TY - JOUR AU - Bowie-DaBreo, Dionne AU - Sünram-Lea, I. Sandra AU - Sas, Corina AU - Iles-Smith, Heather PY - 2020/11/13 TI - Evaluation of Treatment Descriptions and Alignment With Clinical Guidance of Apps for Depression on App Stores: Systematic Search and Content Analysis JO - JMIR Form Res SP - e14988 VL - 4 IS - 11 KW - mobile mental health KW - mHealth KW - mobile apps KW - depression KW - clinical guidance KW - NICE guidelines KW - NHS KW - safety KW - ethics KW - content analysis N2 - Background: The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety. Objective: Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression. Methods: We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults. Results: A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression. Conclusions: App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design. UR - http://formative.jmir.org/2020/11/e14988/ UR - http://dx.doi.org/10.2196/14988 UR - http://www.ncbi.nlm.nih.gov/pubmed/33185566 ID - info:doi/10.2196/14988 ER - TY - JOUR AU - Yoo, Whi Dong AU - Birnbaum, L. Michael AU - Van Meter, R. Anna AU - Ali, F. Asra AU - Arenare, Elizabeth AU - Abowd, D. Gregory AU - De Choudhury, Munmun PY - 2020/8/12 TI - Designing a Clinician-Facing Tool for Using Insights From Patients? Social Media Activity: Iterative Co-Design Approach JO - JMIR Ment Health SP - e16969 VL - 7 IS - 8 KW - social media KW - psychotic disorders KW - information technology N2 - Background: Recent research has emphasized the need for accessing information about patients to augment mental health patients? verbal reports in clinical settings. Although it has not been introduced in clinical settings, computational linguistic analysis on social media has proved it can infer mental health attributes, implying a potential use as collateral information at the point of care. To realize this potential and make social media insights actionable to clinical decision making, the gaps between computational linguistic analysis on social media and the current work practices of mental health clinicians must be bridged. Objective: This study aimed to identify information derived from patients? social media data that can benefit clinicians and to develop a set of design implications, via a series of low-fidelity (lo-fi) prototypes, on how to deliver the information at the point of care. Methods: A team of clinical researchers and human-computer interaction (HCI) researchers conducted a long-term co-design activity for over 6 months. The needs-affordances analysis framework was used to refine the clinicians? potential needs, which can be supported by patients? social media data. On the basis of those identified needs, the HCI researchers iteratively created 3 different lo-fi prototypes. The prototypes were shared with both groups of researchers via a videoconferencing software for discussion and feedback. During the remote meetings, potential clinical utility, potential use of the different prototypes in a treatment setting, and areas of improvement were discussed. Results: Our first prototype was a card-type interface that supported treatment goal tracking. Each card included attribute levels: depression, anxiety, social activities, alcohol, and drug use. This version confirmed what types of information are helpful but revealed the need for a glanceable dashboard that highlights the trends of these information. As a result, we then developed the second prototype, an interface that shows the clinical state and trend. We found that focusing more on the changes since the last visit without visual representation can be more compatible with clinicians? work practices. In addition, the second phase of needs-affordances analysis identified 3 categories of information relevant to patients with schizophrenia: symptoms related to psychosis, symptoms related to mood and anxiety, and social functioning. Finally, we developed the third prototype, a clinical summary dashboard that showed changes from the last visit in plain texts and contrasting colors. Conclusions: This exploratory co-design research confirmed that mental health attributes inferred from patients? social media data can be useful for clinicians, although it also revealed a gap between computational social media analyses and clinicians? expectations and conceptualizations of patients? mental health states. In summary, the iterative co-design process crystallized design directions for the future interface, including how we can organize and provide symptom-related information in a way that minimizes the clinicians? workloads. UR - http://mental.jmir.org/2020/8/e16969/ UR - http://dx.doi.org/10.2196/16969 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784180 ID - info:doi/10.2196/16969 ER - TY - JOUR AU - Manning, B. Julia AU - Blandford, Ann AU - Edbrooke-Childs, Julian AU - Marshall, Paul PY - 2020/4/27 TI - How Contextual Constraints Shape Midcareer High School Teachers' Stress