TY - JOUR AU - Wu, Xiaoli AU - Liew, Kongmeng AU - Dorahy, J. Martin PY - 2025/4/22 TI - Trust, Anxious Attachment, and Conversational AI Adoption Intentions in Digital Counseling: A Preliminary Cross-Sectional Questionnaire Study JO - JMIR AI SP - e68960 VL - 4 KW - attachment style KW - conversational artificial intelligence KW - CAI KW - perceived trust KW - adoption intentions KW - CAI counseling KW - mobile phone N2 - Background: Conversational artificial intelligence (CAI) is increasingly used in various counseling settings to deliver psychotherapy, provide psychoeducational content, and offer support like companionship or emotional aid. Research has shown that CAI has the potential to effectively address mental health issues when its associated risks are handled with great caution. It can provide mental health support to a wider population than conventional face-to-face therapy, and at a faster response rate and more affordable cost. Despite CAI?s many advantages in mental health support, potential users may differ in their willingness to adopt and engage with CAI to support their own mental health. Objective: This study focused specifically on dispositional trust in AI and attachment styles, and examined how they are associated with individuals? intentions to adopt CAI for mental health support. Methods: A cross-sectional survey of 239 American adults was conducted. Participants were first assessed on their attachment style, then presented with a vignette about CAI use, after which their dispositional trust and subsequent adoption intentions toward CAI counseling were surveyed. Participants had not previously used CAI for digital counseling for mental health support. Results: Dispositional trust in artificial intelligence emerged as a critical predictor of CAI adoption intentions (P<.001), while attachment anxiety (P=.04), rather than avoidance (P=.09), was found to be positively associated with the intention to adopt CAI counseling after controlling for age and gender. Conclusions: These findings indicated higher dispositional trust might lead to stronger adoption intention, and higher attachment anxiety might also be associated with greater CAI counseling adoption. Further research into users? attachment styles and dispositional trust is needed to understand individual differences in CAI counseling adoption for enhancing the safety and effectiveness of CAI-driven counseling services and tailoring interventions. Trial Registration: Open Science Framework; https://osf.io/c2xqd UR - https://ai.jmir.org/2025/1/e68960 UR - http://dx.doi.org/10.2196/68960 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68960 ER - 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 - Lattie, G. Emily AU - Beltzer, Miranda AU - Varra, Alethea AU - Chen, E. Connie AU - Lungu, Anita PY - 2025/4/2 TI - Examining the Client Experience of Digital Tools in Blended Care Therapy: Qualitative Interview Study JO - JMIR Form Res SP - e68249 VL - 9 KW - anxiety KW - depression KW - blended care therapy KW - mental health care KW - digital mental health KW - digital tools KW - qualitative interviews KW - Lyra Care Therapy KW - video lesson KW - symptom assessment KW - written exercise KW - thematic analysis KW - LCT model KW - therapeutic value KW - client experience N2 - Background: Lyra Health?s short-term blended care therapy model, Lyra Care Therapy (LCT), has demonstrated effectiveness at scale. In LCT, clients participate in synchronous telehealth sessions and asynchronous guided practice sessions, in which they are provided with digital tools to reinforce key concepts and skills. These digital tools include animated video lessons that use storytelling to show characters learning and implementing new skills from therapy, written psychoeducational materials, interactive exercises that prompt reflection and skills practice, symptom assessments, and messaging with therapists. Past research on LCT found that time spent in therapy sessions and viewing digital video lessons predicts improvements in depression and anxiety symptoms. Objective: This study aims to explore the client experience of LCT digital tools and to understand clients? perceived benefits and challenges of using digital tools while in LCT. Methods: In total, 12 ethnically and racially diverse adults (5 male, 6 female, and 1 pangender) who had graduated from LCT in the previous 4 months participated in semistructured interviews. Interviews focused on experiences with the digital components of LCT (ie, video lessons, symptom assessments, and written exercises). Transcripts were analyzed using thematic analytic methods to determine the benefits and challenges associated with components of the LCT model. Results: In total, 3 primary themes were generated through thematic analysis. These themes centered around supporting knowledge and skill development, the benefits and challenges associated with the range of digital tools, and the combination of flexibility and accountability promoting positive change. First, we summarize the ways in which guided practice sessions allow clients to develop additional knowledge and learn skills related to their mental health and well-being. Then, we describe how the range of digital tools included in LCT presents different benefits and challenges for clients. Finally, we discuss how flexibility inherent in having both synchronous and asynchronous sessions, along with the accountability from a provider, encourages clients to continue to practice skills related to their mental health and well-being. Conclusions: Results provide insights into the unique contributions of different components of the LCT model on therapeutic gains. While perceived time constraints and content preferences can impact engagement with digital tools, overall the digital tools were perceived as carrying significant value for participants in the LCT program. UR - https://formative.jmir.org/2025/1/e68249 UR - http://dx.doi.org/10.2196/68249 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68249 ER - TY - JOUR AU - Cataldo, Francesco AU - Chang, Shanton AU - Mendoza, Antonette AU - Buchanan, George AU - Van Dam, Nicholas PY - 2025/4/1 TI - Exploring Technical Features to Enhance Control in Videoconferencing Psychotherapy: Quantitative Study on Clinicians? Perspectives JO - J Med Internet Res SP - e66904 VL - 27 KW - videoconference psychotherapy KW - control KW - therapeutic relationship KW - therapeutic alliance KW - videoconference technologies KW - technological features KW - video KW - telepsychiatry KW - videoconferencing KW - psychotherapy KW - mental health KW - mental KW - therapy KW - therapist KW - videoconference KW - platform KW - psychology KW - psychologist N2 - Background: The COVID-19 pandemic required psychologists and other mental health professionals to use videoconferencing platforms. Previous research has highlighted therapists? hesitation toward adopting the medium since they find it hard to establish control over videoconferencing psychotherapy (VCP). An earlier study provided a set of potential features that may help enhance psychologists? control in their videoconference sessions, such as screen control functionality, emergency call functionality, eye contact functionality, zooming in and out functionality, and an interactive interface with other apps and software. Objective: This study aims to investigate whether introducing technical features might improve clinicians? control over their video sessions. Additionally, it seeks to understand the role of the video in therapists? VCP experience from a technical and relationship point of view. Methods: A total of 121 mental health professionals responded to the survey, but only 86 participants provided complete data. Exploratory Factor Analysis was used to scrutinize the data collected. A total of three factors were identified: (1) ?challenges in providing VCP,? (2) ?features to enhance the therapeutic relationship,? and (3) ?enhancing control.? Path analysis was used to observe the relationship between factors on their own and with adjustment to participants? areas of expertise and year in practice. Results: This study highlighted a relationship between the three identified factors. It was found that introducing certain features reduced therapists' challenges in the provision of VCP. Moreover, the additional features provided therapists with enhanced control over their VCP sessions. A path analysis was conducted to investigate the relationships between the factors loaded. The results of the analysis revealed a significant relationship between ?challenges in VCP? and ?features to enhance the therapeutic relationship? (adjusted beta [Adj?]=?0.54, 95% CI 0.29-0.79; P<.001). Additionally, a significant positive relationship was found between ?features to enhance the therapeutic relationship? and ?enhancing control? (Adj?=0.25, 95% CI 0.15-0.35; P<.001). Furthermore, there was an indirect effect of ?challenges in providing VCP? on ?enhancing control? (Adj?=0.13, 95% CI 0.05-0.22; P=.001) mediated by ?features to enhance TR.? The analysis identified the factor ?features to enhance TR? (effect size=0.25) as key for improving clinicians? performance and control. Conclusions: This study demonstrates that technology may help improve therapists? VCP experiences by implementing features that respond to their need for enhanced control. By augmenting therapists? control, clinicians can effectively serve their patients and facilitate successful therapy outcomes. Moreover, this study confirms the video as a third agent that prevents therapists from affecting clients? reality due to technical and relational limits. Additionally, this study supports the general system theory, which allowed for the incorporation of video in our exploration and helped explain its agency in VCP. UR - https://www.jmir.org/2025/1/e66904 UR - http://dx.doi.org/10.2196/66904 UR - http://www.ncbi.nlm.nih.gov/pubmed/40168042 ID - info:doi/10.2196/66904 ER - TY - JOUR AU - Han, Areum AU - Oster, Robert AU - Yuen, Hon AU - Jenkins, Jeremy AU - Hawkins, Jessica AU - Edwards, Lauren PY - 2025/3/31 TI - Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e67545 VL - 9 KW - acceptance and commitment therapy KW - Alzheimer disease KW - caregivers KW - dementia KW - depression KW - web-based intervention KW - quality of life KW - randomized controlled trial KW - stress KW - videoconferencing N2 - Background: Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers? mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population. Objective: This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only. Methods: This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes. Results: The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of ?6.09 (1.16) points (95% CI ?8.42 to ?3.76; P<.001) in the posttest and ?6.71 (1.45) points (95% CI ?9.63 to ?3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032). Conclusions: The videoconference-delivered ACT program showed promise in improving mental health outcomes and ACT processes among family caregivers with depression who give care to individuals with dementia. Future studies should aim to replicate these findings with larger, more diverse caregiver populations and explore the long-term efficacy of videoconference-delivered ACT programs. Trial Registration: ClinicalTrials.gov NCT05043441; https://clinicaltrials.gov/study/NCT05043441 UR - https://formative.jmir.org/2025/1/e67545 UR - http://dx.doi.org/10.2196/67545 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67545 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 - Immel, Diana AU - Hilpert, Bernhard AU - Schwarz, Patricia AU - Hein, Andreas AU - Gebhard, Patrick AU - Barton, Simon AU - Hurlemann, René PY - 2025/3/26 TI - Patients? and Health Care Professionals? Expectations of Virtual Therapeutic Agents in Outpatient Aftercare: Qualitative Survey Study JO - JMIR Form Res SP - e59527 VL - 9 KW - socially interactive agent KW - e-mental health KW - mental illness KW - mental disorder KW - depression KW - major depressive disorder KW - suicide prevention KW - suicidal ideation KW - outpatient aftercare KW - artificial intelligence KW - virtual therapeutic assistant KW - public health KW - digital technology KW - digital intervention KW - digital health care N2 - Background: Depression is a serious mental health condition that can have a profound impact on the individual experiencing the disorder and those providing care. While psychotherapy and medication can be effective, there are gaps in current approaches, particularly in outpatient care. This phase is often associated with a high risk of relapse and readmission, and patients often report a lack of support. Socially interactive agents represent an innovative approach to the provision of assistance. Often powered by artificial intelligence, these virtual agents can interact socially and elicit humanlike emotions. In health care, they are used as virtual therapeutic assistants to fill gaps in outpatient aftercare. Objective: We aimed to explore the expectations of patients with depression and health care professionals by conducting a qualitative survey. Our analysis focused on research questions related to the appearance and role of the assistant, the assistant-patient interaction (time of interaction, skills and abilities of the assistant, and modes of interaction) and the therapist-assistant interaction. Methods: A 2-part qualitative study was conducted to explore the perspectives of the 2 groups (patients and care providers). In the first step, care providers (n=30) were recruited during a regional offline meeting. After a short presentation, they were given a link and were asked to complete a semistructured web-based questionnaire. Next, patients (n=20) were recruited from a clinic and were interviewed in a semistructured face-to-face interview. Results: The survey findings suggested that the assistant should be a multimodal communicator (voice, facial expressions, and gestures) and counteract negative self-evaluation. Most participants preferred a female assistant or wanted the option to choose the gender. In total, 24 (80%) health care professionals wanted a selectable option, while patients exhibited a marked preference for a female or diverse assistant. Regrading patient-assistant interaction, the assistant was seen as a proactive recipient of information, and the patient as a passive one. Gaps in aftercare could be filled by the unlimited availability of the assistant. However, patients should retain their autonomy to avoid dependency. The monitoring of health status was viewed positively by both groups. A biofeedback function was desired to detect early warning signs of disease. When appropriate to the situation, a sense of humor in the assistant was desirable. The desired skills of the assistant can be summarized as providing structure and emotional support, especially warmth and competence to build trust. Consistency was important for the caregiver to appear authentic. Regarding the assistant?care provider interaction, 3 key areas were identified: objective patient status measurement, emergency suicide prevention, and an information tool and decision support system for health care professionals. Conclusions: Overall, the survey conducted provides innovative guidelines for the development of virtual therapeutic assistants to fill the gaps in patient aftercare. UR - https://formative.jmir.org/2025/1/e59527 UR - http://dx.doi.org/10.2196/59527 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59527 ER - TY - JOUR AU - Waaler, Niklas Per AU - Hussain, Musarrat AU - Molchanov, Igor AU - Bongo, Ailo Lars AU - Elvevåg, Brita PY - 2025/3/26 TI - Prompt Engineering an Informational Chatbot for Education on Mental Health Using a Multiagent Approach for Enhanced Compliance With Prompt Instructions: Algorithm Development and Validation JO - JMIR AI SP - e69820 VL - 4 KW - schizophrenia KW - mental health KW - prompt engineering KW - AI in health care KW - AI safety KW - self-reflection KW - limiting scope of AI KW - large language model KW - LLM KW - GPT-4 KW - AI transparency KW - adaptive learning N2 - Background: People with schizophrenia often present with cognitive impairments that may hinder their ability to learn about their condition. Education platforms powered by large language models (LLMs) have the potential to improve the accessibility of mental health information. However, the black-box nature of LLMs raises ethical and safety concerns regarding the controllability of chatbots. In particular, prompt-engineered chatbots may drift from their intended role as the conversation progresses and become more prone to hallucinations. Objective: This study aimed to develop and evaluate a critical analysis filter (CAF) system that ensures that an LLM-powered prompt-engineered chatbot reliably complies with its predefined instructions and scope while delivering validated mental health information. Methods: For a proof of concept, we prompt engineered an educational chatbot for schizophrenia powered by GPT-4 that could dynamically access information from a schizophrenia manual written for people with schizophrenia and their caregivers. In the CAF, a team of prompt-engineered LLM agents was used to critically analyze and refine the chatbot?s responses and deliver real-time feedback to the chatbot. To assess the ability of the CAF to re-establish the chatbot?s adherence to its instructions, we generated 3 conversations (by conversing with the chatbot with the CAF disabled) wherein the chatbot started to drift from its instructions toward various unintended roles. We used these checkpoint conversations to initialize automated conversations between the chatbot and adversarial chatbots designed to entice it toward unintended roles. Conversations were repeatedly sampled with the CAF enabled and disabled. In total, 3 human raters independently rated each chatbot response according to criteria developed to measure the chatbot?s integrity, specifically, its transparency (such as admitting when a statement lacked explicit support from its scripted sources) and its tendency to faithfully convey the scripted information in the schizophrenia manual. Results: In total, 36 responses (3 different checkpoint conversations, 3 conversations per checkpoint, and 4 adversarial queries per conversation) were rated for compliance with the CAF enabled and disabled. Activating the CAF resulted in a compliance score that was considered acceptable (?2) in 81% (7/36) of the responses, compared to only 8.3% (3/36) when the CAF was deactivated. Conclusions: Although more rigorous testing in realistic scenarios is needed, our results suggest that self-reflection mechanisms could enable LLMs to be used effectively and safely in educational mental health platforms. This approach harnesses the flexibility of LLMs while reliably constraining their scope to appropriate and accurate interactions. UR - https://ai.jmir.org/2025/1/e69820 UR - http://dx.doi.org/10.2196/69820 UR - http://www.ncbi.nlm.nih.gov/pubmed/39992720 ID - info:doi/10.2196/69820 ER - TY - JOUR AU - Paz-Arbaizar, Leire AU - Lopez-Castroman, Jorge AU - Artés-Rodríguez, Antonio AU - Olmos, M. Pablo AU - Ramírez, David PY - 2025/3/18 TI - Emotion Forecasting: A Transformer-Based Approach JO - J Med Internet Res SP - e63962 VL - 27 KW - affect KW - emotional valence KW - machine learning KW - mental disorder KW - monitoring KW - mood KW - passive data KW - Patient Health Questionnaire-9 KW - PHQ-9 KW - psychological distress KW - time-series forecasting N2 - Background: Monitoring the emotional states of patients with psychiatric problems has always been challenging due to the noncontinuous nature of clinical assessments, the effect of the health care environment, and the inherent subjectivity of evaluation instruments. However, mental states in psychiatric disorders exhibit substantial variability over time, making real-time monitoring crucial for preventing risky situations and ensuring appropriate treatment. Objective: This study aimed to leverage new technologies and deep learning techniques to enable more objective, real-time monitoring of patients. This was achieved by passively monitoring variables such as step count, patient location, and sleep patterns using mobile devices. We aimed to predict patient self-reports and detect sudden variations in their emotional valence, identifying situations that may require clinical intervention. Methods: Data for this project were collected using the Evidence-Based Behavior (eB2) app, which records both passive and self-reported variables daily. Passive data refer to behavioral information gathered via the eB2 app through sensors embedded in mobile devices and wearables. These data were obtained from studies conducted in collaboration with hospitals and clinics that used eB2. We used hidden Markov models (HMMs) to address missing data and transformer deep neural networks for time-series forecasting. Finally, classification algorithms were applied to predict several variables, including emotional state and responses to the Patient Health Questionnaire-9. Results: Through real-time patient monitoring, we demonstrated the ability to accurately predict patients? emotional states and anticipate changes over time. Specifically, our approach achieved high accuracy (0.93) and a receiver operating characteristic (ROC) area under the curve (AUC) of 0.98 for emotional valence classification. For predicting emotional state changes 1 day in advance, we obtained an ROC AUC of 0.87. Furthermore, we demonstrated the feasibility of forecasting responses to the Patient Health Questionnaire-9, with particularly strong performance for certain questions. For example, in question 9, related to suicidal ideation, our model achieved an accuracy of 0.9 and an ROC AUC of 0.77 for predicting the next day?s response. Moreover, we illustrated the enhanced stability of multivariate time-series forecasting when HMM preprocessing was combined with a transformer model, as opposed to other time-series forecasting methods, such as recurrent neural networks or long short-term memory cells. Conclusions: The stability of multivariate time-series forecasting improved when HMM preprocessing was combined with a transformer model, as opposed to other time-series forecasting methods (eg, recurrent neural network and long short-term memory), leveraging the attention mechanisms to capture longer time dependencies and gain interpretability. We showed the potential to assess the emotional state of a patient and the scores of psychiatric questionnaires from passive variables in advance. This allows real-time monitoring of patients and hence better risk detection and treatment adjustment. UR - https://www.jmir.org/2025/1/e63962 UR - http://dx.doi.org/10.2196/63962 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63962 ER - TY - JOUR AU - Tan, Jin Rayner Kay AU - Hensel, Devon AU - Ivanova, Olena AU - Bravo, Gomez Raquel AU - Olumide, Adesola AU - Adebayo, Emmanuel AU - Cleeve, Amanda AU - Gesselman, Amanda AU - Shah, Jyoti Sonam AU - Adesoba, Helen AU - Marley, Gifty AU - Tang, Weiming PY - 2025/3/4 TI - Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study JO - J Med Internet Res SP - e60369 VL - 27 KW - COVID-19 KW - telemedicine KW - sexual and reproductive health KW - pandemic KW - web-based survey KW - sexual health KW - reproductive health KW - communication technology KW - medical education KW - contraception KW - abortion KW - health care delivery KW - care KW - chronic condition N2 - Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use. UR - https://www.jmir.org/2025/1/e60369 UR - http://dx.doi.org/10.2196/60369 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053813 ID - info:doi/10.2196/60369 ER - TY - JOUR AU - Erasmus, Pieter AU - Borrmann, Moritz AU - Becker, Jule AU - Kuchinke, Lars AU - Meinlschmidt, Gunther PY - 2025/2/24 TI - Comparing Digital Versus Face-to-Face Delivery of Systemic Psychotherapy Interventions: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - Interact J Med Res SP - e46441 VL - 14 KW - systemic psychotherapy KW - family therapy KW - adolescent KW - systematic review KW - meta-analysis KW - face to face KW - digital KW - remote KW - distance KW - telehealth KW - delivery modality N2 - Background: As digital mental health delivery becomes increasingly prominent, a solid evidence base regarding its efficacy is needed. Objective: This study aims to synthesize evidence on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities. Methods: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for searching PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and PSYNDEX and conducting a systematic review and meta-analysis. We included randomized controlled trials comparing mental, behavioral, and somatic outcomes of systemic psychotherapy interventions using self- and therapist-guided digital versus face-to-face delivery modalities. The risk of bias was assessed with the revised Cochrane Risk of Bias tool for randomized trials. Where appropriate, we calculated standardized mean differences and risk ratios. We calculated separate mean differences for nonaggregated analysis. Results: We screened 3633 references and included 12 articles reporting on 4 trials (N=754). Participants were youths with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youths with anorexia nervosa. A total of 56 outcomes were identified. Two trials provided digital intervention delivery via videoconferencing: one via an interactive graphic interface and one via a web-based program. In total, 23% (14/60) of risk of bias judgments were high risk, 42% (25/60) were some concerns, and 35% (21/60) were low risk. Due to heterogeneity in the data, meta-analysis was deemed inappropriate for 96% (54/56) of outcomes, which were interpreted qualitatively instead. Nonaggregated analyses of mean differences and CIs between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 18% (10/56) of outcomes, superiority of the face-to-face delivery modality for 5% (3/56) of outcomes, equivalence between delivery modalities for 2% (1/56) of outcomes, and neither superiority of one modality nor equivalence between modalities for 75% (42/56) of outcomes. Consequently, for most outcome measures, no indication of superiority or equivalence regarding the relative efficacy of either delivery modality can be made at this stage. We further meta-analytically compared digital versus face-to-face delivery modalities for attrition (risk ratio 1.03, 95% CI 0.52-2.03; P=.93) and number of sessions attended (standardized mean difference ?0.11; 95% CI ?1.13 to ?0.91; P=.83), finding no significant differences between modalities, while CIs falling outside the range of the minimal important difference indicate that equivalence cannot be determined at this stage. Conclusions: Evidence on digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous, limiting conclusions regarding the differential efficacy of digital and face-to-face delivery. Nonaggregated and meta-analytic analyses did not indicate the superiority of either delivery condition. More research is needed to conclude if digital and face-to-face delivery modalities are generally equivalent or if?and in which contexts?one modality is superior to another. Trial Registration: PROSPERO CRD42022335013; https://tinyurl.com/nprder8h UR - https://www.i-jmr.org/2025/1/e46441 UR - http://dx.doi.org/10.2196/46441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46441 ER - TY - JOUR AU - Snipes, Cassandra AU - Dorner?Ciossek, Cornelia AU - Hare, D. Brendan AU - Besedina, Olya AU - Campellone, Tim AU - Petrova, Mariya AU - Lakhan, E. Shaheen AU - Pratap, Abhishek PY - 2025/1/27 TI - Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies JO - JMIR Ment Health SP - e64959 VL - 12 KW - therapeutic alliance KW - digital working alliance KW - experiential negative symptoms KW - schizophrenia KW - digital therapeutics KW - digital literacy N2 - Background: Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality. Objective: This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia. Methods: Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (?12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies. Results: Of the enrolled participants, 94% (46/49) and 86% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71%, 35/49; study 2: 80%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2. Conclusions: A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms. Trial Registration: Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312 UR - https://mental.jmir.org/2025/1/e64959 UR - http://dx.doi.org/10.2196/64959 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64959 ER - TY - JOUR AU - Vonderlin, Ruben AU - Boritz, Tali AU - Claus, Carola AU - Senyüz, Büsra AU - Mahalingam, Saskia AU - Tennenhouse, Rachel AU - Lis, Stefanie AU - Schmahl, Christian AU - Margraf, Jürgen AU - Teismann, Tobias AU - Kleindienst, Nikolaus AU - McMain, Shelley AU - Bohus, Martin PY - 2025/1/14 TI - Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study JO - JMIR Form Res SP - e66181 VL - 9 KW - dialectical behavior therapy KW - borderline personality disorder KW - online psychotherapy KW - virtual psychotherapy KW - telehealth KW - personality disorders KW - mental KW - psychotherapy KW - online KW - internet KW - telemedicine KW - psychiatry KW - psychiatric KW - acceptance N2 - Background: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. Objective: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). Methods: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists? and patients? perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. Results: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. Conclusions: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Trial Registration: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824 UR - https://formative.jmir.org/2025/1/e66181 UR - http://dx.doi.org/10.2196/66181 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66181 ER - TY - JOUR AU - Katsushima, Masayuki AU - Nakamura, Hideki AU - Shiko, Yuki AU - Hanaoka, Hideki AU - Shimizu, Eiji PY - 2025/1/14 TI - Effectiveness of a Videoconference-Based Cognitive Behavioral Therapy Program for Patients with Schizophrenia: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e59540 VL - 9 KW - schizophrenia KW - randomized controlled trial KW - cognitive behavioral therapy KW - videoconference KW - remote therapy N2 - Background: Cognitive behavioral therapy for psychosis (CBTp) is not sufficiently widespread in clinical practice, although evidence has been presented. Objective: The purpose of this study was to explore whether one-on-one videoconference-based CBTp (vCBTp) is more effective than usual care (UC) alone for improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. Methods: In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp program was conducted once a week, with each session lasting for 50 minutes, for a total of 7 sessions conducted in real-time and in a one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline (week 0) to posttest (week 8). Results: The study included 24 participants. There were no significant differences between the 2 groups at baseline. With regard to significant differences between the 2 groups in terms of the primary outcome, the mean change in the PANSS total score from baseline to week 8 in the vCBTp plus UC group was ?9.5 (95% CI ?12.09 to ?6.91) and the mean change in the UC alone group was 6.9 (95% CI 1.54-12.30). The difference between the 2 groups was significant (P<.001). In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder-7 (GAD-7; P=.04) and EQ-5D-5L (P=.005). There were no dropouts and no serious adverse events in this study. Conclusions: A total of 7 remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life. However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the 2 groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety regarding transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069734 UR - https://formative.jmir.org/2025/1/e59540 UR - http://dx.doi.org/10.2196/59540 UR - http://www.ncbi.nlm.nih.gov/pubmed/39610049 ID - info:doi/10.2196/59540 ER - TY - JOUR AU - Skovslund Nielsen, Eva AU - Kallesøe, Karen AU - Bennedsen Gehrt, Tine AU - Bjerre-Nielsen, Ellen AU - Lalouni, Maria AU - Frostholm, Lisbeth AU - Bonnert, Marianne AU - Rask, Ulrikka Charlotte PY - 2025/1/7 TI - Trajectories of Change, Illness Understanding, and Parental Worries in Children and Adolescents Undergoing Internet-Delivered Cognitive-Behavioral Therapy for Functional Abdominal Pain Disorders: Protocol for a Single-Case Design and Explorative Pilot Study JO - JMIR Res Protoc SP - e58563 VL - 14 KW - functional abdominal pain disorders KW - abdominal pain KW - internet-based intervention KW - cognitive behavioral therapy KW - interoception KW - attentional bias KW - parental distress KW - single case study KW - children KW - adolescents KW - youth KW - study protocol KW - quality of life KW - treatment KW - medication KW - psychological treatment KW - psychology N2 - Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment. Objective: This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect. Methods: Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3). Results: Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Trial Registration: ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7 International Registered Report Identifier (IRRID): DERR1-10.2196/58563 UR - https://www.researchprotocols.org/2025/1/e58563 UR - http://dx.doi.org/10.2196/58563 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58563 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 - 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 - Tartaglia, Julia AU - Jaghab, Brendan AU - Ismail, Mohamed AU - Hänsel, Katrin AU - Meter, Van Anna AU - Kirschenbaum, Michael AU - Sobolev, Michael AU - Kane, M. John AU - Tang, X. Sunny PY - 2024/12/30 TI - Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e63034 VL - 11 KW - digital literacy KW - attitudes KW - mental health KW - digital health technology KW - cluster analysis KW - psychiatry KW - mobile phone N2 - Background: Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients? digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. Objective: This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. Methods: A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. Results: A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9%), Black (39/256, 15.2%), Latinx (44/256, 17.2%), Asian (59/256, 23%), and other races and ethnicities (15/256, 