study on June 28, 2021. We expect to see a relationship between poor sleep and postdischarge suicidality. Results will be available in 2022. Conclusions: This protocol describes the first coproduced EMA study to examine the relationship between sleep and suicidality and to apply the integrated motivational volitional model in young patients transitioning from a psychiatric hospital to the community. We expect our findings will inform coproduction in suicidology research and clarify the role of digital monitoring of suicidality and sleep before and after initial hospital discharge. International Registered Report Identifier (IRRID): PRR1-10.2196/33817 UR - https://www.researchprotocols.org/2022/5/e33817 UR - http://dx.doi.org/10.2196/33817 UR - http://www.ncbi.nlm.nih.gov/pubmed/35579920 ID - info:doi/10.2196/33817 ER - TY - JOUR AU - Tsoi, S. Emily W. AU - Mak, S. Winnie W. AU - Ho, Y. Connie Y. AU - Yeung, Y. Gladys T. PY - 2022/5/13 TI - A Web-Based Stratified Stepped Care Mental Health Platform (TourHeart): Semistructured Interviews With Stakeholders JO - JMIR Hum Factors SP - e35057 VL - 9 IS - 2 KW - stepped care KW - recovery KW - engagement KW - eHealth KW - mental health KW - mental well-being KW - psychological intervention N2 - Background: TourHeart, a web-based stratified stepped care mental health platform, is a one-stop solution that integrates psychoeducation and other well-being promotional tools for mental health promotion and mental illness prevention and evidence-based, low-intensity psychological interventions for the treatment of people with anxiety and depressive symptoms. Instead of focusing only on symptom reduction, the platform aims to be person-centered and recovery-oriented, and continual feedback from stakeholders is sought. Understanding the perspectives of users and service providers enables platform developers to fine-tune both the design and content of the services for enhanced service personalization and personal recovery. Objective: This qualitative study evaluated a web-based mental health platform by incorporating the perspectives of both users and service providers who administered the platform and provided coaching services. The platform included both web-based and offline services targeting adults along the mental health spectrum based on the two-continua model of mental health and mental illness. Methods: Interview questions were designed based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM). Views on offline services, the design of the web-based platform, user experience, and the contents of the platform were explored using semistructured interviews. A total of 27 service users and 22 service providers were recruited using purposive criterion sampling. A hybrid thematic analysis was performed to identify salient aspects of users? and providers? experiences with and views of the platform. Results: Totally, 3 broad themes (namely, the quality of the platform, drivers for platform use, and coaching services) emerged from the interview data that highlighted users? views of and experiences with the web-based platform. The platform?s general esthetics, operations, and contents were found to be critical features and drivers for continued use. Although coaching services were indispensable, participants preferred the autonomy and anonymity associated with web-based mental health services. Conclusions: This study highlights the importance of web-based mental health services being easy to navigate and understand, being user-centric, and providing adequate guidance in self-help. It also confirms existing design standards and recommendations and suggests that more rigorous, iterative user experience research and robust evaluation should be conducted in the future adaptation of web-based stratified stepped care services, so that they can be more personalized and better promote personal recovery. UR - https://humanfactors.jmir.org/2022/2/e35057 UR - http://dx.doi.org/10.2196/35057 UR - http://www.ncbi.nlm.nih.gov/pubmed/35560109 ID - info:doi/10.2196/35057 ER - TY - JOUR AU - Scheutzow, Johanna AU - Attoe, Chris AU - Harwood, Joshua PY - 2022/5/11 TI - Acceptability of Web-Based Mental Health Interventions in the Workplace: Systematic Review JO - JMIR Ment Health SP - e34655 VL - 9 IS - 5 KW - acceptability KW - e-mental health KW - online mental health interventions KW - occupational online interventions KW - employees KW - mobile phone N2 - Background: Web-based interventions have proven to be effective not only in clinical populations but also in the occupational setting. Recent studies conducted in the work environment have focused on the effectiveness of these interventions. However, the role of employees? acceptability of web-based interventions and programs has not yet enjoyed a similar level of attention. Objective: The objective of this systematic review was to conduct the first comprehensive study on employees? level of acceptability of web-based mental health interventions based on direct and indirect measures, outline the utility of different types of web-based interventions for work-related mental health issues, and build a research base in the field. Methods: The search was conducted between October 2018 and July 2019 and allowed for any study design. The studies used either qualitative or quantitative data sources. The web-based interventions were generally aimed at supporting employees with their mental health issues. The study characteristics were outlined in a table as well as graded based on their quality using a traffic light schema. The level of acceptability was individually rated using commonly applied methods, including percentile quartiles ranging from low to very high. Results: A total of 1303 studies were identified through multiple database searches and additional resources, from which 28 (2%) were rated as eligible for the synthesis. The results of employees? acceptability levels were mixed, and the studies were very heterogeneous in design, intervention characteristics, and population. Approximately 79% (22/28) of the studies outlined acceptability measures from high to very high, and 54% (15/28) of the studies reported acceptability levels from low to moderate (overlap when studies reported both quantitative and qualitative results). Qualitative studies also provided insights into barriers and preferences, including simple and tailored application tools as well as the preference for nonstigmatized language. However, there were multiple flaws in the methodology of the studies, such as the blinding of participants and personnel. Conclusions: The results outline the need for further research with more homogeneous acceptability studies to draw a final conclusion. However, the underlying results show that there is a tendency toward general acceptability of web-based interventions in the workplace, with findings of general applicability to the use of web-based mental health interventions. UR - https://mental.jmir.org/2022/5/e34655 UR - http://dx.doi.org/10.2196/34655 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544305 ID - info:doi/10.2196/34655 ER - TY - JOUR AU - Brodbeck, Jeannette AU - Berger, Thomas AU - Biesold, Nicola AU - Rockstroh, Franziska AU - Schmidt, J. Stefanie AU - Znoj, Hansjoerg PY - 2022/5/6 TI - The Role of Emotion Regulation and Loss-Related Coping Self-efficacy in an Internet Intervention for Grief: Mediation Analysis JO - JMIR Ment Health SP - e27707 VL - 9 IS - 5 KW - grief KW - divorce KW - separation KW - bereavement KW - internet intervention KW - emotion regulation KW - coping self-efficacy KW - mediation N2 - Background: Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, little is known about how internet interventions work and the mechanisms through which they are linked to the outcomes. Objective: As a first step in identifying mechanisms of change, this study aimed to examine emotion regulation and loss-related coping self-efficacy as putative mediators in a randomized controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation or divorce. Methods: The sample comprised older adults who reported prolonged grief or adaptation problems after bereavement, separation, or divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. The outcome variables were grief symptoms assessed using the Texas Revised Inventory of Grief and psychopathology symptoms assessed using the Brief Symptom Inventory. A total of 6 module-related items assessed loss-focused emotion regulation and loss-related coping self-efficacy. In the first step, path models were used to examine emotion regulation and loss-related coping self-efficacy as single mediators for improvements in grief and psychopathology symptoms. Subsequently, exploratory path models with the simultaneous inclusion of emotion regulation and self-efficacy were used to investigate the specificity and relative strength of these variables as parallel mediators. Results: A total of 100 participants took part in the guided internet intervention. The average age was 51.11 (SD 13.60) years; 80% (80/100) were separated or divorced, 69% (69/100) were female, and 76% (76/100) were of Swiss origin. The internet intervention increased emotion regulation skills (?=.33; P=.001) and loss-related coping self-efficacy (?=.30; P=.002), both of which correlated with improvements in grief and psychopathology symptoms. Path models suggested that emotion regulation and loss-related coping self-efficacy were mediators for improvement in grief. Emotion regulation showed a significant indirect effect (?=.13; P=.009), whereas coping self-efficacy showed a trend (?=.07; P=.06). Both were confirmed as mediators for psychopathology (?=.12, P=.02; ?=.10; P=.02, respectively). The path from the intervention to the improvement in grief remained significant when including the mediators (?=.26, P=.004; ?=.32, P?.001, respectively) in contrast to the path from the intervention to improvements in psychopathology (?=.15, P=.13; ?=.16, P=.10, respectively). Conclusions: Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Both should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. Trial Registration: ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1759-5 UR - https://mental.jmir.org/2022/5/e27707 UR - http://dx.doi.org/10.2196/27707 UR - http://www.ncbi.nlm.nih.gov/pubmed/35522459 ID - info:doi/10.2196/27707 ER - TY - JOUR AU - Paul, Margot AU - Bullock, Kim AU - Bailenson, Jeremy PY - 2022/5/6 TI - Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial JO - JMIR Ment Health SP - e35526 VL - 9 IS - 5 KW - virtual reality KW - major depressive disorder KW - behavioral activation KW - depression N2 - Background: Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD. Objective: We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD. Methods: A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire?9. Results: Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant?s clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire?9 score. Conclusions: The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs. Trial Registration: ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316 International Registered Report Identifier (IRRID): RR2-10.2196/24331 UR - https://mental.jmir.org/2022/5/e35526 UR - http://dx.doi.org/10.2196/35526 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404830 ID - info:doi/10.2196/35526 ER - TY - JOUR AU - Yeager, M. Carolyn AU - Benight, C. Charles PY - 2022/5/2 TI - Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study JO - JMIR Ment Health SP - e35048 VL - 9 IS - 5 KW - engagement KW - digital health KW - digital mental health intervention KW - social cognitive theory KW - SCT KW - self-efficacy KW - outcome expectations KW - trauma KW - posttraumatic stress disorder KW - PTSD N2 - Background: Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. Objective: The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. Methods: A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). Results: Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit (?22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90% CI 0.040-0.064), indicating that engagement self-efficacy (?=.35; P<.001) and outcome expectations (?=.37; P<.001) were significant predictors of engagement (R2=39%). The overall indirect effect between engagement and PTSD symptom reduction was significant (?=?.065; P<.001; 90% CI ?0.071 to ?0.058). This relationship was serially mediated by both skill activation self-efficacy (?=.80; P<.001) and trauma coping self-efficacy (?=.40; P<.001), which predicted a reduction in PTSD symptoms (?=?.20; P=.02). Conclusions: The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies?skill activation and trauma coping?proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs. UR - https://mental.jmir.org/2022/5/e35048 UR - http://dx.doi.org/10.2196/35048 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499857 ID - info:doi/10.2196/35048 ER - TY - JOUR AU - Wiklund, Tobias AU - Molander, Peter AU - Lindner, Philip AU - Andersson, Gerhard AU - Gerdle, Björn AU - Dragioti, Elena PY - 2022/4/29 TI - Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized Controlled Trial JO - J Med Internet Res SP - e29258 VL - 24 IS - 4 KW - insomnia KW - chronic pain KW - comorbid KW - CBT-i KW - RCT KW - web-based CBT KW - pain KW - online health KW - online treatment KW - digital health KW - mental health KW - rehabilitation N2 - Background: Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important. Objective: This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation. Methods: We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported. Results: Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect. Conclusions: In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain. Trial Registration: ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942 UR - https://www.jmir.org/2022/4/e29258 UR - http://dx.doi.org/10.2196/29258 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486418 ID - info:doi/10.2196/29258 ER - TY - JOUR AU - Cloitre, Marylene AU - Amspoker, Bush Amber AU - Fletcher, L. Terri AU - Hogan, B. Julianna AU - Jackson, Christie AU - Jacobs, Adam AU - Shammet, Rayan AU - Speicher, Sarah AU - Wassef, Miryam AU - Lindsay, Jan PY - 2022/4/27 TI - Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study JO - JMIR Ment Health SP - e33080 VL - 9 IS - 4 KW - PTSD KW - depression KW - veterans KW - blended therapy KW - iCBT KW - web-based KW - webSTAIR KW - noninferiority KW - mental health KW - digital health N2 - Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. UR - https://mental.jmir.org/2022/4/e33080 UR - http://dx.doi.org/10.2196/33080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475777 ID - info:doi/10.2196/33080 ER - TY - JOUR AU - Vega, Julio AU - Bell, T. Beth AU - Taylor, Caitlin AU - Xie, Jue AU - Ng, Heidi AU - Honary, Mahsa AU - McNaney, Roisin PY - 2022/4/25 TI - Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating JO - JMIR Ment Health SP - e32146 VL - 9 IS - 4 KW - eating disorder KW - binge eating KW - mental health KW - mobile sensing KW - context-aware computing KW - NAP KW - EMA KW - mobile phone N2 - Background: Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). Objective: The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. Methods: This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. Results: The findings showed unique differences in the types of sensor data that were triangulated with the individuals? episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants? awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. Conclusions: This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population. UR - https://mental.jmir.org/2022/4/e32146 UR - http://dx.doi.org/10.2196/32146 UR - http://www.ncbi.nlm.nih.gov/pubmed/35086064 ID - info:doi/10.2196/32146 ER - TY - JOUR AU - Turmaine, Kathleen AU - Dumas, Agnès AU - Chevreul, Karine AU - PY - 2022/4/22 TI - Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis JO - J Med Internet Res SP - e30218 VL - 24 IS - 4 KW - eHealth KW - internet-based intervention KW - community participation KW - health promotion KW - prevention KW - mental health N2 - Background: For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective: To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods: The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results: Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions: These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04464-2 UR - https://www.jmir.org/2022/4/e30218 UR - http://dx.doi.org/10.2196/30218 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451977 ID - info:doi/10.2196/30218 ER - TY - JOUR AU - Imai, Hissei AU - Tajika, Aran AU - Narita, Hisashi AU - Yoshinaga, Naoki AU - Kimura, Kenichi AU - Nakamura, Hideki AU - Takeshima, Nozomi AU - Hayasaka, Yu AU - Ogawa, Yusuke AU - Furukawa, Toshi PY - 2022/4/21 TI - Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e35940 VL - 24 IS - 4 KW - randomized controlled trial KW - RCT KW - information technology KW - psychotherapy KW - treatment adherence KW - anxiety disorder KW - anxiety KW - OCD KW - obsessive-compulsive disorder KW - systematic review KW - meta-analysis KW - mental health KW - computer-assisted KW - therapy KW - efficacy KW - acceptability KW - eHealth KW - mental illness N2 - Background: Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective: This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods: Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results: We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference ?0.47, 95% CI ?0.73 to ?0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions: Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644 UR - https://www.jmir.org/2022/4/e35940 UR - http://dx.doi.org/10.2196/35940 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451993 ID - info:doi/10.2196/35940 ER - TY - JOUR AU - Ahlers, Joachim AU - Baumgartner, Christian AU - Augsburger, Mareike AU - Wenger, Andreas AU - Malischnig, Doris AU - Boumparis, Nikolaos AU - Berger, Thomas AU - Stark, Lars AU - Ebert, D. David AU - Haug, Severin AU - Schaub, P. Michael PY - 2022/4/20 TI - Cannabis Use in Adults Who Screen Positive for Attention Deficit/Hyperactivity Disorder: CANreduce 2.0 Randomized Controlled Trial Subgroup Analysis JO - J Med Internet Res SP - e30138 VL - 24 IS - 4 KW - attention deficit/hyperactivity disorder KW - ADHD KW - cannabis KW - cannabis use disorder KW - CANreduce KW - web-based self-help tool KW - online tool KW - online health KW - mental health KW - digital health KW - anxiety KW - depression N2 - Background: Prevalence rates for lifetime cannabis use and cannabis use disorder are much higher in people with attention deficit/hyperactivity disorder than in those without. CANreduce 2.0 is an intervention that is generally effective at reducing cannabis use in cannabis misusers. This self-guided web-based intervention (6-week duration) consists of modules grounded in motivational interviewing and cognitive behavioral therapy. Objective: We aimed to evaluate whether the CANreduce 2.0 intervention affects cannabis use patterns and symptom severity in adults who screen positive for attention deficit/hyperactivity disorder more than in those who do not. Methods: We performed a secondary analysis of data from a previous study with the inclusion criterion of cannabis use at least once weekly over the last 30 days. Adults with and without attention deficit/hyperactivity disorder (based on the Adult Attention deficit/hyperactivity disorder Self-Report screener) who were enrolled to the active intervention arms of CANreduce 2.0 were compared regarding the number of days cannabis was used in the preceding 30 days, the cannabis use disorder identification test score (CUDIT) and the severity of dependence scale score (SDS) at baseline and the 3-month follow-up. Secondary outcomes were Generalized Anxiety Disorder score, Center for Epidemiological Studies Depression scale score, retention, intervention adherence, and safety. Results: Both adults with (n=94) and without (n=273) positive attention-deficit/hyperactivity disorder screening reported significantly reduced frequency (reduction in consumption days: with: mean 11.53, SD 9.28, P<.001; without: mean 8.53, SD 9.4, P<.001) and severity of cannabis use (SDS: with: mean 3.57, SD 3.65, P<.001; without: mean 2.47, SD 3.39, P<.001; CUDIT: with: mean 6.38, SD 5.96, P<.001; without: mean 5.33, SD 6.05, P<.001), as well as anxiety (with: mean 4.31, SD 4.71, P<.001; without: mean 1.84, SD 4.22, P<.001) and depression (with: mean 10.25, SD 10.54; without: mean 4.39, SD 10.22, P<.001). Those who screened positive for attention deficit/hyperactivity disorder also reported significantly decreased attention deficit/hyperactivity disorder scores (mean 4.65, SD 4.44, P<.001). There were no significant differences in change in use (P=.08), dependence (P=.95), use disorder (P=.85), attention deficit/hyperactivity disorder status (P=.84), depression (P=.84), or anxiety (P=.26) between baseline and final follow-up, dependent on positive attention-deficit/hyperactivity disorder screening. Attention deficit/hyperactivity disorder symptom severity at baseline was not associated with reduced cannabis use frequency or severity but was linked to greater reductions in depression (Spearman ?=.33) and anxiety (Spearman ?=.28). Individuals with positive attention deficit/hyperactivity disorder screening were significantly less likely to fill out the consumption diary (P=.02), but the association between continuous attention deficit/hyperactivity disorder symptom severity and retention (Spearman ?