Management and Use of Digital Support Tools: Qualitative Study JO - JMIR Ment Health SP - e15416 VL - 7 IS - 4 KW - school teachers KW - stress KW - health KW - self-management KW - computers KW - technology KW - qualitative research KW - secondary schools KW - wearable devices KW - mobile applications KW - education N2 - Background: Persistent psychosocial stress is endemic in the modern workplace, including among midcareer high school (secondary comprehensive) teachers in England. Understanding contextual influences on teachers' self-management of stress along with their use of digital health technologies could provide important insights into creating more usable and accessible stress support interventions. Objective: The aim of this study was to investigate the constraints on stress management and prevention among teachers in the school environment and how this shapes the use of digitally enabled stress management tools. Methods: Semistructured interviews were conducted with 14 teachers from southern England. The interviews were analyzed using thematic analysis. Results: Teachers were unanimous in their recognition of workplace stress, describing physical (such as isolation and scheduling) and cultural (such as stigma and individualism) aspects in the workplace context, which influence their ability to manage stress. A total of 12 participants engaged with technology to self-manage their physical or psychological well-being, with more than half of the participants using consumer wearables, but Web-based or smartphone apps were rarely accessed in school. However, digital well-being interventions recommended by school leaders could potentially be trusted and adopted. Conclusions: The findings from this study bring together both the important cultural and physical contextual constraints on the ability of midcareer high school teachers to manage workplace stress. This study highlights correlates of stress and offers initial insight into how digital health interventions are currently being used to help with stress, both within and outside high schools. The findings add another step toward designing tailored digital stress support for teachers. UR - http://mental.jmir.org/2020/4/e15416/ UR - http://dx.doi.org/10.2196/15416 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338623 ID - info:doi/10.2196/15416 ER - TY - JOUR AU - Navarro, Pablo AU - Sheffield, Jeanie AU - Edirippulige, Sisira AU - Bambling, Matthew PY - 2020/1/29 TI - Exploring Mental Health Professionals? Perspectives of Text-Based Online Counseling Effectiveness With Young People: Mixed Methods Pilot Study JO - JMIR Ment Health SP - e15564 VL - 7 IS - 1 KW - mental health KW - child health KW - adolescent health KW - distance counseling KW - mHealth KW - applied psychology KW - psychological processes N2 - Background: Population-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups. Objective: This pilot study aimed to explore and confirm e-mental health professional?s perspectives about various domains and themes related to young service users? (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities. Methods: Participants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness. Results: A total of 4 domains and various subthemes were confirmed and identified to be related to YSUs? characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors). Conclusions: Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor?s interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation. UR - https://mental.jmir.org/2020/1/e15564 UR - http://dx.doi.org/10.2196/15564 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012097 ID - info:doi/10.2196/15564 ER - TY - JOUR AU - Qu, Chengcheng AU - Sas, Corina AU - Daudén Roquet, Claudia AU - Doherty, Gavin PY - 2020/1/24 TI - Functionality of Top-Rated Mobile Apps for Depression: Systematic Search and Evaluation JO - JMIR Ment Health SP - e15321 VL - 7 IS - 1 KW - mobile apps KW - depression KW - review KW - ethics KW - mHealth N2 - Background: In the last decade, there has been a proliferation of mobile apps claiming to support the needs of people living with depression. However, it is unclear what functionality is actually provided by apps for depression, or for whom they are intended. Objective: This paper aimed to explore the key features of top-rated apps for depression, including descriptive characteristics, functionality, and ethical concerns, to better inform the design of apps for depression. Methods: We reviewed top-rated iPhone OS (iOS) and Android mobile apps for depression retrieved from app marketplaces in spring 2019. We applied a systematic analysis to review the selected apps, for which data were gathered from the 2 marketplaces and through direct use of the apps. We report an in-depth analysis of app functionality, namely, screening, tracking, and provision of interventions. Of the initially identified 482 apps, 29 apps met the criteria for inclusion