5.7%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. Conclusions: High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools. UR - https://mental.jmir.org/2024/1/e63034 UR - http://dx.doi.org/10.2196/63034 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63034 ER - TY - JOUR AU - Wallraf, Simon AU - Dierks, Marie-Luise AU - John, Cosima AU - Lander, Jonas PY - 2024/12/20 TI - Patient Organizations? Digital Responses to the COVID-19 Pandemic: Scoping Review JO - J Med Internet Res SP - e58566 VL - 26 KW - patient organizations KW - COVID-19 KW - digital adaptation KW - digital transformation KW - scoping review N2 - Background: Patient organizations (POs) play a crucial role in supporting individuals with health conditions. Their activities range from counseling to support groups to advocacy. The COVID-19 pandemic and its related public health measures prompted rapid digital transformation efforts across multiple sectors, including health care. Objective: This study aimed to explore how POs digitally responded to pandemic-related circumstances, focusing on aspects such as the technologies used, positive outcomes, and challenges encountered. Methods: This scoping review followed the methodological guidance of the JBI (Joanna Briggs Institute) Scoping Review Methodology Group and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. A systematic search of PubMed, the Web of Science Core Collection, and the WHO (World Health Organization) COVID-19 database, supplemented by a citation search approach, was conducted. The initial search was performed on November 10, 2022, and updated on November 8, 2023. Publications were eligible if they were published after November 30, 2019, and addressed pandemic-related digitalization efforts of POs, defined as nonprofit organizations with a focus on health-related support. A 2-step screening process was used to identify relevant literature. Data were extracted using a standardized table to capture aspects such as digital adaptation activities (eg, types of technologies implemented, positive outcomes, challenges, and facilitating factors) and coded inductively to identify similarities across included publications, and the findings were synthesized narratively. Results: The search and its subsequent update yielded 2212 records, with 13 articles included in this review. These articles revealed a range of PO services that were digitally adapted during the pandemic, with videoconferencing software emerging as the most commonly used tool (n=9 articles). The digital adaptation of group-based support activities was the most frequently reported transformation (n=9). Other adaptations included the digitalization of counseling services (n=3) and the delivery of information and education (n=3), including educational workshops, weekly webinars, and the dissemination of information through digital newsletters. While the use of digital formats, particularly for POs? group activities, often increased accessibility by breaking down preexisting barriers (n=5), they also created new barriers for certain groups, such as those lacking digital skills or resources (n=4). Some participants experienced a loss of interpersonal aspects, like a sense of community (n=3). However, further findings suggest that the digital delivery of such group activities preserved essential interpersonal aspects (n=7) and a preference among some participants to continue digital group activities (n=4), suggesting the potential for sustainability of such options post the COVID-19 pandemic. Conclusions: The rapid digitalization efforts of POs demonstrate their adaptability and the potential of digital technologies to improve support services, despite some challenges. Future digitalization strategies should focus, among other things, on promoting digital literacy to ensure the accessibility and inclusiveness of digital services. Trial Registration: OSF Registries, https://osf.io/anvf4 UR - https://www.jmir.org/2024/1/e58566 UR - http://dx.doi.org/10.2196/58566 UR - http://www.ncbi.nlm.nih.gov/pubmed/39705075 ID - info:doi/10.2196/58566 ER - TY - JOUR AU - Sourander, Saana AU - Westerlund, Minja AU - Baumel, Amit AU - Hinkka-Yli-Salomäki, Susanna AU - Ristkari, Terja AU - Kurki, Marjo AU - Sourander, Andre PY - 2024/12/16 TI - Web-Based Parent Training With Telephone Coaching Aimed at Treating Child Disruptive Behaviors in a Clinical Setting During the COVID-19 Pandemic: Single-Group Study With 2-Year Follow-Up JO - JMIR Pediatr Parent SP - e63416 VL - 7 KW - parent training KW - disruptive behavior KW - child psychopathology KW - child functioning KW - behaviors KW - behavioral KW - coaching KW - web-based KW - family counseling KW - child KW - disruptive KW - counseling KW - training KW - parents KW - parenting KW - telephone KW - telehealth KW - telemedicine KW - pediatrics KW - COVID-19 N2 - Background: There is a lack of studies examining the long-term outcomes of web-based parent training programs implemented in clinical settings during the COVID-19 pandemic. Objective: The aim is to study 2-year outcomes of families with 3? to 8-year-old children referred from family counseling centers to the Finnish Strongest Families Smart Website (SFSW), which provides digital parent training with telephone coaching aimed at treating child disruptive behaviors. Methods: Counseling centers in Helsinki identified fifty 3? to 8-year-old children with high levels of disruptive behavioral problems. Child psychopathology and functioning as well as parenting styles and parental mental health were collected from parents at baseline; posttreatment; and at 6-, 12-, and 24-month follow-ups. Results: The SFSW program had positive long-term changes in child psychopathology and parenting skills. Improvements in child psychopathology, including Strengths and Difficulties Questionnaire total score (Cohen d=0.47; P<.001), Strengths and Difficulties Questionnaire conduct scores (Cohen d=0.65; P<.001), and Affective Reactivity Index irritability scores (Cohen d=0.52; P<.001), were maintained until the 24-month follow-up. Similarly, changes in parenting skills measured with the Parenting Scale, including overreactivity (Cohen d=0.41; P=.001) and laxness (Cohen d=0.26; P=.02), were maintained until the 24-month follow-up. However, parental hostility changes were not maintained at long-term follow-up (Cohen d=?0.04; P=.70). Conclusions: The study shows that the SFSW parent training program can yield significant long-term benefits. Findings indicate that the benefits of the treatment may vary between different parenting styles, which is important to consider when developing more personalized parenting interventions. UR - https://pediatrics.jmir.org/2024/1/e63416 UR - http://dx.doi.org/10.2196/63416 ID - info:doi/10.2196/63416 ER - TY - JOUR AU - Golsong, Konstanze AU - Kaufmann, Luisa AU - Baldofski, Sabrina AU - Kohls, Elisabeth AU - Rummel-Kluge, Christine PY - 2024/12/4 TI - Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study JO - JMIR Form Res SP - e60461 VL - 8 KW - mental health KW - eHealth KW - app KW - health care KW - app-based support KW - psychiatric symptoms KW - mobile phone KW - COVID-19 N2 - Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment?like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment?like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt ?definitely? or ?rather? encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=?0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. UR - https://formative.jmir.org/2024/1/e60461 UR - http://dx.doi.org/10.2196/60461 UR - http://www.ncbi.nlm.nih.gov/pubmed/39630503 ID - info:doi/10.2196/60461 ER - TY - JOUR AU - Münchenberg, Sarah Pauline AU - Yessimova, Dinara AU - Panteli, Dimitra AU - Kurth, Tobias PY - 2024/11/28 TI - Digital Health Interventions for Informal Family Caregivers of People With First-Episode Psychosis: Systematic Review on User Experience and Effectiveness JO - JMIR Ment Health SP - e63743 VL - 11 KW - first-episode psychosis KW - early psychosis KW - digital health interventions KW - telepsychiatry KW - informal caregivers KW - family caregivers KW - telehealth KW - severe mental disorders KW - psychosis KW - digital intervention KW - digital health KW - mental health KW - psychoeducation KW - mobile phone N2 - Background: First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective: This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods: A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results: The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions?web-based, videoconferences, and mHealth?were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions: The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration: PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9 UR - https://mental.jmir.org/2024/1/e63743 UR - http://dx.doi.org/10.2196/63743 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63743 ER - TY - JOUR AU - Charles, Lesley AU - Tang, Eileen AU - Tian, Jaminal Peter George AU - Chan, Karenn AU - Brémault-Phillips, Suzette AU - Dobbs, Bonnie AU - Vokey, Camelia AU - Polard, Sharna AU - Parmar, Jasneet PY - 2024/11/25 TI - Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey JO - JMIR Form Res SP - e60574 VL - 8 KW - decision making capacity KW - mental competency KW - aged KW - mobile applications KW - mobile phone KW - Canada KW - covid-19 KW - pandemics KW - dementia KW - survey KW - virtual capacity assessment KW - characteristics KW - barriers KW - facilitators KW - virtual decision making KW - assessment N2 - Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients? characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client?s and assessor?s sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors? ability to perform DMCA?s virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. UR - https://formative.jmir.org/2024/1/e60574 UR - http://dx.doi.org/10.2196/60574 UR - http://www.ncbi.nlm.nih.gov/pubmed/39585735 ID - info:doi/10.2196/60574 ER - TY - JOUR AU - Brocklehurst, P. Sarah AU - Morse, R. Alyssa AU - Cruwys, Tegan AU - Batterham, J. Philip AU - Leach, Liana AU - Robertson, M. Alysia AU - Sahib, Aseel AU - Burke, T. Colette AU - Nguyen, Jessica AU - Calear, L. Alison PY - 2024/11/19 TI - Investigating the Effectiveness of Technology-Based Distal Interventions for Postpartum Depression and Anxiety: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e53236 VL - 26 KW - postpartum KW - depression KW - anxiety KW - birth KW - adoptive KW - parents KW - mobile phone N2 - Background: Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media. Objective: This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions. Methods: A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses. Results: Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=?0.28, 95% CI ?0.41 to ?0.15; P<.001) and follow-up (Cohen d=?0.27, 95% CI ?0.52 to ?0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=?0.29, 95% CI ?0.48 to ?0.10; P=.002), with a medium effect at follow-up (Cohen d=?0.47, 95% CI ?0.88 to ?0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95% CI ?0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies. Conclusions: Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties. Trial Registration: PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290525 UR - https://www.jmir.org/2024/1/e53236 UR - http://dx.doi.org/10.2196/53236 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53236 ER - TY - JOUR AU - Dumassais, Shirley AU - Grewal, Singh Karl AU - Aubin, Gabrielle AU - O'Connell, Megan AU - Phillips, A. Natalie AU - Wittich, Walter PY - 2024/11/15 TI - Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults JO - JMIR Form Res SP - e58537 VL - 8 KW - neuropsychological tests KW - telemedicine KW - social inclusion KW - telehealth KW - remote KW - qualitative KW - neuropsychological KW - cognitive KW - screening KW - assessment KW - perception KW - perspective KW - telephone KW - cross-sectional KW - thematic KW - mobile phone KW - Montreal Cognitive Assessment KW - MoCA N2 - Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities. Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener. Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session. Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension. Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability. UR - https://formative.jmir.org/2024/1/e58537 UR - http://dx.doi.org/10.2196/58537 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58537 ER - TY - JOUR AU - Jefferies, Meryem AU - Graham, Robert AU - Tracy, Marguerite AU - Read, Scott AU - Eslam, Mohammed AU - Douglas, W. Mark AU - George, Jacob PY - 2024/11/12 TI - Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review JO - J Med Internet Res SP - e46394 VL - 26 KW - telehealth use KW - emergency department admission KW - substance use disorder KW - drug addiction KW - consent KW - privacy KW - professional indemnity KW - confidentiality KW - data security N2 - Background: The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster. Objective: We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings. Methods: We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed. Results: In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD. Conclusions: Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of conduct, or suggestions for clinicians to consider, but there was little discussion or evidence of how legal considerations are being applied when providing telehealth consultations at drug health services. Clinicians should be aware of the medicolegal implications when providing health care via telehealth at drug health services. UR - https://www.jmir.org/2024/1/e46394 UR - http://dx.doi.org/10.2196/46394 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46394 ER - TY - JOUR AU - Fajnerova, Iveta AU - Hejtmánek, Luká? AU - Sedlák, Michal AU - Jablonská, Markéta AU - Francová, Anna AU - Stopková, Pavla PY - 2024/11/7 TI - The Journey From Nonimmersive to Immersive Multiuser Applications in Mental Health Care: Systematic Review JO - J Med Internet Res SP - e60441 VL - 26 KW - digital health KW - mental health care KW - clinical interventions KW - multiuser KW - immersive KW - virtual reality KW - VR KW - app KW - mental health KW - online tools KW - synthesis KW - mobile phone KW - PRISMA N2 - Background: Over the past 25 years, the development of multiuser applications has seen considerable advancements and challenges. The technological development in this field has emerged from simple chat rooms through videoconferencing tools to the creation of complex, interactive, and often multisensory virtual worlds. These multiuser technologies have gradually found their way into mental health care, where they are used in both dyadic counseling and group interventions. However, some limitations in hardware capabilities, user experience designs, and scalability may have hindered the effectiveness of these applications. Objective: This systematic review aims at summarizing the progress made and the potential future directions in this field while evaluating various factors and perspectives relevant to remote multiuser interventions. Methods: The systematic review was performed based on a Web of Science and PubMed database search covering articles in English, published from January 1999 to March 2024, related to multiuser mental health interventions. Several inclusion and exclusion criteria were determined before and during the records screening process, which was performed in several steps. Results: We identified 49 records exploring multiuser applications in mental health care, ranging from text-based interventions to interventions set in fully immersive environments. The number of publications exploring this topic has been growing since 2015, with a large increase during the COVID-19 pandemic. Most digital interventions were delivered in the form of videoconferencing, with only a few implementing immersive environments. The studies used professional or peer-supported group interventions or a combination of both approaches. The research studies targeted diverse groups and topics, from nursing mothers to psychiatric disorders or various minority groups. Most group sessions occurred weekly, or in the case of the peer-support groups, often with a flexible schedule. Conclusions: We identified many benefits to multiuser digital interventions for mental health care. These approaches provide distributed, always available, and affordable peer support that can be used to deliver necessary help to people living outside of areas where in-person interventions are easily available. While immersive virtual environments have become a common tool in many areas of psychiatric care, such as exposure therapy, our results suggest that this technology in multiuser settings is still in its early stages. Most identified studies investigated mainstream technologies, such as videoconferencing or text-based support, substituting the immersive experience for convenience and ease of use. While many studies discuss useful features of virtual environments in group interventions, such as anonymity or stronger engagement with the group, we discuss persisting issues with these technologies, which currently prevent their full adoption. UR - https://www.jmir.org/2024/1/e60441 UR - http://dx.doi.org/10.2196/60441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60441 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 - 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 - Kabukye, K. Johnblack AU - Nakku, Juliet AU - Niwemuhwezi, Jackline AU - Nsereko, James AU - Namagembe, Rosemary AU - Groen, Emilie Iris Dorothee AU - Neumbe, Ritah AU - Mubiru, Denis AU - Kisakye, Caroline AU - Nanyonga, Roseline AU - Sjölinder, Marie AU - Nilsson, Susanne AU - Wamala-Larsson, Caroline PY - 2024/10/21 TI - Assessing the Usage and Usability of a Mental Health Advice Telephone Service in Uganda: Mixed Methods Study JO - J Med Internet Res SP - e65692 VL - 26 KW - mHealth KW - mental health KW - telephone service KW - usability KW - satisfaction KW - evaluation KW - mixed method KW - Uganda KW - Africa N2 - Background: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers. Objective: This study aims to assess the usage and usability of this mental health telephone service. Methods: We obtained usage data from the system?s call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated. Results: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02). Conclusions: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings. UR - https://www.jmir.org/2024/1/e65692 UR - http://dx.doi.org/10.2196/65692 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65692 ER - TY - JOUR AU - Benda, Natalie AU - Desai, Pooja AU - Reza, Zayan AU - Zheng, Anna AU - Kumar, Shiveen AU - Harkins, Sarah AU - Hermann, Alison AU - Zhang, Yiye AU - Joly, Rochelle AU - Kim, Jessica AU - Pathak, Jyotishman AU - Reading Turchioe, Meghan PY - 2024/9/18 TI - Patient Perspectives on AI for Mental Health Care: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e58462 VL - 11 KW - artificial intelligence KW - AI KW - mental health KW - patient perspectives KW - patients KW - public survey KW - application KW - applications KW - health care KW - health professionals KW - somatic issues KW - radiology KW - perinatal health KW - Black KW - professional relationship KW - patient-health KW - autonomy KW - risk KW - confidentiality KW - machine learning KW - digital mental health KW - computing KW - coding KW - mobile phone N2 - Background: The application of artificial intelligence (AI) to health and health care is rapidly increasing. Several studies have assessed the attitudes of health professionals, but far fewer studies have explored the perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues, including those related to radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health care solutions, but broader perspectives toward AI for mental health care have been underexplored. Objective: This study aims to understand public perceptions regarding potential benefits of AI, concerns about AI, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health care. Methods: We conducted a 1-time cross-sectional survey with a nationally representative sample of 500 US-based adults. Participants provided structured responses on their perceived benefits, concerns, comfort, and values regarding AI for mental health care. They could also add free-text responses to elaborate on their concerns and values. Results: A plurality of participants (245/497, 49.3%) believed AI may be beneficial for mental health care, but this perspective differed based on sociodemographic variables (all P<.05). Specifically, Black participants (odds ratio [OR] 1.76, 95% CI 1.03-3.05) and those with lower health literacy (OR 2.16, 95% CI 1.29-3.78) perceived AI to be more beneficial, and women (OR 0.68, 95% CI 0.46-0.99) perceived AI to be less beneficial. Participants endorsed concerns about accuracy, possible unintended consequences such as misdiagnosis, the confidentiality of their information, and the loss of connection with their health professional when AI is used for mental health care. A majority of participants (80.4%, 402/500) valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked who was responsible for the misdiagnosis of mental health conditions using AI, 81.6% (408/500) of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of patients? information. Conclusions: Future work involving the use of AI for mental health care should investigate strategies for conveying the level of AI?s accuracy, factors that drive patients? mental health risks, and how data are used confidentially so that patients can determine with their health professionals when AI may be beneficial. It will also be important in a mental health care context to ensure the patient?health professional relationship is preserved when AI is used. UR - https://mental.jmir.org/2024/1/e58462 UR - http://dx.doi.org/10.2196/58462 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58462 ER - TY - JOUR AU - Molander, Olof AU - Berman, H. Anne AU - Jakobson, Miriam AU - Gajecki, Mikael AU - Hällström, Hanna AU - Ramnerö, Jonas AU - Bjureberg, Johan AU - Carlbring, Per AU - Lindner, Philip PY - 2024/9/18 TI - Introducing and Evaluating the Effectiveness of Online Cognitive Behavior Therapy for Gambling Disorder in Routine Addiction Care: Comparative Cohort Study JO - J Med Internet Res SP - e54754 VL - 26 KW - gambling disorder KW - internet-delivered cognitive behavioral therapy KW - routine addiction care KW - registry study KW - gambling KW - addiction KW - health care setting KW - iCBT KW - Sweden KW - feasibility KW - clinic KW - hospital KW - psychological treatment KW - digital intervention KW - addictive disorder KW - eHealth KW - digital care KW - survival analysis KW - comorbidity N2 - Background: Several treatment-related challenges exist for gambling disorder, in particular at-scale dissemination in health care settings. Objective: This study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for gambling disorder (GD), provided with therapist support in routine addiction care, in a nationally recruited sample in Sweden. The study details the introduction of the iCBT program, evaluates its effectiveness and acceptability, and compares registry outcomes among iCBT patients with other patients with GD at the clinic who received face-to-face psychological treatment as usual. Methods: The study site was the Stockholm Addiction eClinic, which offers digital interventions for addictive disorders in routine care. The iCBT program was introduced nationally for treatment-seeking patients through the Swedish eHealth platform. After approximately 2 years of routine treatment provision, we conducted a registry study, including ordinary patients in routine digital care (n=218), and a reference sample receiving face-to-face psychological treatment for GD (n=216). Results: A statistically significant reduction in the Gambling Symptom Assessment Scale scores during the treatment was observed (B=?1.33, SE=0.17, P<.001), corresponding to a large within-group Cohen d effect size of d=1.39. The iCBT program was rated high for satisfaction. A registry-based survival analysis, controlling for psychiatric comorbidity, showed that patients receiving iCBT exhibited posttreatment outcomes (re-engagement in outpatient addiction care, receiving new psychiatric prescriptions, enrollment in psychiatric inpatient care, and care events indicative of contact with social services) similar to comparable patients who underwent face-to-face treatment-as-usual. Conclusions: A lack of randomized allocation notwithstanding, the iCBT program for GD evaluated in this study was well-received by patients in routine addiction care, was associated with the expected symptom decrease during treatment, and appears to result in posttreatment registry outcomes similar to face-to-face treatment. Future studies on treatment mechanisms and moderators are warranted. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00647-5 UR - https://www.jmir.org/2024/1/e54754 UR - http://dx.doi.org/10.2196/54754 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54754 ER - TY - JOUR AU - De la Cruz-Torralva, Kelly AU - Escobar-Agreda, Stefan AU - Riega López, Pedro AU - Amaro, James AU - Reategui-Rivera, Mahony C. AU - Rojas-Mezarina, Leonardo PY - 2024/9/10 TI - Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study JO - JMIR Form Res SP - e54005 VL - 8 KW - telemedicine KW - screening KW - treatment KW - mental health KW - suicide KW - depression KW - anxiety KW - alcoholism KW - physicians KW - rural areas KW - Peru N2 - Background: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. Objective: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. Methods: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Results: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. Conclusions: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants. UR - https://formative.jmir.org/2024/1/e54005 UR - http://dx.doi.org/10.2196/54005 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54005 ER - TY - JOUR AU - Shaker, Abbas Ali AU - Simonsen, Erik AU - Tarp, Kristine AU - Borisov, Aleksandrov Radoslav AU - Sørensen, Aasted John AU - Bechmann, Henrik AU - Austin, F. Stephen PY - 2024/8/21 TI - Capturing Patients? and Clinicians? Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis JO - JMIR Form Res SP - e50580 VL - 8 KW - telemedicine KW - telepsychiatry KW - video consultation KW - mobile health KW - mHealth KW - COVID-19 KW - synchronous technology N2 - Background: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. Objective: The aim of this study was to investigate patients? and clinicians? experiences and attitudes toward using VCs in clinical practice. Methods: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. Results: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians? experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. Conclusions: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients? and clinicians? perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions. UR - https://formative.jmir.org/2024/1/e50580 UR - http://dx.doi.org/10.2196/50580 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50580 ER - TY - JOUR AU - Pusnik, Adrijana AU - Hartzler, Bryan AU - Vjorn, Olivia AU - Rutkowski, A. Beth AU - Chaple, Michael AU - Becker, Sara AU - Freese, Thomas AU - Nichols, Maureen AU - Molfenter, Todd PY - 2024/8/12 TI - Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys JO - JMIR Ment Health SP - e52363 VL - 11 KW - telehealth KW - COVID-19 KW - substance use disorders KW - telephone counseling KW - video counseling N2 - Background: The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was ?Will telehealth ever take hold for SUD services?? Now that social distancing guidelines have been lifted, the question is ?Will telehealth remain a commonly used care modality?? Objective: The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners? perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods: An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25?35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results: A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] ?0.23; P=.002), but not for video-based telehealth (MD ?0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD?0.35; P<.001), but no difference was found for phone-based telehealth (MD ?0.12; P=.11). From the staff?s perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions: Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations. UR - https://mental.jmir.org/2024/1/e52363 UR - http://dx.doi.org/10.2196/52363 ID - info:doi/10.2196/52363 ER - TY - JOUR AU - Rosebrock, Laina AU - Freeman, Jason AU - Rovira, Aitor AU - Miguel, Lages Andre AU - Ward, Rupert AU - Bousfield, Matthew AU - Riffiod, Ludovic AU - Kamvar, Roya AU - Kabir, Thomas AU - Waite, Felicity AU - Freeman, Daniel PY - 2024/8/7 TI - Developing an Automated Virtual Reality Therapy for Improving Positive Self-Beliefs and Psychological Well-Being (Phoenix VR Self-Confidence Therapy): Tutorial JO - JMIR Serious Games SP - e51512 VL - 12 KW - virtual reality KW - VR KW - psychosis KW - cognitive behavioural therapy KW - psychological well-being KW - design process KW - self-beliefs KW - psychological therapy KW - real-world KW - efficacy KW - well-being KW - mental health KW - participant KW - stakeholder KW - user KW - Phoenix VR Self-Confidence Therapy UR - https://games.jmir.org/2024/1/e51512 UR - http://dx.doi.org/10.2196/51512 ID - info:doi/10.2196/51512 ER - TY - JOUR AU - Oliver, Amy AU - Chandler, Ella AU - Gillard, A. Julia PY - 2024/7/26 TI - Impact of Digital Inclusion Initiative to Facilitate Access to Mental Health Services: Service User Interview Study JO - JMIR Ment Health SP - e51315 VL - 11 KW - digital exclusion KW - digital inclusion KW - video consultation KW - COVID-19 KW - tablet loan scheme KW - mental health KW - telemedicine KW - digital divide KW - digital inequality KW - technology N2 - Background: Digital exclusion, characterized by a lack of access to digital technology, connectivity, or digital skills, disproportionally affects marginalized groups. An important domain impacted by digital exclusion is access to health care. During COVID-19, health care services had to restrict face-to-face contact to limit the spread of the virus. The subsequent shift toward remote delivery of mental health care exacerbated the digital divide, with limited access to remote mental health care delivery. In response, Camden and Islington National Health Service Foundation Trust launched the innovative Digital Inclusion Scheme (DIS). Objective: This study aimed to examine the impact of facilitating digital inclusion in mental health access. Camden and Islington National Health Service Foundation Trust implemented the trust-wide DIS for service users who were digitally excluded, that is, were without devices or connectivity or reported poor digital skills. The scheme provided access to a loan digital device (a tablet), internet connectivity devices, and mobile data, as well as personalized digital skills support. Methods: The DIS went live in October 2021 and received 106 referrals by June 2022. Semistructured interviews were conducted with 12 service users to ask about their experience of accessing the DIS. A thematic analysis identified themes and subthemes relating to the extent of their digital exclusion before engaging with the scheme and the impact of accessing a scheme on their ability to engage with digital technology and well-being. Results: There were 10 major themes. A total of 6 themes were related to factors impacting the engagement with the scheme, including digital exclusion, relationship to the trust, the importance of personalized digital support, partnership working, device usability and accessibility, and personal circumstances. The remaining 4 themes spoke to the impact of accessing the scheme, including improved access to services, impact on well-being, financial implications, and a greater sense of empowerment. Conclusions: Participants reported an increased reliance on technology driving the need for digital inclusion; however, differences in motivation for engaging with the scheme were noted, as well as potential barriers, including lack of awareness, disability, and age. Overall, the experience of accessing the DIS was reported as positive, with participants feeling supported to access the digital world. The consequences of engaging with the scheme included greater perceived access to and control of physical and mental health care, improved well-being, and a greater sense of empowerment. An overview of the lessons learned are provided along with suggestions for other health care settings that are looking to implement similar schemes. UR - https://mental.jmir.org/2024/1/e51315 UR - http://dx.doi.org/10.2196/51315 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51315 ER - TY - JOUR AU - Shalev, Ligat AU - Eitan, Renana AU - Rose, J. Adam PY - 2024/7/15 TI - The Use of Telepsychiatry Services in Emergency Settings: Scoping Review JO - J Med Internet Res SP - e51814 VL - 26 KW - implementation science KW - emergency department KW - telepsychiatry KW - organizational innovation KW - eHealth KW - mHealth KW - scoping review KW - implementation KW - psychiatric patient KW - clinical outcome KW - rural KW - feasible KW - acceptable KW - effectiveness KW - electronic database N2 - Background: Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP?s effectiveness in the ED setting, as well as the process of implementing TP in this setting. Objective: This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. Methods: The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. Results: A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. Conclusions: Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP?s effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment. UR - https://www.jmir.org/2024/1/e51814 UR - http://dx.doi.org/10.2196/51814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51814 ER - TY - JOUR AU - Cummings, Camilla AU - Raja, Pushpa AU - Gabrielian, Sonya AU - Doran, Neal PY - 2024/7/9 TI - Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data JO - JMIR Ment Health SP - e56886 VL - 11 KW - telemedicine KW - quality of care KW - serious mental illness KW - telehealth KW - adoption KW - mental illness KW - patients KW - patient KW - veterans KW - veteran KW - psychotherapy KW - psychosocial KW - mental healthcare KW - suicide KW - rehabilitation KW - mental health care N2 - Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth?s impacts on SMI care outcomes is mixed, necessitating further investigation. Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. Methods: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). Results: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=?4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=?4.49; P<.001; z=?3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=?3.74; P<.001), and continuity of care after a high-risk event (z=?2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=?4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized. Conclusions: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation?selected through a health equity lens?may improve quality of care among patients with SMI. UR - https://mental.jmir.org/2024/1/e56886 UR - http://dx.doi.org/10.2196/56886 ID - info:doi/10.2196/56886 ER - TY - JOUR AU - Villarreal-Zegarra, David AU - García-Serna, Jackeline AU - Segovia-Bacilio, Piero AU - Mayo-Puchoc, Nikol AU - Navarro-Flores, Alba AU - Huarcaya-Victoria, Jeff PY - 2024/7/8 TI - In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic JO - JMIR Ment Health SP - e53980 VL - 11 KW - health care utilization KW - mental health use KW - COVID-19 KW - mental health KW - health care KW - psychiatric care KW - teleconsultation KW - hospital KW - Peru KW - chronic KW - patient KW - patients KW - telemonitoring N2 - Background: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world?s highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. Objective: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. Methods: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (?0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. Results: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. Conclusions: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users. UR - https://mental.jmir.org/2024/1/e53980 UR - http://dx.doi.org/10.2196/53980 UR - http://www.ncbi.nlm.nih.gov/pubmed/38976320 ID - info:doi/10.2196/53980 ER - TY - JOUR AU - Doukani, Asmae AU - Quartagno, Matteo AU - Sera, Francesco AU - Free, Caroline AU - Kakuma, Ritsuko AU - Riper, Heleen AU - Kleiboer, Annet AU - Cerga-Pashoja, Arlinda AU - van Schaik, Anneke AU - Botella, Cristina AU - Berger, Thomas AU - Chevreul, Karine AU - Matynia, Maria AU - Krieger, Tobias AU - Hazo, Jean-Baptiste AU - Draisma, Stasja AU - Titzler, Ingrid AU - Topooco, Naira AU - Mathiasen, Kim AU - Vernmark, Kristofer AU - Urech, Antoine AU - Maj, Anna AU - Andersson, Gerhard AU - Berking, Matthias AU - Baños, María Rosa AU - Araya, Ricardo PY - 2024/5/31 TI - Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial JO - J Med Internet Res SP - e47515 VL - 26 KW - blended psychotherapy KW - cognitive behavioral therapy KW - depression KW - digital mental health interventions KW - psychotherapy KW - mental health KW - program usability KW - therapeutic alliance KW - usability heuristics KW - working alliance N2 - Background: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. Objective: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. Methods: We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised?Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Results: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=?0.12, 95% CI ?0.17 to ?0.06) and TAU (B=?0.06, 95% CI ?0.11 to ?0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=?0.030, 95% CI ?0.05 to ?0.01; P=.005). Conclusions: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. Trial Registration: ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1511-1 UR - https://www.jmir.org/2024/1/e47515 UR - http://dx.doi.org/10.2196/47515 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819882 ID - info:doi/10.2196/47515 ER - TY - JOUR AU - González-Spinoglio, Leticia AU - Monistrol-Mula, Anna AU - Vindrola-Padros, Cecilia AU - Aguilar-Ortiz, Salvatore AU - Carreras, Bernat AU - Haro, Maria Josep AU - Felez-Nobrega, Mireia PY - 2024/5/29 TI - Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study JO - J Med Internet Res SP - e47546 VL - 26 KW - COVID-19 pandemic KW - digital technology KW - health care professionals KW - long-term care KW - mental health KW - well-being KW - digital mental health KW - digital mental health interventions KW - mobile phone N2 - Background: The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. Objective: This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. Methods: We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. Results: The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. Conclusions: More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees? well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic. UR - https://www.jmir.org/2024/1/e47546 UR - http://dx.doi.org/10.2196/47546 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809605 ID - info:doi/10.2196/47546 ER - TY - JOUR AU - Gotra, Milena AU - Lindberg, Katharine AU - Jasinski, Nicholas AU - Scarisbrick, David AU - Reilly, Shannon AU - Perle, Jonathan AU - Miller, Liv AU - Mahoney III, James PY - 2024/4/29 TI - Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study JO - JMIR Form Res SP - e50303 VL - 8 KW - COVID-19 pandemic KW - mental health KW - social worker KW - psychologist KW - neuropsychologist KW - academic medical center KW - community mental health KW - private practice KW - Veteran?s Affairs hospital KW - longitudinal questionnaire study KW - COVID-19 KW - implementation KW - telemental health KW - hybrid model KW - availability N2 - Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. UR - https://formative.jmir.org/2024/1/e50303 UR - http://dx.doi.org/10.2196/50303 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683653 ID - info:doi/10.2196/50303 ER - TY - JOUR AU - Austin, Tara AU - Smith, Jennifer AU - Rabin, Borsika AU - Lindamer, Laurie AU - Pittman, James AU - Justice, Staley AU - Twamley, W. Elizabeth AU - Lantrip, Crystal PY - 2024/4/12 TI - The Effects of a Single-Session Virtual Rumination Intervention to Enhance Cognitive Functioning in Veterans With Subjective Cognitive Symptoms: Multimethod Pilot Study JO - JMIR Form Res SP - e48525 VL - 8 KW - army KW - cognition KW - cognitive KW - emotion regulation KW - memory symptoms KW - memory KW - military KW - rumination KW - subjective cognitive decline KW - telehealth KW - telemedicine KW - veteran KW - worry N2 - Background: Subjective cognitive concerns (SCCs) entail perceived difficulties in thinking or memory, often reported without substantial objective evidence of cognitive impairment. These concerns are prevalent among individuals with a history of brain injuries, neurological conditions, or chronic illnesses, contributing to both psychological distress and functional limitations. They are increasingly considered to be a risk factor for future objective decline. A considerable number of individuals reporting SCCs also exhibit mental health symptoms, such as a history of trauma, depression, or anxiety. Interventions that address modifiable emotional and cognitive factors related to SCC could improve functioning and quality of life. Therefore, the use of emotion regulation strategies, especially those directed at minimizing rumination, could serve as a promising focus for interventions aimed at mitigating subjective cognitive concerns in veteran populations. Objective: This pilot study explored the feasibility, acceptability, and preliminary efficacy of a brief, 1-session emotion regulation intervention called ?Worry Less, Remember More.? The Worry Less, Remember More intervention was designed to reduce rumination and improve subjective cognitive functioning in veterans with subjective cognitive changes (N=15). Methods: We randomized 15 veterans to either the active telehealth condition or waitlist control and completed the intervention. Participants were aged between 31 and 67 (mean 49.5, SD 10.1) years, and the sample was primarily male (12/15, 83%) and White (10/15, 67%). The most common diagnoses were posttraumatic stress disorder and depression. Following the intervention, veteran input was sought through semistructured interviews with a subset of 12 participants, examining feasibility, acceptability, and perceived efficacy. Preliminary efficacy was also measured using pre- and postintervention self-report measures. Results: Veterans reported that this intervention was acceptable, with 92% (11/12) of the sample reporting that they benefited from the intervention and would recommend the intervention to others with similar difficulties. Semistructured interviews revealed difficulties with feasibility, including problems with the remote consenting process, forgetting appointments, and needing additional strategies to remember to consistently use the interventions. The intervention improved self-reported cognitive symptoms on quantitative measures but did not improve self-reported rumination. Conclusions: This pilot study establishes the preliminary feasibility, acceptability, and efficacy of the Worry Less, Remember More intervention for veterans with subjective cognitive symptoms. Future iterations of the intervention may benefit from simplifying the electronic consent process, providing reminders for appointments, and incorporating compensatory cognitive strategies to assist with using the telehealth system, as well as applying the strategies learned in the intervention. While future research is needed with larger samples, including nonveteran populations, the intervention may also be a useful clinical tool to bridge care between neuropsychology clinics and mental health treatment. UR - https://formative.jmir.org/2024/1/e48525 UR - http://dx.doi.org/10.2196/48525 UR - http://www.ncbi.nlm.nih.gov/pubmed/38608264 ID - info:doi/10.2196/48525 ER - TY - JOUR AU - Voderholzer, Ulrich AU - Meule, Adrian AU - Koch, Stefan AU - Pfeuffer, Simone AU - Netter, Anna-Lena AU - Lehr, Dirk AU - Zisler, Maria Eva PY - 2024/3/13 TI - Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study JO - JMIR Ment Health SP - e52790 VL - 11 KW - obsessive-compulsive disorder KW - videoconference-based treatment KW - therapy KW - exposure KW - response prevention KW - OCD KW - prevention KW - inpatient KW - video KW - videoconference KW - therapist KW - therapists KW - mood KW - positive mood KW - environment KW - clinical setting N2 - Background: Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). Objective: This study aimed to investigate patients? views on 1 ERP session at home via videoconference and its impact on treatment outcome. Methods: A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. Results: Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. Conclusions: Results highlight the importance of administering therapist-guided ERP sessions in patients? natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients? natural environment and foster the generalization of ERP conducted in clinical settings. UR - https://mental.jmir.org/2024/1/e52790 UR - http://dx.doi.org/10.2196/52790 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477970 ID - info:doi/10.2196/52790 ER - TY - JOUR AU - Badaghi, Nasim AU - van Kruijsbergen, Mette AU - Speckens, Anne AU - Vilé, Joëlle AU - Prins, Judith AU - Kelders, Saskia AU - Kwakkenbos, Linda PY - 2024/2/21 TI - Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial JO - JMIR Form Res SP - e52338 VL - 8 KW - cancer KW - eHeath KW - online interventions KW - mindfulness KW - psycho-oncology KW - qualitative research KW - oncology KW - CBT KW - blended KW - eMBCT KW - iCBT KW - cognitive therapy KW - unguided KW - psychotherapy KW - MBCT KW - co-creation KW - therapist KW - self-guided KW - peer-support KW - co-design KW - participatory N2 - Background: Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation. Objective: The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions. Methods: Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention. Results: We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53). Conclusions: Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires. Trial Registration: ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916 UR - https://formative.jmir.org/2024/1/e52338 UR - http://dx.doi.org/10.2196/52338 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381493 ID - info:doi/10.2196/52338 ER - TY - JOUR AU - Bufano, Pasquale AU - Laurino, Marco AU - Said, Sara AU - Tognetti, Alessandro AU - Menicucci, Danilo PY - 2023/12/13 TI - Digital Phenotyping for Monitoring Mental Disorders: Systematic Review JO - J Med Internet Res SP - e46778 VL - 25 KW - digital phenotyping KW - mobile KW - mental health KW - smartphone KW - mobile sensing KW - passive sensing KW - active sensing KW - digital phenotype KW - digital biomarker KW - mobile phone N2 - Background: The COVID-19 pandemic has increased the impact and spread of mental illness and made health services difficult to access; therefore, there is a need for remote, pervasive forms of mental health monitoring. Digital phenotyping is a new approach that uses measures extracted from spontaneous interactions with smartphones (eg, screen touches or movements) or other digital devices as markers of mental status. Objective: This review aimed to evaluate the feasibility of using digital phenotyping for predicting relapse or exacerbation of symptoms in patients with mental disorders through a systematic review of the scientific literature. Methods: Our research was carried out using 2 bibliographic databases (PubMed and Scopus) by searching articles published up to January 2023. By following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, we started from an initial pool of 1150 scientific papers and screened and extracted a final sample of 29 papers, including studies concerning clinical populations in the field of mental health, which were aimed at predicting relapse or exacerbation of symptoms. The systematic review has been registered on the web registry Open Science Framework. Results: We divided the results into 4 groups according to mental disorder: schizophrenia (9/29, 31%), mood disorders (15/29, 52%), anxiety disorders (4/29, 14%), and substance use disorder (1/29, 3%). The results for the first 3 groups showed that several features (ie, mobility, location, phone use, call log, heart rate, sleep, head movements, facial and vocal characteristics, sociability, social rhythms, conversations, number of steps, screen on or screen off status, SMS text message logs, peripheral skin temperature, electrodermal activity, light exposure, and physical activity), extracted from data collected via the smartphone and wearable wristbands, can be used to create digital phenotypes that could support gold-standard assessment and could be used to predict relapse or symptom exacerbations. Conclusions: Thus, as the data were consistent for almost all the mental disorders considered (mood disorders, anxiety disorders, and schizophrenia), the feasibility of this approach was confirmed. In the future, a new model of health care management using digital devices should be integrated with the digital phenotyping approach and tailored mobile interventions (managing crises during relapse or exacerbation). UR - https://www.jmir.org/2023/1/e46778 UR - http://dx.doi.org/10.2196/46778 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090800 ID - info:doi/10.2196/46778 ER - TY - JOUR AU - Dhaliwal, Raman AU - Yap, Sidney AU - Talarico, Fernanda AU - Al-Shamali, Huda AU - Mcweeny, Robert AU - Reeson, Matthew AU - Shalaby, Reham AU - Chen, Teresa AU - Spronk, Elena AU - Snodgrass, Rayven AU - Tu, Eileen AU - Erick, Taylor AU - Marshall, Tyler AU - Kennedy, Megan AU - Greenshaw, J. Andrew AU - Winkler, Olga AU - Burback, Lisa PY - 2023/11/3 TI - Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review JO - J Med Internet Res SP - e40710 VL - 25 KW - acceptability KW - accessibility KW - app KW - application KW - clinical KW - cognitive KW - computerized therapy KW - culture KW - database KW - diagnosis KW - Diagnostic and Statistical Manual of Mental Disorders KW - DSM KW - effectiveness KW - health quality KW - ICD KW - International Statistical Classification of Diseases KW - literature review KW - mental disorder KW - mental health KW - mental KW - Preferred Reporting Items for Systematic Reviews and Meta-Analysis KW - PRISMA KW - privacy KW - psychoeducation KW - psychotherapeutic KW - psychotherapy KW - remote delivery KW - remote psychotherapy KW - remote KW - scoping review KW - security KW - synchronous KW - therapist assisted KW - therapist delivered KW - therapist. N2 - Background: The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. Objective: This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. Methods: This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. Results: From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. Conclusions: In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy. UR - https://www.jmir.org/2023/1/e40710 UR - http://dx.doi.org/10.2196/40710 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921863 ID - info:doi/10.2196/40710 ER - TY - JOUR AU - Shalev, Ligat AU - Bistre, Moises AU - Lubin, Gadi AU - Avirame, Keren AU - Raskin, Sergey AU - Linkovski, Omer AU - Eitan, Renana AU - Rose, J. Adam PY - 2023/10/17 TI - Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study JO - JMIR Res Protoc SP - e49405 VL - 12 KW - eHealth KW - telepsychiatry KW - digital health service KW - emergency department KW - mental health KW - implementation science KW - Promoting Action on Research Implementation in Health Services KW - organizational innovation N2 - Background: Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission. Objective: The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link. Methods: This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation?s viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records. Results: This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others. Conclusions: Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation. Trial Registration: ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545 International Registered Report Identifier (IRRID): DERR1-10.2196/49405 UR - https://www.researchprotocols.org/2023/1/e49405 UR - http://dx.doi.org/10.2196/49405 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847548 ID - info:doi/10.2196/49405 ER - TY - JOUR AU - Levy, N. Amanda AU - Nittas, Vasileios AU - Wray, B. Tyler PY - 2023/10/16 TI - Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study JO - JMIR Form Res SP - e47443 VL - 7 KW - counseling treatment KW - phobias KW - PTSD KW - patient perspective KW - in vivo exposures KW - virtual reality KW - exposure therapy KW - anxiety KW - psychotherapy KW - effectiveness KW - digital therapy KW - affective disorders N2 - Background: Psychotherapy, and particularly exposure therapy, has been proven to be an effective treatment for many anxiety disorders, including social and specific phobias, as well as posttraumatic stress disorders. Currently, exposures are underused and mostly delivered in vivo. Virtual reality exposure therapy (VRET) offers a more flexible delivery mechanism that has the potential to address some of the implementation barriers of in vivo exposures while retaining effectiveness. Yet, there is little evidence on how patients perceive different exposure therapy methods. Objective: This study aims to explore the perceptions of individuals with anxiety disorders toward in vivo and VRET. Our findings can inform therapists about the degree of patient interest in both methods while exploring the demand for VRET as an alternative and novel treatment approach. Methods: Web-based survey assessing the (1) interest in, (2) willingness to use, (3) comfort with, (4) enthusiasm toward, and (5) perceived effectiveness of exposure therapy when delivered in vivo and through VR. Participants included individuals with specific phobia, social phobia, posttraumatic stress disorder, or acute stress disorder or reaction. Participants were presented with educational videos about in vivo and VRET and asked to provide their perceptions quantitatively and qualitatively through a rated scale and free-text responses. Results: In total, 184 surveys were completed and analyzed, in which 82% (n=151) of participants reported being willing to receive in vivo exposures and 90.2% (n=166) reported willingness to receive VRET. Participants reported higher interest in, comfort with, enthusiasm toward, and perceived effectiveness of VRET compared to in vivo. Most reported in vivo concerns were linked to (1) increased anxiety, (2) feelings of embarrassment or shame, and (3) exacerbation of current condition. Most reported VRET concerns were linked to (1) risk of side effects including increased anxiety, (2) efficacy uncertainty, and (3) health insurance coverage. The most frequently mentioned VRET benefits include (1) privacy, (2) safety, (3) the ability to control exposures, (4) comfort, (5) the absence of real-life consequences, (6) effectiveness, and (7) customizability to a wider variety of exposures. Conclusions: On average, our participants expressed positive perceptions toward exposure therapy, with slightly more positive perceptions of VRET over in vivo exposures. Despite valid personal concerns and some misconceptions, our findings emphasize that VRET provides an opportunity to get much-needed therapy to patients in ways that are more acceptable and less concerning. UR - https://formative.jmir.org/2023/1/e47443 UR - http://dx.doi.org/10.2196/47443 UR - http://www.ncbi.nlm.nih.gov/pubmed/37843884 ID - info:doi/10.2196/47443 ER - TY - JOUR AU - Hadjistavropoulos, D. Heather AU - Reiser, J. Sarah AU - Beahm, D. Janine AU - McCall, C. Hugh AU - Dena, Isabelle AU - Phillips, R. Abby AU - Scheltgen, Melissa AU - Sekhar, Shimona AU - Cox, Marilyn AU - Cramm, Heidi AU - Reid, Nathalie PY - 2023/9/27 TI - Internet-Delivered Cognitive Behavioral Therapy Tailored to Spouses and Significant Others of Public Safety Personnel: Formative Evaluation Study JO - JMIR Form Res SP - e51088 VL - 7 KW - internet-delivered cognitive behavioral therapy KW - ICBT KW - internet interventions KW - transdiagnostic KW - spouses and significant others KW - public safety personnel KW - formative evaluation N2 - Background: Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. Objective: This study aimed to assess the initial use and client perceptions (eg, likes, helpfulness, and areas for improvement) of a self-guided, transdiagnostic ICBT course designed for Canadian SSOs of PSP and identify opportunities to further tailor ICBT for this group. Methods: SSOs were invited to complete a 5-lesson, self-guided, transdiagnostic ICBT course. Descriptive statistics were used to analyze the demographic and clinical characteristics of participants. Content analysis was used to analyze the data from open-ended survey responses and interviews to understand their experiences with ICBT. Results: Clients (N=118) endorsed various mental health concerns (eg, depression, anxiety, posttraumatic stress symptoms, and relationship concerns) with a range of severity levels. Most clients identified as White (110/116, 94.8%) and women (108/116, 91.5%), with a mean age of 42.03 (SD 9.36) years. Of the 26 clients who were interviewed, 89% (23/26) reported believing that ICBT is helpful and 92% (24/26) reported finding at least 1 skill helpful. Clients provided suggestions for course improvements. On the basis of this feedback and quantitative data, changes were made to areas such as the delivery of materials, content, case stories, and timelines. Overall, the results indicated that many SSOs of PSP had positive perceptions of ICBT tailored to their needs and found several aspects of the course helpful, supporting the continued delivery of tailored ICBT to this population. However, there remains a need for continued promotion of the course and outreach to diverse groups of SSOs of PSP. Conclusions: Findings from this formative evaluation provide insight into the unique experiences and needs of SSOs of PSP and provide preliminary evidence for the use of tailored ICBT to support the mental health of this group in Canada. UR - https://formative.jmir.org/2023/1/e51088 UR - http://dx.doi.org/10.2196/51088 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756033 ID - info:doi/10.2196/51088 ER - TY - JOUR AU - Jo, Eunkyung AU - Kouaho, Whitney-Jocelyn AU - Schueller, M. Stephen AU - Epstein, A. Daniel PY - 2023/9/22 TI - Exploring User Perspectives of and Ethical Experiences With Teletherapy Apps: Qualitative Analysis of User Reviews JO - JMIR Ment Health SP - e49684 VL - 10 KW - teletherapy KW - therapy KW - ethical guidelines KW - ethics KW - qualitative research KW - digital mental health KW - mobile phone N2 - Background: Teletherapy apps have emerged as a promising alternative to traditional in-person therapy, especially after the COVID-19 pandemic, as they help overcome a range of geographical and emotional barriers to accessing care. However, the rapid proliferation of teletherapy apps has occurred in an environment in which development has outpaced the various regulatory and ethical considerations of this space. Thus, researchers have raised concerns about the ethical implications and potential risks of teletherapy apps given the lack of regulation and oversight. Teletherapy apps have distinct aims to more directly replicate practices of traditional care, as opposed to mental health apps, which primarily provide supplemental support, suggesting a need to examine the ethical considerations of teletherapy apps from the lens of existing ethical guidelines for providing therapy. Objective: In this study, we examined user reviews of commercial teletherapy apps to understand user perceptions of whether and how ethical principles are followed and incorporated. Methods: We identified 8 mobile apps that (1) provided teletherapy on 2 dominant mobile app stores (Google Play and Apple App Store) and (2) had received >5000 app reviews on both app stores. We wrote Python scripts (Python Software Foundation) to scrape user reviews from the 8 apps, collecting 3268 user reviews combined across 2 app stores. We used thematic analysis to qualitatively analyze user reviews, developing a codebook drawing from the ethical codes of conduct for psychologists, psychiatrists, and social workers. Results: The qualitative analysis of user reviews revealed the ethical concerns and opportunities of teletherapy app users. Users frequently perceived unprofessionalism in their teletherapists, mentioning that their therapists did not listen to them, were distracted during therapy sessions, and did not keep their appointments. Users also noted technical glitches and therapist unavailability on teletherapy apps that might affect their ability to provide continuity of care. Users held varied opinions on the affordability of those apps, with some perceiving them as affordable and others not. Users further brought up that the subscription model resulted in unfair pricing and expressed concerns about the lack of cost transparency. Users perceived that these apps could help promote access to care by overcoming geographical and social constraints. Conclusions: Our study suggests that users perceive commercial teletherapy apps as adhering to many ethical principles pertaining to therapy but falling short in key areas regarding professionalism, continuity of care, cost fairness, and cost transparency. Our findings suggest that, to provide high-quality care, teletherapy apps should prioritize fair compensation for therapists, develop more flexible and transparent payment models, and invest in measures to ensure app stability and therapist availability. Future work is needed to develop standards for teletherapy and improve the quality and accessibility of those services. UR - https://mental.jmir.org/2023/1/e49684 UR - http://dx.doi.org/10.2196/49684 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738085 ID - info:doi/10.2196/49684 ER - TY - JOUR AU - Bannon, Sarah AU - Brewer, Julie AU - Ahmad, Nina AU - Cornelius, Talea AU - Jackson, Jonathan AU - Parker, A. Robert AU - Dams-O'Connor, Kristen AU - Dickerson, C. Bradford AU - Ritchie, Christine AU - Vranceanu, Ana-Maria PY - 2023/9/20 TI - A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study JO - JMIR Res Protoc SP - e45532 VL - 12 KW - dyad KW - dementia KW - emotional distress KW - intervention KW - diagnosis KW - telehealth N2 - Background: By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners?together called a ?dyad.? Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms. Objective: This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures. Methods: All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses. Results: This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023. Conclusions: We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD. International Registered Report Identifier (IRRID): PRR1-10.2196/45532 UR - https://www.researchprotocols.org/2023/1/e45532 UR - http://dx.doi.org/10.2196/45532 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728979 ID - info:doi/10.2196/45532 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Bokermann, Josephine AU - Hajek, André PY - 2023/8/18 TI - Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review JO - JMIR Ment Health SP - e46148 VL - 10 KW - telemedicine KW - digital health KW - teletherapy KW - mental health KW - use KW - satisfaction N2 - Background: Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. Objective: The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. Methods: This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. Results: Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). Conclusions: The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. Trial Registration: PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5 UR - https://mental.jmir.org/2023/1/e46148 UR - http://dx.doi.org/10.2196/46148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594785 ID - info:doi/10.2196/46148 ER - TY - JOUR AU - Rohde, Judith AU - Marciniak, Anna Marta AU - Henninger, Mirka AU - Homan, Stephanie AU - Paersch, Christina AU - Egger, T. Stephan AU - Seifritz, Erich AU - Brown, D. Adam AU - Kleim, Birgit PY - 2023/8/14 TI - Investigating Relationships Among Self-Efficacy, Mood, and Anxiety Using Digital Technologies: Randomized Controlled Trial JO - JMIR Form Res SP - e45749 VL - 7 KW - self-efficacy KW - digital intervention KW - digital assessment KW - EMA KW - EMI KW - mood KW - anxiety KW - emotional flexibility N2 - Background: Digital tools assessing momentary parameters and offering interventions in people?s daily lives play an increasingly important role in mental health research and treatment. Ecological momentary assessment (EMA) makes it possible to assess transient mental health states and their parameters. Ecological momentary interventions (EMIs) offer mental health interventions that fit well into individuals? daily lives and routines. Self-efficacy is a transdiagnostic construct that is commonly associated with positive mental health outcomes. Objective: The aim of our study assessing mood, specific self-efficacy, and other parameters using EMA was 2-fold. First, we wanted to determine the effects of daily assessed moods and dissatisfaction with social contacts as well as the effects of baseline variables, such as depression, on specific self-efficacy in the training group (TG). Second, we aimed to explore which variables influenced both groups? positive and negative moods during the 7-day study period. Methods: In this randomized controlled trial, we applied digital self-efficacy training (EMI) to 93 university students with elevated self-reported stress levels and daily collected different parameters, such as mood, dissatisfaction with social contacts, and specific self-efficacy, using EMA. Participants were randomized to either the TG, where they completed the self-efficacy training combined with EMA, or the control group, where they completed EMA only. Results: In total, 93 university students participated in the trial. Positive momentary mood was associated with higher specific self-efficacy in the evening of the same day (b=0.15, SE 0.05, P=.005). Higher self-efficacy at baseline was associated with reduced negative mood during study participation (b=?0.61, SE 0.30, P=.04), while we could not determine an effect on positive mood. Baseline depression severity was significantly associated with lower specific self-efficacy over the week of the training (b=?0.92, SE 0.35, P=.004). Associations between higher baseline anxiety with higher mean negative mood (state anxiety: b=0.78, SE 0.38, P=.04; trait anxiety: b=0.73, SE 0.33, P=.03) and lower mean positive mood (b=?0.64, SE 0.28, P=.02) during study participation were found. Emotional flexibility was significantly enhanced in the TG. Additionally, dissatisfaction with social contacts was associated with both a decreased positive mood (b=?0.56, SE 0.15, P<.001) and an increased negative mood (b=0.45, SE 0.12, P<.001). Conclusions: This study showed several significant associations between mood and self-efficacy as well as those between mood and anxiety in students with elevated stress levels, for example, suggesting that improving mood in people with low mood could enhance the effects of digital self-efficacy training. In addition, engaging in 1-week self-efficacy training was associated with increased emotional flexibility. Future work is needed to replicate and investigate the training?s effects in other groups and settings. Trial Registration: ClinicalTrials.gov NCT05617248; https://clinicaltrials.gov/study/NCT05617248 UR - https://formative.jmir.org/2023/1/e45749 UR - http://dx.doi.org/10.2196/45749 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578827 ID - info:doi/10.2196/45749 ER - TY - JOUR AU - Lukka, Lauri AU - Karhulahti, Veli-Matti AU - Palva, Matias J. PY - 2023/7/10 TI - Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study JO - JMIR Hum Factors SP - e44681 VL - 10 KW - clinical practice KW - digital mental health interventions KW - intervention design KW - mental health applications KW - mental health professionals KW - teletherapy KW - mobile phone N2 - Background: Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. Objective: This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. Methods: A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. Results: We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability?it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs? digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. Conclusions: MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them. UR - https://humanfactors.jmir.org/2023/1/e44681 UR - http://dx.doi.org/10.2196/44681 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428520 ID - info:doi/10.2196/44681 ER - TY - JOUR AU - Shaker, Abbas Ali AU - Austin, F. Stephen AU - Storebø, Jakob Ole AU - Schaug, Perrine Julie AU - Ayad, Alaa AU - Sørensen, Aasted John AU - Tarp, Kristine AU - Bechmann, Henrik AU - Simonsen, Erik PY - 2023/7/5 TI - Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e44790 VL - 10 KW - telemedicine KW - telepsychiatry KW - video consultation KW - mobile health KW - mHealth KW - eHealth KW - COVID-19 KW - synchronous technology KW - anxiety KW - psychiatry KW - patient satisfaction KW - depression KW - posttraumatic stress disorder KW - PTSD N2 - Background: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. Objective: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. Methods: A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. Results: A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference ?0.01, 95% CI ?0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (?0.66, 95% CI ?1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI ?0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). Conclusions: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357 UR - https://mental.jmir.org/2023/1/e44790 UR - http://dx.doi.org/10.2196/44790 UR - http://www.ncbi.nlm.nih.gov/pubmed/37277113 ID - info:doi/10.2196/44790 ER - TY - JOUR AU - Song, Jiyoung AU - Litvin, Boris AU - Allred, Ryan AU - Chen, Shiyu AU - Hull, D. Thomas AU - Areán, A. Patricia PY - 2023/6/29 TI - Comparing Message-Based Psychotherapy to Once-Weekly, Video-Based Psychotherapy for Moderate Depression: Randomized Controlled Trial JO - J Med Internet Res SP - e46052 VL - 25 KW - randomized controlled trial KW - message-based psychotherapy KW - video-based psychotherapy KW - telemedicine KW - depression KW - anxiety KW - functional impairment, credibility, alliance, engagement KW - mental health KW - text mining KW - message therapy KW - Burden of Disease KW - telehealth KW - intervention N2 - Background: Despite the high prevalence of major depressive disorder and the related societal burden, access to effective traditional face-to-face or video-based psychotherapy is a challenge. An alternative that offers mental health care in a flexible setting is asynchronous messaging therapy. To date, no study has evaluated its efficacy and acceptability in a randomized controlled trial for depression. Objective: The aim of this study was to compare the efficacy and acceptability of message-based psychotherapy for depression to once-weekly video-based psychotherapy. Methods: In this 2-armed randomized controlled trial, individuals (N=83) with depressive symptomatology (Patient Health Questionnaire-9 ?10) were recruited on the internet and randomly assigned to either a message-based intervention group (n=46) or a once-weekly video-based intervention group (n=37). Patients in the message-based treatment condition exchanged asynchronous messages with their therapist following an agreed-upon schedule. Patients in the video-based treatment condition met with their therapist once each week for a 45-minute video teletherapy session. Self-report data for depression, anxiety, and functional impairment were collected at pretreatment, weekly during treatment, at posttreatment, and at a 6-month follow-up. Self-reported treatment expectancy and credibility for the assigned intervention were assessed at pretreatment and therapeutic alliance at posttreatment. Results: Findings from multilevel modeling indicated significant, medium-to-large improvements in depression (d=1.04; 95% CI 0.60-1.46), anxiety (d=0.61; 95% CI 0.22-0.99), and functional impairment (d=0.66; 95% CI 0.27-1.05) for patients in the message-based treatment condition. Changes in depression (d=0.11; 95% CI ?0.43 to 0.66), anxiety (d=?0.01; 95% CI ?0.56 to 0.53), and functional impairment (d=0.25; 95% CI ?0.30 to 0.80) in the message-based treatment condition were noninferior to those in the video-based treatment condition. There were no significant differences in treatment credibility (d=?0.09; 95% CI ?0.64 to 0.45), therapeutic alliance (d=?0.15; 95% CI ?0.75 to 0.44), or engagement (d=0.24; 95% CI ?0.20 to 0.67) between the 2 treatment conditions. Conclusions: Message-based psychotherapy could present an effective and accessible alternative treatment modality for patients who might not be able to engage in traditional scheduled services such as face-to-face or video-based psychotherapy. Trial Registration: ClinicalTrials.gov NCT05467787; https://www.clinicaltrials.gov/ct2/show/NCT05467787 UR - https://www.jmir.org/2023/1/e46052 UR - http://dx.doi.org/10.2196/46052 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384392 ID - info:doi/10.2196/46052 ER - TY - JOUR AU - Fountaine, R. Alex AU - Iyar, M. Megumi AU - Lutes, D. Lesley PY - 2023/6/20 TI - Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study JO - JMIR Form Res SP - e40274 VL - 7 KW - integrated primary care KW - integrated care KW - patient-centered medical home KW - warm handoff KW - treatment engagement KW - collaborative care N2 - Background: A warm handoff from a physician to a mental health provider is often patients? first contact with psychological services and provides a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. Objective: In light of the COVID-19 pandemic, this study sought to examine the impact of different types of telehealth mental health referrals on both the anticipated likelihood of accepting treatment services and anticipated likelihood of continued treatment engagement. Methods: A convenience sample of young adults (N=560) was randomized to view 1 of 3 video vignettes: warm handoff in IPC, referral as usual (RAU) in IPC, or RAU in standard primary care. Results: Logistic associations between referral type and the likelihood of referral acceptance (?21=10.9, P=.004) and the likelihood of continued engagement (?21=32.6, P<.001) were significant. Participants who received a warm handoff were significantly more likely to anticipate both accepting the referral (b=0.35; P=.002; odds ratio 1.42, 95% CI 1.15-1.77) and engaging in continued treatment (b=0.62; P<.001; odds ratio 1.87, 95% CI 1.49-2.34) compared with those who received RAU in the standard primary care condition. Furthermore, 77.9% (436/560) of the sample indicated that they would be at least somewhat likely to access IPC mental health services for their own mental health concerns if they were readily available in their own primary care physician?s office. Conclusions: A telehealth warm handoff resulted in the increased anticipated likelihood of both initial and continued engagement in mental health treatment. A telehealth warm handoff may have utility in fostering the uptake of mental health treatment. Nonetheless, a longitudinal assessment in a primary care clinic of the utility of a warm handoff for fostering referral acceptance and continued treatment engagement is needed to hone the adoptability of a warm handoff process and demonstrate practical evidence of effectiveness. The optimization of a warm handoff would also benefit from additional studies examining patient and provider perspectives about the factors affecting treatment engagement in IPC settings. UR - https://formative.jmir.org/2023/1/e40274 UR - http://dx.doi.org/10.2196/40274 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338963 ID - info:doi/10.2196/40274 ER - TY - JOUR AU - Coteur, Kristien AU - Van Nuland, Marc AU - Schoenmakers, Birgitte AU - Anthierens, Sibyl AU - Van den Broeck, Kris PY - 2023/4/7 TI - Implementing Blended Care to Discontinue Benzodiazepine Receptor Agonist Use for Insomnia: Process Evaluation of a Pragmatic Cluster Randomized Controlled Trial JO - JMIR Form Res SP - e43738 VL - 7 KW - benzodiazepines KW - long-term use KW - deprescriptions KW - deprescribing KW - telemedicine KW - general practice KW - insomnia KW - cognitive behavioral therapy KW - eHealth N2 - Background: Long-term use of benzodiazepine receptor agonists (BZRAs) remains common despite European guidelines advising that these drugs be used in the lowest possible dose and for the shortest possible duration. Half of all BZRAs are prescribed in family practice. This creates a window of opportunity for discontinuation in primary care. Therefore, the effectiveness of blended care for the discontinuation of long-term BZRA use in adult primary care patients with chronic insomnia disorder was tested in a multicenter, pragmatic, and cluster randomized controlled superiority trial in Belgium. In the literature, information on implementing blended care in a primary care setting is scarce. Objective: The study aimed to contribute to a framework for the successful implementation of blended care in a primary care setting by increasing our understanding of this complex intervention through an evaluation of e-tool use and views and ideas of participants in a BZRA discontinuation trial. Methods: Based on a theoretical framework, this study evaluated the processes of recruitment, delivery, and response using 4 components: a survey on recruitment (n=76), semistructured in-depth interviews with patients (n=18), web-based asynchronous focus groups with general practitioners (GPs; n=19), and usage data of the web-based tool. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results: For recruitment, the most common barriers were refusal by the patient and the lack of digital literacy, while facilitators were starting the conversation and the curiosity of patients. The delivery of the intervention to the patients was diverse, ranging from GPs who never informed the patient about their access to the e-tool to GPs consulting the e-tool in between consultations to have discussion points when the patient visited. Concerning response, patients? and GPs? narratives also showed much variety. For some GPs, daily practice changed because they received more positive reactions than expected and felt empowered to talk more often about BZRA discontinuation. Conversely, some GPs reported no changes in practice or among patients. In general, patients found follow-up by an expert to be the most important component in blended care, whereas GPs deemed the intrinsic motivation of patients to be the key element of success. An important barrier to implementation by the GP was time. Conclusions: Overall, the participants who had used the e-tool were positive about its structure and content. Nevertheless, many patients desired a more tailored application with feedback from an expert and personal tapering schedules. Strict pragmatic implementation of blended care seems to only reach GPs with an interest in digitalization. Although not superior to usual care, blended care could be a complementary tool that allows tailoring the discontinuation process to the personal style of the GP and the needs of the patient. Trial Registration: ClinicalTrials.gov NCT03937180; https://clinicaltrials.gov/ct2/show/NCT03937180 UR - https://formative.jmir.org/2023/1/e43738 UR - http://dx.doi.org/10.2196/43738 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027198 ID - info:doi/10.2196/43738 ER - TY - JOUR AU - Eadie, Jazmin AU - Gutierrez, Gilmar AU - Moghimi, Elnaz AU - Stephenson, Callum AU - Khalafi, Payam AU - Nikjoo, Niloofar AU - Jagayat, Jasleen AU - Gizzarelli, Tessa AU - Reshetukha, Taras AU - Omrani, Mohsen AU - Yang, Megan AU - Alavi, Nazanin PY - 2023/1/25 TI - Developing and Implementing a Web-Based Relapse Prevention Psychotherapy Program for Patients With Alcohol Use Disorder: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e44694 VL - 12 KW - mental health KW - alcohol use disorder KW - psychotherapy KW - eHealth KW - cognitive behavioral therapy KW - online KW - internet KW - treatment KW - electronic care N2 - Background:  Alcohol use disorder (AUD) is characterized by problematic alcohol use accompanied by clinically substantial distress. Patients with AUD frequently experience high relapse rates, and only 1 in 5 remain abstinent 12 months post treatment. Traditional face-to-face relapse prevention therapy (RPT) is a form of cognitive behavioral therapy (CBT) that examines one's situational triggers, maladaptive thought processes, self-efficacy, and motivation. However, access to this treatment is frequently limited due to its high cost, long waitlists, and inaccessibility. A web-based adaptation of RPT (e-RPT) could address these limitations by providing a more cost-effective and accessible delivery method for mental health care in this population. Objective:  This study protocol aims to establish the first academic e-RPT program to address AUD in the general population. The primary objective of this study is to compare the efficacy of e-RPT to face-to-face RPT in decreasing relapse rates. The secondary objective is to assess the effects of e-RPT on quality of life, self-efficacy, resilience, and depressive symptomatology. The tertiary objective is to evaluate the cost-effectiveness of e-RPT compared to face-to-face RPT. Methods:  Adult participants (n=60) with a confirmed diagnosis of AUD will be randomly assigned to receive 10 sessions of e-RPT or face-to-face RPT. e-RPT will consist of 10 predesigned modules and homework with asynchronous, personalized feedback from a therapist. Face-to-face RPT will comprise 10 one-hour face-to-face sessions with a therapist. The predesigned modules and the face-to-face sessions will present the same content and structure. Self-efficacy, resilience, depressive symptomatology, and alcohol consumption will be measured through various questionnaires at baseline, amid treatment, and at the end of treatment. Results:  Participant recruitment is expected to begin in October 2022 through targeted advertisements and physician referrals. Completed data collection and analysis are expected to conclude by October 2023. Outcome data will be assessed using linear and binomial regression (for continuous and categorical outcomes, respectively). Qualitative data will be analyzed using thematic analysis methods. Conclusions:  This study will be the first to examine the effectiveness of e-RPT compared to face-to-face RPT. It is posited that web-based care can present benefits in terms of accessibility and affordability compared to traditional face-to-face psychotherapy. Trial Registration: ClinicalTrials.gov NCT05579210; https://clinicaltrials.gov/ct2/show/NCT05579210 International Registered Report Identifier (IRRID): PRR1-10.2196/44694 UR - https://www.researchprotocols.org/2023/1/e44694 UR - http://dx.doi.org/10.2196/44694 UR - http://www.ncbi.nlm.nih.gov/pubmed/36567076 ID - info:doi/10.2196/44694 ER - TY - JOUR AU - Høgsdal, Helene AU - Kaiser, Sabine AU - Kyrrestad, Henriette PY - 2023/1/6 TI - Adolescents? Assessment of Two Mental Health?Promoting Mobile Apps: Results of Two User Surveys JO - JMIR Form Res SP - e40773 VL - 7 KW - mental health app KW - mobile app KW - mental health KW - mental health promotion KW - cyberbullying KW - adolescents KW - user satisfaction KW - system usability KW - app quality KW - mental health intervention KW - health promotion KW - app usability KW - user experience N2 - Background: The importance of mental health promotion is irrevocable and is especially important at a young age. More mental health-promoting mobile apps have been developed in the last few years. However, their usability and quality have been rarely assessed. Objective: The aim of this study is to investigate how adolescents assess the usability, quality, and potential goal achievement of Opp and NettOpp. Opp is a universal mental health?promoting mobile app aimed at 13- to 19-year-olds, and NettOpp is a mobile app for children and adolescents between 11 to 16 years of age that have experienced negative incidents online. Methods: A total of 45 adolescents tested either Opp (n=30) or NettOpp (n=15) for a period of 3 weeks and answered a questionnaire. The System Usability Scale (SUS) was used to measure the usability of the apps. A SUS score above 70 indicates acceptable usability. Items from the Mobile Application Rating Scale were adapted for study purposes and used to measure the quality and perceived goal achievement that Opp and NettOpp might have on adolescents? knowledge, attitudes, and intention to change behavior. Furthermore, adolescents could answer an open comment question. Results: Opp had a mean SUS score of 80.37 (SD 9.27), and NettOpp?s mean SUS score was 80.33 (SD 10.30). In the overall evaluation, Opp and NettOpp were given a mean score of 3.78 (SD 0.42) and 4.20 (SD 0.56), respectively, on a 5-point scale, where 5 was best. Most adolescents who evaluated Opp rated that the app would increase knowledge about mental health and help young people deal with stress and difficult emotions or situations. Most adolescents who evaluated NettOpp agreed that the app would increase awareness and knowledge about cyberbullying, change attitudes toward cyberbullying, and motivate them to address cyberbullying. Some adolescents stated that Opp was difficult to navigate and consisted of too much text. Some of the adolescents that tested NettOpp stated that the app had crashed and that the design was a bit childish. Conclusions: All in all, this study indicates that Opp and NettOpp have good usability and that adolescents are satisfied with both apps. It also indicates that the potential goal achievement of the apps, for example, increasing knowledge about mental health (Opp) or cyberbullying (NettOpp) is promising. While there are some comments from the users that are more difficult to solve (eg, Opp is too text-based), some comments helped improve the apps (eg, that the app crashed). Overall, the user evaluation provided valuable knowledge about how adolescents assess Opp and NettOpp. However, more extensive effectiveness studies are necessary to measure their actual goal achievement. UR - https://formative.jmir.org/2023/1/e40773 UR - http://dx.doi.org/10.2196/40773 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607734 ID - info:doi/10.2196/40773 ER - TY - JOUR AU - De Veirman, M. Ann E. AU - Thewissen, Viviane AU - Spruijt, G. Matthijs AU - Bolman, W. Catherine A. PY - 2022/12/20 TI - Factors Associated With Intention and Use of e?Mental Health by Mental Health Counselors in General Practices: Web-Based Survey JO - JMIR Form Res SP - e34754 VL - 6 IS - 12 KW - mental health counselors KW - general practices KW - e?mental health KW - adoption readiness KW - eligibility for e?mental health KW - e?mental health use KW - mental health KW - eHealth N2 - Background: Mental health care counselors have a high intention to use e?mental health (EMH), whereas actual use is limited. Facilitating future use requires insight into underlying factors as well as eligibility criteria that mental health care counselors use in their decision to apply EMH. Objective: The aim of this study was to unfold the intention and underlying reasons for mental health counselors to use EMH and to unveil the criteria they use to estimate patient eligibility for EMH. The theoretical framework was based on the reasoned action approach model, the Unified Theory of Acceptance and Use of Technology, and the Measurement Instrument for Determinants of Innovation model. Methods: To empirically validate our theoretical model, a web-based survey was conducted among mental health care counselors (n=132). To unveil the eligibility criteria, participants were asked to rank their reasons for considering EMH suitable or unsuitable for a patient. Results: The mean intention to use EMH was positive (mean 4.04, SD 0.64). The mean use of EMH before the COVID-19 pandemic was 38% (mean 0.38, SD 0.22), and it was 49% (mean 0.49, SD 0.25) during the pandemic. In total, 57% of the patient population was considered eligible for EMH. Usefulness and benefits (?=.440; P<.001), Task perception (?=.306; P=.001), and Accessibility (?=.140; P=.02) explained the intention to use EMH (F3,131=54.151; P<.001; R2=0.559). In turn, intention explained patient eligibility (F1,130=34.716; P<.001; R2=0.211), whereas intention and patient eligibility explained EMH use (F2,129=41.047; P<.001; R2=0.389). Patient eligibility partially mediated the relationship between intention to use EMH and EMH use, with a larger direct effect (c?=0.116; P<.001) than indirect effect (c=0.065, 95% CI 0.035-0.099; P<.001). Mental health counselors assessed patients? eligibility for EMH mainly through the availability of computers and the internet and patient motivation. Conclusions: To stimulate the use of EMH, intention and patient eligibility need to be influenced. Intention, in turn, can be enhanced by addressing the perceived usefulness and benefits of EMH, perceived accessibility, and task perception. Access to a computer and patients? motivation to use EMH are important in facilitating patient eligibility. To cause an impact with EMH in general practice, mental health counselors need to be convinced of the benefits of EMH and transfer this enthusiasm to the patient. It is recommended to involve mental health counselors in the development of EMH to increase the (perceived) added value and use. UR - https://formative.jmir.org/2022/12/e34754 UR - http://dx.doi.org/10.2196/34754 UR - http://www.ncbi.nlm.nih.gov/pubmed/36538357 ID - info:doi/10.2196/34754 ER - TY - JOUR AU - Cantù, Filippo AU - Biagianti, Bruno AU - Lisi, Ilaria AU - R Zanier, Elisa AU - Bottino, Nicola AU - Fornoni, Chiara AU - Gallo, Francesca AU - Ginex, Valeria AU - Tombola, Valentina AU - Zito, Silvana AU - Colombo, Elisa AU - Stocchetti, Nino AU - Brambilla, Paolo PY - 2022/11/16 TI - Psychotherapeutic and Psychiatric Intervention in Patients With COVID-19 and Their Relatives: Protocol for the DigiCOVID Trial JO - JMIR Res Protoc SP - e39080 VL - 11 IS - 11 KW - telepsychiatry KW - telemedicine KW - COVID-19 KW - mental health KW - digital mental health KW - digital support KW - clinical outcome KW - telehealth KW - psychiatric health KW - health intervention N2 - Background: The COVID-19 pandemic is negatively impacting the mental health of both patients with COVID-19 and the general population. As current guidelines are limiting in-person contacts to reduce the spread of the virus, the development of a digital approach to implement in psychiatric and psychological consultations is needed. In this paper, we present the DigiCOVID protocol, a digital approach to offer remote, personalized psychological and psychiatric support to former or current patients with COVID-19 and their relatives. Objective: The main goal of this project is to evaluate the feasibility, acceptability, and usability of the DigiCOVID protocol. Furthermore, we also aim to assess the impact of the abovementioned protocol by means of pre-post changes in psychological clinical variables. Methods: Participants undergo an initial telephonic screening to ensure inclusion criteria are met. Secondly, participants complete a video-assisted neuropsychological IQ test as well as web-based self-reports of health and general well-being. Participants are then assigned to a psychotherapist who offers 8 teletherapy sessions. At the end of the therapy cycle, the web-based questionnaires are administered for a posttreatment evaluation. Results: As of April 2022, we enrolled a total of 122 participants, of which 94 have completed neuropsychological tests and web-based questionnaires. Conclusions: Our study aims at testing the feasibility and preliminary efficacy of DigiCOVID, a remote telemedicine protocol for the improvement of psychological and psychiatric health in patients with COVID-19 and their relatives. To date, the approach used seems to be feasible and highly customizable to patients? needs, and therefore, the DigiCOVID protocol might pave the way for future telepsychiatry-based interventions. Trial Registration: ClinicalTrials.gov NCT05231018; https://clinicaltrials.gov/ct2/show/NCT05231018?term=NCT05231018 &draw=2&rank=1 International Registered Report Identifier (IRRID): DERR1-10.2196/39080 UR - https://www.researchprotocols.org/2022/11/e39080 UR - http://dx.doi.org/10.2196/39080 UR - http://www.ncbi.nlm.nih.gov/pubmed/36228130 ID - info:doi/10.2196/39080 ER - TY - JOUR AU - Gliske, Kate AU - Berry, R. Katie AU - Ballard, Jaime AU - Evans-Chase, Michelle AU - Solomon, L. Phyllis AU - Fenkel, Caroline PY - 2022/11/10 TI - Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis JO - JMIR Form Res SP - e41721 VL - 6 IS - 11 KW - telehealth KW - telepsychiatry KW - telemedicine KW - intensive outpatient KW - remote outpatient KW - mental health KW - quality improvement KW - routine outcome monitoring KW - mental health treatment KW - patient outcome KW - outpatient program KW - youth KW - young adult KW - depression KW - suicidal ideation KW - health outcome KW - outcome monitoring N2 - Background: COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective: This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods: Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ?7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results: Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, ?21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, ?21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=?0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=?0.87 and P=.38; active suicidal ideation: N=200, ?21=0.6 and P=.49; NSSI frequency: t426=?0.98 and P=.33). Conclusions: Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes. UR - https://formative.jmir.org/2022/11/e41721 UR - http://dx.doi.org/10.2196/41721 UR - http://www.ncbi.nlm.nih.gov/pubmed/36355428 ID - info:doi/10.2196/41721 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 - Smith, Katharine AU - Torous, John AU - Cipriani, Andrea PY - 2022/10/14 TI - Teaching Telepsychiatry Skills: Building on the Lessons of the COVID-19 Pandemic to Enhance Mental Health Care in the Future JO - JMIR Ment Health SP - e37939 VL - 9 IS - 10 KW - mHealth KW - mental health KW - smartphones KW - telehealth KW - telepsychiatry KW - COVID-19 UR - https://mental.jmir.org/2022/10/e37939 UR - http://dx.doi.org/10.2196/37939 UR - http://www.ncbi.nlm.nih.gov/pubmed/35358948 ID - info:doi/10.2196/37939 ER - TY - JOUR AU - Tougas, Hailee AU - Chan, Steven AU - Shahrvini, Tara AU - Gonzalez, Alvaro AU - Chun Reyes, Ruth AU - Burke Parish, Michelle AU - Yellowlees, Peter PY - 2022/9/6 TI - The Use of Automated Machine Translation to Translate Figurative Language in a Clinical Setting: Analysis of a Convenience Sample of Patients Drawn From a Randomized Controlled Trial JO - JMIR Ment Health SP - e39556 VL - 9 IS - 9 KW - telepsychiatry KW - automated machine translation KW - language barriers KW - psychiatry KW - assessment KW - automated translation KW - automated KW - translation KW - artificial intelligence KW - AI KW - speech recognition KW - limited English proficiency KW - LEP KW - asynchronous telepsychiatry KW - ATP KW - automated speech recognition KW - ASR KW - AMT KW - figurative language device KW - FLD KW - language concordant KW - language discordant KW - AI interpretation N2 - Background: Patients with limited English proficiency frequently receive substandard health care. Asynchronous telepsychiatry (ATP) has been established as a clinically valid method for psychiatric assessments. The addition of automated speech recognition (ASR) and automated machine translation (AMT) technologies to asynchronous telepsychiatry may be a viable artificial intelligence (AI)?language interpretation option. Objective: This project measures the frequency and accuracy of the translation of figurative language devices (FLDs) and patient word count per minute, in a subset of psychiatric interviews from a larger trial, as an approximation to patient speech complexity and quantity in clinical encounters that require interpretation. Methods: A total of 6 patients were selected from the original trial, where they had undergone 2 assessments, once by an English-speaking psychiatrist through a Spanish-speaking human interpreter and once in Spanish by a trained mental health interviewer-researcher with AI interpretation. 3 (50%) of the 6 selected patients were interviewed via videoconferencing because of the COVID-19 pandemic. Interview transcripts were created by automated speech recognition with manual corrections for transcriptional accuracy and assessment for translational accuracy of FLDs. Results: AI-interpreted interviews were found to have a significant increase in the use of FLDs and patient word count per minute. Both human and AI-interpreted FLDs were frequently translated inaccurately, however FLD translation may be more accurate on videoconferencing. Conclusions: AI interpretation is currently not sufficiently accurate for use in clinical settings. However, this study suggests that alternatives to human interpretation are needed to circumvent modifications to patients? speech. While AI interpretation technologies are being further developed, using videoconferencing for human interpreting may be more accurate than in-person interpreting. Trial Registration: ClinicalTrials.gov NCT03538860; https://clinicaltrials.gov/ct2/show/NCT03538860 UR - https://mental.jmir.org/2022/9/e39556 UR - http://dx.doi.org/10.2196/39556 UR - http://www.ncbi.nlm.nih.gov/pubmed/36066959 ID - info:doi/10.2196/39556 ER - TY - JOUR AU - Zangani, Caroline AU - Ostinelli, G. Edoardo AU - Smith, A. Katharine AU - Hong, W. James S. AU - Macdonald, Orla AU - Reen, Gurpreet AU - Reid, Katherine AU - Vincent, Charles AU - Syed Sheriff, Rebecca AU - Harrison, J. Paul AU - Hawton, Keith AU - Pitman, Alexandra AU - Bale, Rob AU - Fazel, Seena AU - Geddes, R. John AU - Cipriani, Andrea PY - 2022/8/22 TI - Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review JO - JMIR Ment Health SP - e38600 VL - 9 IS - 8 KW - COVID-19 KW - coronavirus KW - mental health services KW - telemental health KW - telepsychiatry KW - face-to-face N2 - Background: The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. Objective: We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. Methods: We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country?s COVID-19 Stringency Index, which reflects the stringency of a government?s response to COVID-19 restrictions at a specific time. Results: Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries? face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. Conclusions: During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients? preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users. UR - https://mental.jmir.org/2022/8/e38600 UR - http://dx.doi.org/10.2196/38600 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994310 ID - info:doi/10.2196/38600 ER - TY - JOUR AU - Bos, M. Fionneke AU - von Klipstein, Lino AU - Emerencia, C. Ando AU - Veermans, Erwin AU - Verhage, Tom AU - Snippe, Evelien AU - Doornbos, Bennard AU - Hadders-Prins, Grietje AU - Wichers, Marieke AU - Riese, Harriëtte PY - 2022/8/9 TI - A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application JO - JMIR Ment Health SP - e36430 VL - 9 IS - 8 KW - eHealth KW - clinical implementation KW - ecological momentary assessment KW - experience sampling method KW - smartphone KW - mobile health KW - mHealth KW - personalized diaries KW - personalized psychiatry KW - client-tailored KW - cocreation KW - shared decision-making KW - mobile phone N2 - Background: Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. Objective: This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). Methods: The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. Results: The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message?based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. Conclusions: PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care. UR - https://mental.jmir.org/2022/8/e36430 UR - http://dx.doi.org/10.2196/36430 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943762 ID - info:doi/10.2196/36430 ER - TY - JOUR AU - Venkatesan, Aarathi AU - Forster, Benjamin AU - Rao, Prasanna AU - Miller, Melissa AU - Scahill, Michael PY - 2022/7/5 TI - Improvements in Depression Outcomes Following a Digital Cognitive Behavioral Therapy Intervention in a Polychronic Population: Retrospective Study JO - JMIR Form Res SP - e38005 VL - 6 IS - 7 KW - depression KW - anxiety KW - CBT KW - digital mental health intervention KW - cognitive behavioral therapy KW - digital health KW - obesity KW - diabetes KW - mental health N2 - Background: Digital mental health interventions have shown promise in reducing barriers to effective care for depression. Depression and related mental disorders are known to be highly comorbid with common chronic physical conditions, such as obesity and type 2 diabetes. While some research has explored the interaction dynamics of treating populations living with both mental and physical disorders, very little is known about such dynamics in digital care. Objective: We aimed to examine the effectiveness of a 12-week, therapist-supported, app-based cognitive behavioral therapy program in improving symptoms of depression and anxiety. The studied population included adults with a heavy burden of chronic physical disease, including obesity and type 2 diabetes. Methods: A total of 1512 participants with at least moderate depression were enrolled. The treatment cohort consisted of 831 (54.96%) participants who completed a follow-up assessment. The program included structured lessons and tools (ie, exercises and practices) and offered one-on-one weekly video counseling sessions with a licensed therapist for 12 weeks and monthly sessions thereafter. The clinically validated 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder scale (GAD-7) were used to assess depression and anxiety, respectively. Linear mixed-effects modeling was employed to examine changes in depression and anxiety over time. Given correlation among various measures of program usage, a composite variable for depth of usage was used to analyze the correlation between usage and changes in depressive symptoms. Body weight changes from baseline were assessed primarily with digitally connected scales. Results: Out of 831 participants in the treatment cohort, 74.5% (n=619) showed a clinically significant reduction in depressive symptom severity after 12 weeks, where follow-up PHQ-8 scores had shifted downward by at least one diagnostic category. In total, 67.5% (n=561) of the participants showed a reliable improvement in PHQ-8 scores as measured by the reliable change index. There was an average reduction of 5.9 (SD 5.2) points (P<.001) between baseline and follow-up. Greater program usage was correlated with greater likelihood of reliable improvement in depressive symptoms (odds ratio 1.3, 95% CI 1.1-1.5; P=.002). An exploratory analysis of body weight changes with a multilevel, mixed-effect model suggested that reliable improvement in depressive symptoms at follow-up was associated with significantly greater weight loss at 9 months (?