=?0.10, P=.13) was nonsignificant. There also was no significant intergroup difference in the number of completed modules (with: mean 2.10, SD 2.33; without: mean 2.36, SD 2.36, P=.34), and there was no association with attention deficit/hyperactivity disorder symptom severity (Spearman ?=?0.09; P=.43). The same was true for the rate of adverse effects (P=.33). Conclusions: Cannabis users screening positive for attention deficit/hyperactivity disorder may benefit from CANreduce 2.0 to decrease the frequency and severity of cannabis dependence and attenuate symptoms of depression and attention deficit/hyperactivity disorder-related symptoms. This web-based program?s advantages include its accessibility for remote users and a personalized counselling option that may contribute to increased adherence and motivation to change among program users. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 11086185; http://www.isrctn.com/ISRCTN11086185 UR - https://www.jmir.org/2022/4/e30138 UR - http://dx.doi.org/10.2196/30138 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442196 ID - info:doi/10.2196/30138 ER - TY - JOUR AU - Newson, Jane Jennifer AU - Pastukh, Vladyslav AU - Thiagarajan, C. Tara PY - 2022/4/20 TI - Assessment of Population Well-being With the Mental Health Quotient: Validation Study JO - JMIR Ment Health SP - e34105 VL - 9 IS - 4 KW - psychiatry KW - public health KW - methods KW - mental health KW - population health KW - social determinants of health KW - global health KW - behavioral symptoms KW - diagnosis KW - symptom assessment KW - psychopathology KW - mental disorders KW - mHealth KW - depression KW - anxiety KW - attention deficit disorder with hyperactivity KW - autistic disorder KW - internet N2 - Background: The Mental Health Quotient (MHQ) is an anonymous web-based assessment of mental health and well-being that comprehensively covers symptoms across 10 major psychiatric disorders, as well as positive elements of mental function. It uses a novel life impact scale and provides a score to the individual that places them on a spectrum from Distressed to Thriving along with a personal report that offers self-care recommendations. Since April 2020, the MHQ has been freely deployed as part of the Mental Health Million Project. Objective: This paper demonstrates the reliability and validity of the MHQ, including the construct validity of the life impact scale, sample and test-retest reliability of the assessment, and criterion validation of the MHQ with respect to clinical burden and productivity loss. Methods: Data were taken from the Mental Health Million open-access database (N=179,238) and included responses from English-speaking adults (aged?18 years) from the United States, Canada, the United Kingdom, Ireland, Australia, New Zealand, South Africa, Singapore, India, and Nigeria collected during 2021. To assess sample reliability, random demographically matched samples (each 11,033/179,238, 6.16%) were compared within the same 6-month period. Test-retest reliability was determined using the subset of individuals who had taken the assessment twice ?3 days apart (1907/179,238, 1.06%). To assess the construct validity of the life impact scale, additional questions were asked about the frequency and severity of an example symptom (feelings of sadness, distress, or hopelessness; 4247/179,238, 2.37%). To assess criterion validity, elements rated as having a highly negative life impact by a respondent (equivalent to experiencing the symptom ?5 days a week) were mapped to clinical diagnostic criteria to calculate the clinical burden (174,618/179,238, 97.42%). In addition, MHQ scores were compared with the number of workdays missed or with reduced productivity in the past month (7625/179,238, 4.25%). Results: Distinct samples collected during the same period had indistinguishable MHQ distributions and MHQ scores were correlated with r=0.84 between retakes within an 8- to 120-day period. Life impact ratings were correlated with frequency and severity of symptoms, with a clear linear relationship (R2>0.99). Furthermore, the aggregate MHQ scores were systematically related to both clinical burden and productivity. At one end of the scale, 89.08% (8986/10,087) of those in the Distressed category mapped to one or more disorders and had an average productivity loss of 15.2 (SD 11.2; SEM [standard error of measurement] 0.5) days per month. In contrast, at the other end of the scale, 0% (1/24,365) of those in the Thriving category mapped to any of the 10 disorders and had an average productivity loss of 1.3 (SD 3.6; SEM 0.1) days per month. Conclusions: The MHQ is a valid and reliable assessment of mental health and well-being when delivered anonymously on the web. UR - https://mental.jmir.org/2022/4/e34105 UR - http://dx.doi.org/10.2196/34105 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442210 ID - info:doi/10.2196/34105 ER - TY - JOUR AU - Korpilahti-Leino, Tarja AU - Luntamo, Terhi AU - Ristkari, Terja AU - Hinkka-Yli-Salomäki, Susanna AU - Pulkki-Råback, Laura AU - Waris, Otto AU - Matinolli, Hanna-Maria AU - Sinokki, Atte AU - Mori, Yuko AU - Fukaya, Mami AU - Yamada, Yuko AU - Sourander, Andre PY - 2022/4/13 TI - Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study JO - J Med Internet Res SP - e26438 VL - 24 IS - 4 KW - adolescent KW - anxiety KW - child KW - cognitive behavioral therapy KW - coping KW - COVID-19 KW - Internet KW - mental health KW - parents KW - web-based N2 - Background: The COVID-19 pandemic has had a major impact on families? daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children?s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let?s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program?s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children?s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. UR - https://www.jmir.org/2022/4/e26438 UR - http://dx.doi.org/10.2196/26438 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138265 ID - info:doi/10.2196/26438 ER - TY - JOUR AU - Wickersham, Alice AU - Barack, Tamara AU - Cross, Lauren AU - Downs, Johnny PY - 2022/4/11 TI - Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e29842 VL - 24 IS - 4 KW - adolescent KW - anxiety KW - depression KW - meta-analysis N2 - Background: Depression and anxiety are major public health concerns among adolescents. Computerized cognitive behavioral therapy (cCBT) has emerged as a potential intervention, but its efficacy in adolescents remains unestablished. Objective: This review aimed to systematically review and meta-analyze findings on the efficacy of cCBT for the treatment of adolescent depression and anxiety. Methods: Embase, PsycINFO, and Ovid MEDLINE were systematically searched for randomized controlled trials in English, which investigated the efficacy of cCBT for reducing self-reported depression or anxiety in adolescents aged 11 to 19 years. Titles, abstracts, and full texts were screened for eligibility by 2 independent researchers (TB and LC). A random-effects meta-analysis was conducted to pool the effects of cCBT on depression and anxiety symptom scores compared with the control groups. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool. Results: A total of 16 randomized controlled trials were eligible for inclusion in this review, of which 13 (81%) were included in the meta-analysis. The quality of the studies was mixed, with 5 (31%) studies rated as good overall, 2 (13%) rated as fair, and 9 (56%) rated as poor. Small but statistically significant effects of cCBT were detected, with cCBT conditions showing lower symptom scores at follow-up compared with control conditions for both anxiety (standardized mean difference ?0.21, 95% CI ?0.33 to ?0.09; I2=36.2%) and depression (standardized mean difference ?0.23, 95% CI ?0.39 to ?0.07; I2=59.5%). Secondary analyses suggested that cCBT may be comparable with alternative, active interventions (such as face-to-face therapy or treatment as usual). Conclusions: This meta-analysis reinforces the efficacy of cCBT for the treatment of anxiety and depression and is the first to examine this exclusively in adolescents. Future research could aim to identify the active components of these interventions toward optimizing their development and increasing the feasibility and acceptability of cCBT in this age group. Trial Registration: PROSPERO CRD42019141941; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941 UR - https://www.jmir.org/2022/4/e29842 UR - http://dx.doi.org/10.2196/29842 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404263 ID - info:doi/10.2196/29842 ER - TY - JOUR AU - Martin-Key, A. Nayra AU - Spadaro, Benedetta AU - Funnell, Erin AU - Barker, Jane Eleanor AU - Schei, Sofie Thea AU - Tomasik, Jakub AU - Bahn, Sabine PY - 2022/3/30 TI - The Current State and Validity of Digital Assessment Tools for Psychiatry: Systematic Review JO - JMIR Ment Health SP - e32824 VL - 9 IS - 3 KW - diagnostic accuracy KW - digital mental health KW - digital questionnaire KW - psychiatry KW - systematic review N2 - Background: Given the role digital technologies are likely to play in the future of mental health care, there is a need for a comprehensive appraisal of the current state and validity (ie, screening or diagnostic accuracy) of digital mental health assessments. Objective: The aim of this review is to explore the current state and validity of question-and-answer?based digital tools for diagnosing and screening psychiatric conditions in adults. Methods: This systematic review was based on the Population, Intervention, Comparison, and Outcome framework and was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO were systematically searched for articles published between 2005 and 2021. A descriptive evaluation of the study characteristics and digital solutions and a quantitative appraisal of the screening or diagnostic accuracy of the included tools were conducted. Risk of bias and applicability were assessed using the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2. Results: A total of 28 studies met the inclusion criteria, with the most frequently evaluated conditions encompassing generalized anxiety disorder, major depressive disorder, and any depressive disorder. Most of the studies used digitized versions of existing pen-and-paper questionnaires, with findings revealing poor to excellent screening or diagnostic accuracy (sensitivity=0.32-1.00, specificity=0.37-1.00, area under the receiver operating characteristic curve=0.57-0.98) and a high risk of bias for most of the included studies. Conclusions: The field of digital mental health tools is in its early stages, and high-quality evidence is lacking. International Registered Report Identifier (IRRID): RR2-10.2196/25382 UR - https://mental.jmir.org/2022/3/e32824 UR - http://dx.doi.org/10.2196/32824 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353053 ID - info:doi/10.2196/32824 ER - TY - JOUR AU - Marcu, Gabriela AU - Ondersma, J. Steven AU - Spiller, N. Allison AU - Broderick, M. Brianna AU - Kadri, Reema AU - Buis, R. Lorraine PY - 2022/3/30 TI - Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis JO - J Med Internet Res SP - e34301 VL - 24 IS - 3 KW - computers KW - mobile apps KW - screening KW - brief interventions KW - diagnosis KW - computer-assisted/methods KW - surveys and questionnaires KW - motivational interviewing KW - therapy KW - implementation KW - qualitative KW - mobile phone N2 - Background: Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective: This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients? technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions: Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space. UR - https://www.jmir.org/2022/3/e34301 UR - http://dx.doi.org/10.2196/34301 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353043 ID - info:doi/10.2196/34301 ER - TY - JOUR AU - Marcu, Gabriela AU - Ondersma, J. Steven AU - Spiller, N. Allison AU - Broderick, M. Brianna AU - Kadri, Reema AU - Buis, R. Lorraine PY - 2022/3/30 TI - The Perceived Benefits of Digital Interventions for Behavioral Health: Qualitative Interview Study JO - J Med Internet Res SP - e34300 VL - 24 IS - 3 KW - computers KW - mobile apps KW - screening KW - brief interventions KW - diagnosis KW - computer-assisted/methods KW - surveys and questionnaires KW - motivational interviewing KW - therapy KW - implementation KW - qualitative KW - mobile phone N2 - Background: Digital interventions have gained momentum in terms of behavioral health. However, owing to lacking standard approaches or tools for creating digital behavioral interventions, clinical researchers follow widely varying conceptions of how best to go about digital intervention development. Researchers also face significant cost-, time-, and expertise-related challenges in digital intervention development. Improving the availability of tools and guidance for researchers will require a thorough understanding of the motivations and needs of researchers seeking to create digital interventions. Objective: This study aims to understand the perceptions of behavioral researchers toward digital interventions, and inform the use of these interventions, by documenting the reasons why researchers are increasingly focusing their efforts on digital interventions and their perspectives on the perceived benefits that digital approaches can provide for researchers and intervention recipients. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience designing digital behavioral interventions or running studies with them. A convenience sample of interviewees was recruited from among users of the Computerized Intervention Authoring System platform, a web-based tool that facilitates the process of creating and deploying digital interventions in behavioral research. Interviews were conducted over teleconference between February and April 2020. Recordings from the interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 individuals and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project or study staff. Four major themes came out of the interviews concerning the benefits of digital interventions for behavioral health: convenience and flexibility for interventionists and recipients, support for implementing evidence-based interventions with fidelity, scaling and improving access to interventions, and getting a foot in the door despite stigma and disenfranchisement. Conclusions: Interviewees described a number of important potential benefits of digital interventions, particularly with respect to scientific rigor, scalability, and overcoming barriers to reaching more people. There are complex considerations with regard to translating behavior change strategies into digital forms of delivery, and interventionists make individual, sometimes unexpected, choices with minimal evidence of their relative effectiveness. Future research should investigate how behavioral researchers can be supported in making these choices toward usability, ease of access, and approachability of digital interventions. Our study underscores the need for authoring platforms that can facilitate the process of creating and deploying digital interventions to reach their full potential for interventionists and recipients alike. UR - https://www.jmir.org/2022/3/e34300 UR - http://dx.doi.org/10.2196/34300 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353045 ID - info:doi/10.2196/34300 ER - TY - JOUR AU - Villarreal-Zegarra, David AU - Alarcon-Ruiz, A. Christoper AU - Melendez-Torres, GJ AU - Torres-Puente, Roberto AU - Navarro-Flores, Alba AU - Cavero, Victoria AU - Ambrosio-Melgarejo, Juan AU - Rojas-Vargas, Jefferson AU - Almeida, Guillermo AU - Albitres-Flores, Leonardo AU - Romero-Cabrera, B. Alejandra AU - Huarcaya-Victoria, Jeff PY - 2022/3/29 TI - Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews JO - JMIR Ment Health SP - e34760 VL - 9 IS - 3 KW - telemedicine KW - digital health KW - internet-based intervention KW - mental health KW - mental disorders KW - systematic reviews KW - qualitative research KW - realist review KW - mHealth KW - eHealth KW - telehealth N2 - Background: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. Objective: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. Methods: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. Results: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. Conclusions: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811 International Registered Report Identifier (IRRID): RR2-10.12688/f1000research.27150.2 UR - https://mental.jmir.org/2022/3/e34760 UR - http://dx.doi.org/10.2196/34760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348469 ID - info:doi/10.2196/34760 ER - TY - JOUR AU - van Eijndhoven, Philip AU - Collard, Rose AU - Vrijsen, Janna AU - Geurts, M. Dirk E. AU - Vasquez, Arias Alejandro AU - Schellekens, Arnt AU - van den Munckhof, Eva AU - Brolsma, Sophie AU - Duyser, Fleur AU - Bergman, Annemiek AU - van Oort, Jasper AU - Tendolkar, Indira AU - Schene, Aart PY - 2022/3/29 TI - Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET): Protocol for a Cross-sectional Comorbidity Study From a Research Domain Criteria Perspective JO - JMIRx Med SP - e31269 VL - 3 IS - 1 KW - psychiatry KW - mental health KW - psychiatric disorders KW - neuropsychology KW - stress KW - comorbidity N2 - Background: It is widely acknowledged that comorbidity between psychiatric disorders is common. Shared and diverse underpinnings of psychiatric disorders cannot be systematically understood based on symptom-based categories of mental disorders, which map poorly onto pathophysiological mechanisms. In the Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET) study, we make use of current concepts of comorbidity that transcend the current diagnostic categories. We test this approach to psychiatric problems in patients with frequently occurring psychiatric disorders and their comorbidities (excluding psychosis). Objective: The main aim of the MIND-SET project is to determine the shared and specific mechanisms of neurodevelopmental and stress-related psychiatric disorders at different observational levels. Methods: This is an observational cross-sectional study. Data from different observational levels as defined in the Research Domain Criteria (genetics, physiology, neuropsychology, system-level neuroimaging, behavior, self-report, and experimental neurocognitive paradigms) are collected over four time points. Included are adult (aged ?18 years), nonpsychotic, psychiatric patients with a clinical diagnosis of a stress-related disorder (mood disorder, anxiety disorder, or substance use disorder) or a neurodevelopmental disorder (autism spectrum disorder or attention-deficit/hyperactivity disorder). Individuals with no current or past psychiatric diagnosis are included as neurotypical controls. Data collection started in June 2016 with the aim to include a total of 650 patients and 150 neurotypical controls by 2021. The data collection procedure includes online questionnaires and three subsequent sessions with (1) standardized clinical examination, physical examination, and blood sampling; (2) psychological constructs, neuropsychological tests, and biological marker sampling; and (3) neuroimaging measures. Results: We aim to include a total of 650 patients and 150 neurotypical control participants in the time period between 2016 and 2022. In October 2021, we are at 95% of our target. Conclusions: The MIND-SET study enables us to investigate the mechanistic underpinnings of nonpsychotic psychiatric disorders transdiagnostically. We will identify both shared and disorder-specific markers at different observational levels that can be used as targets for future diagnostic and treatment approaches. UR - https://med.jmirx.org/2022/1/e31269 UR - http://dx.doi.org/10.2196/31269 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725542 ID - info:doi/10.2196/31269 ER - TY - JOUR AU - Hanano, Maria AU - Rith-Najarian, Leslie AU - Boyd, Meredith AU - Chavira, Denise PY - 2022/3/28 TI - Measuring Adherence Within a Self-Guided Online Intervention for Depression and Anxiety: Secondary Analyses of a Randomized Controlled Trial JO - JMIR Ment Health SP - e30754 VL - 9 IS - 3 KW - self-guided KW - adherence KW - depression KW - anxiety KW - online intervention N2 - Background: Self-guided online interventions offer users the ability to participate in an intervention at their own pace and address some traditional service barriers (eg, attending in-person appointments, cost). However, these interventions suffer from high dropout rates, and current literature provides little guidance for defining and measuring online intervention adherence as it relates to clinical outcomes. Objective: This study aims to develop and test multiple measures of adherence to a specific self-guided online intervention, as guided by best practices from the literature. Methods: We conducted secondary analyses on data from a randomized controlled trial of an 8-week online cognitive behavioral program that targets depression and anxiety in college students. We defined multiple behavioral and attitudinal adherence measures at varying levels of effort (ie, low, moderate, and high). Linear regressions were run with adherence terms predicting improvement in the primary outcome measure, the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Results: Of the 947 participants, 747 initiated any activity and 449 provided posttest data. Results from the intent-to-treat sample indicated that high level of effort for behavioral adherence significantly predicted symptom change (F4,746=17.18, P<.001; and ?=?.26, P=.04). Moderate level of effort for attitudinal adherence also significantly predicted symptom change (F4,746=17.25, P<.001; and ?