in this review. Apps were included if they remained accessible at the moment of evaluation, were offered in mental health?relevant categories, received a review score greater than 4.0 out of 5.0 by more than 100 reviewers, and had depression as a primary target. Results: The analysis revealed that a majority of apps specify the evidence base for their intervention (18/29, 62%), whereas a smaller proportion describes receiving clinical input into their design (12/29, 41%). All the selected apps are rated as suitable for children and adolescents on the marketplace, but 83% (24/29) do not provide a privacy policy consistent with their rating. The findings also show that most apps provide multiple functions. The most commonly implemented functions include provision of interventions (24/29, 83%) either as a digitalized therapeutic intervention or as support for mood expression; tracking (19/29, 66%) of moods, thoughts, or behaviors for supporting the intervention; and screening (9/29, 31%) to inform the decision to use the app and its intervention. Some apps include overtly negative content. Conclusions: Currently available top-ranked apps for depression on the major marketplaces provide diverse functionality to benefit users across a range of age groups; however, guidelines and frameworks are still needed to ensure users? privacy and safety while using them. Suggestions include clearly defining the age of the target population and explicit disclosure of the sharing of users? sensitive data with third parties. In addition, we found an opportunity for apps to better leverage digital affordances for mitigating harm, for personalizing interventions, and for tracking multimodal content. The study further demonstrated the need to consider potential risks while using depression apps, including the use of nonvalidated screening tools, tracking negative moods or thinking patterns, and exposing users to negative emotional expression content. UR - https://mental.jmir.org/2020/1/e15321 UR - http://dx.doi.org/10.2196/15321 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012079 ID - info:doi/10.2196/15321 ER - TY - JOUR AU - D'Alfonso, Simon AU - Phillips, Jessica AU - Valentine, Lee AU - Gleeson, John AU - Alvarez-Jimenez, Mario PY - 2019/12/4 TI - Moderated Online Social Therapy: Viewpoint on the Ethics and Design Principles of a Web-Based Therapy System JO - JMIR Ment Health SP - e14866 VL - 6 IS - 12 KW - Web-based intervention KW - social network KW - well-being KW - eudaimonia KW - persuasive technology KW - ethical design UR - https://mental.jmir.org/2019/12/e14866 UR - http://dx.doi.org/10.2196/14866 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799937 ID - info:doi/10.2196/14866 ER - TY - JOUR AU - Glover, C. Angela AU - Schueller, M. Stephen AU - Winiarski, A. Dominika AU - Smith, L. Dale AU - Karnik, S. Niranjan AU - Zalta, K. Alyson PY - 2019/10/11 TI - Automated Mobile Phone?Based Mental Health Resource for Homeless Youth: Pilot Study Assessing Feasibility and Acceptability JO - JMIR Ment Health SP - e15144 VL - 6 IS - 10 KW - mental health KW - young adult KW - homelessness KW - telemedicine KW - treatment KW - mHealth KW - mobile phone N2 - Background: Youth experiencing housing instability have higher rates of mental health problems than their housed peers. Few studies have evaluated technological resources for homeless youth to determine how to effectively engage and reach them. Objective: The primary aims of this pilot study were to establish the feasibility (as measured by phone retention rates) and acceptability (ie, participant ratings of resources) of delivering automated mental health resources via smartphone technology. Methods: Youth aged 16 to 25 years (N=100) were recruited through homeless shelter agencies in the Chicago metropolitan area. Eligible participants completed a baseline assessment and received a smartphone with a 3-month data plan. The phone was preloaded with several apps designed to promote mental health wellness and provide real-time resources. One app specifically designed for this study, Pocket Helper 2.0, sent participants daily surveys and tips via push notification. The tips focused on coping and motivation, and the surveys assessed mood. This app also included an automated self-help system with brief cognitive behavioral interventions (5-10 min) and access to several interactive mobile tools, including a crisis text line, a telephone hotline, a crowd-based emotional support tool, and an app providing up-to-date information on social service and mental health resources for homeless youth in Chicago. Participants completed assessments at 3 and 6 months. Results: Some individuals (23%, 23/100) experienced problems with the phones (eg, theft, loss, and technological issues) throughout the study. Participant retention at the midpoint was moderate, with 48% (48/100) of youth responding to the 3-month surveys. At 6 months, only 19% (19/100) of