=?1.11, P=.002). Conclusions: The results provide further support that digital interventions can support clinically meaningful improvements in depression. Some form of synergy in treatment of comorbid depression and obesity or diabetes could be studied in future research. The study was limited by postintervention participant attrition as well as the retrospective observational study design. UR - https://formative.jmir.org/2022/7/e38005 UR - http://dx.doi.org/10.2196/38005 UR - http://www.ncbi.nlm.nih.gov/pubmed/35788442 ID - info:doi/10.2196/38005 ER - TY - JOUR AU - Gangamma, Rashmi AU - Walia, Bhavneet AU - Luke, Melissa AU - Lucena, Claudine PY - 2022/6/1 TI - Continuation of Teletherapy After the COVID-19 Pandemic: Survey Study of Licensed Mental Health Professionals JO - JMIR Form Res SP - e32419 VL - 6 IS - 6 KW - teletherapy KW - relational teletherapy KW - teletherapy predictors KW - postpandemic teletherapy KW - mental health KW - telemedicine KW - COVID-19 KW - telehealth N2 - Background: The use of teletherapy has exponentially increased in the context of the ongoing COVID-19 pandemic. Studies on teletherapy documented substantial benefits of accessibility and convenience even before the start of the pandemic. Although recent studies show that this modality of therapy delivery is here to stay, few have studied who will most benefit from this trend. Objective: In this paper, we report predictors of continued teletherapy usage in a sample of licensed mental health professionals in the United States during a time period when pandemic-related restrictions began diminishing. As such, it is one of the first studies to examine factors related to continued benefits of teletherapy postpandemic. Methods: Participation from licensed mental health professionals was sought on listservs of national organizations of multiple mental health organizations. Data were collected via an anonymous link to a survey on Qualtrics between January 2021 and April 2021. Participants responded to questions on therapist demographics, practice setting, experiences of shifting to teletherapy, perspectives on continued use of teletherapy, and their client characteristics. Findings related to client characteristics that predicted continued teletherapy usage are presented here. Results: A total of 186 individuals consented to participate in the survey, with a final sample of 114 with complete data. A majority of participants identified as female (92/114, 80.7%), White (94/114, 82.5%), and having a master's degree (75/114, 65.5%) from a nationally accredited program (106/114, 93%). Data were analyzed using heteroskedastic regression modeling with client-related factors as predictors. Two models were run with and without distance travelled by clients as a control variable. Model estimates from both models showed that continued use of teletherapy postpandemic was predicted by the following factors: higher percentage of clients from rural areas, younger and older adult clients, clients with Medicare, and clients with marginalized gender and religious/spiritual identities. Significantly, having a higher percentage of clients from lower socioeconomic status, a higher percentage of those with Medicaid coverage, and a higher percentage of couples and families as clients predicted decreased use of teletherapy postpandemic. Conclusions: Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries, and those who seek couple and family therapy may be less likely to be served by it. These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing, and childcare issues, as well as the need for continued training for licensed professionals. UR - https://formative.jmir.org/2022/6/e32419 UR - http://dx.doi.org/10.2196/32419 UR - http://www.ncbi.nlm.nih.gov/pubmed/35584317 ID - info:doi/10.2196/32419 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 - Zentner, Kristen AU - Gaine, Graham AU - Ethridge, Paige AU - Surood, Shireen AU - Abba-Aji, Adam PY - 2022/5/13 TI - Clinicians? Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study JO - JMIR Form Res SP - e35535 VL - 6 IS - 5 KW - mental health KW - telepsychology KW - clinician attitude KW - unified theory of acceptance and use of technology KW - therapeutic alliance N2 - Background: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. Objective: This study (1) explored clinicians? experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians? intentions to offer telepsychology after the COVID-19 pandemic. Methods: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. Results: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (?=0.46; P<.001) and telephone services (?=0.35; P<.001) after the pandemic. Social influence (?=0.24; P=.004) and facilitating conditions (?=0.19; P=.03) additionally predicted the intention to use telephone services. Conclusions: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities. UR - https://formative.jmir.org/2022/5/e35535 UR - http://dx.doi.org/10.2196/35535 UR - http://www.ncbi.nlm.nih.gov/pubmed/35559793 ID - info:doi/10.2196/35535 ER - TY - JOUR AU - Philippe, J. Tristan AU - Sikder, Naureen AU - Jackson, Anna AU - Koblanski, E. Maya AU - Liow, Eric AU - Pilarinos, Andreas AU - Vasarhelyi, Krisztina PY - 2022/5/12 TI - Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review JO - JMIR Ment Health SP - e35159 VL - 9 IS - 5 KW - digital health KW - telepsychology KW - computer-assisted therapy KW - online therapy KW - mobile applications KW - mobile apps KW - telemedicine KW - telepsychiatry KW - virtual reality exposure therapy KW - mental health KW - COVID-19 N2 - Background: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. Objective: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. Methods: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. Results: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions. UR - https://mental.jmir.org/2022/5/e35159 UR - http://dx.doi.org/10.2196/35159 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551058 ID - info:doi/10.2196/35159 ER - TY - JOUR AU - Bell, H. Imogen AU - Thompson, Andrew AU - Valentine, Lee AU - Adams, Sophie AU - Alvarez-Jimenez, Mario AU - Nicholas, Jennifer PY - 2022/5/11 TI - Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey JO - JMIR Ment Health SP - e30716 VL - 9 IS - 5 KW - adolescent KW - youth mental health KW - mental health KW - attitude KW - digital technology KW - internet-based interventions KW - digital mental health KW - mental health services KW - clinician KW - mobile phone N2 - Background: There is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies. Objective: This study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients? mental health. Methods: Youth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients. Results: A total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80%) and video chat (69/76, 91%) commonly in clinical practice and found them to be helpful. Approximately 50% (296/609) of the young people used mental health apps, which was significantly less than the clinicians (?23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy. Conclusions: Technology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health. UR - https://mental.jmir.org/2022/5/e30716 UR - http://dx.doi.org/10.2196/30716 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544295 ID - info:doi/10.2196/30716 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 - Braund, A. Taylor AU - Zin, The May AU - Boonstra, W. Tjeerd AU - Wong, J. Quincy J. AU - Larsen, E. Mark AU - Christensen, Helen AU - Tillman, Gabriel AU - O?Dea, Bridianne PY - 2022/5/4 TI - Smartphone Sensor Data for Identifying and Monitoring Symptoms of Mood Disorders: A Longitudinal Observational Study JO - JMIR Ment Health SP - e35549 VL - 9 IS - 5 KW - depression KW - bipolar disorder KW - sensors KW - mobile app KW - circadian rhythm KW - mobile phone N2 - Background: Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode. Objective: Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder. Methods: A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline. Results: Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants? social support networks at baseline (r=0.22; P=.03; R2=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5. Conclusions: Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders. UR - https://mental.jmir.org/2022/5/e35549 UR - http://dx.doi.org/10.2196/35549 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507385 ID - info:doi/10.2196/35549 ER - TY - JOUR AU - Mercadal Rotger, Josep AU - Cabré, Victor PY - 2022/5/2 TI - Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study JO - JMIR Ment Health SP - e36775 VL - 9 IS - 5 KW - online psychological intervention KW - therapeutic alliance KW - digital health KW - mental health KW - mental health education KW - mental health treatment KW - health interventions KW - health professional KW - online health KW - web-based health KW - intervention modality N2 - Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances?observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=?42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. UR - https://mental.jmir.org/2022/5/e36775 UR - http://dx.doi.org/10.2196/36775 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499910 ID - info:doi/10.2196/36775 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 - 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 - 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 - Hallenbeck, Wu Haijing AU - Jaworski, K. Beth AU - Wielgosz, Joseph AU - Kuhn, Eric AU - Ramsey, M. Kelly AU - Taylor, Katherine AU - Juhasz, Katherine AU - McGee-Vincent, Pearl AU - Mackintosh, Margaret-Anne AU - Owen, E. Jason PY - 2022/3/29 TI - PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public JO - JMIR Ment Health SP - e34744 VL - 9 IS - 3 KW - posttraumatic stress disorder KW - trauma KW - mental health KW - mHealth KW - mobile app KW - public health KW - self-management KW - mobile phone N2 - Background: With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated. Objective: We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach. Methods: We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users. Results: During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean ?1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean ?4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements. Conclusions: PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement. UR - https://mental.jmir.org/2022/3/e34744 UR - http://dx.doi.org/10.2196/34744 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348458 ID - info:doi/10.2196/34744 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 - Ainslie, Marcy AU - Brunette, F. Mary AU - Capozzoli, Michelle PY - 2022/3/21 TI - Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis JO - JMIR Ment Health SP - e33092 VL - 9 IS - 3 KW - telemedicine KW - mental health KW - serious mental illness KW - retention KW - mental illness KW - telehealth N2 - Background: Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. Objective: We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. Methods: We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. Results: A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. Conclusions: The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness. UR - https://mental.jmir.org/2022/3/e33092 UR - http://dx.doi.org/10.2196/33092 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311673 ID - info:doi/10.2196/33092 ER - TY - JOUR AU - Rothmann, Juel Mette AU - Mouritsen, Drotner Julie AU - Ladefoged, Skov Nanna AU - Jeppesen, Nedergaard Marie AU - Lillevang, Sofie Anna AU - Laustrup, Helle AU - Ellingsen, Torkell PY - 2022/3/21 TI - The Use of Telehealth for Psychological Counselling of Vulnerable Adult Patients With Rheumatic Diseases or Diabetes: Explorative Study Inspired by Participatory Design JO - JMIR Hum Factors SP - e30829 VL - 9 IS - 1 KW - telehealth KW - videoconferencing KW - app KW - co-production KW - co-creation KW - psychologist KW - psychology KW - rheumatic diseases KW - diabetes KW - mobile phone N2 - Background: Video consultation is increasingly used in different health care settings to reach patients. However, little is known about telehealth in psychological counselling for vulnerable patients with somatic and chronic conditions such as rheumatoid arthritis and diabetes. Objective: This study aimed to develop and pilot test a telepsychology module for inclusion in the app My Hospital (Mit Sygehus) to provide remote psychological counselling to vulnerable adults with either rheumatic diseases or diabetes. Methods: With inspiration from participatory design, the content of the telepsychology module was developed through user involvement and evaluated by individual interviews with patients and psychologists as well as questionnaires. Results: We developed a module with our patient partners that targeted patients with rheumatic diseases and diabetes in relation to the psychological challenges of living with chronic diseases. The module included information, tools, exercises, and videoconferencing. In total, 16 patients and 3 psychologists participated in the pilot test. Psychological counselling was described by 4 themes: ?The good relation despite physical distance,? ?The comfort of being at home,? ?The pros of saving time on transport and energy,? and ?A therapeutic alliance at a distance.? Conclusions: Psychological counselling in relation to somatic care can be provided by videoconferencing supported by web-based or mobile delivery of tailored information, tools, and exercises without compromising on the quality of care. To ensure a good alliance between the patient and psychologist, a first face-to-face meeting is important. The home location provided patients with a safe environment and increased accessibility and reduced travel time to the hospital. UR - https://humanfactors.jmir.org/2022/1/e30829 UR - http://dx.doi.org/10.2196/30829 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311690 ID - info:doi/10.2196/30829 ER - TY - JOUR AU - Greenwood, Hannah AU - Krzyzaniak, Natalia AU - Peiris, Ruwani AU - Clark, Justin AU - Scott, Mae Anna AU - Cardona, Magnolia AU - Griffith, Rebecca AU - Glasziou, Paul PY - 2022/3/11 TI - Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - JMIR Ment Health SP - e31780 VL - 9 IS - 3 KW - telemedicine KW - psychology KW - mental health KW - psychotherapy KW - primary health care KW - behavioral sciences KW - systematic review N2 - Background: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. Methods: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. Results: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI ?0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI ?0.40 to 0.39), function (SMD 0.13, 95% CI ?0.16 to 0.42), working alliance client (SMD 0.11, 95% CI ?0.34 to 0.57), working alliance therapist (SMD ?0.16, 95% CI ?0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI ?0.30 to 0.53), or at any other time point (3, 6, and 12 months). Conclusions: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions. UR - https://mental.jmir.org/2022/3/e31780 UR - http://dx.doi.org/10.2196/31780 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275081 ID - info:doi/10.2196/31780 ER - TY - JOUR AU - Kaiser, Julia AU - Nagl, Michaela AU - Hoffmann, Rahel AU - Linde, Katja AU - Kersting, Anette PY - 2022/2/8 TI - Therapist-Assisted Web-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement: Randomized Controlled Trial JO - JMIR Ment Health SP - e27642 VL - 9 IS - 2 KW - digital interventions KW - grief KW - traumatic loss KW - treatment effectiveness evaluation KW - cognitive behavioral therapy KW - neoplasms N2 - Background: Bereavement due to cancer increases the risk of prolonged grief disorder. However, specialized treatment options for prolonged grief after a loss due to illness are still scarce. Objective: The aim of this study is to extend previous findings by evaluating a web-based cognitive behavioral intervention with asynchronous therapist support, consisting of structured writing tasks adapted specifically for prolonged grief after cancer bereavement. Methods: The intervention was evaluated in a purely web-based randomized waitlist-controlled trial. Open-access recruitment of participants was conducted on the web. Prolonged grief (Inventory of Complicated Grief), depression, anxiety, posttraumatic stress, posttraumatic growth, somatization, sleep quality, and mental and physical health were assessed on the web via validated self-report measures. Results: A total of 87 participants were randomized into the intervention group (IG; 44/87, 51%) or the waitlist control group (43/87, 49%). Of the participants, 7% (6/87) dropped out of the study (5/44, 11%, in the IG). Of the 39 completers in the IG, 37 (95%) completed all intervention tasks. The intervention reduced symptoms of prolonged grief (intention-to-treat: P<.001; ?2=0.34; Cohen d=0.80) to a clinically significant extent. It had favorable effects on depression, anxiety, posttraumatic stress, posttraumatic growth, and overall mental health but not on somatization, sleep quality, or physical health. Conclusions: The web-based intervention for prolonged grief after cancer bereavement is effective in reducing symptoms of prolonged grief disorder and accompanying syndromes in a timely, easily realizable manner and addresses specific challenges of bereavement to illness. Considering web-based approaches in future mental health care policy and practice can reduce health care gaps for those who are bereaved to cancer. Trial Registration: German?Clinical?Trial?Register?U1111?1186-6255;?https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011001 UR - https://mental.jmir.org/2022/2/e27642 UR - http://dx.doi.org/10.2196/27642 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133286 ID - info:doi/10.2196/27642 ER - TY - JOUR AU - Kane, Hélène AU - Gourret Baumgart, Jade AU - El-Hage, Wissam AU - Deloyer, Jocelyn AU - Maes, Christine AU - Lebas, Marie-Clotilde AU - Marazziti, Donatella AU - Thome, Johannes AU - Fond-Harmant, Laurence AU - Denis, Frédéric PY - 2022/2/4 TI - Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review JO - JMIR Hum Factors SP - e30359 VL - 9 IS - 1 KW - COVID-19 KW - e?mental health KW - professional practices KW - quality of care KW - telepsychiatry KW - videoconferencing N2 - Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. UR - https://humanfactors.jmir.org/2022/1/e30359 UR - http://dx.doi.org/10.2196/30359 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736224 ID - info:doi/10.2196/30359 ER - TY - JOUR AU - Skime, K. Michelle AU - Puspitasari, J. Ajeng AU - Gentry, T. Melanie AU - Heredia Jr, Dagoberto AU - Sawchuk, N. Craig AU - Moore, R. Wendy AU - Taylor-Desir, J. Monica AU - Schak, M. Kathryn PY - 2022/1/28 TI - Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study JO - JMIR Ment Health SP - e30204 VL - 9 IS - 1 KW - COVID-19 KW - telemental health KW - teletherapy KW - telepsychiatry KW - telemedicine KW - intensive outpatient KW - patient satisfaction N2 - Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients? feedback on future improvements should be considered to help ensure long-term success. UR - https://mental.jmir.org/2022/1/e30204 UR - http://dx.doi.org/10.2196/30204 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878999 ID - info:doi/10.2196/30204 ER - TY - JOUR AU - Yue, Han AU - Mail, Victoria AU - DiSalvo, Maura AU - Borba, Christina AU - Piechniczek-Buczek, Joanna AU - Yule, M. Amy PY - 2022/1/26 TI - Patient Preferences for Patient Portal?Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study JO - JMIR Form Res SP - e33697 VL - 6 IS - 1 KW - patient portal KW - telemedicine KW - telepsychiatry KW - COVID-19 KW - portal KW - mental health KW - psychiatry KW - engagement KW - behavior KW - video KW - hospital KW - urban KW - outreach N2 - Background: Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the ?digital divide,? prevent some patients from accessing the technology needed to use telepsychiatry services. Objective: As an extension to a clinic?s outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital?s patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal?based video visits or telephone-only visits and to identify the demographic variables associated with their preference. Methods: Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. Results: A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. Conclusions: Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital?s patient portal, particularly among older adults. UR - https://formative.jmir.org/2022/1/e33697 UR - http://dx.doi.org/10.2196/33697 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932497 ID - info:doi/10.2196/33697 ER - TY - JOUR AU - Thesen, Terje AU - Himle, A. Joseph AU - Martinsen, W. Egil AU - Walseth, T. Liv AU - Thorup, Frode AU - Gallefoss, Frode AU - Jonsbu, Egil PY - 2022/1/24 TI - Effectiveness of Internet-Based Cognitive Behavioral Therapy With Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial JO - J Med Internet Res SP - e33631 VL - 24 IS - 1 KW - noncardiac chest pain KW - internet-based treatment KW - internet-assisted treatment KW - cognitive behavioral therapy KW - psychosomatic medicine KW - randomized controlled trial KW - pain KW - treatment KW - internet-based cognitive behavioral therapy KW - effectiveness KW - support KW - intervention N2 - Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective: In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ?5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (?3.4 points, 95% CI ?5.7 to ?1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (?2.7 points, 95% CI ?5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain. Trial Registration: ClinicalTrials.gov NCT03096925; http://clinicaltrials.gov/ct2/show/NCT03096925 UR - https://www.jmir.org/2022/1/e33631 UR - http://dx.doi.org/10.2196/33631 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072641 ID - info:doi/10.2196/33631 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 - Appleton, Rebecca AU - Williams, Julie AU - Vera San Juan, Norha AU - Needle, J. Justin AU - Schlief, Merle AU - Jordan, Harriet AU - Sheridan Rains, Luke AU - Goulding, Lucy AU - Badhan, Monika AU - Roxburgh, Emily AU - Barnett, Phoebe AU - Spyridonidis, Spyros AU - Tomaskova, Magdalena AU - Mo, Jiping AU - Harju-Seppänen, Jasmine AU - Haime, Zoë AU - Casetta, Cecilia AU - Papamichail, Alexandra AU - Lloyd-Evans, Brynmor AU - Simpson, Alan AU - Sevdalis, Nick AU - Gaughran, Fiona AU - Johnson, Sonia PY - 2021/12/9 TI - Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e31746 VL - 23 IS - 12 KW - telemental health KW - COVID-19 KW - remote care KW - telemedicine KW - mental health KW - systematic review, implementation science N2 - Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 UR - https://www.jmir.org/2021/12/e31746 UR - http://dx.doi.org/10.2196/31746 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709179 ID - info:doi/10.2196/31746 ER - TY - JOUR AU - Lal, Shalini AU - Gleeson, F. John AU - D'Alfonso, Simon AU - Etienne, Geraldine AU - Joober, Ridha AU - Lepage, Martin AU - Lee, Hajin AU - Alvarez-Jimenez, Mario PY - 2021/12/7 TI - A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2) JO - JMIR Res Protoc SP - e28141 VL - 10 IS - 12 KW - psychotic disorders KW - mental health KW - telemedicine KW - young adult KW - mental health services KW - e?mental health KW - virtual care KW - schizophrenia KW - eHealth KW - social support KW - therapy KW - psychiatry KW - psychology N2 - Background: Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. Objective: In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). Methods: This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. Results: This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. Conclusions: This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. Trial Registration: ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105 International Registered Report Identifier (IRRID): RR1-10.2196/28141 UR - https://www.researchprotocols.org/2021/12/e28141 UR - http://dx.doi.org/10.2196/28141 UR - http://www.ncbi.nlm.nih.gov/pubmed/34879000 ID - info:doi/10.2196/28141 ER - TY - JOUR AU - Ellis, A. Louise AU - Meulenbroeks, Isabelle AU - Churruca, Kate AU - Pomare, Chiara AU - Hatem, Sarah AU - Harrison, Reema AU - Zurynski, Yvonne AU - Braithwaite, Jeffrey PY - 2021/12/6 TI - The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis JO - JMIR Ment Health SP - e32948 VL - 8 IS - 12 KW - e-mental health KW - mental health KW - COVID-19 KW - bibliometrics KW - health systems N2 - Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the ?new normal.? Objective: The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. Methods: We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. Results: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. Conclusions: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. UR - https://mental.jmir.org/2021/12/e32948 UR - http://dx.doi.org/10.2196/32948 UR - http://www.ncbi.nlm.nih.gov/pubmed/34666306 ID - info:doi/10.2196/32948 ER - TY - JOUR AU - Fung, Kenneth AU - Liu, JW Jenny AU - Vahabi, Mandana AU - Li, Tai-Wai Alan AU - Zurowski, Mateusz AU - Wong, Pui-Hing Josephine PY - 2021/12/6 TI - Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment JO - JMIR Res Protoc SP - e33495 VL - 10 IS - 12 KW - COVID KW - COVID-19 KW - coronavirus KW - pandemic KW - resilience KW - acceptance commitment therapy KW - group empowerment N2 - Background: During a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities. Objective: This is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building. Methods: Based on acceptance and commitment therapy (ACT) and social justice?based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions. Results: As of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members. Conclusions: The PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/33495 UR - https://www.researchprotocols.org/2021/12/e33495 UR - http://dx.doi.org/10.2196/33495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726602 ID - info:doi/10.2196/33495 ER - TY - JOUR AU - Fisher, B. Lauren AU - Tuchman, Sylvie AU - Curreri, J. Andrew AU - Markgraf, Maggie AU - Nyer, B. Maren AU - Cassano, Paolo AU - Iverson, L. Grant AU - Fava, Maurizio AU - Zafonte, D. Ross AU - Pedrelli, Paola PY - 2021/12/1 TI - Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study JO - JMIR Form Res SP - e28734 VL - 5 IS - 12 KW - COVID-19 KW - telemental health KW - clinical trial KW - traumatic brain injury KW - depression KW - cognitive behavioral therapy N2 - Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 UR - https://formative.jmir.org/2021/12/e28734 UR - http://dx.doi.org/10.2196/28734 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662285 ID - info:doi/10.2196/28734 ER - TY - JOUR AU - Saad, Anthony AU - Bruno, Deanna AU - Camara, Bettina AU - D?Agostino, Josephine AU - Bolea-Alamanac, Blanca PY - 2021/11/26 TI - Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review JO - JMIR Ment Health SP - e27404 VL - 8 IS - 11 KW - digital therapeutics KW - self-directed KW - mental health KW - telehealth KW - technology KW - mobile applications KW - telemedicine KW - internet KW - mobile phone N2 - Background: Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. Objective: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient?s or at the technology?s end), so the patients can implement them without any support. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. Results: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. Conclusions: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates. UR - https://mental.jmir.org/2021/11/e27404 UR - http://dx.doi.org/10.2196/27404 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842556 ID - info:doi/10.2196/27404 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 - Klein, Arno AU - Clucas, Jon AU - Krishnakumar, Anirudh AU - Ghosh, S. Satrajit AU - Van Auken, Wilhelm AU - Thonet, Benjamin AU - Sabram, Ihor AU - Acuna, Nino AU - Keshavan, Anisha AU - Rossiter, Henry AU - Xiao, Yao AU - Semenuta, Sergey AU - Badioli, Alessandra AU - Konishcheva, Kseniia AU - Abraham, Ann Sanu AU - Alexander, M. Lindsay AU - Merikangas, R. Kathleen AU - Swendsen, Joel AU - Lindner, B. Ariel AU - Milham, P. Michael PY - 2021/11/11 TI - Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study JO - J Med Internet Res SP - e22369 VL - 23 IS - 11 KW - mental health KW - mHealth KW - mobile health KW - digital health KW - eHealth KW - digital psychiatry KW - digital phenotyping KW - teletherapy KW - mobile device KW - mobile phone KW - smartphone KW - ecological momentary assessment KW - ecological momentary intervention KW - EMA KW - EMI KW - ESM KW - experience sampling KW - experience sampling methods N2 - Background: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform?s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users? data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser?based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health?related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population. UR - https://www.jmir.org/2021/11/e22369 UR - http://dx.doi.org/10.2196/22369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762054 ID - info:doi/10.2196/22369 ER - TY - JOUR AU - Winkler, Olga AU - Dhaliwal, Raman AU - Greenshaw, Andrew AU - O'Shea, Katie AU - Abba-Aji, Adam AU - Chima, Chidi AU - Purdon, E. Scot AU - Burback, Lisa PY - 2021/11/4 TI - Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30711 VL - 10 IS - 11 KW - suicide KW - trauma KW - eye movement desensitization and reprocessing (EMDR) KW - telemedicine KW - psychotherapy KW - digital health KW - eHealth KW - remote delivery KW - virtual care N2 - Background: Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. Objective: The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. Methods: In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. Results: The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. Conclusions: The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. Trial Registration: ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047 International Registered Report Identifier (IRRID): DERR1-10.2196/30711 UR - https://www.researchprotocols.org/2021/11/e30711 UR - http://dx.doi.org/10.2196/30711 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734835 ID - info:doi/10.2196/30711 ER - TY - JOUR AU - Lippke, Sonia AU - Gao, Lingling AU - Keller, Maria Franziska AU - Becker, Petra AU - Dahmen, Alina PY - 2021/11/3 TI - Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials JO - J Med Internet Res SP - e31274 VL - 23 IS - 11 KW - psychotherapeutic aftercare KW - medical rehabilitation KW - online therapy KW - face-to-face therapy KW - care as usual KW - retention KW - dropout N2 - Background: Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention?s impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine. Objective: This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered. Methods: In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1. Results: There were no significant differences between the groups regarding dropout rates (?21=0.02-1.06, P?.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P?.