=?.36, P=.03). Results differed in the initiators-only sample, such that none of the adherence measures significantly predicted symptom change (P=.09-.27). Conclusions: Our findings highlight the differential results of dose-response models testing adherence measures in predicting clinical outcomes. We summarize recommendations that might provide helpful guidance to future researchers and intervention developers aiming to investigate online intervention adherence. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/ct2/show/NCT04361045 UR - https://mental.jmir.org/2022/3/e30754 UR - http://dx.doi.org/10.2196/30754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35343901 ID - info:doi/10.2196/30754 ER - TY - JOUR AU - Ritola, Ville AU - Lipsanen, Olavi Jari AU - Pihlaja, Satu AU - Gummerus, Eero-Matti AU - Stenberg, Jan-Henry AU - Saarni, Suoma AU - Joffe, Grigori PY - 2022/3/24 TI - Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study JO - J Med Internet Res SP - e29384 VL - 24 IS - 3 KW - CBT KW - iCBT KW - cognitive behavioral therapy KW - routine care KW - generalized anxiety disorder KW - internet KW - web-based KW - digital health KW - mental health N2 - Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7?measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ?10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital?iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients. UR - https://www.jmir.org/2022/3/e29384 UR - http://dx.doi.org/10.2196/29384 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323119 ID - info:doi/10.2196/29384 ER - TY - JOUR AU - Kranenburg, W. Leonieke AU - Gillis, Jamie AU - Mayer, Birgit AU - Hoogendijk, G. Witte J. PY - 2022/3/18 TI - The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial JO - JMIR Ment Health SP - e32123 VL - 9 IS - 3 KW - mHealth KW - mindfulness KW - stress KW - burnout KW - non-clinical population KW - nonclinical N2 - Background: Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth). Objective: The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months. Methods: A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model. Results: At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ. Conclusions: These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation. Trial Registration: ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800 UR - https://mental.jmir.org/2022/3/e32123 UR - http://dx.doi.org/10.2196/32123 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302504 ID - info:doi/10.2196/32123 ER - TY - JOUR AU - Martinengo, Laura AU - Stona, Anne-Claire AU - Tudor Car, Lorainne AU - Lee, Jimmy AU - Griva, Konstadina AU - Car, Josip PY - 2022/3/9 TI - Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines JO - J Med Internet Res SP - e28942 VL - 24 IS - 3 KW - health literacy KW - mental health literacy KW - depression KW - mobile apps KW - apps KW - telemedicine KW - mHealth KW - self-management KW - mobile phone N2 - Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non?evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user?s support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non?evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. UR - https://www.jmir.org/2022/3/e28942 UR - http://dx.doi.org/10.2196/28942 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262489 ID - info:doi/10.2196/28942 ER - TY - JOUR AU - LaMonica, M. Haley AU - Iorfino, Frank AU - Lee, Yeeun Grace AU - Piper, Sarah AU - Occhipinti, Jo-An AU - Davenport, A. Tracey AU - Cross, Shane AU - Milton, Alyssa AU - Ospina-Pinillos, Laura AU - Whittle, Lisa AU - Rowe, C. Shelley AU - Dowling, Mitchell AU - Stewart, Elizabeth AU - Ottavio, Antonia AU - Hockey, Samuel AU - Cheng, Sze Vanessa Wan AU - Burns, Jane AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2022/3/9 TI - Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy JO - JMIR Ment Health SP - e33060 VL - 9 IS - 3 KW - mental health KW - technology KW - co-design KW - participatory research KW - health care reform KW - stakeholder participation KW - mobile phone N2 - Background: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users? needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. Objective: Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. Methods: Participating health care organizations included the following: Open Arms?Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation?s National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. Results: Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. Conclusions: Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care. UR - https://mental.jmir.org/2022/3/e33060 UR - http://dx.doi.org/10.2196/33060 UR - http://www.ncbi.nlm.nih.gov/pubmed/34974414 ID - info:doi/10.2196/33060 ER - TY - JOUR AU - Meyer, Ashley AU - Wisniewski, Hannah AU - Torous, John PY - 2022/3/8 TI - Coaching to Support Mental Health Apps: Exploratory Narrative Review JO - JMIR Hum Factors SP - e28301 VL - 9 IS - 1 KW - smartphone KW - apps KW - mental health KW - coaching KW - engagement N2 - Background: The therapeutic alliance is crucial for the success of face-to-face therapies. Little is known about how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities such as smartphone apps. Objective: The aim of this paper was to assess how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities. Methods: We conducted a selected review to gather preliminary data about the role of coaching in mobile technology use for mental health care. We identified 26 trials using a 2019 review by Tønning et al and a 2021 scoping review by Tokgöz et al to assess how coaching is currently being used across different studies. Results: Our results showed a high level of heterogeneity as studies used varying types of coaching methods but provided little information about coaching protocols and training. Coaching was feasible by clinicians and nonclinicians, scheduled and on demand, and across all technologies ranging from phone calls to social media. Conclusions: Further research is required to better understand the effects of coaching in mobile mental health treatments, but examples offered from reviewed papers suggest several options to implement coaching today. Coaching based on replicable protocols that are verifiable for fidelity will enable the scaling of this model and a better exploration of the digital therapeutic alliance. UR - https://humanfactors.jmir.org/2022/1/e28301 UR - http://dx.doi.org/10.2196/28301 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258468 ID - info:doi/10.2196/28301 ER - TY - JOUR AU - Thangavel, Gomathi AU - Memedi, Mevludin AU - Hedström, Karin PY - 2022/3/7 TI - Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review JO - JMIR Ment Health SP - e34221 VL - 9 IS - 3 KW - social isolation KW - loneliness KW - review KW - ICT KW - older adults KW - customization KW - mobile phone N2 - Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77%) evaluated the usability and acceptance aspects, and few studies (11/39, 28%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. UR - https://mental.jmir.org/2022/3/e34221 UR - http://dx.doi.org/10.2196/34221 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254273 ID - info:doi/10.2196/34221 ER - TY - JOUR AU - Kirk, A. Megan AU - Taha, Bilal AU - Dang, Kevin AU - McCague, Hugh AU - Hatzinakos, Dimitrios AU - Katz, Joel AU - Ritvo, Paul PY - 2022/2/28 TI - A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial JO - JMIR Ment Health SP - e26479 VL - 9 IS - 2 KW - posttraumatic stress disorder KW - cognitive therapy KW - internet delivery KW - pupillometry KW - psychophysiology KW - PTSD KW - therapy KW - cognitive behavioral therapy KW - mindfulness KW - intervention N2 - Background: Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice. Objective: This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use. Methods: We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46). Results: Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=?0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice. Conclusions: Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study. Trial Registration: ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473 UR - https://mental.jmir.org/2022/2/e26479 UR - http://dx.doi.org/10.2196/26479 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499613 ID - info:doi/10.2196/26479 ER - TY - JOUR AU - Goulding, H. Evan AU - Dopke, A. Cynthia AU - Rossom, C. Rebecca AU - Michaels, Tania AU - Martin, R. Clair AU - Ryan, Chloe AU - Jonathan, Geneva AU - McBride, Alyssa AU - Babington, Pamela AU - Bernstein, Mary AU - Bank, Andrew AU - Garborg, Spencer C. AU - Dinh, M. Jennifer AU - Begale, Mark AU - Kwasny, J. Mary AU - Mohr, C. David PY - 2022/2/21 TI - A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30710 VL - 11 IS - 2 KW - bipolar disorder KW - self-management KW - mHealth KW - eHealth KW - smartphone KW - mobile phone KW - mental health KW - mobile health N2 - Background: Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment. Objective: A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response. Methods: The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk. Results: Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022. Conclusions: This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders. Trial Registration: ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462 International Registered Report Identifier (IRRID): DERR1-10.2196/30710 UR - https://www.researchprotocols.org/2022/2/e30710 UR - http://dx.doi.org/10.2196/30710 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188473 ID - info:doi/10.2196/30710 ER - TY - JOUR AU - Wang, Hsin-Yi AU - Cheng, Cecilia PY - 2022/2/17 TI - The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis JO - JMIR Ment Health SP - e23700 VL - 9 IS - 2 KW - gaming motivation KW - problematic gaming KW - gaming disorder KW - video gaming KW - online gaming KW - compulsive gaming KW - escapism KW - culture KW - cross-cultural comparison, cultural individualism N2 - Background: There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming. Objective: This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD. Methods: We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation. Results: The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions. Conclusions: This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations. UR - https://mental.jmir.org/2022/2/e23700 UR - http://dx.doi.org/10.2196/23700 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175204 ID - info:doi/10.2196/23700 ER - TY - JOUR AU - Skaczkowski, Gemma AU - van der Kruk, Shannen AU - Loxton, Sophie AU - Hughes-Barton, Donna AU - Howell, Cate AU - Turnbull, Deborah AU - Jensen, Neil AU - Smout, Matthew AU - Gunn, Kate PY - 2022/2/8 TI - Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review JO - JMIR Ment Health SP - e31018 VL - 9 IS - 2 KW - web-based interventions KW - depression KW - anxiety KW - suicide KW - well-being KW - mental health KW - technology KW - access to health care N2 - Background: A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. Objective: This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. Results: Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%. Conclusions: There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist. UR - https://mental.jmir.org/2022/2/e31018 UR - http://dx.doi.org/10.2196/31018 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133281 ID - info:doi/10.2196/31018 ER - TY - JOUR AU - Vlake, H. Johan AU - van Bommel, Jasper AU - Wils, Evert-Jan AU - Bienvenu, Joe AU - Hellemons, E. Merel AU - Korevaar, IM Tim AU - Schut, FC Anna AU - Labout, AM Joost AU - Schreuder, LH Lois AU - van Bavel, P. Marten AU - Gommers, Diederik AU - van Genderen, E. Michel PY - 2022/1/31 TI - Intensive Care Unit?Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial JO - J Med Internet Res SP - e32368 VL - 24 IS - 1 KW - SARS-CoV-2 KW - intensive care KW - post-intensive care syndrome KW - virtual reality KW - quality of life KW - satisfaction KW - COVID-19 N2 - Background: Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective: This study aimed to explore the effects of ICU-VR on mental health and on patients? perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods: This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results: Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=?2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=?3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions: ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR?s widespread availability and application during follow-up. Trial Registration: Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05271-z UR - https://www.jmir.org/2022/1/e32368 UR - http://dx.doi.org/10.2196/32368 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978530 ID - info:doi/10.2196/32368 ER - TY - JOUR AU - Hennemann, Severin AU - Kuhn, Sebastian AU - Witthöft, Michael AU - Jungmann, M. Stefanie PY - 2022/1/31 TI - Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients JO - JMIR Ment Health SP - e32832 VL - 9 IS - 1 KW - mHealth KW - symptom checker KW - diagnostics KW - mental disorders KW - psychotherapy KW - mobile phone N2 - Background: Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. Objective: This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists? diagnoses based on structured clinical interviews. Methods: Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada?check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. Results: A total of 49 patients (30/49, 61% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA?s first condition suggestion in 51% (25/49; 95% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69% (34/49; 95% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA?s first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. Conclusions: Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments. UR - https://mental.jmir.org/2022/1/e32832 UR - http://dx.doi.org/10.2196/32832 UR - http://www.ncbi.nlm.nih.gov/pubmed/35099395 ID - info:doi/10.2196/32832 ER - TY - JOUR AU - Lockwood, Joanna AU - Williams, Laura AU - Martin, L. Jennifer AU - Rathee, Manjul AU - Hill, Claire PY - 2022/1/24 TI - Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivering Exposure-Based Cognitive Behavioral Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study JO - JMIR Ment Health SP - e29008 VL - 9 IS - 1 KW - anxiety KW - children KW - exposure therapy KW - cognitive behavioral therapy KW - immersive gaming KW - digital intervention KW - app KW - smartphone KW - mobile phone N2 - Background: Childhood anxiety disorders are a prevalent mental health problem that can be treated effectively with cognitive behavioral therapy, in which exposure is a key component; however, access to treatment is poor. Mobile-based apps on smartphones or tablets may facilitate the delivery of evidence-based therapy for child anxiety, thereby overcoming the access and engagement barriers of traditional treatment. Apps that deliver therapeutic content via immersive gaming technology could offer an effective, highly engaging, and flexible treatment proposition. Objective: In this paper, we aim to describe a preliminary multi-method evaluation of Lumi Nova, a mobile app intervention targeting mild to moderate anxiety problems in children aged 7-12 years using exposure therapy delivered via an immersive game. The primary objective is to evaluate the effectiveness, user engagement and experience, and safety of the beta version of Lumi Nova. Methods: Lumi Nova was co-designed with children, parents, teachers, clinicians, game industry experts, and academic partnerships. In total, 120 community-based children with mild to moderate anxiety and their guardians were enrolled to participate in an 8-week pilot study. The outcome measures captured the app?s effectiveness (anxiety symptoms, child-identified goal-based outcomes, and functional impairment), user engagement (game play data and ease-of-use ratings), and safety (mood ratings and adverse events). The outcome measures before and after the intervention were available for 30 children (age: mean 9.8, SD 1.7 years; girls: 18/30, 60%; White: 24/30, 80%). Additional game play data were automatically generated for 67 children (age: mean 9.6, SD 1.53 years; girls: 35/67, 52%; White: 42/67, 63%). Postintervention open-response data from 53% (16/30) of guardians relating to the primary objectives were also examined. Results: Playing Lumi Nova was effective in reducing anxiety symptom severity over the 8-week period of game play (t29=2.79; P=.009; Cohen d=0.35) and making progress toward treatment goals (z=2.43; P=.02), but there were no improvements in relation to functional impairment. Children found it easy to play the game and engaged safely with therapeutic content. However, the positive effects were small, and there were limitations to the game play data. Conclusions: This preliminary study provides initial evidence that an immersive mobile game app may safely benefit children experiencing mild to moderate anxiety. It also demonstrates the value of the rigorous evaluation of digital interventions during the development process to rapidly improve readiness for full market launch. UR - https://mental.jmir.org/2022/1/e29008 UR - http://dx.doi.org/10.2196/29008 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072644 ID - info:doi/10.2196/29008 ER - TY - JOUR AU - Lee, Hojun AU - Choi, JongKwan AU - Jung, Dooyoung AU - Hur, Ji-Won AU - Cho, Chul-Hyun PY - 2021/12/17 TI - The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study JO - J Med Internet Res SP - e31844 VL - 23 IS - 12 KW - anxiety KW - social anxiety disorder KW - virtual reality KW - fNIRS KW - brain activity KW - prefrontal cortex KW - effectiveness N2 - Background: Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. Objective: The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). Methods: Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant?s self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant?s self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). Results: We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=?2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=?2.93, P<.001; left: t=?2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=?2.10, P=.045; left: t=?2.21, P=.04) while watching video 2. Conclusions: Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. Trial Registration: Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp UR - https://www.jmir.org/2021/12/e31844 UR - http://dx.doi.org/10.2196/31844 UR - http://www.ncbi.nlm.nih.gov/pubmed/34801979 ID - info:doi/10.2196/31844 ER - TY - JOUR AU - Pérez, Carola J. AU - Fernández, Olga AU - Cáceres, Cristián AU - Carrasco, E. Álvaro AU - Moessner, Markus AU - Bauer, Stephanie AU - Espinosa-Duque, Daniel AU - Gloger, Sergio AU - Krause, Mariane PY - 2021/12/16 TI - An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial JO - JMIR Ment Health SP - e26814 VL - 8 IS - 12 KW - depression KW - e-mental health KW - blended care KW - internet N2 - Background: Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. Objective: The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider?assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center?s internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. Results: Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). Conclusions: The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients? limited use of the online platform. Trial Registration: ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467 UR - https://mental.jmir.org/2021/12/e26814 UR - http://dx.doi.org/10.2196/26814 UR - http://www.ncbi.nlm.nih.gov/pubmed/34927594 ID - info:doi/10.2196/26814 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Hamatani, Sayo AU - Shimizu, Eiji PY - 2021/12/13 TI - Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review JO - J Med Internet Res SP - e31293 VL - 23 IS - 12 KW - videoconference-delivered cognitive behavioral therapy KW - depression KW - anxiety KW - psychiatric disorders KW - systematic review KW - meta-analysis KW - digital health KW - mental health KW - cognitive therapy KW - internet-based therapy KW - cognition KW - neurodevelopment KW - communication technology KW - health technology KW - psychological disorders KW - anxiety disorder N2 - Background: Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective: This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods: A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results: The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of ?0.49 (95% CI ?0.68 to ?0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions: While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832 UR - https://www.jmir.org/2021/12/e31293 UR - http://dx.doi.org/10.2196/31293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898445 ID - info:doi/10.2196/31293 ER - TY - JOUR AU - Mcgeough, Julienne AU - Gallagher-Mitchell, Thomas AU - Clark, Andrew Dan Philip AU - Harrison, Neil PY - 2021/12/7 TI - Reliability and Confirmatory Factor Analysis (CFA) of a Paper- Versus App-Administered Resilience Scale in Scottish Youths: Comparative Study JO - JMIR Mhealth Uhealth SP - e11055 VL - 9 IS - 12 KW - resilience KW - psychometrics KW - app administration KW - cyberpsychology N2 - Background: Adequately measuring resilience is important to support young people and children who may need to access resources through social work or educational settings. A widely accepted measure of youth resilience has been developed previously and has been shown to be suitable for vulnerable youth. While the measure is completed by the young person on paper, it has been designed to be worked through with a teacher or social worker in case further clarification is required. However, this method is time consuming and, when faced with large groups of pupils who need assessment, can be overwhelming for schools and practitioners. This study assesses app software with a built-in avatar that can guide young persons through the assessment and its interpretation. Objective: Our primary objective is to compare the reliability and psychometric properties of a mobile software app to a paper version of the Child and Youth Resilience measure (CYRM-28). Second, this study assesses the use of the CYRM-28 in a Scottish youth population (aged 11-18 years). Methods: Following focus groups and discussion with teachers, social workers, and young people, an avatar was developed by a software company and integrated into an android smartphone app designed to ask questions via the device?s inbuilt text-to-voice engine. In total, 714 students from 2 schools in North East Scotland completed either a paper version or app version of the CYRM-28. A cross-sectional design was used, and students completed their allocated version twice, with a 2-week period in between each testing. All participants could request clarification either from a guidance teacher (paper version) or from the in-built software glossary (app version). Results: Test and retest correlations showed that the app version performed better than the paper version of the questionnaire (paper version: r303=0.81; P<.001; 95% CI 0.77-0.85; app version: r413=0.84; P<.001; 95% CI 0.79-0.89). Fisher r to z transformation revealed a significant difference in the correlations (Z=?2.97, P<.01). Similarly, Cronbach ? in both conditions was very high (app version: ?