the total sample responded to the end point survey. Overall, 63% (30/48) to 68% (13/19) of respondents at both time points reported benefiting from the intervention; however, participant usage and satisfaction varied with the different features. At both time points, participants reported receiving the most benefit from the daily tips and daily surveys. Daily tips that were most preferred by participants involved motivational tips related to overcoming struggles and making progress in life. Aside from the tips and surveys, the most used features were the app providing up-to-date resources and the automated self-help system. Interactive features, including the telephone hotline and crowd-based emotional support tool, were the least used features and were rated as the least beneficial. Conclusions: Automated mental health interventions seem to be an acceptable way to engage homeless youth in mental health support. The participants preferred fully automated features and brief interventions over features requiring interaction with others or more engagement. Future research should explore ways to retain homeless youth in interventions and evaluate the clinical impact of automated technology-based interventions for improving mental health. Trial Registration: ClinicalTrials.gov NCT03776422; https://clinicaltrials.gov/ct2/show/NCT03776422 UR - http://mental.jmir.org/2019/10/e15144/ UR - http://dx.doi.org/10.2196/15144 UR - http://www.ncbi.nlm.nih.gov/pubmed/31605516 ID - info:doi/10.2196/15144 ER - TY - JOUR AU - Ijaz, Kiran AU - Ahmadpour, Naseem AU - Naismith, L. Sharon AU - Calvo, A. Rafael PY - 2019/09/03 TI - An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study JO - JMIR Ment Health SP - e13887 VL - 6 IS - 9 KW - virtual reality KW - healthy aging KW - memory KW - cognition KW - dementia N2 - Background: Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements. Objective: This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC). Methods: VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup. Results: Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87). Conclusions: The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future. UR - https://mental.jmir.org/2019/9/e13887/ UR - http://dx.doi.org/10.2196/13887 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482851 ID - info:doi/10.2196/13887 ER - TY - JOUR AU - Pretorius, Claudette AU - Chambers, Derek AU - Cowan, Benjamin AU - Coyle, David PY - 2019/08/26 TI - Young People Seeking Help Online for Mental Health: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e13524 VL - 6 IS - 8 KW - mental health KW - eHealth KW - mHealth KW - Internet KW - help-seeking behavior KW - health literacy KW - young adults KW - survey and questionnaires N2 - Background: Young people are particularly vulnerable to experiencing mental health difficulties, but very few seek treatment or help during this time. Online help-seeking may offer an additional domain where young people can seek aid for mental health difficulties, yet our current understanding of how young people seek help online is limited. Objective: This was an exploratory study which aimed to investigate the online help-seeking behaviors and preferences of young people. Methods: This study made use of an anonymous online survey. Young people aged 18-25, living in Ireland, were recruited through social media ads on Twitter and Facebook and participated in the survey. Results: A total of 1308 respondents completed the survey. Many of the respondents (80.66%; 1055/1308) indicated that they would use their mobile phone to look online for help for a personal or emotional concern. When looking for help online, 82.57% (1080/1308) of participants made use of an Internet search, while 57.03% (746/1308) made use of a health website. When asked about their satisfaction with these resources, 36.94% (399/1080) indicated that they were satisfied or very satisfied with an Internet search while 49.33% (368/746) indicated that they were satisfied or very satisfied with a health website. When asked about credibility, health websites were found to be the most trustworthy, with 39.45% (516/1308) indicating that they found them to be trustworthy or very trustworthy. Most of the respondents (82.95%; 1085/1308) indicated that a health service logo was an important indicator of credibility, as was an endorsement by schools and colleges (54.97%; 719/1308). Important facilitators of online help-seeking included the anonymity and confidentiality offered by the Internet, with 80% (1046/1308) of the sample indicating that it influenced their decision a lot or quite a lot. A noted barrier was being uncertain whether information on an online resource was reliable, with 55.96% (732/1308) of the respondents indicating that this influenced their decision a lot or quite a lot. Conclusions: Findings from this survey suggest that young people are engaging with web-based mental health resources to assist