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51). Conclusions: While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients? challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients. Trial Registration: ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842 UR - https://www.jmir.org/2021/11/e31274 UR - http://dx.doi.org/10.2196/31274 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730541 ID - info:doi/10.2196/31274 ER - TY - JOUR AU - Sora, Beatriz AU - Nieto, Rubén AU - Montesano del Campo, Adrian AU - Armayones, Manuel PY - 2021/10/15 TI - Acceptance and Use of Telepsychology From the Clients? Perspective: Questionnaire Study to Document Perceived Advantages and Barriers JO - JMIR Ment Health SP - e22199 VL - 8 IS - 10 KW - telepsychology KW - telepsychology advantages KW - telepsychology barriers KW - telepsychology use KW - telepsychology usefulness KW - intention to use telepsychology N2 - Background: Telepsychology is increasingly being incorporated in clinical practice, being offered in many psychotherapy centers, especially after the impact of the pandemic. However, there seems to be a remarkable discrepancy between the offer, or interest in, and real-world uptake of e-mental health interventions among the population. A critical precondition is clients? willingness to accept and use telepsychology, although this issue has thus far been overlooked in research. Objective: The aim of this study was to examine people?s acceptance and use of telepsychology by adopting an extended model of the unified theory of acceptance and use of technology (UTAUT) that integrates perceived telepsychology advantages and barriers, usefulness perceptions, behavioral intention, and telepsychology use. Methods: An online survey was conducted with a convenience sample of 514 participants. Structural equation models were computed to test a mediation model. Results: Results supported the UTAUT model to explain participants? acceptance and use of telepsychology. They showed a causal chain in which perceived telepsychology advantages and barriers were related to telepsychology use through the perceived usefulness of and intention to use telepsychology. Conclusions: Telepsychology use may be explained according to the UTAUT model when coupled with participants? perceptions of telepsychology advantages and barriers. Mental health stakeholders could consider these factors in order to increase the acceptance and use of telepsychology. UR - https://mental.jmir.org/2021/10/e22199 UR - http://dx.doi.org/10.2196/22199 UR - http://www.ncbi.nlm.nih.gov/pubmed/34652276 ID - info:doi/10.2196/22199 ER - TY - JOUR AU - Thakur, Anupam AU - Pereira, Cheryl AU - Hardy, Jenny AU - Bobbette, Nicole AU - Sockalingam, Sanjeev AU - Lunsky, Yona PY - 2021/10/7 TI - Virtual Education Program to Support Providers Caring for People With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Rapid Development and Evaluation Study JO - JMIR Ment Health SP - e28933 VL - 8 IS - 10 KW - COVID-19 KW - coronavirus KW - pandemic KW - intellectual disability KW - mental health KW - community of practice KW - ECHO, virtual KW - capacity-building N2 - Background: People with intellectual and developmental disabilities are at increased health-related risk due to the COVID-19 pandemic. Virtual training programs that support providers in caring for the physical and mental health needs of this population, as well provide psychological support to the providers themselves, are needed during the pandemic. Objective: This paper describes the design, delivery, and evaluation of a virtual educational COVID-19?focused Extension for Community Healthcare Outcomes program to support providers during the COVID-19 pandemic in caring for the mental health of people with intellectual and developmental disabilities. Methods: A rapid design thinking approach was used to develop a 6-session program that incorporates mindfulness practice, a wellness check, COVID-19?related research and policy updates, a didactic presentation on a combination mental health and COVID-19 related topic, and a case-based discussion to encourage practical learning. We used the first 5 outcome levels of Moore?s evaluation framework?focusing on participation, satisfaction, learning, self-efficacy, and change in practice?which were rated (out of 5) by care providers from health and disability service sectors, as well as additional reflection measures about innovations to the program. Qualitative feedback from open-text responses from participants were analyzed using modified manifest content analysis. Results: A total of 104 care providers from health and disability service sectors participated in the program. High levels of engagement (81 participants per session on average) and satisfaction (overall satisfaction score: mean 4.31, SD 0.17) were observed. Self-efficacy (score improvement: 19.8%), support, and coping improved. Participants also rated the newly developed COVID-19 program and its innovative components highly. Open text feedback showed participants felt that the Extension for Community Healthcare Outcomes program expanded their knowledge and competency and created a sense of being part of a community of practice; provided value for the COVID-19 innovations; supported resource-sharing within and beyond program participants; and facilitated changes to participants? approaches to client care in practice and increased participants? confidence in supporting clients and families. Conclusions: The Extension for Community Healthcare Outcomes program is an effective model for capacity-building programs with a shared-learning approach. Future iterations should include targeted evaluation of long-term outcomes such as staff burnout. UR - https://mental.jmir.org/2021/10/e28933 UR - http://dx.doi.org/10.2196/28933 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617917 ID - info:doi/10.2196/28933 ER - TY - JOUR AU - Budhwani, Suman AU - Fujioka, Keiko Jamie AU - Chu, Cherry AU - Baranek, Hayley AU - Pus, Laura AU - Wasserman, Lori AU - Vigod, Simone AU - Martin, Danielle AU - Agarwal, Payal AU - Mukerji, Geetha PY - 2021/9/21 TI - Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context JO - JMIR Form Res SP - e30280 VL - 5 IS - 9 KW - virtual care KW - mental health KW - quality of care KW - implementation KW - COVID-19 KW - digital health KW - pandemic KW - ambulatory care N2 - Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women?s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. UR - https://formative.jmir.org/2021/9/e30280 UR - http://dx.doi.org/10.2196/30280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406967 ID - info:doi/10.2196/30280 ER - TY - JOUR AU - Burbach, R. Frank AU - Stiles, M. Katie PY - 2021/9/17 TI - Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation JO - JMIR Form Res SP - e29845 VL - 5 IS - 9 KW - telehealth KW - young people KW - adolescents KW - online psychological therapy KW - online neurodevelopmental assessments KW - digital services KW - realist evaluation KW - multiple case study KW - CBT KW - autism N2 - Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case?study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services. UR - https://formative.jmir.org/2021/9/e29845 UR - http://dx.doi.org/10.2196/29845 UR - http://www.ncbi.nlm.nih.gov/pubmed/34369382 ID - info:doi/10.2196/29845 ER - TY - JOUR AU - van Agteren, Joep AU - Ali, Kathina AU - Fassnacht, B. Daniel AU - Iasiello, Matthew AU - Furber, Gareth AU - Howard, Alexis AU - Woodyatt, Lydia AU - Musker, Michael AU - Kyrios, Mike PY - 2021/9/15 TI - Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study JO - JMIR Ment Health SP - e28044 VL - 8 IS - 9 KW - COVID-19 KW - internet-based interventions KW - mental health KW - well-being KW - intervention KW - study KW - impact KW - internet KW - online intervention KW - distress KW - resilience KW - depression KW - anxiety KW - stress N2 - Background: During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective: This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods: A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results: The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks ?=.71; partial ?2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (?2=.22 and ?2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions: The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness. UR - https://mental.jmir.org/2021/9/e28044 UR - http://dx.doi.org/10.2196/28044 UR - http://www.ncbi.nlm.nih.gov/pubmed/34357876 ID - info:doi/10.2196/28044 ER - TY - JOUR AU - Kozlov, Elissa AU - McDarby, Meghan AU - Prescott, Maximo AU - Altman, Myra PY - 2021/9/15 TI - Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study JO - JMIR Form Res SP - e30162 VL - 5 IS - 9 KW - stepped care KW - technology KW - mental health care KW - patient-centered care N2 - Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. UR - https://formative.jmir.org/2021/9/e30162 UR - http://dx.doi.org/10.2196/30162 UR - http://www.ncbi.nlm.nih.gov/pubmed/34343965 ID - info:doi/10.2196/30162 ER - TY - JOUR AU - Miguel-Cruz, Antonio AU - Ladurner, Anna-Maria AU - Kohls-Wiebe, Megan AU - Rawani, David PY - 2021/9/14 TI - The Effects of 3D Immersion Technology (3Scape) on Mental Health in Outpatients From a Short-Term Assessment, Rehabilitation, and Treatment Program: Feasibility Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e25017 VL - 10 IS - 9 KW - technology assessment KW - mental health KW - technology for rehabilitation KW - clinical engineering KW - biomedical engineering N2 - Background: Mental health conditions are prevalent among Canadians and are a leading cause of disability. Each year, 1 in 5 Canadians experiences a mental health issue. A total of 5% of people aged ?65 years perceive their mental health as fair or poor, and 6.3% of them have mood disorders. Regarding older adults with cognitive impairments such as dementia, up to 40%-50% of them experience depression at some point. We believe that older adults can benefit significantly from information and telecommunication technologies as a strategy for improving mental health conditions such as depression and anxiety, while simultaneously improving their quality of life. 3Scape Systems Inc is an Alberta-based private company that has produced a series of specialized 3D videos designed to simulate real-life events and engage individuals living with mental health disorders and cognitive impairments such as dementia. Objective: This study aims to explore the trial design and effects of 3Scape videos on older adults? symptoms of depression and anxiety and the efficacy of this technology in improving the quality of life of patients attending the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital and to provide data to estimate the parameters required to design a definitive randomized controlled trial. Methods: The trial will use a randomized controlled design comprising 15 intervention participants and 15 control group participants. The participants will be adults aged ?65 years who are cognitively intact or have minimal cognitive impairment (ie, Montreal Cognitive Assessment score ?18), and are clients of the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital. This study?s primary outcome variables are related to clients? depressive and anxiety symptoms and their quality of life. The control group will receive the standard of care (ie, the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital). The intervention group will receive the same standard of care as the control group and will use 3Scape Systems videos for therapeutic activities. Results: Our study is currently on hold because of the COVID-19 pandemic. The recruitment process is expected to resume by November 2021, and the primary impact analysis is expected to be conducted by February 2022. Conclusions: This study will provide valuable information such as the measurement of comparative intervention effects, perception of older adults and mental health therapists about the 3Scape Systems, the associated costs of treatment, and product costs. This will contribute to the evidence planning process, which will be crucial for the future adoption of 3Scape Systems. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 93685907; https://www.isrctn.com/ISRCTN93685907. International Registered Report Identifier (IRRID): PRR1-10.2196/25017 UR - https://www.researchprotocols.org/2021/9/e25017 UR - http://dx.doi.org/10.2196/25017 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519669 ID - info:doi/10.2196/25017 ER - TY - JOUR AU - Rashid Soron, Tanjir AU - Ashiq, Rahman Md Ashiqur AU - Al-Hakeem, Marzia AU - Chowdhury, Farzan Zaid AU - Uddin Ahmed, Helal AU - Afrooz Chowdhury, Chaman PY - 2021/9/13 TI - Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh JO - JMIR Form Res SP - e24624 VL - 5 IS - 9 KW - domestic violence KW - COVID-19 KW - mental health KW - violence KW - Bangladesh KW - lockdown KW - isolation KW - anxiety KW - stress KW - telemental health KW - telepsychiatry KW - web-based survey N2 - Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. UR - https://formative.jmir.org/2021/9/e24624 UR - http://dx.doi.org/10.2196/24624 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346893 ID - info:doi/10.2196/24624 ER - TY - JOUR AU - Fung, Po-Lun Kenneth AU - Vahabi, Mandana AU - Moosapoor, Masoomeh AU - Akbarian, Abdolreza AU - Jing-Wen Liu, Jenny AU - Wong, Pui-Hing Josephine PY - 2021/9/13 TI - Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol JO - JMIR Res Protoc SP - e31211 VL - 10 IS - 9 KW - migrant live-in caregiver KW - women KW - mental health KW - acceptance commitment therapy KW - resiliency KW - empowerment N2 - Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective: The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants? satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale ? Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID): DERR1-10.2196/31211 UR - https://www.researchprotocols.org/2021/9/e31211 UR - http://dx.doi.org/10.2196/31211 UR - http://www.ncbi.nlm.nih.gov/pubmed/34515642 ID - info:doi/10.2196/31211 ER - TY - JOUR AU - Krückl, Sophia Jana AU - Moeller, Julian AU - Gaupp, Rainer AU - Meier, E. Christoph AU - Roth, Bénédict Carl AU - Lang, Emmi Undine AU - Huber, G. Christian PY - 2021/9/1 TI - Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report JO - JMIR Ment Health SP - e28849 VL - 8 IS - 9 KW - home office KW - psychiatry KW - employees KW - mental health KW - depression KW - anxiety KW - stress factors KW - Patient Health Questionnaire KW - PHQ-2 KW - General Anxiety Disorder KW - GAD-2 KW - PHQ-D KW - COVID-19 KW - pandemic N2 - Background: During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. Objective: The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees? mental health in a large psychiatric university hospital in Switzerland. Methods: We obtained and analyzed home office implementation and use data from the psychiatric university hospital?s information technology services. We also conducted a cross-sectional web-based survey to assess the employees? attitudes toward the clinic?s crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]?2), anxiety (General Anxiety Disorder [GAD]?2), and stress factors (stress module of the PHQ-D); a cut-off score ?3 was used for the PHQ-2 and GAD-2. Results: Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (?162=72.72, P?.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (?42=9.72, P=.04). Conclusions: In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees? work?life balance, to save employers costs and foster other benefits. UR - https://mental.jmir.org/2021/9/e28849 UR - http://dx.doi.org/10.2196/28849 UR - http://www.ncbi.nlm.nih.gov/pubmed/34115606 ID - info:doi/10.2196/28849 ER - TY - JOUR AU - Keller, Maria Franziska AU - Dahmen, Alina AU - Derksen, Christina AU - Kötting, Lukas AU - Lippke, Sonia PY - 2021/8/26 TI - Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects JO - JMIR Ment Health SP - e30610 VL - 8 IS - 8 KW - mental health KW - COVID-19 KW - medical rehabilitation KW - psychosomatic rehabilitation KW - internet-delivered digital trainings N2 - Background: The COVID-19 pandemic has largely affected people?s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19?related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients? rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points?before (N=1719) and after (n=738) rehabilitation?between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19?related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, ?2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, ?2p=0.04), had lower financial worries (F1,837=38.96, P<.001, ?2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, ?2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, ?2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, ?2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (?=?.14, P<.001), anxiety (?=?.12, P<.001), loneliness (?=?.18, P<.001), and stress postrehabilitation (?=?.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, ?2p=0.01) and anxiety (F1,725=6.22, P=.01, ?2p=0.01) from pre- to postrehabilitation. Conclusions: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 UR - https://mental.jmir.org/2021/8/e30610 UR - http://dx.doi.org/10.2196/30610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34270444 ID - info:doi/10.2196/30610 ER - TY - JOUR AU - Knapp, A. Ashley AU - Cohen, Katherine AU - Nicholas, Jennifer AU - Mohr, C. David AU - Carlo, D. Andrew AU - Skerl, J. Joshua AU - Lattie, G. Emily PY - 2021/8/19 TI - Integration of Digital Tools Into Community Mental Health Care Settings That Serve Young People: Focus Group Study JO - JMIR Ment Health SP - e27379 VL - 8 IS - 8 KW - digital mental health KW - treatment KW - young people KW - children KW - adolescents KW - community mental health care KW - mobile phone N2 - Background: Digital mental health tools have substantial potential to be easily integrated into people?s lives and fundamentally impact public health. Such tools can extend the reach and maximize the impact of mental health interventions. Before implementing digital tools in new settings, it is critical to understand what is important to organizations and individuals who will implement and use these tools. Given that young people are highly familiar with technology and many mental health concerns emerge in childhood and adolescence, it is especially crucial to understand how digital tools can be integrated into settings that serve young people. Objective: This study aims to learn about considerations and perspectives of community behavioral health care providers on incorporating digital tools into their clinical care for children and adolescents. Methods: Data were analyzed from 5 focus groups conducted with clinicians (n=37) who work with young people at a large community service organization in the United States. This organization provides care to more than 27,000 people annually, most of whom are of low socioeconomic status. The transcripts were coded using thematic analysis. Results: Clinicians first provided insight into the digital tools they were currently using in their treatment sessions with young people, such as web-based videos and mood-tracking apps. They explained that their main goals in using these tools were to help young people build skills, facilitate learning, and monitor symptoms. Benefits were expressed, such as engagement of adolescents in treatment, along with potential challenges (eg, accessibility and limited content) and developmental considerations (eg, digital devices getting taken away as punishment). Clinicians discussed their desire for a centralized digital platform that securely connects the clinician, young person, and caregivers. Finally, they offered several considerations for integrating digital tools into mental health care, such as setting up expectations with clients and the importance of human support. Conclusions: Young people have unique considerations related to complex accessibility patterns and technology expectations that may not be observed when adults are the intended users of mental health technologies. Therefore, these findings provide critical insights to inform the development of future tools, specifically regarding connectivity, conditional restraints (eg, devices taken away as punishment and school restrictions), expectations of users from different generations, and the blended nature in which digital tools can support young people. UR - https://mental.jmir.org/2021/8/e27379 UR - http://dx.doi.org/10.2196/27379 UR - http://www.ncbi.nlm.nih.gov/pubmed/34420928 ID - info:doi/10.2196/27379 ER - TY - JOUR AU - McCall, Terika AU - Ali, Osama Muhammad AU - Yu, Fei AU - Fontelo, Paul AU - Khairat, Saif PY - 2021/8/17 TI - Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study JO - JMIR Form Res SP - e24393 VL - 5 IS - 8 KW - African Americans KW - women KW - mental health KW - anxiety KW - depression KW - telemedicine KW - mHealth KW - mobile applications KW - digital health KW - user-centered design KW - mobile phone N2 - Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants? visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants? acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. UR - https://formative.jmir.org/2021/8/e24393 UR - http://dx.doi.org/10.2196/24393 UR - http://www.ncbi.nlm.nih.gov/pubmed/34133313 ID - info:doi/10.2196/24393 ER - TY - JOUR AU - Venville, Annie AU - O'Connor, Sarah AU - Roeschlein, Hannah AU - Ennals, Priscilla AU - McLoughlan, Grace AU - Thomas, Neil PY - 2021/8/12 TI - Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study JO - JMIR Ment Health SP - e29671 VL - 8 IS - 8 KW - telehealth KW - mental health KW - psychosocial support KW - COVID-19 KW - service user KW - workers KW - qualitative KW - e-mental health KW - support KW - telemedicine KW - intervention KW - user experience N2 - Background: During the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed. Objective: We focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic. Methods: This study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics. Results: Service users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth. Conclusions: Overall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood. UR - https://mental.jmir.org/2021/8/e29671 UR - http://dx.doi.org/10.2196/29671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34182461 ID - info:doi/10.2196/29671 ER - TY - JOUR AU - Smith-MacDonald, Lorraine AU - Jones, Chelsea AU - Sevigny, Phillip AU - White, Allison AU - Laidlaw, Alexa AU - Voth, Melissa AU - Mikolas, Cynthia AU - Heber, Alexandra AU - Greenshaw, J. Andrew AU - Brémault-Phillips, Suzette PY - 2021/8/12 TI - The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis JO - JMIR Form Res SP - e26369 VL - 5 IS - 8 KW - trauma KW - mental health KW - telemedicine KW - therapy KW - rehabilitation KW - digital health KW - psychotherapy KW - military KW - veteran KW - first responder KW - public safety personnel KW - teletherapy KW - telepsychiatry KW - mobile phone N2 - Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants? responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers? perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. UR - https://formative.jmir.org/2021/8/e26369 UR - http://dx.doi.org/10.2196/26369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387549 ID - info:doi/10.2196/26369 ER - TY - JOUR AU - Damerau, Mirjam AU - Teufel, Martin AU - Musche, Venja AU - Dinse, Hannah AU - Schweda, Adam AU - Beckord, Jil AU - Steinbach, Jasmin AU - Schmidt, Kira AU - Skoda, Eva-Maria AU - Bäuerle, Alexander PY - 2021/7/30 TI - Determining Acceptance of e-Mental Health Interventions in Digital Psychodiabetology Using a Quantitative Web-Based Survey: Cross-sectional Study JO - JMIR Form Res SP - e27436 VL - 5 IS - 7 KW - e-mental health KW - acceptance KW - UTAUT KW - mental health KW - diabetes KW - e-mental health intervention KW - psychodiabetology N2 - Background: Diabetes is a very common chronic disease that exerts massive physiological and psychological burdens on patients. The digitalization of mental health care has generated effective e-mental health approaches, which offer an indubitable practical value for patient treatment. However, before implementing and optimizing e-mental health tools, their acceptance and underlying barriers and resources should be first determined for developing and establishing effective patient-oriented interventions. Objective: This study aims to assess the acceptance of e-mental health interventions among patients with diabetes and explore its underlying barriers and resources. Methods: A cross-sectional study was conducted in Germany from April 9, 2020, to June 15, 2020, through a web-based survey for which patients were recruited via web-based diabetes channels. The eligibility requirements were adult age (18 years or older), a good command of the German language, internet access, and a diagnosis of diabetes. Acceptance was measured using a modified questionnaire, which was based on the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) and assessed health-related internet use, acceptance of e-mental health interventions, and its barriers and resources. Mental health was measured using validated and established instruments, namely the Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-2, and Distress Thermometer. In addition, sociodemographic and medical data regarding diabetes were collected. Results: Of the 340 participants who started the survey, 261 (76.8%) completed it and the final sample comprised 258 participants with complete data sets. The acceptance of e-mental health interventions in patients with diabetes was overall moderate (mean 3.02, SD 1.14). Gender and having a mental disorder had a significant influence on acceptance (P<.001). In an extended UTAUT regression model (UTAUT predictors plus sociodemographics and mental health variables), distress (?=.11; P=.03) as well as the UTAUT predictors performance expectancy (?=.50; P<.001), effort expectancy (?=.15; P=.001), and social influence (?=.28; P<.001) significantly predicted acceptance. The comparison between an extended UTAUT regression model (13 predictors) and the UTAUT-only regression model (performance expectancy, effort expectancy, social influence) revealed no significant difference in explained variance (F10,244=1.567; P=.12). Conclusions: This study supports the viability of the UTAUT model and its predictors in assessing the acceptance of e-mental health interventions among patients with diabetes. Three UTAUT predictors reached a notable amount of explained variance of 75% in the acceptance, indicating that it is a very useful and efficient method for measuring e-mental health intervention acceptance in patients with diabetes. Owing to the close link between acceptance and use, acceptance-facilitating interventions focusing on these three UTAUT predictors should be fostered to bring forward the highly needed establishment of effective e-mental health interventions in psychodiabetology. UR - https://formative.jmir.org/2021/7/e27436 UR - http://dx.doi.org/10.2196/27436 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328429 ID - info:doi/10.2196/27436 ER - TY - JOUR AU - Mazziotti, Raffaele AU - Rutigliano, Grazia PY - 2021/7/29 TI - Tele?Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction JO - JMIR Ment Health SP - e26187 VL - 8 IS - 7 KW - telepsychiatry KW - telepsychology KW - e-mental health KW - document clustering KW - survey KW - COVID-19 KW - access to care KW - patient satisfaction KW - mental health KW - tele?mental health KW - review KW - telemedicine KW - satisfaction KW - access N2 - Background: The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele?mental health was rapidly implemented to deliver health care services. Objective: The aims of this study were (1) to present state-of-the-art tele?mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele?mental health. Methods: Document clustering was applied to map research topics within tele?mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele?mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. Results: Evidence on tele?mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele?mental health delivery of care. However, respondents held skeptical views about tele?mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele?mental health as they are with face-to-face interventions (Hedges g=?0.001, 95% CI ?0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. Conclusions: Mental health services equipped with tele?mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations. UR - https://mental.jmir.org/2021/7/e26187 UR - http://dx.doi.org/10.2196/26187 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114956 ID - info:doi/10.2196/26187 ER - TY - JOUR AU - Echelard, Jean-François PY - 2021/7/26 TI - Use of Telemedicine in Depression Care by Physicians: Scoping Review JO - JMIR Form Res SP - e29159 VL - 5 IS - 7 KW - telemedicine KW - telepsychiatry KW - depression KW - mental health KW - videoconferencing N2 - Background: Depression is a common disorder, and it creates burdens on people?s mental and physical health as well as societal costs. Although traditional in-person consultations are the usual mode of caring for patients with depression, telemedicine may be well suited to psychiatric assessment and management. Telepsychiatry can be defined as the use of information and communication technologies such as videoconferencing and telephone calls for the care of psychopathologies. Objective: This review aims to evaluate the extent and nature of the existing literature on the use of telemedicine for the care of depression by physicians. This review also aims to examine the effects and perceptions regarding this virtual care and determine how it compares to traditional in-person care. Methods: The Arksey and O?Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed. Relevant articles were identified through a search of three databases (MEDLINE, Cochrane Database of Systematic Reviews, and PsycArticles) on October 11, 2020. The search terms were ?(virtual OR telemedicine OR teleconsultation* OR telehealth OR phone* OR webcam* OR telepsychiatry) AND (depress*)?. Eligibility criteria were applied to select studies about the use of telemedicine for the care of patients with depression specifically by physicians. An Excel file (Microsoft Corporation) was used to chart data from all included articles. Results: The search resulted in the identification of 28 articles, and all 13 nonreview studies were analyzed in detail. Most nonreview studies were conducted in the United States during the last decade. Most telemedicine programs were led by psychiatrists, and the average study population size was 135. In all applicable studies, telepsychiatry tended to perform at least as well as in-person care regarding improvement in depression severity, patient satisfaction, quality of life, functioning, cost-effectiveness, and most other perceptions and variables. Cultural sensitivity and collaborative care were part of the design of some telemedicine programs. Conclusions: Additional randomized, high-quality studies are recommended to evaluate various outcomes of the use of telemedicine for depression care, including depression variables, perceptions, health care outcomes and other outcomes. Studies should be conducted in various clinical contexts, including primary care. Telepsychiatry is a promising modality of care for patients suffering from depression. UR - https://formative.jmir.org/2021/7/e29159 UR - http://dx.doi.org/10.2196/29159 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309571 ID - info:doi/10.2196/29159 ER - TY - JOUR AU - Scholl, Julia AU - Kohls, Elisabeth AU - Görges, Frauke AU - Steinbrecher, Marc AU - Baldofski, Sabrina AU - Moessner, Markus AU - Rummel-Kluge, Christine PY - 2021/7/23 TI - Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study JO - JMIR Form Res SP - e27865 VL - 5 IS - 7 KW - online KW - group chats KW - COVID-19 pandemic KW - psychiatric outpatient setting KW - online interventions KW - e-mental health KW - COVID-19 KW - pandemic KW - mental health KW - psychoeducation KW - online chat N2 - Background: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people?s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. Methods: Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants? satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. Results: Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight,nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5).A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=?0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants? satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). Conclusions: A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. Trial Registration: German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r UR - https://formative.jmir.org/2021/7/e27865 UR - http://dx.doi.org/10.2196/27865 UR - http://www.ncbi.nlm.nih.gov/pubmed/34161252 ID - info:doi/10.2196/27865 ER - TY - JOUR AU - Mundt, P. Adrian AU - Irarrázaval, Matías AU - Martínez, Pablo AU - Fernández, Olga AU - Martínez, Vania AU - Rojas, Graciela PY - 2021/7/22 TI - Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study JO - JMIR Public Health Surveill SP - e25836 VL - 7 IS - 7 KW - telemedicine KW - psychiatry KW - primary health care KW - child protective services N2 - Background: Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities. Objective: The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services. Methods: We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program. Results: During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions. Conclusions: The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation. UR - https://publichealth.jmir.org/2021/7/e25836 UR - http://dx.doi.org/10.2196/25836 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292164 ID - info:doi/10.2196/25836 ER - TY - JOUR AU - Alavi, Nazanin AU - Stephenson, Callum AU - Omrani, Mohsen AU - Gerritsen, Cory AU - Martin, S. Michael AU - Knyahnytskyi, Alex AU - Zhu, Yiran AU - Kumar, Anchan AU - Jagayat, Jasleen AU - Shirazi, Amirhossein AU - Moghimi, Elnaz AU - Patel, Charmy AU - Knyahnytska, Yuliya AU - Simpson, F. Alexander I. AU - Zaheer, Juveria AU - Andersen, Judith AU - Munshi, Alpna AU - Groll, Dianne PY - 2021/7/22 TI - Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e30845 VL - 10 IS - 7 KW - mental health KW - correctional workers KW - public safety personnel KW - depression KW - anxiety KW - psychotherapy KW - cognitive behavioral therapy KW - online KW - internet KW - treatment N2 - Background: Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. Objective: This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers? mental health problems. Methods: This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. Results: The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. Conclusions: If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. Trial Registration: ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974 International Registered Report Identifier (IRRID): DERR1-10.2196/30845 UR - https://www.researchprotocols.org/2021/7/e30845 UR - http://dx.doi.org/10.2196/30845 UR - http://www.ncbi.nlm.nih.gov/pubmed/34088656 ID - info:doi/10.2196/30845 ER - TY - JOUR AU - Barnett, Phoebe AU - Goulding, Lucy AU - Casetta, Cecilia AU - Jordan, Harriet AU - Sheridan-Rains, Luke AU - Steare, Thomas AU - Williams, Julie AU - Wood, Lisa AU - Gaughran, Fiona AU - Johnson, Sonia PY - 2021/7/20 TI - Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews JO - J Med Internet Res SP - e26492 VL - 23 IS - 7 KW - umbrella review KW - remote KW - telemental health KW - telepsychiatry KW - video-based therapy KW - COVID-19 KW - remote therapy KW - review KW - mental health KW - therapy KW - eHealth KW - telemedicine KW - mobile phone N2 - Background: Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. Objective: We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. Methods: Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. Results: In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people?s services and inpatient settings, was found to be lacking. Conclusions: This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health. UR - https://www.jmir.org/2021/7/e26492 UR - http://dx.doi.org/10.2196/26492 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061758 ID - info:doi/10.2196/26492 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 - Lederman, Reeva AU - D'Alfonso, Simon PY - 2021/7/20 TI - The Digital Therapeutic Alliance: Prospects and Considerations JO - JMIR Ment Health SP - e31385 VL - 8 IS - 7 KW - therapeutic alliance KW - digital therapeutic alliance KW - digital mental health KW - mental health apps KW - teletherapy KW - chatbots UR - https://mental.jmir.org/2021/7/e31385 UR - http://dx.doi.org/10.2196/31385 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283035 ID - info:doi/10.2196/31385 ER - TY - JOUR AU - Philipp-Muller, Emile Aaron AU - Reshetukha, Taras AU - Vazquez, Gustavo AU - Milev, Roumen AU - Armstrong, Dawn AU - Jagayat, Jasleen AU - Alavi, Nazanin PY - 2021/7/20 TI - Combining Ketamine and Internet-Based Cognitive Behavioral Therapy for the Treatment of Posttraumatic Stress Disorder: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30334 