=.92; paper version: ?=.87), suggesting item redundancy. Ordinarily, this would lead to a possible removal of highly correlated items; however, our primary objective was to compare app delivery methods over a pen-and-paper mode and was hence beyond the scope of the study. Fisher r to z transformation revealed a significant difference in the correlations (Z=?3.69, P<.01). A confirmatory factor analysis supported the 3-factor solution (individual, relational, and contextual) and reported a good model fit (?215=27.6 [n=541], P=.24). Conclusions: ALEX, an avatar with an integrated voice guide, had higher reliability when measuring resilience than a paper version with teacher assistance. The CFA reports similar structure using the avatar when compared against the original validation. UR - https://mhealth.jmir.org/2021/12/e11055 UR - http://dx.doi.org/10.2196/11055 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878995 ID - info:doi/10.2196/11055 ER - TY - JOUR AU - Yan, Mingli AU - Yin, Huiru AU - Meng, Qiuyan AU - Wang, Shuo AU - Ding, Yiwen AU - Li, Guichen AU - Wang, Chunyan AU - Chen, Li PY - 2021/12/3 TI - A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study JO - JMIR Serious Games SP - e30919 VL - 9 IS - 4 KW - virtual reality KW - mild cognitive impairment KW - dementia KW - ambient intelligence KW - digital health KW - elderly population KW - aging N2 - Background: Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI. Objective: The objectives of this study are to validate a VR game?based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels. Methods: Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively. Results: A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048). Conclusions: The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639 UR - https://games.jmir.org/2021/4/e30919 UR - http://dx.doi.org/10.2196/30919 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870610 ID - info:doi/10.2196/30919 ER - TY - JOUR AU - Schick, Anita AU - Paetzold, Isabell AU - Rauschenberg, Christian AU - Hirjak, Dusan AU - Banaschewski, Tobias AU - Meyer-Lindenberg, Andreas AU - Boehnke, R. Jan AU - Boecking, Benjamin AU - Reininghaus, Ulrich PY - 2021/12/3 TI - Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e27462 VL - 10 IS - 12 KW - experience sampling methodology (ESM) KW - ecological momentary assessment (EMA) KW - mobile intervention KW - at-risk individuals KW - smartphone training KW - blended care KW - mental health KW - stress reactivity KW - mobile phone N2 - Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. Objective: This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth?EMIcompass. Methods: In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. Results: The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. Conclusions: This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial Registration: German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): DERR1-10.2196/27462 UR - https://www.researchprotocols.org/2021/12/e27462 UR - http://dx.doi.org/10.2196/27462 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870613 ID - info:doi/10.2196/27462 ER - TY - JOUR AU - Roy, Alexandra AU - Hoge, A. Elizabeth AU - Abrante, Pablo AU - Druker, Susan AU - Liu, Tao AU - Brewer, A. Judson PY - 2021/12/2 TI - Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial JO - J Med Internet Res SP - e26987 VL - 23 IS - 12 KW - anxiety KW - generalized anxiety disorder KW - worry KW - mindfulness KW - mHealth KW - digital therapeutics KW - mobile phone N2 - Background: Current treatments for generalized anxiety disorder (GAD) often yield suboptimal outcomes, partly because of insufficient targeting of underlying psychological mechanisms (eg, avoidance reinforcement learning). Mindfulness training (MT) has shown efficacy for anxiety; yet, widespread adoption has been limited, partly because of the difficulty in scaling in-person?based delivery. Digital therapeutics are emerging as potentially viable treatments; however, very few have been empirically validated. Objective: The aim of this study is to test the efficacy and mechanism of an app-delivered MT that was designed to target a potential mechanism of anxiety (reinforcement learning), based on which previous studies have shown concern regarding feedback and the perpetuation of anxiety through negative reinforcement. Methods: Individuals with GAD were recruited using social media advertisements and randomized during an in-person visit to receive treatment as usual (n=33) or treatment as usual+app?delivered MT (Unwinding Anxiety; n=32). The latter was composed of 30 modules to be completed over a 2-month period. Associated changes in outcomes were assessed using self-report questionnaires 1 and 2 months after treatment initiation. Results: We randomized 65 participants in this study, and a modified intent-to-treat approach was used for analysis. The median number of modules completed by the MT group was 25.5 (IQR 17) out of 30; 46% (13/28) of the participants completed the program. In addition, the MT group demonstrated a significant reduction in anxiety (GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: ?8.5 [IQR 6.5] vs ?1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Increases in mindfulness at 1 month (nonreactivity subscale) mediated decreases in worry at 2 months (Penn State Worry Questionnaire; P=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (P=.03). Conclusions: To our knowledge, this is the first report on the efficacy and mechanism of an app-delivered MT for GAD. These findings demonstrate the clinical efficacy of MT as a digital therapeutic for individuals with anxiety (number needed to treat=1.6). These results also link recent advances in our mechanistic understanding of anxiety with treatment development, showing that app-delivered MT targets key reinforcement learning pathways, resulting in tangible, clinically meaningful reductions in worry and anxiety. Evidence-based, mechanistically targeted digital therapeutics have the potential to improve health at a population level at a low cost. Trial Registration: ClinicalTrials.gov NCT03683472; https://clinicaltrials.gov/ct2/show/NCT03683472 UR - https://www.jmir.org/2021/12/e26987 UR - http://dx.doi.org/10.2196/26987 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860673 ID - info:doi/10.2196/26987 ER - TY - JOUR AU - Piqueras, A. Jose AU - Vidal-Arenas, Verónica AU - Falcó, Raquel AU - Moreno-Amador, Beatriz AU - Marzo, C. Juan AU - Holcomb, M. Juliana AU - Murphy, Michael PY - 2021/12/1 TI - Short Form of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y): Spanish Validation Study JO - J Med Internet Res SP - e31127 VL - 23 IS - 12 KW - PSC-17-Y KW - psychometric properties KW - screening KW - mental problems KW - adolescents KW - adolescent health KW - adolescent medicine KW - psychiatry KW - psychology KW - psychosocial issues N2 - Background: The short form, 17-item version of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y) is a validated measure that assesses psychosocial problems overall (OVR) and in 3 major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5-10 min to complete. Prior research has established sound psychometric properties of the PSC-17-Y for English speakers. Objective: This study extends psychometric evidence for the acceptability of the PSC-17-Y in a large sample of Spanish adolescents, providing proof of its reliability and structure, convergent and discriminant validity, and longitudinal and gender invariance. Methods: Data were collected on 5430 adolescents, aged 12-18 years, who filled out the PSC-17-Y twice during 2018-2019 (7-month interval). We calculated the Cronbach alpha and the McDonald omega coefficients to test reliability, the Pearson correlation for convergent (distress) and criterion validity (well-being, quality of life, and socioemotional skills), confirmatory factor analysis (CFA) for structure validity, and multigroup and longitudinal measurement invariance analysis for longitudinal and gender stability. Results: Within structural analysis for the PSC-17-Y, CFA supported a correlated 3-factor solution, which was also invariant longitudinally and across gender. All 3 subscales showed evidence of reliability, with coefficients near or above .70. Moreover, scores of PSC-17-Y subscales were positively related with convergent measures and negatively related with criterion measures. Normative data for the PSC-17-Y are presented in the form of percentiles (75th and 90th). Conclusions: This work provides the first evidence of the reliability and validity of the Spanish version of the PSC-17-Y administered over the internet to assess mental health problems among adolescents, maintaining the same domains as the long version. UR - https://www.jmir.org/2021/12/e31127 UR - http://dx.doi.org/10.2196/31127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855614 ID - info:doi/10.2196/31127 ER - TY - JOUR AU - Medina, Rafael AU - Bouhaben, Jaime AU - de Ramón, Ignacio AU - Cuesta, Pablo AU - Antón-Toro, Luis AU - Pacios, Javier AU - Quintero, Javier AU - Ramos-Quiroga, Antoni Josep AU - Maestú, Fernando PY - 2021/11/26 TI - Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial JO - J Med Internet Res SP - e25466 VL - 23 IS - 11 KW - ADHD KW - cognitive stimulation KW - magnetoencephalography KW - artificial intelligence KW - Conners continuous performance test KW - KAD_SCL_01 KW - AI KW - cognitive impairment KW - attention deficit hyperactivity disorder KW - pediatrics KW - children KW - rehabilitation N2 - Background: Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. Objective: Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. Methods: In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians. Results: In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship. Conclusions: The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. Trial Registration: ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318 UR - https://www.jmir.org/2021/11/e25466 UR - http://dx.doi.org/10.2196/25466 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842533 ID - info:doi/10.2196/25466 ER - TY - JOUR AU - Taguchi, Kayoko AU - Numata, Noriko AU - Takanashi, Rieko AU - Takemura, Ryo AU - Yoshida, Tokiko AU - Kutsuzawa, Kana AU - Yoshimura, Kensuke AU - Nozaki-Taguchi, Natsuko AU - Ohtori, Seiji AU - Shimizu, Eiji PY - 2021/11/22 TI - Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial JO - J Med Internet Res SP - e30690 VL - 23 IS - 11 KW - cognitive behavioral therapy KW - chronic pain KW - medical economic evaluation KW - EQ-5D-5L KW - telemedicine N2 - Background: Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. Objective: This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. Methods: This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. Results: In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (?1.43, 95% CI ?2.49 to ?0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (?9.42, 95% CI ?14.47 to ?4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (?1.95, 95% CI ?3.33 to ?0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. Conclusions: The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Trial Registration: University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb UR - https://www.jmir.org/2021/11/e30690 UR - http://dx.doi.org/10.2196/30690 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813489 ID - info:doi/10.2196/30690 ER - TY - JOUR AU - Xiang, Xiaoling AU - Kayser, Jay AU - Sun, Yihang AU - Himle, Joseph PY - 2021/11/22 TI - Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants? Experiences JO - JMIR Aging SP - e27630 VL - 4 IS - 4 KW - internet-based cognitive behavioral therapy KW - homebound older adults KW - home care KW - direct care workers KW - depression KW - qualitative study N2 - Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants? experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants? perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 UR - https://aging.jmir.org/2021/4/e27630 UR - http://dx.doi.org/10.2196/27630 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813491 ID - info:doi/10.2196/27630 ER - TY - JOUR AU - Martel, Rhiannon AU - Shepherd, Matthew AU - Goodyear-Smith, Felicity PY - 2021/11/19 TI - Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review JO - JMIR Ment Health SP - e30479 VL - 8 IS - 11 KW - adolescent KW - mental health KW - risk behavior KW - screening KW - primary care N2 - Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases?MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews?were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. UR - https://mental.jmir.org/2021/11/e30479 UR - http://dx.doi.org/10.2196/30479 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807833 ID - info:doi/10.2196/30479 ER - TY - JOUR AU - Slovak, Petr AU - Ford, Q. Brett AU - Widen, Sherri AU - Daudén Roquet, Claudia AU - Theofanopoulou, Nikki AU - Gross, J. James AU - Hankin, Benjamin AU - Klasnja, Predrag PY - 2021/11/9 TI - An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e28914 VL - 10 IS - 11 KW - randomized controlled trial KW - children KW - emotion regulation KW - in situ intervention KW - intervention KW - emotion KW - protocol KW - exploratory KW - efficacy KW - model KW - prevention KW - treatment KW - risk factor N2 - Background: Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot?in the form of an interactive plush toy?that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children?s emotion regulation routines, there is no quantitative evidence of the intervention?s impact on child outcomes. Objective: The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation?Purrble?that can be deployed across prevention and treatment contexts. Methods: Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents? rating of child dysregulation will be ?10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child?s emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis. Results: The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022. Conclusions: This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization. Trial Registration: ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455 International Registered Report Identifier (IRRID): PRR1-10.2196/28914 UR - https://www.researchprotocols.org/2021/11/e28914 UR - http://dx.doi.org/10.2196/28914 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751666 ID - info:doi/10.2196/28914 ER - TY - JOUR AU - Eisenstadt, Mia AU - Liverpool, Shaun AU - Infanti, Elisa AU - Ciuvat, Maria Roberta AU - Carlsson, Courtney PY - 2021/11/8 TI - Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis JO - JMIR Ment Health SP - e31170 VL - 8 IS - 11 KW - systematic review KW - MHapp, mHealth KW - mental health KW - well-being KW - emotion regulation KW - mobile apps KW - effectiveness KW - monitoring KW - management KW - mental health app N2 - Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=?0.24, 95% CI ?0.34 to ?0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. UR - https://mental.jmir.org/2021/11/e31170 UR - http://dx.doi.org/10.2196/31170 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747713 ID - info:doi/10.2196/31170 ER - TY - JOUR AU - McIntyre, Heather AU - Loughhead, Mark AU - Hayes, Laura AU - Procter, Gerard Nicholas PY - 2021/11/4 TI - National Disability Insurance Scheme and Lived Experience of People Presenting to the Emergency Department: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e33268 VL - 10 IS - 11 KW - lived experience KW - National Disability Insurance Scheme KW - emergency department KW - psychosocial disability KW - communication pathways N2 - Background: Currently, within Australia, 3.6% of all emergency department (ED) presentations are mental health?related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early support and care continuity that could potentially inform ED practitioners to revise current practices. Objective: The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for improving continuity of care and consumer experience. Methods: This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring concerns that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals? meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). Results: This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. Conclusions: Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for consumers and carers, while also informing health policy. International Registered Report Identifier (IRRID): PRR1-10.2196/33268 UR - https://www.researchprotocols.org/2021/11/e33268 UR - http://dx.doi.org/10.2196/33268 UR - http://www.ncbi.nlm.nih.gov/pubmed/34554101 ID - info:doi/10.2196/33268 ER - TY - JOUR AU - Eisenstadt, Amelia AU - Liverpool, Shaun AU - Metaxa, Athina-Marina AU - Ciuvat, Maria Roberta AU - Carlsson, Courtney PY - 2021/11/1 TI - Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis JO - JMIR Form Res SP - e31064 VL - 5 IS - 11 KW - smartphone KW - app KW - well-being KW - awareness KW - mental health KW - formative KW - mobile phone N2 - Background: There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users? understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling. Objective: This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data. Results: A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app?s content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t33=?2.16) and the increase in the well-being measures (t33=2.87) were statistically significant. No adverse events were reported during the follow-up period. Conclusions: The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app. UR - https://formative.jmir.org/2021/11/e31064 UR - http://dx.doi.org/10.2196/31064 UR - http://www.ncbi.nlm.nih.gov/pubmed/34569466 ID - info:doi/10.2196/31064 ER - TY - JOUR AU - Carmona, E. Nicole AU - Usyatynsky, Aleksandra AU - Kutana, Samlau AU - Corkum, Penny AU - Henderson, Joanna AU - McShane, Kelly AU - Shapiro, Colin AU - Sidani, Souraya AU - Stinson, Jennifer AU - Carney, E. Colleen PY - 2021/11/1 TI - A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study JO - JMIR Form Res SP - e25392 VL - 5 IS - 11 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone N2 - Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz?s with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode?4) on the items ?easy to use,? ?easy to understand,? ?time commitment,? and ?overall satisfaction? and was rated as credible (mode?4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 UR - https://formative.jmir.org/2021/11/e25392 UR - http://dx.doi.org/10.2196/25392 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723820 ID - info:doi/10.2196/25392 ER - TY - JOUR AU - Martin-Key, A. Nayra AU - Mirea, Dan-Mircea AU - Olmert, Tony AU - Cooper, Jason AU - Han, Sarah Sung Yeon AU - Barton-Owen, Giles AU - Farrag, Lynn AU - Bell, Emily AU - Eljasz, Pawel AU - Cowell, Daniel AU - Tomasik, Jakub AU - Bahn, Sabine PY - 2021/10/28 TI - Toward an Extended Definition of Major Depressive Disorder Symptomatology: Digital Assessment and Cross-validation Study JO - JMIR Form Res SP - e27908 VL - 5 IS - 10 KW - major depressive disorder KW - subthreshold depression, transdiagnostic symptoms KW - digital assessment KW - digital mental health KW - mobile phone N2 - Background: Diagnosing major depressive disorder (MDD) is challenging, with diagnostic manuals failing to capture the wide range of clinical symptoms that are endorsed by individuals with this condition. Objective: This study aims to provide evidence for an extended definition of MDD symptomatology. Methods: Symptom data were collected via a digital assessment developed for a delta study. Random forest classification with nested cross-validation was used to distinguish between individuals with MDD and those with subthreshold symptomatology of the disorder using disorder-specific symptoms and transdiagnostic symptoms. The diagnostic performance of the Patient Health Questionnaire?9 was also examined. Results: A depression-specific model demonstrated good predictive performance when distinguishing between individuals with MDD (n=64) and those with subthreshold depression (n=140) (area under the receiver operating characteristic