them with their mental health concerns. However, levels of satisfaction with the available resources vary. Young people are engaging in strategies to assign credibility to web-based resources, however, uncertainty around their reliability is a significant barrier to online help-seeking. UR - http://mental.jmir.org/2019/8/e13524/ UR - http://dx.doi.org/10.2196/13524 UR - http://www.ncbi.nlm.nih.gov/pubmed/31452519 ID - info:doi/10.2196/13524 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 - Bosch, Lilian AU - Kanis, Marije AU - Dunn, Julia AU - Stewart, A. Kearsley AU - Kröse, Ben PY - 2019/05/28 TI - How Is the Caregiver Doing? Capturing Caregivers? Experiences With a Reflective Toolkit JO - JMIR Ment Health SP - e13688 VL - 6 IS - 5 KW - human-centered design KW - informal caregivers KW - experience sampling KW - home care KW - positive psychology KW - mental health KW - reflective technologies KW - well-being KW - HCI (human computer interaction) N2 - Background: This paper describes the Co-Care-KIT, a reflective toolkit designed to provide insights into the diverse experiences of home-based informal caregivers during the delivery of care to a relative or loved one. Objective: The aim of this study was to evaluate the toolkit, including a custom-designed journal, tools for photography-based experience sampling, and heart rate tracking, which enables caregivers to collect and reflect on their positive and negative daily experiences in situ. Methods: A 2-week field study with informal caregivers (N=7) was conducted to evaluate the Co-Care-KIT and to capture their daily personal emotional experiences. The collected data samples were analyzed and used for collaborative dialogue between the researcher and caregiver. Results: The results suggest that the toolkit (1) increased caregivers? awareness of their own well-being through in situ reflection on their experiences; (2) empowered caregivers to share their identities and experiences as a caregiver within their social networks; (3) enabled the capturing of particularly positive experiences; and (4) provided caregivers reassurance with regards to their own mental health. Conclusion: By enabling capturing and collaborative reflection, the kit helped to gain a new understanding of caregivers? day-to-day needs and emotional experiences. UR - http://mental.jmir.org/2019/5/e13688/ UR - http://dx.doi.org/10.2196/13688 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140435 ID - info:doi/10.2196/13688 ER - TY - JOUR AU - Aji, Melissa AU - Gordon, Christopher AU - Peters, Dorian AU - Bartlett, Delwyn AU - Calvo, A. Rafael AU - Naqshbandi, Khushnood AU - Glozier, Nick PY - 2019/05/24 TI - Exploring User Needs and Preferences for Mobile Apps for Sleep Disturbance: Mixed Methods Study JO - JMIR Ment Health SP - e13895 VL - 6 IS - 5 KW - mobile apps KW - mHealth KW - sleep N2 - Background: Mobile health (mHealth) apps demonstrate promise for improving sleep at scale. End-user engagement is a prerequisite for sustained use and effectiveness. Objective: We assessed the needs and preferences of those with poor sleep and insomnia to inform the development of an engaging sleep app. Methods: We triangulated results from qualitative (focus groups and app reviews) and quantitative (online survey) approaches. A total of 2 focus groups were conducted (N=9). An online survey tested themes identified from the focus groups against a larger population (N=167). In addition, we analyzed 434 user reviews of 6 mobile apps available on app stores. Results: Common focus group themes included the need to account for diverse sleep phenotypes with an adaptive and tailored program, key app features (alarms and sleep diaries), the complex yet condescending nature of existing resources, providing rationale for information requested, and cost as a motivator. Most survey participants (156/167, 93%) would try an evidence-based sleep app. The most important app features reported were sleep diaries (148/167, 88%), sharing sleep data with a doctor (116/167, 70%), and lifestyle tracking (107/167, 64%). App reviews highlighted the alarm as the most salient app feature (43/122, 35%) and data synchronization with a wearable device (WD) as the most commonly mentioned functionality (40/135, 30%). Conclusions: This co-design process involving end users through 3 methods consistently highlighted sleep tracking (through a diary and WD), alarms, and personalization as vital for engagement, although their implementation was commonly criticized in review. Engagement is negatively affected by poorly designed features, bugs, and didactic information which must be addressed. Other needs depend upon the type of user, for example, those with severe insomnia. UR - http://mental.jmir.org/2019/5/e13895/ UR - http://dx.doi.org/10.2196/13895 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127714 ID - info:doi/10.2196/13895 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 -