VL - 10 IS - 7 KW - mental health KW - PTSD KW - psychotherapy KW - cognitive behavioral therapy KW - online KW - internet KW - electronic KW - virtual KW - mental health care KW - ketamine N2 - Background: Over one third of patients with posttraumatic stress disorder (PTSD) do not respond to current interventions. Ketamine presents a potential treatment option; however, its effects are temporary. Administering ketamine alongside psychotherapy is one potential means of prolonging its effects; however, only a few studies have investigated this treatment method to date, and none have tested ketamine with internet-based or electronically delivered cognitive behavioral therapy (e-CBT). Objective: This open-label randomized controlled trial aims to assess the efficacy of a combined treatment method of subanesthetic intravenous ketamine and e-CBT for treating patients with PTSD. Methods: In total, 20 patients with refractory PTSD recruited from a community clinic will be randomly assigned to either an experimental group (n=10), receiving a combination of ketamine and therapist-administered e-CBT over 14 weeks, or a waitlist control group (n=10), receiving the experimental treatment after 14 weeks. Both groups will be assessed for the symptoms of PTSD and comorbid disorders before treatment, at two midway points, and at the end of the experiment. Results: PTSD symptoms of participants in the experimental group are expected to improve significantly more than those of participants in the waitlist control group (P=.05) with a large effect size (?2=0.14). Conclusions: This is the first study to assess the relationship between e-CBT and ketamine and their combined ability to treat refractory PTSD. If successful, this study will open web-based, asynchronous therapeutic options for patients with PTSD and will provide new insights into the functional role of glutamate in trauma-related disorders as well as in learning, memory, and fear extinction. Trial Registration: ClinicalTrials.gov NCT04771767; https://clinicaltrials.gov/ct2/show/NCT04771767. International Registered Report Identifier (IRRID): PRR1-10.2196/30334 UR - https://www.researchprotocols.org/2021/7/e30334 UR - http://dx.doi.org/10.2196/30334 UR - http://www.ncbi.nlm.nih.gov/pubmed/34092549 ID - info:doi/10.2196/30334 ER - TY - JOUR AU - Gullslett, K. Monika AU - Kristiansen, Eli AU - Nilsen, R. Etty PY - 2021/7/15 TI - Therapists? Experience of Video Consultation in Specialized Mental Health Services During the COVID-19 Pandemic: Qualitative Interview Study JO - JMIR Hum Factors SP - e23150 VL - 8 IS - 3 KW - mental health services KW - recovery, telemedicine KW - telepsychiatry KW - video consultation KW - COVID-19 KW - coronavirus KW - therapists? experiences KW - hospital services N2 - Background: As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective: The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists? experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods: This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results: Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists? overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC??it?s better than nothing?; (2) VC affects therapists? work situation?opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions: Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists? overall impression of VC. Further qualitative research is needed, and future studies should focus on service users? experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available. UR - https://humanfactors.jmir.org/2021/3/e23150 UR - http://dx.doi.org/10.2196/23150 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096505 ID - info:doi/10.2196/23150 ER - TY - JOUR AU - Ye, Jiancheng PY - 2021/6/30 TI - Advancing Mental Health and Psychological Support for Health Care Workers Using Digital Technologies and Platforms JO - JMIR Form Res SP - e22075 VL - 5 IS - 6 KW - mental health KW - health care workers KW - health informatics KW - digital intervention KW - health technology KW - mobile health KW - COVID-19 N2 - Background: The COVID-19 pandemic is a global public health crisis that has not only endangered the lives of patients but also resulted in increased psychological issues among medical professionals, especially frontline health care workers. As the crisis caused by the pandemic shifts from acute to protracted, attention should be paid to the devastating impacts on health care workers? mental health and social well-being. Digital technologies are being harnessed to support the responses to the pandemic, which provide opportunities to advance mental health and psychological support for health care workers. Objective: The aim of this study is to develop a framework to describe and organize the psychological and mental health issues that health care workers are facing during the COVID-19 pandemic. Based on the framework, this study also proposes interventions from digital health perspectives that health care workers can leverage during and after the pandemic. Methods: The psychological problems and mental health issues that health care workers have encountered during the COVID-19 pandemic were reviewed and analyzed based on the proposed MEET (Mental Health, Environment, Event, and Technology) framework, which also demonstrated the interactions among mental health, digital interventions, and social support. Results: Health care workers are facing increased risk of experiencing mental health issues due to the COVID-19 pandemic, including burnout, fear, worry, distress, pressure, anxiety, and depression. These negative emotional stressors may cause psychological problems for health care workers and affect their physical and mental health. Digital technologies and platforms are playing pivotal roles in mitigating psychological issues and providing effective support. The proposed framework enabled a better understanding of how to mitigate the psychological effects during the pandemic, recover from associated experiences, and provide comprehensive institutional and societal infrastructures for the well-being of health care workers. Conclusions: The COVID-19 pandemic presents unprecedented challenges due to its prolonged uncertainty, immediate threat to patient safety, and evolving professional demands. It is urgent to protect the mental health and strengthen the psychological resilience of health care workers. Given that the pandemic is expected to exist for a long time, caring for mental health has become a ?new normal? that needs a strengthened multisector collaboration to facilitate support and reduce health disparities. The proposed MEET framework could provide structured guidelines for further studies on how technology interacts with mental and psychological health for different populations. UR - https://formative.jmir.org/2021/6/e22075 UR - http://dx.doi.org/10.2196/22075 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106874 ID - info:doi/10.2196/22075 ER - TY - JOUR AU - Alavi, Nazanin AU - Stephenson, Callum AU - Yang, Megan AU - Kumar, Anchan AU - Shao, Yijia AU - Miller, Shadé AU - Yee, S. Caitlin AU - Stefatos, Anthi AU - Gholamzadehmir, Maedeh AU - Abbaspour, Zara AU - Jagayat, Jasleen AU - Shirazi, Amirhossein AU - Omrani, Mohsen AU - Patel, Archana AU - Patel, Charmy AU - Groll, Dianne PY - 2021/6/16 TI - Feasibility and Efficacy of Delivering Cognitive Behavioral Therapy Through an Online Psychotherapy Tool for Depression: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e27489 VL - 10 IS - 6 KW - mental health KW - depression KW - psychotherapy KW - cognitive behavioral therapy KW - online KW - internet KW - electronic KW - virtual KW - mental health care N2 - Background: Major depressive disorder (MDD) is a prevalent and debilitating mental health disorder. Among different therapeutic approaches (eg, medication and psychotherapy), psychotherapy in the form of cognitive behavioral therapy (CBT) is considered the gold standard treatment for MDD. However, although efficacious, CBT is not readily accessible to many patients in need because of hurdles such as stigma, long wait times, high cost, the large time commitment for health care providers, and cultural or geographic barriers. Electronically delivered cognitive behavioral therapy (e-CBT) can effectively address many of these accessibility barriers. Objective: This study aims to investigate the efficacy and feasibility of implementing an e-CBT program compared with in-person treatment for MDD. It is hypothesized that the e-CBT program will offer results comparable with those of the in-person treatment program, regarding symptom reduction and quality of life improvement. Methods: This nonrandomized controlled trial intervention will provide e-CBT for MDD through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants (aged 18-65 years) will be offered 12 weekly sessions of an e-CBT program tailored to MDD to address their depressive symptoms. Participants (n=55) will complete predesigned modules and homework assignments while receiving personalized feedback and interacting with a therapist through the platform. Using clinically validated symptomology questionnaires, the efficacy of the e-CBT program will be compared with that of a group (n=55) receiving in-person CBT. Questionnaires will be completed at baseline, at week 6 and week 12, and at a 6-month follow-up. Focus groups will be conducted to investigate personal, cultural, and social factors impacting the accessibility and feasibility of implementing a web-based psychotherapy tool from a patient and care provider perspective. Inclusion criteria include diagnosis of MDD, competence to consent to participate, ability to speak and read English, and consistent and reliable access to the internet. Exclusion criteria include active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. Results: Ethics approval was obtained in January 2019, and recruitment of participants began in June 2019. Recruitment has been conducted via social media, web-based communities, and physician referrals. To date, 52 participants have been recruited to the e-CBT group, and 48 patients have been recruited to the in-person CBT group. Data collection is expected to be completed by March 2021, and analyses are expected to be completed by June 2021, as linear regression (for continuous outcomes) and binomial regression analysis (for categorical outcomes) are still being conducted. Conclusions: The results of this study can provide valuable information for the development of more accessible and scalable mental health interventions with increased care capacity for MDD, without sacrificing the quality of care. Trial Registration: ClinicalTrials.gov NCT04478058; http://clinicaltrials.gov/ct2/show/NCT04478058 International Registered Report Identifier (IRRID): DERR1-10.2196/27489 UR - https://www.researchprotocols.org/2021/6/e27489 UR - http://dx.doi.org/10.2196/27489 UR - http://www.ncbi.nlm.nih.gov/pubmed/33990076 ID - info:doi/10.2196/27489 ER - TY - JOUR AU - Beresford, Thomas AU - Ronan, J. Patrick AU - Hipp, Daniel PY - 2021/6/14 TI - A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series JO - JMIR Form Res SP - e26417 VL - 5 IS - 6 KW - cognition KW - COVID-19 KW - safety KW - remote use KW - delirium KW - brain injury, brain KW - diagnosis KW - assessment KW - test KW - telehealth KW - telemedicine N2 - Background: Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective: The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods: We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results: The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions: Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus. UR - https://formative.jmir.org/2021/6/e26417 UR - http://dx.doi.org/10.2196/26417 UR - http://www.ncbi.nlm.nih.gov/pubmed/34010137 ID - info:doi/10.2196/26417 ER - TY - JOUR AU - Dohnt, C. Henriette AU - Dowling, J. Mitchell AU - Davenport, A. Tracey AU - Lee, Grace AU - Cross, P. Shane AU - Scott, M. Elizabeth AU - Song, C. Yun Ju AU - Hamilton, Blake AU - Hockey, J. Samuel AU - Rohleder, Cathrin AU - LaMonica, M. Haley AU - Hickie, B. Ian PY - 2021/6/14 TI - Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study JO - JMIR Res Protoc SP - e24697 VL - 10 IS - 6 KW - mental health service delivery KW - youth mental health KW - model of care coordination KW - transdiagnostic KW - health information technology KW - education KW - training KW - adoption into clinical practice KW - Kirkpatrick evaluation N2 - Background: Australia?s mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney?s Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC?s Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. Objective: This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. Methods: The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. Results: This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District?s Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. Conclusions: The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. International Registered Report Identifier (IRRID): PRR1-10.2196/24697 UR - https://www.researchprotocols.org/2021/6/e24697 UR - http://dx.doi.org/10.2196/24697 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125074 ID - info:doi/10.2196/24697 ER - TY - JOUR AU - Morgiève, Margot AU - Mesdjian, Pierre AU - Las Vergnas, Olivier AU - Bury, Patrick AU - Demassiet, Vincent AU - Roelandt, Jean-Luc AU - Sebbane, Déborah PY - 2021/5/27 TI - Social Representations of e-Mental Health Among the Actors of the Health Care System: Free-Association Study JO - JMIR Ment Health SP - e25708 VL - 8 IS - 5 KW - e-mental health KW - social representations KW - free association task KW - psychiatry KW - mental health KW - mental health service users KW - technology KW - digital health N2 - Background: Electronic mental (e-mental) health offers an opportunity to overcome many challenges such as cost, accessibility, and the stigma associated with mental health, and most people with lived experiences of mental problems are in favor of using applications and websites to manage their mental health problems. However, the use of these new technologies remains weak in the area of mental health and psychiatry. Objective: This study aimed to characterize the social representations associated with e-mental health by all actors to implement new technologies in the best possible way in the health system. Methods: A free-association task method was used. The data were subjected to a lexicometric analysis to qualify and quantify words by analyzing their statistical distribution, using the ALCESTE method with the IRaMuTeQ software. Results: In order of frequency, the terms most frequently used to describe e-mental health in the whole corpus are: ?care? (n=21), ?internet? (n=21), ?computing? (n=15), ?health? (n=14), ?information? (n=13), ?patient? (n=12), and ?tool? (n=12). The corpus of text is divided into 2 themes, with technological and computing terms on one side and medical and public health terms on the other. The largest family is focused on ?care,? ?advances,? ?research,? ?life,? ?quality,? and ?well-being,? which was significantly associated with users. The nursing group used very medical terms such as ?treatment,? ?diagnosis,? ?psychiatry?,? and ?patient? to define e-mental health. Conclusions: This study shows that there is a gap between the representations of users on e-mental health as a tool for improving their quality of life and those of health professionals (except nurses) that are more focused on the technological potential of these digital care tools. Developers, designers, clinicians, and users must be aware of the social representation of e-mental health conditions uses and intention of use. This understanding of everyone?s stakes will make it possible to redirect the development of tools to adapt them as much as possible to the needs and expectations of the actors of the mental health system. UR - https://mental.jmir.org/2021/5/e25708 UR - http://dx.doi.org/10.2196/25708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34042591 ID - info:doi/10.2196/25708 ER - TY - JOUR AU - Alavi, Nazanin AU - Stephenson, Callum AU - Yang, Megan AU - Shirazi, Amirhossein AU - Shao, Yijia AU - Kumar, Anchan AU - Yee, S. Caitlin AU - Miller, Shadé AU - Stefatos, Anthi AU - Gholamzadehmir, Maedeh AU - Abbaspour, Zara AU - Patel, Archana AU - Patel, Charmy AU - Reshetukha, Taras AU - Omrani, Mohsen AU - Groll, Dianne PY - 2021/5/27 TI - Determining the Efficacy of Electronic Cognitive Behavioral Therapy for Generalized Anxiety Disorder Compared to Pharmaceutical Interventions: Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e27772 VL - 10 IS - 5 KW - eHealth KW - mental health KW - anxiety KW - generalized anxiety disorder KW - cognitive behavioral therapy KW - psychotherapy KW - online KW - internet KW - electronic KW - virtual KW - mental health care N2 - Background: Generalized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is cognitive behavioral therapy (CBT) and/or pharmacotherapy. The most common medications used to treat GAD are selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. While CBT is the gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, the electronic delivery of CBT (e-CBT) has emerged as a promising solution to address these barriers. e-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians. Objective: This study aims to investigate the treatment efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD. Methods: This study will use a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis of GAD will be enrolled in 1 of 3 possible treatment arms: (1) e-CBT, (2) medication, or (3) a combination of e-CBT and medication. The e-CBT program will include a 12-week psychotherapy program delivered through the Online Psychotherapy Tool?a secure, cloud-based, digital mental health platform. The treatment efficacy of e-CBT will be compared with that of medication alone and medication in combination with e-CBT. Results: The study received ethics approval in April 2019 and participant recruitment began in June 2019. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 146 participants (e-CBT: n=53; medication: n=49; combination: n=44) have been recruited. Data collection is expected to conclude by June 2021, and data analysis is expected to be completed by October 2021. Linear regression (for continuous outcomes) and binomial regression (for categorical outcomes) analysis will be conducted using interpretive qualitative methods. Conclusions: If either the efficacy of e-CBT is shown to be comparable to that of medication or the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible and affordable treatment that could increase mental health care capacity 4-fold if proven viable. Trial Registration: ClinicalTrials.gov NCT04478526; https://clinicaltrials.gov/ct2/show/NCT04478526 International Registered Report Identifier (IRRID): DERR1-10.2196/27772 UR - https://www.researchprotocols.org/2021/5/e27772 UR - http://dx.doi.org/10.2196/27772 UR - http://www.ncbi.nlm.nih.gov/pubmed/33857917 ID - info:doi/10.2196/27772 ER - TY - JOUR AU - Huygens, J. Martine W. AU - Voogdt-Pruis, R. Helene AU - Wouters, Myrah AU - Meurs, M. Maaike AU - van Lettow, Britt AU - Kleijweg, Conchita AU - Friele, D. Roland PY - 2021/5/3 TI - The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands JO - J Med Internet Res SP - e24908 VL - 23 IS - 5 KW - eHealth KW - telemonitoring KW - self-management KW - telemedicine KW - telehealth N2 - Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2% (18/161) in 2014 to 19.6% (36/184) in 2019 (?24=12.3; P=.02). In 2019, telemonitoring was used by 5.8% (28/485) of people with chronic disease. This was 18.2% (41/225) in GP organizations and 40.4% (44/109), 38.0% (78/205), and 8.9% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were ?comfort? (421/1043, 40.4%) and ?living at home for longer/more comfortably? (334/1047, 31.9%). Health care professionals added ?improvement of self-management? (63/176, 35.8% to 57/71, 80.3%), ?better understanding of the patient?s condition? (47/176, 26.7% to 42/71, 59.2%), ?reduction of workload? (53/134, 39.6% of nurses in elderly care), ?better tailoring of care plan to the patient?s situation? (95/225, 42.2% of GPs), and ?saves time for patients/caregivers? (61/176, 34.7% of medical specialists). Disadvantages mentioned by professionals were that ?it takes time to monitor data? (13/130, 10% to 108/225, 48.0%), ?it takes time to follow up alerts? (15/130, 11.5% to 117/225, 52.0%), and ?it is difficult to estimate which patients can work with telemonitoring? (22/113, 19.5% to 94/225, 41.8%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. UR - https://www.jmir.org/2021/5/e24908 UR - http://dx.doi.org/10.2196/24908 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938808 ID - info:doi/10.2196/24908 ER - TY - JOUR AU - AlHadi, N. Ahmad AU - Alammari, A. Khawla AU - Alsiwat, J. Lojain AU - Alhaidri, E. Nojood AU - Alabdulkarim, H. Nouf AU - Altwaijri, A. Nouf AU - AlSohaili, A. Shamma PY - 2021/5/3 TI - Perception of Mental Health Care Professionals in Saudi Arabia on Computerized Cognitive Behavioral Therapy: Observational Cross-sectional Study JO - JMIR Form Res SP - e26294 VL - 5 IS - 5 KW - CBT KW - iCBT KW - cCBT KW - knowledge KW - attitude KW - mental health care professionals KW - computer usage KW - psychotherapy KW - therapy KW - cognitive behavioral therapy KW - health care worker KW - perception KW - Saudi Arabia KW - preference KW - mental health N2 - Background: Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population. UR - https://formative.jmir.org/2021/5/e26294 UR - http://dx.doi.org/10.2196/26294 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938810 ID - info:doi/10.2196/26294 ER - TY - JOUR AU - Marcotte-Beaumier, Gabrielle AU - Bouchard, Stéphane AU - Gosselin, Patrick AU - Langlois, Frédéric AU - Belleville, Geneviève AU - Marchand, André AU - Dugas, J. Michel PY - 2021/3/15 TI - The Role of Intolerance of Uncertainty and Working Alliance in the Outcome of Cognitive Behavioral Therapy for Generalized Anxiety Disorder Delivered by Videoconference: Mediation Analysis JO - JMIR Ment Health SP - e24541 VL - 8 IS - 3 KW - working alliance KW - videoconference KW - cognitive behavioral therapy KW - intolerance of uncertainty KW - generalized anxiety disorder KW - treatment KW - outcome KW - therapy KW - anxiety KW - uncertainty KW - telehealth N2 - Background: Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. Objective: As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. Methods: A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. Results: The results revealed that the therapeutic bond did not predict treatment outcome (r=?0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=?0.42; P=.004 and r=?0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized ?=?0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. Conclusions: These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027. UR - https://mental.jmir.org/2021/3/e24541 UR - http://dx.doi.org/10.2196/24541 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720024 ID - info:doi/10.2196/24541 ER - TY - JOUR AU - Tönnies, Justus AU - Hartmann, Mechthild AU - Wensing, Michel AU - Szecsenyi, Joachim AU - Peters-Klimm, Frank AU - Brinster, Regina AU - Weber, Dorothea AU - Vomhof, Markus AU - Icks, Andrea AU - Friederich, Hans-Christoph AU - Haun, W. Markus PY - 2021/3/12 TI - Mental Health Specialist Video Consultations Versus Treatment-as-Usual for Patients With Depression or Anxiety Disorders in Primary Care: Randomized Controlled Feasibility Trial JO - JMIR Ment Health SP - e22569 VL - 8 IS - 3 KW - primary care KW - integrated care KW - telepsychiatry KW - videoconferencing KW - depression KW - anxiety KW - recovery KW - randomized controlled trial N2 - Background: Most people affected by depression or anxiety disorders are treated solely by their primary care physician. Access to specialized mental health care is impeded by patients? comorbidity and immobility in aging societies and long waiting times at the providers? end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in primary care settings. Objective: The study aims to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression or anxiety disorders. Methods: Participants were recruited by their primary care physicians during regular practice visits. Patients who had experienced at least moderate symptoms of depression and/or anxiety disorders were considered eligible for the study. Patients were randomized into 2 groups receiving either treatment-as-usual as provided by their general practitioner or up to 5 video consultations conducted by a mental health specialist. Video consultations focused on systematic diagnosis and proactive monitoring using validated clinical rating scales, the establishment of an effective working alliance, and a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment, and attendance at sessions. Effectiveness outcomes included depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale-12), recovery (Recovery Assessment Scale-German [RAS-G]), and perception of chronic illness care (Patient Assessment of Chronic Illness Care), which were measured at baseline and 16 weeks postallocation by assessors blinded to the group allocation. Results: A total of 50 patients with depression and/or anxiety disorders were randomized, 23 in the intervention group and 27 in the treatment-as-usual group. The recruitment yield (number randomized per number screened) and the consent rate (number randomized per number eligible) were 69% (50/73) and 86% (50/58), respectively. Regarding acceptability, 87% (20/23) of the participants in the intervention group completed the intervention. Of the 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 96% (22/23) and 85% (23/27) for the intervention and control groups, respectively. The change from baseline scores at postmeasurement for the No Domination by Symptoms domain of recovery (RAS-G) was somewhat higher in the intervention group than in the control group (Mann-Whitney U test: rank-biserial r=0.19; 95% CI ?0.09 to 0.46; P=.18). We did not detect any notable differences between the intervention and control groups in terms of other effectiveness outcomes. We did not observe any serious adverse events related to the trial. Conclusions: The intervention and study procedures were found to be feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate their effectiveness in routine care. Trial Registration: German Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812. UR - https://mental.jmir.org/2021/3/e22569 UR - http://dx.doi.org/10.2196/22569 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709931 ID - info:doi/10.2196/22569 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 - Rauschenberg, Christian AU - Schick, Anita AU - Hirjak, Dusan AU - Seidler, Andreas AU - Paetzold, Isabell AU - Apfelbacher, Christian AU - Riedel-Heller, G. Steffi AU - Reininghaus, Ulrich PY - 2021/3/10 TI - Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review JO - J Med Internet Res SP - e23365 VL - 23 IS - 3 KW - COVID-19 KW - mHealth KW - eHealth KW - telemedicine KW - prevention KW - mental health promotion KW - intervention KW - digital mental health KW - digital intervention KW - public mental health N2 - Background: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs. UR - https://www.jmir.org/2021/3/e23365 UR - http://dx.doi.org/10.2196/23365 UR - http://www.ncbi.nlm.nih.gov/pubmed/33606657 ID - info:doi/10.2196/23365 ER - TY - JOUR AU - Lewis, Matthew AU - Palmer, J. Victoria AU - Kotevski, Aneta AU - Densley, Konstancja AU - O'Donnell, L. Meaghan AU - Johnson, Caroline AU - Wohlgezogen, Franz AU - Gray, Kathleen AU - Robins-Browne, Kate AU - Burchill, Luke PY - 2021/3/9 TI - Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol JO - JMIR Res Protoc SP - e26168 VL - 10 IS - 3 KW - mental health KW - mobile applications KW - COVID-19 KW - health personnel KW - experience-based co-design KW - impact KW - evaluation KW - digital interventions KW - app KW - intervention KW - health care worker KW - design KW - delivery KW - support N2 - Background: The COVID-19 pandemic has highlighted the importance of health care workers? mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 UR - https://www.researchprotocols.org/2021/3/e26168 UR - http://dx.doi.org/10.2196/26168 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635823 ID - info:doi/10.2196/26168 ER - TY - JOUR AU - Dwyer, Anne AU - de Almeida Neto, Abílio AU - Estival, Dominique AU - Li, Weicong AU - Lam-Cassettari, Christa AU - Antoniou, Mark PY - 2021/2/24 TI - Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review JO - JMIR Ment Health SP - e19478 VL - 8 IS - 2 KW - mental health services KW - text messaging KW - counseling KW - mobile health KW - natural language processing N2 - Background: People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. Objective: This scoping review maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm. Methods: We conducted a comprehensive electronic literature search of PsycINFO, PubMed, ERIC, and Web of Science databases for articles published in English through November 2020. Results: Of the 9134 articles screened, 70 met the eligibility criteria and were included in the review. There is preliminary evidence to suggest that text-based, real-time communication with a qualified therapist is an effective form of e-mental health service delivery, particularly for individuals concerned with stigma and confidentiality. There is also converging evidence that text-based communications that have been analyzed using computational linguistic techniques can be used to accurately predict progress during treatment and identify individuals at risk of serious mental health conditions and suicide. Conclusions: This review reveals a clear need for intensified research into the extent to which text-based counseling (and predictive models using modern computational linguistics tools) may help deliver mental health treatments to underserved groups such as regional communities, identify at-risk individuals for targeted intervention, and predict progress during treatment. Such approaches have implications for policy development to improve intervention accessibility in at-risk and underserved populations. UR - https://mental.jmir.org/2021/2/e19478 UR - http://dx.doi.org/10.2196/19478 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625373 ID - info:doi/10.2196/19478 ER - TY - JOUR AU - Gamble, Beau AU - Depa, Katherine AU - Holmes, A. Emily AU - Kanstrup, Marie PY - 2021/2/22 TI - Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma: Qualitative Interview Study JO - JMIR Ment Health SP - e23712 VL - 8 IS - 2 KW - digital intervention KW - remote delivery KW - intrusive memories KW - psychological trauma KW - qualitative feedback KW - cognitive science KW - posttraumatic stress disorder N2 - Background: The COVID-19 pandemic has escalated the global need for remotely delivered and scalable interventions after psychological trauma. A brief intervention involving a computer game as an imagery-competing task has shown promising results for reducing the number of intrusive memories of trauma?one of the core clinical symptoms of posttraumatic stress disorder. To date, the intervention has only been delivered face-to-face. To be tested and implemented on a wider scale, digital adaptation for remote delivery is crucial. An important first step is to develop digitalized intervention materials in a systematic way based on feedback from clinicians, researchers, and students in preparation for pilot testing with target users. Objective: The first aim of this study is to obtain and analyze qualitative feedback on digital intervention materials, namely two animated videos and two quizzes that explain the target clinical symptoms and provide intervention instructions. The second aim is to refine the digitalized materials based on this feedback. Methods: We conducted semistructured interviews with 12 participants who had delivered or had knowledge of the intervention when delivered face-to-face. We obtained in-depth feedback on the perceived feasibility of using the digitalized materials and suggestions for improvements. Interviews were assessed using qualitative content analysis, and suggested improvements were evaluated for implementation using a systematic method of prioritization. Results: A total of three overarching themes were identified from the data. First, participants were highly positive about the potential benefits of using these digital materials for remote delivery, reporting that the videos effectively conveyed key concepts of the symptom and its treatment. Second, some modifications to the materials were suggested for improving clarity. On the basis of this feedback, we made nine specific changes. Finally, participants raised some key challenges for remote delivery, mainly in overcoming the lack of real-time communication during the intervention. Conclusions: Clinicians, researchers, and clinical psychology students were overall confident in the use of digitalized materials to remotely deliver a brief intervention to reduce intrusive memories of trauma. Guided by participant feedback, we identified and implemented changes to refine the intervention materials. This study lays the groundwork for the next step: pilot testing remote delivery of the full intervention to trauma survivors. UR - https://mental.jmir.org/2021/2/e23712 UR - http://dx.doi.org/10.2196/23712 UR - http://www.ncbi.nlm.nih.gov/pubmed/33616540 ID - info:doi/10.2196/23712 ER - TY - JOUR AU - Cataldo, Francesco AU - Chang, Shanton AU - Mendoza, Antonette AU - Buchanan, George PY - 2021/2/19 TI - A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review JO - JMIR Ment Health SP - e19004 VL - 8 IS - 2 KW - videoconference KW - psychotherapy KW - professional-patient relations KW - client-psychologist relationships KW - therapeutic alliance KW - telehealth KW - mobile phone N2 - Background: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. Objective: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. Methods: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. Results: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. Conclusions: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients. UR - http://mental.jmir.org/2021/2/e19004/ UR - http://dx.doi.org/10.2196/19004 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605891 ID - info:doi/10.2196/19004 ER - TY - JOUR AU - Molfenter, Todd AU - Roget, Nancy AU - Chaple, Michael AU - Behlman, Stephanie