curve=0.89; sensitivity=82.4%; specificity=81.3%; accuracy=81.6%). The inclusion of transdiagnostic symptoms of psychopathology, including symptoms of depression, generalized anxiety disorder, insomnia, emotional instability, and panic disorder, significantly improved the model performance (area under the receiver operating characteristic curve=0.95; sensitivity=86.5%; specificity=90.8%; accuracy=89.5%). The Patient Health Questionnaire?9 was excellent at identifying MDD but overdiagnosed the condition (sensitivity=92.2%; specificity=54.3%; accuracy=66.2%). Conclusions: Our findings are in line with the notion that current diagnostic practices may present an overly narrow conception of mental health. Furthermore, our study provides proof-of-concept support for the clinical utility of a digital assessment to inform clinical decision-making in the evaluation of MDD. UR - https://formative.jmir.org/2021/10/e27908 UR - http://dx.doi.org/10.2196/27908 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709182 ID - info:doi/10.2196/27908 ER - TY - JOUR AU - Wu, S. Monica AU - Chen, Shih-Yin AU - Wickham, E. Robert AU - O?Neil-Hart, Shane AU - Chen, Connie AU - Lungu, Anita PY - 2021/10/21 TI - Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study JO - JMIR Ment Health SP - e32100 VL - 8 IS - 10 KW - blended care KW - coaching KW - cognitive KW - behavior KW - depression KW - anxiety KW - digital health KW - retrospective KW - mental health KW - CBT KW - cognitive behavioral therapy KW - outcome KW - video conference N2 - Background: Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. Objective: The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. Methods: This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. Results: Out of the total sample of 1496 clients, 75.9% (n=1136) demonstrated reliable improvement, and 88.6% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=?1.04) and depression (b=?0.79) symptoms in the same week, as well as lower anxiety (b=?0.74) and depression (b=?0.91) symptoms the following week (P<.001). Conclusions: The BCC program demonstrated strong outcomes in decreasing symptomology for clients presenting with moderate levels of anxiety and depression. When clients received coaching sessions, significant decreases in symptoms were observed, reflecting the importance of session attendance. Additionally, the steepest declines in symptoms tended to occur during the initial weeks of coaching, emphasizing the importance of client buy-in and early engagement. Collectively, these findings have implications for addressing unmet mental health care needs in a more accessible, cost-effective manner. UR - https://mental.jmir.org/2021/10/e32100 UR - http://dx.doi.org/10.2196/32100 UR - http://www.ncbi.nlm.nih.gov/pubmed/34673534 ID - info:doi/10.2196/32100 ER - TY - JOUR AU - Shalaby, Reham AU - Hrabok, Marianne AU - Spurvey, Pamela AU - Abou El-Magd, M. Rabab AU - Knox, Michelle AU - Rude, Rebecca AU - Vuong, Wesley AU - Surood, Shireen AU - Urichuk, Liana AU - Snaterse, Mark AU - Greenshaw, J. Andrew AU - Li, Xin-Min AU - Agyapong, Opoku Vincent Israel PY - 2021/9/3 TI - Recovery Following Peer and Text Messaging Support After Discharge From Acute Psychiatric Care in Edmonton, Alberta: Controlled Observational Study JO - JMIR Form Res SP - e27137 VL - 5 IS - 9 KW - peer support KW - recovery KW - controlled observational study KW - inpatients KW - mental health KW - supportive text messages N2 - Background: Peer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. Objective: This study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care. Methods: This prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points. Results: A total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention. Conclusions: Peer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge. UR - https://formative.jmir.org/2021/9/e27137 UR - http://dx.doi.org/10.2196/27137 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477565 ID - info:doi/10.2196/27137 ER - TY - JOUR AU - Fung, Kenneth AU - Cheng, Sheng-Li AU - Ning, Xuan AU - Li, Tai-Wai Alan AU - Zhang, Jingxuan AU - Liu, Jing-Wen Jenny AU - Hilario, T. Carla AU - Cheng, Xiaojing AU - Yu, Miao AU - Jia, Cun-Xian AU - Gao, Jianguo AU - Wong, Pui-Hing Josephine PY - 2021/8/26 TI - Mental Health Promotion and Stigma Reduction Among University Students Using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) Framework: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e25592 VL - 10 IS - 8 KW - China KW - implementation science KW - intervention KW - mental health KW - stigma reduction KW - university students N2 - Background: Rapid urbanization, academic pressures, and developmental life transition stressors contribute to mental health stress for postsecondary students in China. Effective prevention, early identification, and timely intervention are challenged by stigma, a lack of mental health literacy, and inadequate mental health resources. Objective: Our implementation science (IS) research project is aimed at evaluating the use of an evidence-informed mental health promotion intervention named Acceptance and Commitment to Empowerment ? Linking Youth and ?Xin? (hearts) (ACE-LYNX) to promote university student mental health in Jinan, China. Methods: We will engage and collaborate with Shandong Mental Health Center, the provincial mental health center, and six local universities in different regions of Jinan. The ACE-LYNX intervention aims to reduce social stigma against mental illness, enhance mental health literacy, and improve access to quality mental health care by increasing interdisciplinary collaboration and forming a mental health network. It is based on two evidence-based approaches, Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP), and it will be delivered through online learning and in-person group training. The project will train 90 interdisciplinary professionals using the model. They will in turn train 15 professionals and 20 students at each university. The project will adopt the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which provides a structure to examine the process and outcomes of implementation using mixed methods comprising quantitative and qualitative approaches along five dimensions: reach, efficacy, adoption, implementation, and maintenance. Results: Over the course of the project, 720 champions will be directly trained. They will contribute to developing a formal and informal mental health network, strengthened by student-led mental health initiatives and professional-led initiatives to promote collaborative care and facilitated care pathways. We anticipate that our project will reach out to 11,000 to 18,000 students. Conclusions: This IS protocol will outline our unique intervention model and key steps to contextualize, implement, and evaluate community-based mental health intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/25592 UR - https://www.researchprotocols.org/2021/8/e25592 UR - http://dx.doi.org/10.2196/25592 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435956 ID - info:doi/10.2196/25592 ER - TY - JOUR AU - Yellowlees, M. Peter AU - Parish, Burke Michelle AU - Gonzalez, D. Alvaro AU - Chan, R. Steven AU - Hilty, M. Donald AU - Yoo, Byung-Kwang AU - Leigh, Paul J. AU - McCarron, M. Robert AU - Scher, M. Lorin AU - Sciolla, F. Andres AU - Shore, Jay AU - Xiong, Glen AU - Soltero, M. Katherine AU - Fisher, Alice AU - Fine, R. Jeffrey AU - Bannister, Jennifer AU - Iosif, Ana-Maria PY - 2021/7/20 TI - Clinical Outcomes of Asynchronous Versus Synchronous Telepsychiatry in Primary Care: Randomized Controlled Trial JO - J Med Internet Res SP - e24047 VL - 23 IS - 7 KW - asynchronous telepsychiatry KW - synchronous telepsychiatry KW - psychiatrist KW - primary care physician KW - psychiatric consultation KW - Spanish-speaking KW - collaborative care KW - workforce KW - depression KW - telehealth N2 - Background: Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. Objective: This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. Methods: Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients? self-reported physical and mental health and depression) outcomes were assessed every 6 months. Results: For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI ?0.2 to 0.6; P=.28; and GAF: ?0.6, 95% CI ?3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI ?0.04 to 0.8; P=.07; and GAF: ?0.5, 95% CI ?3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. Conclusions: This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. Trial Registration: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979. UR - https://www.jmir.org/2021/7/e24047 UR - http://dx.doi.org/10.2196/24047 UR - http://www.ncbi.nlm.nih.gov/pubmed/33993104 ID - info:doi/10.2196/24047 ER - TY - JOUR AU - Hadjistavropoulos, D. Heather AU - McCall, C. Hugh AU - Thiessen, L. David AU - Huang, Ziyin AU - Carleton, Nicholas R. AU - Dear, F. Blake AU - Titov, Nickolai PY - 2021/5/5 TI - Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study JO - J Med Internet Res SP - e27610 VL - 23 IS - 5 KW - internet KW - cognitive behavior therapy KW - anxiety KW - depression KW - posttraumatic stress disorder KW - public safety personnel KW - CBT KW - internet-based cognitive behavioral therapy KW - ICBT KW - PTSD KW - outcome KW - diagnosis KW - longitudinal KW - observational KW - literature KW - effectiveness N2 - Background: Canadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. Objective: This study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan. Methods: We employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns. Results: Clients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance. Conclusions: Tailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation. Trial Registration: Clinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032 UR - https://www.jmir.org/2021/5/e27610 UR - http://dx.doi.org/10.2196/27610 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949959 ID - info:doi/10.2196/27610 ER - TY - JOUR AU - Li, H. Sophie AU - Graham, M. Bronwyn AU - Werner-Seidler, Aliza PY - 2021/3/23 TI - Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App?Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study JO - JMIR Form Res SP - e22498 VL - 5 IS - 3 KW - insomnia KW - gender differences KW - adolescents KW - sleep disturbance KW - sleep quality KW - sleep KW - gender KW - digital interventions N2 - Background: Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents. Objective: The purpose of this study was to examine gender differences in sleep symptom profiles and treatment response in adolescents. Methods: Digital cognitive behavioral therapy for insomnia (CBT-I) treatment responsiveness, as indexed by changes in Insomnia Severity Index (ISI) and Global Pittsburgh Sleep Quality Index (PSQI) scores, was compared in boys and girls (aged 12-16 years; N=49) who participated in a pilot evaluation of the Sleep Ninja smartphone app. Gender differences in self-reported baseline insomnia symptom severity (ISI), sleep quality (PSQI), and sleep characteristics derived from sleep diaries were also examined. Results: Compared with boys, we found that girls reported greater symptom severity (P=.04) and nighttime wakefulness (P=.01 and P=.04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), more nighttime awakenings (P=.16), or longer time to get to sleep (P=.21). However, gender differences in symptom severity and sleep duration were accounted for by boys being marginally younger in age. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity (P=.32); there was a trend showing gender differences in improvements in sleep quality, but this was not statistically significant (P=.07). Conclusions: These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents. UR - https://formative.jmir.org/2021/3/e22498 UR - http://dx.doi.org/10.2196/22498 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755029 ID - info:doi/10.2196/22498 ER - TY - JOUR AU - Ito-Masui, Asami AU - Kawamoto, Eiji AU - Sakamoto, Ryota AU - Yu, Han AU - Sano, Akane AU - Motomura, Eishi AU - Tanii, Hisashi AU - Sakano, Shoko AU - Esumi, Ryo AU - Imai, Hiroshi AU - Shimaoka, Motomu PY - 2021/3/18 TI - Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study JO - JMIR Res Protoc SP - e24799 VL - 10 IS - 3 KW - shift work sleep disorders KW - health care workers KW - wearable sensors KW - shift work KW - sleep disorder KW - medical safety KW - safety issue KW - shift workers KW - sleep KW - safety KW - cognitive behavioral therapy KW - CBT KW - online intervention KW - pilot study KW - machine learning KW - well-being N2 - Background: Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. Objective: In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. Methods: This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. Results: Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. Conclusions: iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. Trial Registration: UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284 International Registered Report Identifier (IRRID): DERR1-10.2196/24799 UR - https://www.researchprotocols.org/2021/3/e24799 UR - http://dx.doi.org/10.2196/24799 UR - http://www.ncbi.nlm.nih.gov/pubmed/33626497 ID - info:doi/10.2196/24799 ER - TY - JOUR AU - Puspitasari, J. Ajeng AU - Heredia, Dagoberto AU - Coombes, J. Brandon AU - Geske, R. Jennifer AU - Gentry, T. Melanie AU - Moore, R. Wendy AU - Sawchuk, N. Craig AU - Schak, M. Kathryn PY - 2021/3/11 TI - Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19 JO - JMIR Ment Health SP - e25542 VL - 8 IS - 3 KW - COVID-19 KW - teletherapy KW - intensive outpatient KW - serious mental illness KW - mental health KW - therapy KW - telemedicine KW - telehealth KW - feasibility KW - outcome KW - behavioral science KW - pilot KW - implementation KW - effective N2 - Background: In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. Objective: This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. Methods: Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. Results: Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI ?3.6 to ?6.2; Cohen d=0.77; P<.001), anxiety (95% CI ?3.0 to ?4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI ?0.5 to ?0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI ?0.2 to ?1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. Conclusions: Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials. UR - https://mental.jmir.org/2021/3/e25542 UR - http://dx.doi.org/10.2196/25542 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651706 ID - info:doi/10.2196/25542 ER - TY - JOUR AU - Rahmadiana, Metta AU - Karyotaki, Eirini AU - Schulte, Mieke AU - Ebert, Daniel David AU - Passchier, Jan AU - Cuijpers, Pim AU - Berger, Thomas AU - van Ballegooijen, Wouter AU - Wimbarti, Supra AU - Riper, Heleen PY - 2021/3/5 TI - Transdiagnostic Internet Intervention for Indonesian University Students With Depression and Anxiety: Evaluation of Feasibility and Acceptability JO - JMIR Ment Health SP - e20036 VL - 8 IS - 3 KW - anxiety KW - cultural adaptation KW - depression KW - guided KW - internet-based intervention KW - transdiagnostic KW - university students N2 - Background: University students with depression and anxiety do not easily receive or seek treatment; therefore, internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, internet-based intervention is effective for treating symptoms of depression, anxiety, or both among university students in Indonesia. Objective: This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, internet-based intervention among university students with symptoms of depression, anxiety, or both in Indonesia. Methods: Students from Universitas Gadjah Mada, Yogyakarta, Indonesia, were screened for symptoms of depression, anxiety, or both, and filled online informed consent, demographic questionnaires, and a quality of life measure at pretreatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at posttreatment assessment (T1) using the 8-item Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Mean and SDs for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semistructured interview and synthesized descriptively. Results: A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (?70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes indicated a decrease in depression and anxiety. For depression, the overall mean difference between the 2 time points for depression was 3.92 (95% CI 2.75-5.1; Hedges g 1.15; P<.001). For anxiety, the overall mean difference between the 2 time points was 3.34 (95% CI 2.06-4.61; Hedges g 1.02; P<.001). Further, a moderate effect in improving quality of life was found (g=0.50). Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. Conclusions: A culturally adapted, transdiagnostic, internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression, anxiety, or both, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs, and maximize treatment accessibility in low-resourced settings. International Registered Report Identifier (IRRID): RR2-10.1016/j.invent.2018.11.002 UR - https://mental.jmir.org/2021/3/e20036 UR - http://dx.doi.org/10.2196/20036 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666553 ID - info:doi/10.2196/20036 ER - TY - JOUR AU - Díaz-García, Amanda AU - González-Robles, Alberto AU - García-Palacios, Azucena AU - Fernández-Álvarez, Javier AU - Castilla, Diana AU - Bretón, María Juana AU - Baños, María Rosa AU - Quero, Soledad AU - Botella, Cristina PY - 2021/2/1 TI - Negative and Positive Affect Regulation in a Transdiagnostic Internet-Based Protocol for Emotional Disorders: Randomized Controlled Trial JO - J Med Internet Res SP - e21335 VL - 23 IS - 2 KW - transdiagnostic KW - positive affectivity KW - negative affectivity KW - emotion regulation KW - emotional disorders KW - internet N2 - Background: Emotional disorders (EDs) are among the most prevalent mental disorders. Existing evidence-based psychological treatments are not sufficient to reduce the disease burden of mental disorders. It is therefore essential to implement innovative solutions to achieve a successful dissemination of psychological treatment protocols, and in this regard, the use of information and communication technologies such as the internet can be very useful. Furthermore, the literature suggests that not everyone with an ED receives the appropriate treatment. This situation has led to the development of new intervention proposals based on the transdiagnostic perspective, which attempts to address the underlying processes common to EDs. Most of these transdiagnostic interventions focus primarily on downregulating negative affectivity (NA), and less attention has been paid to strengths and the upregulation of positive affectivity, despite its importance for well-being and mental health. Objective: This study aims to evaluate the efficacy of a transdiagnostic internet-based treatment for EDs in a community sample. Methods: A 3-armed randomized controlled trial was conducted. A total of 216 participants were randomly assigned to a transdiagnostic internet-based protocol (TIBP), a TIBP+ positive affect (PA) component, or a waiting list (WL) control group. The treatment protocol contained core components mainly addressed to downregulate NA (ie, present-focused emotional awareness and acceptance, cognitive flexibility, behavioral and emotional avoidance patterns, and interoceptive and situational exposure) as well as a PA regulation component to promote psychological strengths and enhance well-being. Data on depression, anxiety, quality of life, neuroticism and extraversion, and PA/NA before and after treatment were analyzed. Expectations and opinions of treatment were also analyzed. Results: Within-group comparisons indicated significant pre-post reductions in the two experimental conditions. In the TIBP+PA condition, the effect sizes were large for all primary outcomes (d=1.42, Beck Depression Inventory [BDI-II]; d=0.91, Beck Anxiety Inventory [BAI]; d=1.27, Positive and Negative Affect Schedule-Positive [PANAS-P]; d=1.26, Positive and Negative Affect Schedule-Negative [PANAS-N]), whereas the TIBP condition yielded large effect sizes for BDI-II (d=1.19) and PANAS-N (d=1.28) and medium effect sizes for BAI (d=0.63) and PANAS-P (d=0.69). Between-group comparisons revealed that participants who received one of the two active treatments scored better at posttreatment than WL participants. Although there were no statistically significant differences between the two intervention groups on the PA measure, effect sizes were consistently larger in the TIBP+PA condition than in the standard transdiagnostic protocol. Conclusions: Overall, the findings indicate that EDs can be effectively treated with a transdiagnostic intervention via the internet, as significant improvements in depression, anxiety, and quality of life measures were observed. Regarding PA measures, promising effects were found, but more research is needed to study the role of PA as a therapeutic component. Trial Registration: ClinicalTrials.gov NCT02578758; https://clinicaltrials.gov/ct2/show/NCT02578758 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-017-1297-z UR - https://www.jmir.org/2021/2/e21335 UR - http://dx.doi.org/10.2196/21335 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522977 ID - info:doi/10.2196/21335 ER - TY - JOUR AU - Bielinski, Luisa Laura AU - Krieger, Tobias AU - Moggi, Franz AU - Trimpop, Leonie AU - Willutzki, Ulrike AU - Nissen, Christoph AU - Berger, Thomas PY - 2020/11/12 TI - REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e20936 VL - 9 IS - 11 KW - blended therapy KW - internet-based intervention KW - emotion regulation KW - transdiagnostic KW - online therapy N2 - Background: Emotion regulation has been identified as an important transdiagnostic factor relevant to the treatment of mental health disorders. Many empirically validated psychotherapeutic treatments incorporate elements targeting emotion regulation. Most of these treatment approaches are conceptualized as standard face-to-face treatments not as blended treatments, which include an internet-based intervention. Objective: The aim of this study is to examine, for the first time, a new internet-based intervention?REMOTION?that will be provided transdiagnostically, as an add-on to psychotherapy, to provide a blended treatment format. Methods: A total of 70 participants will be assigned (1:1 allocation ratio) to either the intervention group (REMOTION + psychotherapy) or the treatment-as-usual group that receives psychotherapy alone. To maximize external validity, a typical outpatient treatment sample of patients diagnosed with a range of disorders such as depression, anxiety disorders, and adjustment disorder will be recruited from a university outpatient clinic. Patients with bipolar disorder, psychotic disorders, or acute suicidality will be excluded from the study. The feasibility and potential effectiveness of the intervention will be examined by assessing data at baseline, 6 weeks (post), and 12 weeks (follow-up). The primary outcome is general symptom severity, assessed with the Brief Symptom Inventory. Secondary outcomes are emotion regulation, depressive symptoms, anxiety symptoms, health related quality of life, well-being, and a variety of feasibility parameters. Quantitative data will be analyzed on an intention-to-treat basis. Results: Participant recruitment and data collection started in February 2020, and as of November 2020, are ongoing. Results for the study are expected in 2022. Conclusions: This pilot randomized controlled trial will inform future studies using transdiagnostic blended treatment. Trial Registration: ClinicalTrials.gov NCT04262726; http://clinicaltrials.gov/ct2/show/NCT04262726 International Registered Report Identifier (IRRID): DERR1-10.2196/20936 UR - http://www.researchprotocols.org/2020/11/e20936/ UR - http://dx.doi.org/10.2196/20936 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180026 ID - info:doi/10.2196/20936 ER - TY - JOUR AU - Edmonds, R. Michael AU - Hadjistavropoulos, D. Heather AU - Gullickson, M. Kirsten AU - Asmundson, JN Aleiia AU - Dear, F. Blake AU - Titov, Nickolai PY - 2020/10/13 TI - Understanding Problems With Sleep, Sexual Functioning, Energy, and Appetite Among Patients Who Access Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression: Qualitative Exploratory Study JO - JMIR Form Res SP - e15037 VL - 4 IS - 10 KW - cognitive behavioral therapy KW - anxiety KW - depression KW - internet-based intervention KW - sleep KW - sexual health KW - motivation KW - appetite N2 - Background: Transdiagnostic internet-delivered cognitive behavioral therapy (T-ICBT) is an effective treatment for anxiety and depression, and nowadays, there is interest in exploring ways to optimize T-ICBT in routine care. T-ICBT programs are designed to address the primary cognitive-affective and behavioral symptoms of anxiety and depression (eg, low mood, worry, anhedonia, and avoidance). Treatment also has the potential to resolve other symptom concerns (eg, sleep disruption, sexual dysfunction, lack of energy, and appetite or weight changes). Having additional information regarding the extent of these concerns and how concerns change over time could prove beneficial for further development of T-ICBT in routine care. Objective: This exploratory formative study aims to better understand sleep, sexual functioning, energy, and appetite concerns among T-ICBT clients seeking treatment for depression and anxiety. A qualitative analytic approach was used to identify themes in the symptom concerns reported by patients in the areas of sleep, sexual functioning, energy, and appetite at the time of enrollment. Patient responses to related items from screening measures for anxiety and depression were also examined pre- and posttreatment. Methods: Patients in routine care who applied for a T-ICBT program for depression and anxiety over a 1-year period were included in this study. As part of the application and screening process, participants completed depression and anxiety symptom measures (ie, 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale). These same measures were administered posttreatment. Subsequently, they were asked if they were experiencing any problems with sleep, sexual activity, energy, or appetite (yes or no). If their response was yes, they were presented with an open-ended comment box that asked them to describe the problems they had experienced in those areas. Results: A total of 462 patients were admitted to T-ICBT during the study period, of which 438 endorsed having some problems with sleep, sexual activity, energy, or appetite. The analysis of open-ended responses indicated that 73.4% (339/462) of patients reported sleep problems (eg, difficulty initiating or maintaining sleep), 69.3% (320/462) of patients reported problems with energy or motivation (eg, tiredness and low motivation), 57.4% (265/462) of patients reported appetite or body weight concerns (eg, changes in appetite and weight loss or gain), and 30.1% (139/462) of patients described concerns with sexual functioning (eg, loss of interest in sex and difficulty with arousal). Item analysis of symptom measures demonstrated that T-ICBT produced improvements in sleep, energy, and appetite in 8 weeks. Sexual dysfunction and weight changes were not represented in the screening measures, so it remains unclear what effect T-ICBT has on these symptoms. Conclusions: Sleep disruption, lack of energy, appetite or weight changes, and sexual dysfunction are common concerns reported by clients enrolled in T-ICBT in routine practice and may deserve greater attention in T-ICBT program development and administration. UR - http://formative.jmir.org/2020/10/e15037/ UR - http://dx.doi.org/10.2196/15037 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048054 ID - info:doi/10.2196/15037 ER - TY - JOUR AU - Zargaran, David AU - Walsh, Caoimhe AU - Koumpa, Stefania Foteini AU - Ashraf, Arsalan Muhammad AU - White, Jayne Amelia AU - Patel, Nikhil AU - Tanna, Ravina AU - Trepekli, Anna AU - Zargaran, Alexander PY - 2020/8/12 TI - Comment on ?Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial? JO - J Med Internet Res SP - e13234 VL - 22 IS - 8 KW - internet KW - CBT KW - cognitive behavioral therapy KW - telemedicine KW - telehealth UR - https://www.jmir.org/2020/8/e13234 UR - http://dx.doi.org/10.2196/13234 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784172 ID - info:doi/10.2196/13234 ER - TY - JOUR AU - González-Robles, Alberto AU - Díaz-García, Amanda AU - García-Palacios, Azucena AU - Roca, Pablo AU - Ramos-Quiroga, Antoni Josep AU - Botella, Cristina PY - 2020/7/7 TI - Effectiveness of a Transdiagnostic Guided Internet-Delivered Protocol for Emotional Disorders Versus Treatment as Usual in Specialized Care: Randomized Controlled Trial JO - J Med Internet Res SP - e18220 VL - 22 IS - 7 KW - transdiagnostic KW - internet KW - cognitive behavioral therapy KW - emotional disorders KW - depression KW - anxiety KW - specialized care N2 - Background: Anxiety disorders and depression (emotional disorders) are highly prevalent mental disorders. Extensive empirical evidence supports the efficacy of cognitive behavioral therapy (CBT) for the treatment of these disorders. However, there are still some barriers related to their dissemination and implementation, which make it difficult for patients to receive these treatments, especially in public health care settings where resources are limited. Recent advances in improving CBT dissemination encompass different perspectives. One is the transdiagnostic approach, which offers treatment protocols that can be used for a range of emotional disorders. Another approach is the use of the internet to reach a larger number of people who could benefit from CBT. Objective: This study aimed to analyze the effectiveness and acceptability of a transdiagnostic internet-delivered protocol (EmotionRegulation) with human and automated guidance in patients from public specialized mental health care settings. Methods: A 2-armed randomized controlled trial (RCT) was conducted to compare the effectiveness of EmotionRegulation with treatment as usual (TAU) in specialized mental health care. In all, 214 participants were randomly assigned to receive either EmotionRegulation (n=106) or TAU (n=108). Measurement assessments were conducted at pre- and postintervention and at a 3-month follow-up. Results: The results revealed the superiority of EmotionRegulation over TAU on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=?0.45) at posttreatment, and these gains were maintained at the 3-month follow-up. Furthermore, the results for expectations and opinions showed that EmotionRegulation was well accepted by participants. Conclusions: EmotionRegulation was more effective than TAU for the treatment of emotional disorders in the Spanish public mental health system. The implications of this RCT, limitations, and suggestions for future research are discussed. Trial Registration: ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668 UR - https://www.jmir.org/2020/7/e18220 UR - http://dx.doi.org/10.2196/18220 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673226 ID - info:doi/10.2196/18220 ER - TY - JOUR AU - van der Vaart, Rosalie AU - van Driel, Dorine AU - Pronk, Kristel AU - Paulussen, Suzan AU - te Boekhorst, Selma AU - Rosmalen, M. Judith G. AU - Evers, M. Andrea W. PY - 2019/11/21 TI - The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study JO - JMIR Form Res SP - e12883 VL - 3 IS - 4 KW - internet-based cognitive behavior therapy KW - chronic pain KW - usability KW - digital health literacy skills KW - eHealth literacy N2 - Background: Internet-based cognitive behavior therapy (iCBT) can be effective in mental and somatic health care. Research on the feasibility of internet interventions in clinical practice is, however, still scarce. Studies with a focus on the patient regarding usability of interventions and digital health literacy skills are especially lacking. Objective: The goal of this study was to assess the usability of an iCBT for chronic pain, Master Your Pain, and the relationship between its usability outcomes and the factors age, educational level, and digital health literacy skills. The aims were to determine what changes were needed in the program for sufficient usability and which individual characteristics were related to the usability of the program. Methods: Patients were recruited from two mental health care practices. A mixed methods approach was used in this study. A qualitative observational study comprising performance tasks in the iCBT program was used to test usability. A quantitative questionnaire was used to measure possible related constructs. Usability was operationalized as the number of tasks that could be completed and the type and number of problems that occurred while doing so. Performance tasks were set up to measure 6 digital skills: (1) operating the computer and internet browser, (2) navigation and orientation, (3) using search strategies, (4) evaluating relevance of content, (5) adding personal content, and (6) protecting and respecting privacy. Participants were asked to think aloud while performing the tasks, and screen activities and webcam recordings were captured. The qualitative observational data was coded using inductive analysis by two independent researchers. Correlational analyses were performed to test how usability relates to sociodemographics and digital health literacy. Results: A total of 32 patients participated, with a mean age of 49.9 years and 84% (27/32) being female. All performance tasks except one (fill in a diary registration) could be completed independently by more than 50% of the participants. On operational, navigation, and search levels, participants struggled most with logging in, logging out, and finding specific parts of the intervention. Half of the sample experienced problems evaluating the relevance and adding content to the program to some extent. Usability correlated moderately negatively with age and moderately positively with digital health literacy skills but not with educational level. Conclusions: The results provide insight into what is essential for proper usability regarding the design of an iCBT program considering variations in age, educational level, and digital health literacy. Furthermore, the results provide insight into what type of support is needed by patients to properly use the intervention. Tailoring support among the needs of certain age groups or skill levels could be beneficial and could range from no extra support (only online feedback, as intended) to practical support (an additional usability introduction session) to blended care (combined face-to-face sessions throughout the therapy). UR - http://formative.jmir.org/2019/4/e12883/ UR - http://dx.doi.org/10.2196/12883 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750839 ID - info:doi/10.2196/12883 ER - TY - JOUR AU - McCashin, Darragh AU - Coyle, David AU - O'Reilly, Gary PY - 2019/11/12 TI - Qualitative Synthesis of Young People?s Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review JO - J Med Internet Res SP - e13540 VL - 21 IS - 11 KW - cognitive behavioral therapy KW - systematic review KW - qualitative research KW - children KW - mental health KW - technology KW - mHealth KW - eHealth N2 - Background: Cognitive behavioral therapy (CBT) for young people is increasingly being provided using technology-assisted formats. Although there is increasing evidence regarding the efficacy of such approaches, as illustrated by quantitative systematic reviews, the literature has also highlighted challenges with implementation factors, including high attrition rates and variable user engagement. Qualitative review methods can help to address the factors that impact young peoples? experience of technology-assisted cognitive behavioral therapy (tech-assisted CBT) and, thus, enable us to better understand such implementation factors. To date, no such qualitative synthesis exists. Objective: The primary aim of this review was to systematically identify and synthesize the qualitative literature concerning the experiences of young people who have used tech-assisted CBT. Methods: This systematic review applied Thomas and Harden?s 2008 qualitative thematic synthesis approach. This involved line-by-line coding of the results sections of included studies and an inductive analysis on identified themes, followed by the generation of analytical themes through a process of iteration and interpretation of the descriptive themes. PsycINFO, ACM Digital Library, PubMed, EMBASE, and JMIR Publications databases were searched. The inclusion criteria were (1) studies involving school-aged young people over preschool age (6 years) but under the age of 18 years, (2) use of any form of tech-assisted CBT for any time period, (3) a stated focus of qualitative data to document the experiences of participants, and (4) studies published in English. The exclusion criteria were (1) interventions only provided face-to-face with no technological component, (2) only focused on the performance of the technology rather than participant experience, and (3) numerical data that sought to represent qualitative data. Results: A total of 14 studies were included in this review. Overall, these studies represented interventions for low mood and anxiety (n=10), trauma or self-harm (n=2), and physical difficulties (n=2). Overall, 5 analytical themes emerged on young people?s experiences with tech-assisted CBT: (1) helpfulness, (2) therapeutic process, (3) transferability, (4) gameplay experience, and (5) limitations. In addition, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face CBT, understanding of a CBT model, process of change, skills development, application to everyday life settings, parental involvement, character relatedness, playability, negative experiences, and broad content. Conclusions: Overall, young people?s experiences with tech-assisted CBT were mostly positive. The use of gaming environments, relatable characters, concrete metaphors, and age-appropriate narratives contributed to these positive experiences. Evidence suggests that technology can help to mediate face-to-face relationships with therapists and help young people to understand the CBT model. Clear barriers also emerged, including over-reliance on reading and writing skills and dissatisfaction with overly generalized content and comparison with commercial technologies. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018103388; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103388 UR - http://www.jmir.org/2019/11/e13540/ UR - http://dx.doi.org/10.2196/13540 UR - http://www.ncbi.nlm.nih.gov/pubmed/31714251 ID - info:doi/10.2196/13540 ER - TY - JOUR AU - Zhang, Melvyn AU - Ying, Jiangbo AU - Song, Guo AU - Fung, S. Daniel S. AU - Smith, Helen PY - 2019/10/24 TI - Web-Based Cognitive Bias Modification Interventions for Psychiatric Disorders: Scoping Review JO - JMIR Ment Health SP - e11841 VL - 6 IS - 10 KW - cognitive bias KW - attention bias KW - psychiatry KW - eHealth N2 - Background: Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this. Objective: This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness. Methods: Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: (?attention bias? OR ?cognitive bias? OR ?approach bias? OR ?avoidance bias? OR ?interpretative bias?) AND (?Internet? OR ?Web? OR ?Online?). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported. Results: Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD. Conclusions: This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions. International Registered Report Identifier (IRRID): RR1-10.2196/10427 UR - http://mental.jmir.org/2019/10/e11841/ UR - http://dx.doi.org/10.2196/11841 UR - http://www.ncbi.nlm.nih.gov/pubmed/31651410 ID - info:doi/10.2196/11841 ER - TY - JOUR AU - Gaffney, Hannah AU - Mansell, Warren AU - Tai, Sara PY - 2019/10/18 TI - Conversational Agents in the Treatment of Mental Health Problems: Mixed-Method Systematic Review JO - JMIR Ment Health SP - e14166 VL - 6 IS - 10 KW - artificial intelligence KW - mental health KW - stress, pychological KW - psychiatry KW - therapy, computer-assisted KW - conversational agent KW - chatbot KW - digital health N2 - Background: The use of conversational agent interventions (including chatbots and robots) in mental health is growing at a fast pace. Recent existing reviews have focused exclusively on a subset of embodied conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health. Objective: This study aimed to review the use of conversational agent interventions in the treatment of mental health problems. Methods: We performed a systematic search using relevant databases (MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane library). Studies that reported on an autonomous conversational agent that simulated conversation and reported on a mental health outcome were included. Results: A total of 13 studies were included in the review. Among them, 4 full-scale randomized controlled trials (RCTs) were included. The rest were feasibility, pilot RCTs and quasi-experimental studies. Interventions were diverse in design and targeted a range of mental health problems using a wide variety of therapeutic orientations. All included studies reported reductions in psychological distress postintervention. Furthermore, 5 controlled studies demonstrated significant reductions in psychological distress compared with inactive control groups. In addition, 3 controlled studies comparing interventions with active control groups failed to demonstrate superior effects. Broader utility in promoting well-being in nonclinical populations was unclear. Conclusions: The efficacy and acceptability of conversational agent interventions for mental health problems are promising. However, a more robust experimental design is required to demonstrate efficacy and efficiency. A focus on streamlining interventions, demonstrating equivalence to other treatment modalities, and elucidating mechanisms of action has the potential to increase acceptance by users and clinicians and maximize reach. UR - https://mental.jmir.org/2019/10/e14166 UR - http://dx.doi.org/10.2196/14166 UR - http://www.ncbi.nlm.nih.gov/pubmed/31628789 ID - info:doi/10.2196/14166 ER - TY - JOUR AU - Derks, PMJ Youri AU - Klaassen, Randy AU - Westerhof, J. Gerben AU - Bohlmeijer, T. Ernst AU - Noordzij, L. Matthijs PY - 2019/10/15 TI - Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study JO - JMIR Mhealth Uhealth SP - e13479 VL - 7 IS - 10 KW - mental health KW - borderline personality disorder KW - mobile health KW - emotional awareness KW - ambulatory biofeedback KW - design science KW - user centered design KW - iterative prototype testing N2 - Background: Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients? emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. Objective: The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. Methods: Using several methods in a tailored User Centred Design (UCD) framework, we tested the app?s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). Results: The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as ?Good? (average score of 78.8), whereas the therapists rated the app as ?OK? (average score of 59.4). The UCD experts judged the app?s overall usability as between ?OK? and ?acceptable? (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. Conclusions: mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed. UR - https://mhealth.jmir.org/2019/10/e13479 UR - http://dx.doi.org/10.2196/13479 UR - http://www.ncbi.nlm.nih.gov/pubmed/31617851 ID - info:doi/10.2196/13479 ER - TY - JOUR AU - Klein, Pauline AU - Lawn, Sharon AU - Tsourtos, George AU - van Agteren, Joep PY - 2019/09/03 TI - Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study JO - JMIR Hum Factors SP - e14023 VL - 6 IS - 3 KW - mental health KW - mHealth KW - tobacco KW - smoking cessation KW - public health KW - technology N2 - Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants? smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants? responses to the second interview. Stage 2 interviews explored participants? perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users? psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations. UR - https://humanfactors.jmir.org/2019/3/e14023 UR - http://dx.doi.org/10.2196/14023 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482850 ID - info:doi/10.2196/14023 ER - TY - JOUR AU - IJzerman, H. Renée V. AU - van der Vaart, Rosalie AU - Evers, M. Andrea W. PY - 2019/08/09 TI - Internet-Based Cognitive Behavioral Therapy Among Psychologists in a Medical Setting: A Survey on Implementation JO - J Med Internet Res SP - e13432 VL - 21 IS - 8 KW - eHealth KW - chronic care KW - self-management KW - implementation KW - psychologists KW - UTAUT N2 - Background: Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for patients with a chronic somatic illness to improve self-management skills and to learn to adjust to their chronic disease and its impact on daily life. However, the implementation of iCBT in clinical practice is challenging. Objective: This study aimed to examine the current degree of implementation of iCBT among psychologists in a medical setting and discover determinants influencing the implementation of iCBT among nonusers. Methods: A Web-based survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), was distributed among psychologists in a medical setting. The survey included questions regarding the current use of iCBT, intention to use iCBT in the future, and operationalized concepts of the UTAUT constructs, that is, performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Results: In total, 107 (24.8%) psychologists completed the survey. Of them, 16.8% have access to iCBT, 15.9% currently use iCBT, and 21.5% are expected to use iCBT within the next year. The constructs PE, EE, and SI together significantly influenced behavioral intention (BI; mean 3.9 [SD=0.8]) among nonusers (R2=0.490; F4.85=20.405; P<.001). Conclusions: In spite of an average to high BI, the current implementation of iCBT is rather low among psychologists in a medical setting. Further research should focus on reducing the gap between intention to use and actual use by focusing on influencing the predictive UTAUT constructs. UR - https://www.jmir.org/2019/8/e13432/ UR - http://dx.doi.org/10.2196/13432 UR - http://www.ncbi.nlm.nih.gov/pubmed/31400101 ID - info:doi/10.2196/13432 ER - TY - JOUR AU - Theofanopoulou, Nikki AU - Isbister, Katherine AU - Edbrooke-Childs, Julian AU - Slovák, Petr PY - 2019/08/05 TI - A Smart Toy Intervention to Promote Emotion Regulation in Middle Childhood: Feasibility Study JO - JMIR Ment Health SP - e14029 VL - 6 IS - 8 KW - mental health KW - children KW - families KW - stress, psychological KW - emotional adjustment N2 - Background: A common challenge with existing psycho-social prevention interventions for children is the lack of effective, engaging, and scalable delivery mechanisms, especially beyond in-person therapeutic or school-based contexts. Although digital technology has the potential to address these issues, existing research on technology-enabled interventions for families remains limited. This paper focuses on emotion regulation (ER) as an example of a core protective factor that is commonly targeted by prevention interventions. Objective: The aim of this pilot study was to provide an initial validation of the logic model and feasibility of in situ deployment for a new technology-enabled intervention, designed to support children?s in-the-moment ER efforts. The novelty of the proposed approach relies on delivering the intervention through an interactive object (a smart toy) sent home with the child, without any prior training necessary for either the child or their carer. This study examined (1) engagement and acceptability of the toy in the homes during 1-week deployments, and (2) qualitative indicators of ER effects, as reported by parents and children. In total, 10 families (altogether 11 children aged 6-10 years) were recruited from 3 predominantly underprivileged communities in the United Kingdom, as low SES populations have been shown to be particularly at risk for less developed ER competencies. Children were given the prototype, a discovery book, and a simple digital camera to keep at home for 7 to 8 days. Data were gathered through a number of channels: (1) semistructured interviews with parents and children prior to and right after the deployment, (2) photos children took during the deployment, and (3) touch interactions automatically logged by the prototype throughout the deployment. Results: Across all families, parents and children reported that the smart toy was incorporated into the children?s ER practices and engaged with naturally in moments the children wanted to relax or calm down. Data suggested that the children interacted with the toy throughout the deployment, found the experience enjoyable, and all requested to keep the toy longer. Children?s emotional connection to the toy appears to have driven this strong engagement. Parents reported satisfaction with and acceptability of the toy. Conclusions: This is the first known study on the use of technology-enabled intervention delivery to support ER in situ. The strong engagement, incorporation into children?s ER practices, and qualitative indications of effects are promising. Further efficacy research is needed to extend these indicative data by examining the psychological efficacy of the proposed intervention. More broadly, our findings argue for the potential of a technology-enabled shift in how future prevention interventions are designed and delivered: empowering children and parents through child-led, situated interventions, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent skills application. UR - https://mental.jmir.org/2019/8/e14029/ UR - http://dx.doi.org/10.2196/14029 UR - http://www.ncbi.nlm.nih.gov/pubmed/31381502 ID - info:doi/10.2196/14029 ER - TY - JOUR AU - Hafiz, Pegah AU - Miskowiak, Woznica Kamilla AU - Kessing, Vedel Lars AU - Elleby Jespersen, Andreas AU - Obenhausen, Kia AU - Gulyas, Lorant AU - Zukowska, Katarzyna AU - Bardram, Eyvind Jakob PY - 2019/07/26 TI - The Internet-Based Cognitive Assessment Tool: System Design and Feasibility Study JO - JMIR Form Res SP - e13898 VL - 3 IS - 3 KW - screening KW - memory KW - executive function KW - bipolar disorder KW - depression KW - cognitive impairments KW - neuropsychological tests KW - computer software KW - speech recognition software N2 - Background: Persistent cognitive impairment is prevalent in unipolar and bipolar disorders and is associated with decreased quality of life and psychosocial dysfunction. The screen for cognitive impairment in psychiatry (SCIP) test is a validated paper-and-pencil instrument for the assessment of cognition in affective disorders. However, there is no digital cognitive screening tool for the brief and accurate assessment of cognitive impairments in this patient group. Objective: In this paper, we present the design process and feasibility study of the internet-based cognitive assessment tool (ICAT) that is designed based on the cognitive tasks of the SCIP. The aims of this feasibility study were to perform the following tasks among healthy individuals: (1) evaluate the usability of the ICAT, (2) investigate the feasibility of the ICAT as a patient-administered cognitive assessment tool, and (3) examine the performance of automatic speech recognition (ASR) for the assessment of verbal recall. Methods: The ICAT was developed in a user-centered design process. The cognitive measures of the ICAT were immediate and delayed recall, working memory, and psychomotor speed. Usability and feasibility studies were conducted separately with 2 groups of healthy individuals (N=21 and N=19, respectively). ICAT tests were available in the English and Danish languages. The participants were asked to fill in the post study system usability questionnaire (PSSUQ) upon completing the ICAT test. Verbal recall in the ICAT was assessed using ASR, and the performance evaluation criterion was word error rate (WER). A Pearson 2-tailed correlation analysis significant at the .05 level was applied to investigate the association between the SCIP and ICAT scores. Results: The overall psychometric factors of PSSUQ for both studies gave scores above 4 (out of 5). The analysis of the feasibility study revealed a moderate to strong correlation between the total scores of the SCIP and ICAT (r=0.63; P=.009). There were also moderate to strong correlations between the SCIP and ICAT subtests for immediate verbal recall (r=0.67; P=.002) and psychomotor speed (r=0.71; P=.001). The associations between the respective subtests for working memory, executive function, and delayed recall, however, were not statistically significant. The corresponding WER for English and Danish responses were 17.8% and 6.3%, respectively. Conclusions: The ICAT is the first digital screening instrument modified from the SCIP using Web-based technology and ASR. There was good accuracy of the ASR for verbal memory assessment. The moderate correlation between the ICAT and SCIP scores suggests that the ICAT is a valid tool for assessing cognition, although this should be confirmed in a larger study with greater statistical power. Taken together, the ICAT seems to be a valid Web-based cognitive assessment tool that, after some minor modifications and further validation, may be used to screen for cognitive impairment in clinical settings. UR - http://formative.jmir.org/2019/3/e13898/ UR - http://dx.doi.org/10.2196/13898 UR - http://www.ncbi.nlm.nih.gov/pubmed/31350840 ID - info:doi/10.2196/13898 ER - TY - JOUR AU - Ose, Osborg Solveig AU - Færevik, Hilde AU - Kaasbøll, Jannike AU - Lindgren, Martin AU - Thaulow, Kristin AU - Antonsen, Stig AU - Burkeland, Olav PY - 2019/6/10 TI - Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers JO - JMIR Form Res SP - e13633 VL - 3 IS - 2 KW - virtual reality KW - severe mental illness KW - collaborative research KW - technology KW - social work N2 - Background: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. Objective: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. Methods: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians?four from specialist mental health services and four from municipal mental health services?was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR?s potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. Results: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. Conclusions: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation. UR - http://formative.jmir.org/2019/2/e13633/ UR - http://dx.doi.org/10.2196/13633 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199315 ID - info:doi/10.2196/13633 ER - TY - JOUR AU - Beard, Courtney AU - Silverman, L. Alexandra AU - Forgeard, Marie AU - Wilmer, Taylor M. AU - Torous, John AU - Bjo?rgvinsson, Thro?stur PY - 2019/6/7 TI - Smartphone, Social Media, and Mental Health App Use in an Acute Transdiagnostic Psychiatric Sample JO - JMIR Mhealth Uhealth SP - e13364 VL - 7 IS - 6 KW - mobile health KW - smartphone KW - social media KW - serious mental illness N2 - Background: Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health. Objective: This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use. Methods: The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale). Results: Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type. Conclusions: The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health?specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life. UR - https://mhealth.jmir.org/2019/6/e13364/ UR - http://dx.doi.org/10.2196/13364 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199338 ID - info:doi/10.2196/13364 ER - TY - JOUR AU - Ben-Zeev, Dror AU - Buck, Benjamin AU - Chu, Vu Phuonguyen AU - Razzano, Lisa AU - Pashka, Nicole AU - Hallgren, A. Kevin PY - 2019/04/12 TI - Transdiagnostic Mobile Health: Smartphone Intervention Reduces Depressive Symptoms in People With Mood and Psychotic Disorders JO - JMIR Ment Health SP - e13202 VL - 6 IS - 4 KW - mHealth KW - schizophrenia KW - bipolar disorder KW - depression KW - illness management KW - symptoms KW - transdiagnostic N2 - Background: Depression is the most prevalent mental health problem. The need for effective treatments for depression far outstrips the availability of trained mental health professionals. Smartphones and other widely available technologies are increasingly being leveraged to deliver treatments for depression. Whether there are patient characteristics that affect the potency of smartphone interventions for depression is not well understood. Objective: This study aimed to evaluate whether patient characteristics including clinical diagnosis, depression severity, psychosis status, and current use of antidepressant medications impact the effects of an evidence-based smartphone intervention on depressive symptoms. Methods: Data were collected as part of a 2-arm randomized controlled trial comparing a multimodal smartphone intervention called FOCUS with a clinic-based intervention. Here, we report on 82 participants assigned to 12 weeks of FOCUS treatment. We conducted assessments of depressive symptoms using the Beck Depression Inventory-second edition (BDI-II) at baseline, postintervention (3 months), and follow-up (6 months). We tested for differences in the amount of improvement in BDI-II scores from baseline to posttreatment and 6-month follow-up between each of the following patient subgroups using 2 (group) × 2 (time) mixed effects models: diagnosis (ie, schizophrenia spectrum disorder vs bipolar disorder vs major depressive disorder), depression severity (ie, minimal-mild vs moderate-severe depression), psychosis status (ie, presence vs absence of psychotic symptoms), and antidepressant use (ie, taking antidepressants vs not taking antidepressants). Results: The majority of participants were male (60%, 49/82), African American (65%, 53/82), and middle-aged (mean age 49 years), with a high school education or lower (62%, 51/82). There were no differences in patient demographics across the variables that were used to stratify the analyses. There was a significant group × time interaction for baseline depression severity (F1,76.8=5.26, P=.02 [posttreatment] and F1,77.4=6.56, P=.01 [6-month follow-up]). Participants with moderate or severe depression had significant improvements (t42=3.20, P=.003 [posttreatment] and t42=4.20, P<.001 [6-month follow-up]), but participants with minimal or mild depression did not (t31=0.20, P=.84 [posttreatment] and t30=0.43, P=.67 [6-month follow-up]). There were no significant group × time interactions for diagnosis, psychosis status, or antidepressant medication use. Participants with minimal or mild depression had negligible nonsignificant improvements (<1 point on the BDI-II). Reduction in depression in all other groups was larger (range 1.7-6.5 points on the BDI-II). Conclusions: Our results suggest that FOCUS can be deployed to treat moderate to severe depressive symptoms among people with schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder, in concert with antidepressant medications or without them, in both people with and without active psychotic symptoms. The study results are consistent with research on transdiagnostic models in psychotherapy and extend our knowledge about the potential of transdiagnostic mobile health. Trial Registration: ClinicalTrials.gov NCT02421965; http://clinicaltrials.gov/ct2/show/NCT02421965 (Archived by WebCite at http://www.webcitation.org/76pyDlvAS) UR - http://mental.jmir.org/2019/4/e13202/ UR - http://dx.doi.org/10.2196/13202 UR - http://www.ncbi.nlm.nih.gov/pubmed/30977736 ID - info:doi/10.2196/13202 ER - TY - JOUR AU - Garabiles, R. Melissa AU - Harper Shehadeh, Melissa AU - Hall, J. Brian PY - 2019/03/29 TI - Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers JO - JMIR Form Res SP - e11600 VL - 3 IS - 1 KW - cultural adaptation KW - migrant workers KW - e-mental health KW - overseas Filipino workers N2 - Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization?s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. UR - https://formative.jmir.org/2019/1/e11600/ UR - http://dx.doi.org/10.2196/11600 UR - http://www.ncbi.nlm.nih.gov/pubmed/30924784 ID - info:doi/10.2196/11600 ER - TY - JOUR AU - Buitenweg, C. David AU - Bongers, L. Ilja AU - van de Mheen, Dike AU - van Oers, AM Hans AU - van Nieuwenhuizen, Chijs PY - 2019/03/28 TI - Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems JO - JMIR Ment Health SP - e12378 VL - 6 IS - 3 KW - mobile app KW - quality of life KW - mental health KW - homeless persons KW - medical informatics N2 - Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language?based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants? previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. UR - http://mental.jmir.org/2019/3/e12378/ UR - http://dx.doi.org/10.2196/12378 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920381 ID - info:doi/10.2196/12378 ER - TY - JOUR AU - Smith-Merry, Jennifer AU - Goggin, Gerard AU - Campbell, Andrew AU - McKenzie, Kirsty AU - Ridout, Brad AU - Baylosis, Cherry PY - 2019/03/26 TI - Social Connection and Online Engagement: Insights From Interviews With Users of a Mental Health Online Forum JO - JMIR Ment Health SP - e11084 VL - 6 IS - 3 KW - internet KW - mental health KW - social stigma KW - self-help groups KW - qualitative research KW - mental health recovery KW - mental disorders N2 - Background: Over the past 2 decades, online forums for mental health support have emerged as an important tool for improving mental health and well-being. There has been important research that analyzes the content of forum posts, studies on how and why individuals engage with forums, and how extensively forums are used. However, we still lack insights into key questions on how they are experienced from the perspective of their users, especially those in rural and remote settings. Objective: The aim of our study was to investigate the dynamics, benefits, and challenges of a generalized peer-to-peer mental health online forum from a user perspective; in particular, to better explore and understand user perspectives on connection, engagement, and support offered in such forums; information and advice they gained; and what issues they encountered. We studied experiences of the forums from the perspective of both people with lived experience of mental illness and people who care for people with mental illness. Methods: To understand the experience of forum users, we devised a qualitative study utilizing semistructured interviews with 17 participants (12 women and 5 men). Data were transcribed, and a thematic analysis was undertaken. Results: The study identified 3 key themes: participants experienced considerable social and geographical isolation, which the forums helped to address; participants sought out the forums to find a social connection that was lacking in their everyday lives; and participants used the forums to both find and provide information and practical advice. Conclusions: The study suggests that online peer support provides a critical, ongoing role in providing social connection for people with a lived experience of mental ill-health and their carers, especially for those living in rural and remote areas. Forums may offer a way for individuals to develop their own understanding of recovery through reflecting on the recovery experiences and peer support shown by others and individuals enacting peer support themselves. Key to the success of this online forum was the availability of appropriate moderation, professional support, and advice. UR - http://mental.jmir.org/2019/3/e11084/ UR - http://dx.doi.org/10.2196/11084 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912760 ID - info:doi/10.2196/11084 ER - TY - JOUR AU - Ridout, Brad AU - Campbell, Andrew PY - 2018/12/18 TI - The Use of Social Networking Sites in Mental Health Interventions for Young People: Systematic Review JO - J Med Internet Res SP - e12244 VL - 20 IS - 12 KW - social media KW - social networking KW - mental health KW - social support KW - support groups N2 - Background: The onset of mental health problems peaks between adolescence and young adulthood; however, young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health via the Web, especially via social networking sites (SNSs), and hence, there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people; however, none of the reviews have covered the breadth of SNS?based youth mental health interventions available across all mental health issues. Objective: This review aimed to systematically identify available evidence regarding the use of SNS?based interventions to support the mental health of young people aged up to 25 years, to evaluate their effectiveness, suitability, and safety, and identify gaps and opportunities for future research. Methods: The PubMed and PsycINFO databases were searched using Medical Subject Headings terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, 9 articles met the review inclusion criteria. Given the small number of studies, and the variety of outcome measures used, a quantitative meta-analysis was not possible. Results: The 9 articles (quantitative studies, qualitative studies, and descriptions of the iterative design process) covered 5 separate interventions. Of the 5 interventions, 2 interventions used purpose-built platforms based on the moderated online social therapy (MOST) model, 2 used Facebook, and 1 evaluated a purpose-built mobile app. The 2 MOST interventions targeted specific mental health issues (depression and psychosis), whereas the others focused on improving mental health literacy, social support, and general well-being. Only 3 quantitative studies were identified, and all used a pre-post design (without a control group) to establish proof of concept. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms were generally high, as were perceptions of usefulness and safety. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over Web-based interfaces. Conclusions: The evidence reviewed suggests young people find SNS?based interventions highly usable, engaging, and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given young people are already turning to SNSs to engage in knowledge seeking and peer-to-peer support, SNS?based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information. UR - https://www.jmir.org/2018/12/e12244/ UR - http://dx.doi.org/10.2196/12244 UR - http://www.ncbi.nlm.nih.gov/pubmed/30563811 ID - info:doi/10.2196/12244 ER - TY - JOUR AU - Schuster, Raphael AU - Pokorny, Raffaela AU - Berger, Thomas AU - Topooco, Naira AU - Laireiter, Anton-Rupert PY - 2018/12/18 TI - The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria JO - J Med Internet Res SP - e11007 VL - 20 IS - 12 KW - computer-assisted therapy KW - eHealth KW - psychotherapy KW - attitude of health personnel KW - attitude to health KW - mobile phone N2 - Background: Web-based and blended (face-to-face plus Web-based) interventions for mental health disorders are gaining significance. However, many licensed psychotherapists still have guarded attitudes toward computer-assisted therapy, hindering dissemination efforts. Objective: The objective of this study was to provide a therapist-oriented evaluation of Web-based and blended therapies and identify commonalities and differences in attitudes toward both formats. Furthermore, it aimed to test the impact of an information clip on expressed attitudes. Methods: In total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational email address. An 8-minute information video was shown to half of the therapists before 19 advantages and 13 disadvantages had to be rated on a 6-point Likert scale. Results: The sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, perceived advantages of both interventions were rated as neutral (t94=1.89, P=.06; d=0.11), whereas Web-based interventions were associated with more disadvantages and risks (t94=9.86, P<.001; d=0.81). The information clip did not excerpt any detectable effect on therapists? attitudes (r95=?.109, P=.30). The application of modern technologies in the own therapeutic practice and cognitive behavioral orientation were positively related to the given ratings. Conclusions: This study is the first to directly compare therapists? attitudes toward Web-based and blended therapies. Positive attitudes play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. To speed up implementation, these aspects need to be addressed in the development of new interventions. Furthermore, the preference of blended treatments over Web-based interventions seems to relate to avoidance of risks. Although this study is likely to represent therapists? attitudes in countries with less advanced electronic health services, therapists? attitudes in more advanced countries might present differently. UR - https://www.jmir.org/2018/12/e11007/ UR - http://dx.doi.org/10.2196/11007 UR - http://www.ncbi.nlm.nih.gov/pubmed/30563817 ID - info:doi/10.2196/11007 ER - TY - JOUR AU - Nygren, Tomas AU - Berg, Matilda AU - Sarkohi, Ali AU - Andersson, Gerhard PY - 2018/12/18 TI - Development of an Internet-Based Cognitive Behavioral Therapy Self-Help Program for Arabic-Speaking Immigrants: Mixed-Methods Study JO - JMIR Res Protoc SP - e11872 VL - 7 IS - 12 KW - internet KW - cognitive behavioral therapy KW - Arabs KW - focus groups N2 - Background: Recent years have seen an increase in Arabic-speaking immigrants in Sweden and other European countries, with research showing this group to suffer from elevated levels of various forms of psychological disorders. There is a lack of treatment options for immigrants with mild to moderate mental health problems, with barriers including lack of accessible services and concerns that problems will not be understood by health care providers. Objective: This study aims to describe the process of developing a transdiagnostic internet-based cognitive behavioral therapy self-help program in Arabic for mild to moderate symptoms of common psychological problems such as anxiety, depression, and insomnia. Methods: The iterative development process, including feedback from 105 pilot users as well as 2 focus groups, is described. Results: Overall, the modules were rated as acceptable by the pilot users, with overall ratings ranging from 3 to 4 points on average for the respective modules on a 5-point Likert scale. Feedback from the 2 focus groups was overall positive with regard to the content and structure of the program but also included suggestions for improving the Arabic translation as well as the usability of the material. Conclusions: An internet-based self-help program that is deemed acceptable by an Arabic-speaking audience can be successfully developed, thus providing increased access to psychological help for an at-risk population. However, further research regarding the efficacy of this type of intervention is warranted. UR - http://www.researchprotocols.org/2018/12/e11872/ UR - http://dx.doi.org/10.2196/11872 UR - http://www.ncbi.nlm.nih.gov/pubmed/30563819 ID - info:doi/10.2196/11872 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Sutoh, Chihiro AU - Asano, Kenichi AU - Seki, Yoichi AU - Urao, Yuko AU - Yokoo, Mizue AU - Takanashi, Rieko AU - Yoshida, Tokiko AU - Tanaka, Mari AU - Noguchi, Remi AU - Nagata, Shinobu AU - Oshiro, Keiko AU - Numata, Noriko AU - Hirose, Motohisa AU - Yoshimura, Kensuke AU - Nagai, Kazue AU - Sato, Yasunori AU - Kishimoto, Taishiro AU - Nakagawa, Akiko AU - Shimizu, Eiji PY - 2018/12/17 TI - Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial JO - J Med Internet Res SP - e12091 VL - 20 IS - 12 KW - clinical trial KW - cognitive behavioral therapy KW - feasibility study KW - obsessive-compulsive disorder KW - panic disorder KW - social anxiety disorder KW - videoconference N2 - Background: Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time. Objectives: This study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD. Methods: A total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants? points and 95% CIs were estimated by the paired t tests with the change between pre- and posttreatment. Results: A significant reduction in symptom of obsession-compulsion (Y-BOCS=?6.2; Cohen d=0.74; 95% CI ?9.4 to ?3.0, P=.002), panic (PDSS=?5.6; Cohen d=0.89; 95% CI ?9.83 to ?1.37; P=.02), social anxiety (LSAS=?33.6; Cohen d=1.10; 95% CI ?59.62 to ?7.49, P=.02) were observed. In addition, depression (PHQ-9=?1.72; Cohen d=0.27; 95% CI ?3.26 to ?0.19; P=.03) and general anxiety (GAD-7=?3.03; Cohen d=0.61; 95% CI ?4.57 to ?1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95% CI ?0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95% CI 1.24 to 7.04; P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30). Conclusions: Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable. UR - http://www.jmir.org/2018/12/e12091/ UR - http://dx.doi.org/10.2196/12091 UR - http://www.ncbi.nlm.nih.gov/pubmed/30559094 ID - info:doi/10.2196/12091 ER - TY - JOUR AU - Cheng, Sze Vanessa Wan AU - Davenport, A. Tracey AU - Johnson, Daniel AU - Vella, Kellie AU - Mitchell, Jo AU - Hickie, B. Ian PY - 2018/11/19 TI - An App That Incorporates Gamification, Mini-Games, and Social Connection to Improve Men's Mental Health and Well-Being (MindMax): Participatory Design Process JO - JMIR Ment Health SP - e11068 VL - 5 IS - 4 KW - football KW - mental health KW - well-being KW - video games KW - adolescent KW - young adult KW - cell phone KW - gamification KW - sport KW - men?s health KW - social connection N2 - Background: Men have different mental health needs as compared with women, and women make up the primary audience of most digital mental health interventions. An Australian football-themed (specifically Australian Football League, AFL) app named MindMax incorporating psychoeducation, gamification, mini-games, and social connection was developed in an effort to address this issue. Objective: The aim of this study was to identify the best way to structure and present MindMax, an app that aims to deliver psychoeducational modules, and create a Web-based community centering on well-being, AFL, and video games for men aged 16 to 35 years who are interested in AFL or video games. Methods: We conducted 6 participatory design (PD) workshops with people aged 16 to 35 years in 3 cities in Australia, to identify the best way to present MindMax, and contracted a digital development agency to develop MindMax. We then iteratively tested MindMax prototypes with 15 user experience testing interviews across 3 separate time points: 2 before app launch and 1 after app launch. Results: A total of 40 individuals (25 male and 15 female) participated in the PD workshops, and a total of 15 individuals (10 male and 5 female) participated in user experience interviews. Broadly, participants expressed a preference for activities requiring active engagement that practiced useful skills. They were also sensitive to how content was presented and wanted the ability to customize their own app experience. Although participants agreed that social motivations were important for engagement with an app, they recommended not to mimic existing social networks. Conclusions: In basing itself strongly within the AFL subculture and by incorporating gamification as well as mini-games, MindMax aimed to tackle mental health help-seeking barriers for people who enjoy AFL or video games, with a particular emphasis on men, and to provide psychoeducation on strategies to increase mental health and well-being. If MindMax is successful, this would indicate that generalizing this approach to other traditional sporting codes and even competitive video gaming leagues (esports) would be fruitful. UR - http://mental.jmir.org/2018/4/e11068/ UR - http://dx.doi.org/10.2196/11068 UR - http://www.ncbi.nlm.nih.gov/pubmed/30455165 ID - info:doi/10.2196/11068 ER - TY - JOUR AU - Zhang, Melvyn AU - Ying, Jiangbo AU - Song, Guo AU - Fung, SS Daniel AU - Smith, Helen PY - 2018/10/25 TI - Gamified Cognitive Bias Modification Interventions for Psychiatric Disorders: Review JO - JMIR Ment Health SP - e11640 VL - 5 IS - 4 KW - attention bias KW - cognitive bias KW - gamification KW - psychiatry N2 - Background: Automatic biases, such as attentional biases and avoidance and interpretative biases, have been purported to be responsible for several psychiatric disorders. Gamification has been considered for cognitive bias modification, mainly to address the core issues of diminishing motivation to train over time, as bias modification intervention tasks tend to be highly repetitive. While a prior review has suggested how gamification strategies could be applied to such tasks, there remains a lack of systematic evaluation of gamified cognitive bias modification interventions in the literature. Objective: The objective of this review is to understand the overall effectiveness of a gamified approach for cognitive bias modification and inform future research that seeks to integrate gamification technologies into existing conventional bias modification interventions. Methods: To identify the relevant articles for our review, the following search terminologies were used: (?cognitive bias? OR ?attention bias? OR ?interpret* bias? OR ?approach bias? OR ?avoidance bias?) AND (?training? OR ?modification? OR ?practice? OR ?therapy?) AND (?gamification? OR ?game elements? OR ?game? OR ?gaming? OR ?game mechanics?). PubMed, MEDLINE, PsycINFO, and Scopus databases were searched systematically for articles published after 2000. Articles were included if they described a gamified cognitive bias modification task and included participants with underlying psychopathological symptoms. Data were systematically extracted from the identified articles, and a qualitative synthesis was performed. Results: Four studies evaluated gamified cognitive bias modification interventions. Two studies included participants with anxiety symptoms, one with affective symptoms, and one with alcohol problems. The conventional visual probe task paradigm was used in 3 studies, and the attentional visual search task paradigm was used in the last study. We found gaming elements incorporated to include that of animations, sounds, feedback, and a point-scoring system for response time and difficulty. Of the 4 identified studies, only 2 reported their gamified interventions to be effective. Conclusions: Our review is the first to systematically synthesize the evidence for gamified cognitive bias modification interventions. The results arising from our review should be considered in the future design and conceptualization of gamified cognitive bias modification interventions. International Registered Report Identifier (IRRID): RR2-10.2196/10154 UR - http://mental.jmir.org/2018/4/e11640/ UR - http://dx.doi.org/10.2196/11640 UR - http://www.ncbi.nlm.nih.gov/pubmed/30361194 ID - info:doi/10.2196/11640 ER - TY - JOUR AU - Tighe, Joseph AU - Nicholas, Jennifer AU - Shand, Fiona AU - Christensen, Helen PY - 2018/06/25 TI - Efficacy of Acceptance and Commitment Therapy in Reducing Suicidal Ideation and Deliberate Self-Harm: Systematic Review JO - JMIR Ment Health SP - e10732 VL - 5 IS - 2 KW - suicidal ideation KW - suicide KW - deliberate self-harm KW - depression KW - mental health KW - acceptance and commitment therapy KW - cognitive behavioral therapy KW - mHealth KW - psychology KW - ACT N2 - Background: Since its emergence in the 1980s, acceptance and commitment therapy (ACT) has become a reputable evidence-based psychological therapy for certain disorders. Trials examining the efficacy of ACT are spread across a broad spectrum of presentations, such as chronic pain, anxiety, and depression. Nevertheless, ACT has very rarely been trialed as an intervention for suicidal ideation (SI) or deliberate self-harm (DSH). Objective: The objective of this review is to assess the efficacy of ACT in reducing SI and DSH and to examine the suitability of reported SI, DSH, and other measures in determining the efficacy of ACT. Methods: We systematically reviewed studies on ACT as intervention for SI and self-harm. Electronic databases, including MEDLINE, PubMed, EMBASE, PsycINFO, SCOPUS, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched. The reference lists of included studies and relevant systematic reviews were examined to identify additional publications. Search terms were identified with reference to the terminology used in previous review papers on ACT and suicide prevention. The study design was not restricted to randomized controlled trials. Screening was completed by 2 reviewers, and all duplicates were removed. Publications were excluded if they were not published in English, were multicomponent therapy or were not based on ACT, or lacked a validated measure or structured reporting of SI/DSH outcomes. Results: After removing the duplicates, 554 articles were screened for relevance. Following the screening, 5 studies that used ACT as an intervention for suicidal or self-harming individuals were identified. The studies used diverse methodologies and included 2 case studies, 2 pre?post studies, and 1 mHealth randomized controlled trial. Conclusions: The review found that ACT is effective in reducing SI in the 2 pre?post studies but not in other studies. However, given the small number and lack of methodological rigor of the studies included in this review, insufficient evidence exists for the recommendation of ACT as an intervention for SI or DSH. UR - http://mental.jmir.org/2018/2/e10732/ UR - http://dx.doi.org/10.2196/10732 UR - http://www.ncbi.nlm.nih.gov/pubmed/29941419 ID - info:doi/10.2196/10732 ER - TY - JOUR AU - Tulbure, Tudor Bogdan AU - Rusu, Andrei AU - Sava, Alin Florin AU - S?l?gean, Nastasia AU - Farchione, J. Todd PY - 2018/05/24 TI - A Web-Based Transdiagnostic Intervention for Affective and Mood Disorders: Randomized Controlled Trial JO - JMIR Ment Health SP - e36 VL - 5 IS - 2 KW - transdiagnostic KW - anxiety disorders KW - depressive disorder KW - cognitive therapy N2 - Background: Research increasingly supports a transdiagnostic conceptualization of emotional disorders (ie applying the same underlying treatment principles across mental disorders, without tailoring the protocol to specific diagnoses), and many international researchers are currently investigating this issue. Objective: The aim of this study was to evaluate the efficacy and acceptability of a Web-based transdiagnostic program using a sample of Romanian adults diagnosed with anxiety and/or depression. Methods: Volunteer participants registered for the study and completed a series of online self-report measures. Participants who fulfilled basic inclusion criteria on these measures were contacted for a telephone diagnostic interview using the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders (SCID-I). Enrolled participants were randomized to either the active treatment group (N=69) or the wait-list control group (N=36) using a 2:1 ratio. The transdiagnostic treatment was based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al, 2011) that addresses common underlying mechanisms of anxiety and depression. Participants randomized to the active treatment condition received 10 weeks of Web-based treatment based on the UP. Throughout treatment, graduate students in clinical psychology provided guidance that consisted of asynchronous written communication on a secure Web platform. After the intervention, participants in both study conditions were invited to complete a set of self-report measures and a postintervention SCID-I interview conducted by a different team of graduate students blinded to participants? group and diagnostic status. Six months later, participants in the active treatment group were invited to complete an online follow-up assessment. Results: During the intervention, active treatment participants completed on average 19 homework assignments (SD 12.10), and we collected data from 79.0% (83/105) at postintervention and 51% (35/69) at follow-up for self-report measures. Postintervention SCID-I interviews were collected from 77.1% (81/105) participants. Relative to the wait-list control group, the transdiagnostic intervention yielded overall medium to large effect sizes for the primary outcome measures (within-group Hedges g=0.52-1.34 and between-group g=0.39-0.86), and also for anxiety sensitivity (g=0.80), symptom interference (g=0.48), and quality of life (g=0.38). Significant within-groups effects only were reported for the active treatment group on Panic Disorder Severity Scale-Self Report (PDSS-SR, g=0.58-0.65) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS, g=0.52-0.58). Conclusions: Insignificant between-group differences for the Y-BOCS and PDSS-SR could be explained by the small number of participants with the associated primary diagnostic (eg, only 3 participants with obsessive compulsive disorder) by the choice of outcome measure (PDSS-SR was not rated among the evidence-based measures) and by the fact that these disorders may be more difficult to treat. However, the overall results suggest that the transdiagnostic intervention tested in this study represents an effective treatment option that may prove easier to disseminate through the use of Web-based delivery systems. Trial Registration: ClinicalTrials.gov CT02739607; https://clinicaltrials.gov/ct2/show/study/NCT02739607 (Archived by WebCite at http://www.webcitation.org/6yY1VeYIZ) UR - http://mental.jmir.org/2018/2/e36/ UR - http://dx.doi.org/10.2196/mental.8901 UR - http://www.ncbi.nlm.nih.gov/pubmed/29798831 ID - info:doi/10.2196/mental.8901 ER - TY - JOUR AU - Zhang, Melvyn AU - Ying, JiangBo AU - Song, Guo AU - Fung, SS Daniel AU - Smith, Helen PY - 2018/05/24 TI - Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps JO - JMIR Mhealth Uhealth SP - e10034 VL - 6 IS - 5 KW - attention bias KW - cognitive bias KW - smartphone KW - mHealth KW - psychiatry KW - telemedicine KW - mobile applications N2 - Background: Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective: The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods: To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were ?attention bias? OR ?cognitive bias? AND ?smartphone? OR ?smartphone application? OR ?smartphone app? OR ?mobile phones? OR ?mobile application? OR mobile app? OR ?personal digital assistant.? To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were ?attention bias? and ?cognitive bias.? We also conducted a manual search on the apps with published evaluations. Results: The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions: This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically. UR - http://mhealth.jmir.org/2018/5/e10034/ UR - http://dx.doi.org/10.2196/10034 UR - http://www.ncbi.nlm.nih.gov/pubmed/29793899 ID - info:doi/10.2196/10034 ER -