AU - Cody, Olivia AU - Hartzler, Bryan AU - Johnson, Edward AU - Nichols, Maureen AU - Stilen, Patricia AU - Becker, Sara PY - 2021/2/8 TI - Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study JO - JMIR Ment Health SP - e25835 VL - 8 IS - 2 KW - COVID-19 KW - substance use disorders KW - technology acceptance model KW - telehealth N2 - Background: Social distancing guidelines for COVID-19 have caused a rapid transition to telephone and video technologies for delivering treatment for substance use disorders (SUDs). Objective: This study examined the adoption of these technologies across the SUD service continuum, acceptance of these technologies among service providers, and intent of providers to use these technologies after the pandemic. Additional analysis using the validated technology acceptance model (TAM) was performed to test the potential applications of these technologies after the pandemic. The study objectives were as follows: (1) to assess the use of telehealth (telephone and video technologies) for different SUD services during COVID-19 in May-June 2020, (2) to assess the intended applications of telehealth for SUD services beyond COVID-19, (3) to evaluate the perceived ease of use and value of telehealth for delivering SUD services, and (4) to assess organizational readiness for the sustained use of telehealth services. Methods: An online survey on the use of telephonic and video services was distributed between May and August 2020 to measure the current use of these services, perceived organizational readiness to use these services, and the intent to use these services after COVID-19. In total, 8 of 10 regional Addiction Technology Transfer Centers representing 43 states distributed the survey. Individual organizations were the unit of analysis. Results: In total, 457 organizations responded to the survey. Overall, the technology was widely used; >70% (n>335) of organizations reported using telephone or video platforms for most services. The odds of the intent of organizations to use these technologies to deliver services post COVID-19 were significantly greater for all but two services (ie, telephonic residential counseling and buprenorphine therapy; mean odds ratio 3.79, range 1.87-6.98). Clinical users preferred video technologies to telephone technologies for virtually all services. Readiness to use telephone and video technologies was high across numerous factors, though telephonic services were considered more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced the intent to use both telephone and video technologies. Conclusions: The overall perceived ease of use and usefulness of telephonic and video services suggest promising post?COVID-19 applications of these services. Survey participants consistently preferred video services to telephonic services; however, the availability of telephonic services to those lacking easy access to video technology is an important characteristic of these services. Future studies should review the acceptance of telehealth services and their comparative impact on SUD care outcomes. UR - http://mental.jmir.org/2021/2/e25835/ UR - http://dx.doi.org/10.2196/25835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481760 ID - info:doi/10.2196/25835 ER - TY - JOUR AU - Depp, Colin AU - Ehret, Blaire AU - Villa, Jennifer AU - Perivoliotis, Dimitri AU - Granholm, Eric PY - 2021/2/8 TI - A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial JO - JMIR Res Protoc SP - e14378 VL - 10 IS - 2 KW - prevention KW - mental health services KW - psychosis KW - technology N2 - Background: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378 UR - https://www.researchprotocols.org/2021/2/e14378 UR - http://dx.doi.org/10.2196/14378 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555265 ID - info:doi/10.2196/14378 ER - TY - JOUR AU - Kunkle, Sarah AU - Yip, Manny AU - Hunt, Justin AU - ?, Watson AU - Udall, Dana AU - Arean, Patricia AU - Nierenberg, Andrew AU - Naslund, A. John PY - 2021/1/26 TI - Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study JO - JMIR Form Res SP - e24662 VL - 5 IS - 1 KW - mental health KW - digital health KW - anxiety KW - telehealth KW - virtual care KW - utilization KW - outcome KW - retrospective KW - observational N2 - Background: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. Objective: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. Methods: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. Results: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (?app-only?). Higher GAD-7 intake scores were also associated with decreased odds of improvement. Conclusions: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members. UR - http://formative.jmir.org/2021/1/e24662/ UR - http://dx.doi.org/10.2196/24662 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496679 ID - info:doi/10.2196/24662 ER - TY - JOUR AU - Beentjes, A. Titus A. AU - van Gaal, I. Betsie G. AU - Vermeulen, Hester AU - Nijhuis-van der Sanden, G. Maria W. AU - Goossens, J. Peter J. PY - 2021/1/20 TI - A Blended Electronic Illness Management and Recovery Program for People With Severe Mental Illness: Qualitative Process Evaluation Alongside a Randomized Controlled Trial JO - JMIR Ment Health SP - e20860 VL - 8 IS - 1 KW - mental health recovery KW - self-management KW - telemedicine KW - mental health services KW - qualitative research N2 - Background: We conducted a trial to test the electronic Illness Management and Recovery (e-IMR) intervention to provide conclusions on the potential efficacy of eHealth for people with severe mental illness (SMI). In the e-IMR intervention, we used the standard IMR program content and methodology and combined face-to-face sessions with internet-based strategies on the constructed e-IMR internet platform. During the trial, the e-IMR platform was sparsely used. Objective: This study aimed to evaluate the added value of the e-IMR intervention and the barriers and facilitators that can explain the low use of the e-IMR platform. Methods: This process evaluation was designed alongside a multicenter, cluster randomized controlled trial. In this study, we included all available participants and trainers from the intervention arm of the trial. Baseline characteristics were used to compare users with nonusers. Qualitative data were gathered at the end of the semistructured interviews. Using theoretical thematic analyses, the data were analyzed deductively using a pre-existing coding frame. Results: Out of 41 eligible participants and 14 trainers, 27 participants and 11 trainers were interviewed. Of the 27 participants, 10 were identified as users. eHealth components that had added value were the persuasive nature of the goal-tracking sheets, monitoring, and the peer testimonials, which had the potential to enhance group discussions and disclosure by participants. The low use of the e-IMR platform was influenced by the inflexibility of the platform, the lack of information technology (IT) resources, the group context, participants? low computer skills and disabilities, and the hesitant eHealth attitude of the trainers. Conclusions: The extent of eHealth readiness and correlations with vulnerabilities in persons with SMI need further investigation. This study shows that flexible options were needed for the use of e-IMR components and that options should be provided only in response to a participant?s need. Use of the e-IMR intervention in the future is preconditioned by checking the available IT resources (such as tablets for participants) providing computer or internet guidance to participants outside the group sessions, evaluating the eHealth attitude and skills of trainers, and tailoring eHealth training to increase the skills of future e-IMR trainers. Trial Registration: Netherlands Trial Register NTR4772; https://www.trialregister.nl/trial/4621 International Registered Report Identifier (IRRID): RR2-10.1186/s12913-016-1267-z UR - http://mental.jmir.org/2021/1/e20860/ UR - http://dx.doi.org/10.2196/20860 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470945 ID - info:doi/10.2196/20860 ER - TY - JOUR AU - Richardson, G. Chris AU - Slemon, Allie AU - Gadermann, Anne AU - McAuliffe, Corey AU - Thomson, Kimberly AU - Daly, Zachary AU - Salway, Travis AU - Currie, M. Leanne AU - David, Anita AU - Jenkins, Emily PY - 2020/12/30 TI - Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic?Related Stress Among the General Population in Canada: Cross-Sectional Survey Study JO - J Med Internet Res SP - e24868 VL - 22 IS - 12 KW - virtual health KW - digital health KW - virtual mental health KW - mental health KW - public health KW - COVID-19 KW - coping KW - stress KW - implementation KW - utilization N2 - Background: The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. Objective: The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. Methods: Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. Results: Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping ?not well? with COVID-19?related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. Conclusions: Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use. UR - http://www.jmir.org/2020/12/e24868/ UR - http://dx.doi.org/10.2196/24868 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315583 ID - info:doi/10.2196/24868 ER - TY - JOUR AU - Guinart, Daniel AU - Marcy, Patricia AU - Hauser, Marta AU - Dwyer, Michael AU - Kane, M. John PY - 2020/12/22 TI - Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey JO - JMIR Ment Health SP - e24761 VL - 7 IS - 12 KW - telehealth KW - telepsychiatry KW - telemedicine KW - attitude KW - patients KW - survey KW - COVID-19 KW - mental health N2 - Background: The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. Objective: The aim of this study is to examine a large number of patients? experiences of, use of, and attitudes toward telepsychiatry. Methods: An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. Results: In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2%) participants using video and 2312 (81.5%) using telephone. In addition, 1922 (63.6%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1%) and flexible scheduling/rescheduling (n=1389, 45.5%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. Conclusions: Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients? perceptions change over time. UR - http://mental.jmir.org/2020/12/e24761/ UR - http://dx.doi.org/10.2196/24761 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302254 ID - info:doi/10.2196/24761 ER - TY - JOUR AU - Severe, Jennifer AU - Tang, Ruiqi AU - Horbatch, Faith AU - Onishchenko, Regina AU - Naini, Vidisha AU - Blazek, Carol Mary PY - 2020/12/22 TI - Factors Influencing Patients? Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey JO - JMIR Form Res SP - e25469 VL - 4 IS - 12 KW - telepsychiatry KW - COVID-19 KW - video visit KW - telephone visit KW - telehealth KW - mental health KW - United States KW - decision making KW - virtual care N2 - Background: Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients? initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective: This paper seeks to examine factors influencing patients? initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods: Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor?s stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results: A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8%) initially chose to receive psychiatric care through video visits, while 13.5% (n=33) chose telephone visits and 1.2% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95% CI 0.02-0.06). Patients aged ?44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions: In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth. UR - https://formative.jmir.org/2020/12/e25469 UR - http://dx.doi.org/10.2196/25469 UR - http://www.ncbi.nlm.nih.gov/pubmed/33320823 ID - info:doi/10.2196/25469 ER - TY - JOUR AU - Wright, Jesse AU - Dewan, Shyam AU - Hilty, Donald AU - Dewan, A. Naakesh PY - 2020/12/4 TI - Health Care Providers? Perceptions of Quality, Acceptance, and Satisfaction With Telebehavioral Health Services During the COVID-19 Pandemic: Survey-Based Study JO - JMIR Ment Health SP - e23245 VL - 7 IS - 12 KW - telepsychiatry KW - COVID-19 KW - telehealth KW - perception KW - quality KW - acceptability KW - satisfaction KW - behavior KW - mental health KW - health care provider N2 - Background: Due to rapidly increasing rates of COVID-19 across the country, system-wide changes were needed to protect the health and safety of health care providers and consumers alike. Technology-based care has received buy-in from all participants, and the need for technological assistance has been prioritized. Objective: The objective of this study was to determine the initial perceptions and experiences of interprofessional behavioral health providers about shifting from traditional face-to-face care to virtual technologies (telephonic and televideo) during the COVID-19 pandemic. Methods: A survey-based study was performed at a large, integrated medical health care system in West-Central Florida that rapidly implemented primary care provision via telephone and televideo as of March 18, 2020. A 23-item anonymous survey based on a 7-point Likert scale was developed to determine health care providers? perceptions about telephonic and televideo care. The survey took 10 minutes to complete and was administered to 280 professionals between April 27 and May 11, 2020. Results: In all, 170 respondents completed the survey in entirety, among which 78.8% (134/170) of the respondents were female and primarily aged 36-55 years (89/170, 52.4%). A majority of the respondents were outpatient-based providers (159/170, 93.5%), including psychiatrists, therapists, counselors, and advanced practice nurses. Most of them (144/170, 84.7%) had used televideo for less than 1 year; they felt comfortable and satisfied with either telephonic or televideo mode and that they were able to meet the patients? needs. Conclusions: Our survey findings suggest that health care providers valued televideo visits equally or preferred them more than telephonic visits in the domains of quality of care, technology performance, satisfaction of technology, and user acceptance. UR - http://mental.jmir.org/2020/12/e23245/ UR - http://dx.doi.org/10.2196/23245 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180740 ID - info:doi/10.2196/23245 ER - TY - JOUR AU - Humer, Elke AU - Stippl, Peter AU - Pieh, Christoph AU - Pryss, Rüdiger AU - Probst, Thomas PY - 2020/11/27 TI - Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study JO - J Med Internet Res SP - e20246 VL - 22 IS - 11 KW - psychotherapists KW - remote psychotherapy KW - telephone KW - internet KW - experiences KW - expectations KW - COVID-19 KW - telehealth KW - therapy KW - psychology N2 - Background: The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy. Objective: This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020). Methods: Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed. Results: Psychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P<.001). Psychodynamic (P=.001) and humanistic (P=.005) therapists reported a higher comparability of telephone-based psychotherapy to in-person psychotherapy than behavioral therapists. Experiences with remote therapy (both web- and telephone-based) were more positive than previously expected (P<.001). Psychodynamic therapists reported more positive experiences with telephone-based psychotherapy than expected compared to behavioral (P=.03) and systemic (P=.002) therapists. In general, web-based psychotherapy was rated more positively (regarding comparability to psychotherapy with personal contact and experiences vs expectations) than telephone-based psychotherapy (P<.001); however, psychodynamic therapists reported their previous expectations to be equal to their actual experiences for both telephone- and web-based psychotherapy. Conclusions: Psychotherapists found their experiences with remote psychotherapy (ie, web- or telephone-based psychotherapy) to be better than expected but found that this mode was not totally comparable to face-to-face psychotherapy with personal contact. Especially, behavioral therapists were found to rate telephone-based psychotherapy less favorably than therapists with other theoretical backgrounds. UR - http://www.jmir.org/2020/11/e20246/ UR - http://dx.doi.org/10.2196/20246 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151896 ID - info:doi/10.2196/20246 ER - TY - JOUR AU - Dominguez-Rodriguez, Alejandro AU - De La Rosa-Gómez, Anabel AU - Hernández Jiménez, Jesús M. AU - Arenas-Landgrave, Paulina AU - Martínez-Luna, Cristina Sofía AU - Alvarez Silva, Joabian AU - García Hernández, Ernesto José AU - Arzola-Sánchez, Carlos AU - Acosta Guzmán, Victoria PY - 2020/11/16 TI - A Self-Administered Multicomponent Web-Based Mental Health Intervention for the Mexican Population During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e23117 VL - 9 IS - 11 KW - e-health KW - positive psychology KW - cognitive behavioral therapy, behavioral activation therapy, COVID-19 KW - internet KW - intervention KW - telepsychology, Mexican sample N2 - Background: The COVID-19 pandemic has become a public health emergency of international concern; it has not only threatened people's physical health but has also affected their mental health and psychological well-being. It is necessary to develop and offer strategies to reduce the psychological impact of the outbreak and promote adaptive coping. Objective: This study protocol aims to describe a self-administered web-based intervention (Mental Health COVID-19) based on the principles of positive psychology supported by elements of cognitive behavioral therapy and behavioral activation therapy to reduce the symptoms of anxiety and depression and increase positive emotions and sleep quality during and after the COVID-19 outbreak through a telepsychology system. Methods: A randomized controlled clinical superiority trial with two independent groups will be performed, with intrasubject measures at four evaluation periods: pretest, posttest, 3-month follow-up, and 6-month follow-up. Participants will be randomly assigned to one of two groups: self-administered intervention with assistance via chat or self-administered intervention without assistance via chat. The total required sample size will be 166 participants (83 per group). Results: The clinical trial is ongoing. This protocol was approved by the Research Ethics Board of the Free School of Psychology-University of Behavioral Sciences (Escuela libre de Psicología-Universidad de Ciencias del Comportamiento). The aim is to publish the preliminary results in December 2020. A conservative approach will be adopted, and the size effect will be estimated using the Cohen d index with a significance level (?) of .05 (95% reliability) and a conventional 80% power statistic. Conclusions: The central mechanism of action will be to investigate the effectiveness of an intervention based on positive psychology through a web platform that can be delivered through computers and tablets, with content that has been rigorously contextualized to the Mexican culture to provide functional strategies to help the target users cope with the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/ct2/show/NCT04468893 International Registered Report Identifier (IRRID): DERR1-10.2196/23117 UR - http://www.researchprotocols.org/2020/11/e23117/ UR - http://dx.doi.org/10.2196/23117 UR - http://www.ncbi.nlm.nih.gov/pubmed/33196449 ID - info:doi/10.2196/23117 ER - TY - JOUR AU - Lal, Shalini AU - Gleeson, John AU - Rivard, Lysanne AU - D'Alfonso, Simon AU - Joober, Ridha AU - Malla, Ashok AU - Alvarez-Jimenez, Mario PY - 2020/10/29 TI - Adaptation of a Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Services for First-Episode Psychosis: Results From the Horyzons-Canada Phase 1 Study JO - JMIR Form Res SP - e19887 VL - 4 IS - 10 KW - psychotic disorders KW - mental health KW - telemedicine KW - young adult KW - mental health services KW - cultural adaptation KW - mobile phone KW - e-mental health KW - virtual care KW - schizophrenia KW - e-health N2 - Background: Developing a digital health innovation can require a substantial amount of financial and human resource investment before it can be scaled for implementation across geographical, cultural, and health care contexts. As such, there is an increased interest in leveraging eHealth innovations developed and tested in one country or jurisdiction and using these innovations in local settings. However, limited knowledge exists on the processes needed to appropriately adapt digital health innovations to optimize their transferability across geographical, cultural, and contextual settings. Objective: We report on the results of an adaptation study of Horyzons, a digital health innovation originally developed and tested in Australia. Horyzons is designed to prevent relapses and support recovery in young people receiving services for first-episode psychosis (FEP). The aim of this study is to assess the initial acceptability of Horyzons and adapt it in preparation for pilot testing in Canada. Methods: This research took place in 2 specialized early intervention clinics for FEP, located in 1 urban and 1 urban-rural setting, in 2 Canadian provinces. A total of 26 participants were recruited: 15 clinicians (age range 26-56 years) and 11 patients (age range 19-37 years). Following the digital health adaptation framework developed by our team, we used a mixed methods approach, combining descriptive quantitative and qualitative methods across 3 stages of data collection (focus groups, interviews, and consultations), analysis, and adaptations. Results: Overall, patients and clinicians appreciated the strengths-based approach and social media features of Horyzons. However, participants expressed concerns related to implementation, especially in relation to capacity (eg, site moderation, crisis management, internet speed in rural locations). They also provided suggestions for adapting content and features, for example, in relation to community resources, volume of text, universal accessibility (eg, for individuals with limitations in vision), and optimization of platform accessibility through mobile devices. Additional aspects of the innovation were flagged for adaptation during the final stages of preparing it for live implementation. These included terms of use, time zone configuration to reflect local time and date, safety and moderation protocols, the need help now feature, and the list of trigger words to flag posts indicative of potential risk. Conclusions: In the context of the COVID-19 pandemic and public health guidelines for social distancing, there is an increasing interest and need to leverage the internet and mobile technologies for delivering youth mental health services. As countries look to one another for guidance on how to navigate changing social dynamics, knowledge on how to utilize and adapt existing innovations across contexts is now more important than ever. Using a systematic approach, this study illustrates the methods, processes, results, and lessons learned on adapting a digital health innovation to enhance its local acceptability. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8810 UR - http://formative.jmir.org/2020/10/e19887/ UR - http://dx.doi.org/10.2196/19887 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118945 ID - info:doi/10.2196/19887 ER - TY - JOUR AU - Haun, W. Markus AU - Stephan, Isabella AU - Wensing, Michel AU - Hartmann, Mechthild AU - Hoffmann, Mariell AU - Friederich, Hans-Christoph PY - 2020/10/15 TI - Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory JO - JMIR Ment Health SP - e23660 VL - 7 IS - 10 KW - video consultations KW - videoconferencing KW - telehealth KW - integrated care KW - mental health KW - preimplementation KW - diffusion of innovations KW - early adopters KW - mixed methods KW - cumulative logit model KW - content analysis N2 - Background: Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. Objective: This mixed method preimplementation study aims to assess GPs? intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). Methods: Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. Results: This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (?=2.03, SE 0.345, P<.001), supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC, and characteristics of supporting and nonsupporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. Conclusions: A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs. UR - http://mental.jmir.org/2020/10/e23660/ UR - http://dx.doi.org/10.2196/23660 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055058 ID - info:doi/10.2196/23660 ER - TY - JOUR AU - Stull, W. Samuel AU - McKnight, R. Erin AU - Bonny, E. Andrea PY - 2020/10/9 TI - Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? JO - JMIR Pediatr Parent SP - e23463 VL - 3 IS - 2 KW - adolescent KW - opioid use disorder KW - treatment KW - telehealth KW - drug KW - perspective KW - opioid KW - COVID-19 KW - young adult UR - http://pediatrics.jmir.org/2020/2/e23463/ UR - http://dx.doi.org/10.2196/23463 UR - http://www.ncbi.nlm.nih.gov/pubmed/33016885 ID - info:doi/10.2196/23463 ER - TY - JOUR AU - Bierbooms, A. Joyce J. P. AU - van Haaren, Monique AU - IJsselsteijn, A. Wijnand AU - de Kort, W. Yvonne A. AU - Feijt, Milou AU - Bongers, B. Inge M. PY - 2020/10/8 TI - Integration of Online Treatment Into the ?New Normal? in Mental Health Care in Post?COVID-19 Times: Exploratory Qualitative Study JO - JMIR Form Res SP - e21344 VL - 4 IS - 10 KW - online treatment KW - sustainability KW - mental health care KW - COVID-19 N2 - Background: The COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the ?new normal? in mental health care will be like in post?COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? Objective: In this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. Methods: In an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. Results: From the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. Conclusions: Sustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care. UR - http://formative.jmir.org/2020/10/e21344/ UR - http://dx.doi.org/10.2196/21344 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001835 ID - info:doi/10.2196/21344 ER - TY - JOUR AU - Waqas, Ahmed AU - Teoh, Huat Soo AU - Lapão, Velez Luís AU - Messina, Ary Luiz AU - Correia, César Jorge PY - 2020/10/2 TI - Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis JO - J Med Internet Res SP - e18835 VL - 22 IS - 10 KW - telemedicine KW - scientometric analysis KW - evidence synthesis KW - health information technology KW - research KW - theme N2 - Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. UR - https://www.jmir.org/2020/10/e18835 UR - http://dx.doi.org/10.2196/18835 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006571 ID - info:doi/10.2196/18835 ER - TY - JOUR AU - Sasangohar, Farzan AU - Bradshaw, R. Major AU - Carlson, Millen Marianne AU - Flack, N. James AU - Fowler, C. James AU - Freeland, Diana AU - Head, John AU - Marder, Kate AU - Orme, William AU - Weinstein, Benjamin AU - Kolman, M. Jacob AU - Kash, Bita AU - Madan, Alok PY - 2020/10/1 TI - Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective JO - J Med Internet Res SP - e22523 VL - 22 IS - 10 KW - telemedicine KW - psychiatry KW - preventive psychiatry KW - SARS virus KW - pandemic KW - prevention KW - COVID-19 KW - telehealth KW - perspective UR - https://www.jmir.org/2020/10/e22523 UR - http://dx.doi.org/10.2196/22523 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936768 ID - info:doi/10.2196/22523 ER - TY - JOUR AU - Reilly, E. Shannon AU - Zane, L. Katherine AU - McCuddy, T. William AU - Soulliard, A. Zachary AU - Scarisbrick, M. David AU - Miller, E. Liv AU - Mahoney III, J. James PY - 2020/10/1 TI - Mental Health Practitioners? Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study JO - JMIR Ment Health SP - e21237 VL - 7 IS - 9 KW - COVID-19 KW - clinical practice KW - tele?mental health KW - mental health KW - survey N2 - Background: The COVID-19 pandemic has been associated with increased psychological distress, signaling the need for increased mental health services in the context of stay-at-home policies. Objective: This study aims to characterize how mental health practitioners have changed their practices during the pandemic. The authors hypothesize that mental health practitioners would increase tele?mental health services and that certain provider types would be better able to adapt to tele?mental health than others. Methods: The study surveyed 903 practitioners, primarily psychologists/doctoral-level (Psych/DL) providers, social workers/master?s-level (SW/ML) providers, and neuropsychologists employed in academic medical centers or private practices. Differences among providers were examined using Bonferroni-adjusted chi-square tests and one-way Bonferroni-adjusted analyses of covariance. Results: The majority of the 903 mental health practitioners surveyed rapidly adjusted their practices, predominantly by shifting to tele?mental health appointments (n=729, 80.82%). Whereas 80.44% (n=625) were not using tele?mental health in December 2019, only 22.07% (n=188) were not by late March or early April 2020. Only 2.11% (n=19) reported no COVID-19?related practice adjustments. Two-thirds (596/888, 67.10%) reported providing additional therapeutic services specifically to treat COVID-19?related concerns. Neuropsychologists were less likely and Psych/DL providers and SW/ML providers were more likely than expected to transition to tele?mental health (P<.001). Trainees saw fewer patients (P=.01) and worked remotely more than licensed practitioners (P=.03). Despite lower rates of information technology service access (P<.001), private practice providers reported less difficulty implementing tele?mental health than providers in other settings (P<.001). Overall, the majority (530/889, 59.62%) were interested in continuing to provide tele?mental health services in the future. Conclusions: The vast majority of mental health providers in this study made practice adjustments in response to COVID-19, predominantly by rapidly transitioning to tele?mental health services. Although the majority reported providing additional therapeutic services specifically to treat COVID-19?related concerns, only a small subset endorsed offering such services to medical providers. This has implications for future practical directions, as frontline workers may begin to seek mental health treatment related to the pandemic. Despite differences in tele?mental health uptake based on provider characteristics, the majority were interested in continuing to provide such services in the future. This may help to expand clinical services to those in need via tele?mental health beyond the COVID-19 pandemic. UR - https://mental.jmir.org/2020/10/e21237/ UR - http://dx.doi.org/10.2196/21237 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931440 ID - info:doi/10.2196/21237 ER - TY - JOUR AU - Serhal, Eva AU - Kirvan, Anne AU - Sanches, Marcos AU - Crawford, Allison PY - 2020/9/29 TI - Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains JO - J Med Internet Res SP - e19198 VL - 22 IS - 9 KW - telemedicine KW - psychiatry KW - mental health KW - patient satisfaction KW - quality of health care N2 - Background: Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. Objective: This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. Methods: The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. Results: The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. Conclusions: By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens. UR - http://www.jmir.org/2020/9/e19198/ UR - http://dx.doi.org/10.2196/19198 UR - http://www.ncbi.nlm.nih.gov/pubmed/32755896 ID - info:doi/10.2196/19198 ER - TY - JOUR AU - Jones, Chelsea AU - Miguel-Cruz, Antonio AU - Smith-MacDonald, Lorraine AU - Cruikshank, Emily AU - Baghoori, Delaram AU - Kaur Chohan, Avneet AU - Laidlaw, Alexa AU - White, Allison AU - Cao, Bo AU - Agyapong, Vincent AU - Burback, Lisa AU - Winkler, Olga AU - Sevigny, R. Phillip AU - Dennett, Liz AU - Ferguson-Pell, Martin AU - Greenshaw, Andrew AU - Brémault-Phillips, Suzette PY - 2020/9/21 TI - Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review JO - JMIR Mhealth Uhealth SP - e22079 VL - 8 IS - 9 KW - trauma KW - mental health KW - telemedicine KW - therapy KW - rehabilitation KW - digital health KW - psychotherapy KW - military KW - veteran KW - first responder KW - public safety personnel KW - teletherapy KW - telepsychiatry KW - mobile phone N2 - Background: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. Objective: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. Methods: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. Results: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. Conclusions: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted. UR - http://mhealth.jmir.org/2020/9/e22079/ UR - http://dx.doi.org/10.2196/22079 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955456 ID - info:doi/10.2196/22079 ER - TY - JOUR AU - Ramtekkar, Ujjwal AU - Bridge, A. Jeffrey AU - Thomas, Glenn AU - Butter, Eric AU - Reese, Jennifer AU - Logan, Erica AU - Lin, Simon AU - Axelson, David PY - 2020/9/18 TI - Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19 JO - JMIR Ment Health SP - e20157 VL - 7 IS - 9 KW - telepsychiatry KW - telebehavioral health KW - child and adolescent psychiatry KW - COVID-19 UR - https://mental.jmir.org/2020/9/e20157 UR - http://dx.doi.org/10.2196/20157 UR - http://www.ncbi.nlm.nih.gov/pubmed/32525485 ID - info:doi/10.2196/20157 ER - TY - JOUR AU - Smith, Katharine AU - Ostinelli, Edoardo AU - Macdonald, Orla AU - Cipriani, Andrea PY - 2020/8/28 TI - COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians JO - JMIR Ment Health SP - e21108 VL - 7 IS - 8 KW - digital mental health KW - telepsychiatry KW - evidence-based guidance KW - systematic review KW - mental health KW - COVID-19 N2 - Background: The coronavirus disease (COVID-19) presents unique challenges in health care, including mental health care provision. Telepsychiatry can provide an alternative to face-to-face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. Objective: The aim of this paper is to produce an open-access, easy-to-consult, and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach. Methods: We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre?COVID-19 guidelines and other digital mental health topics where relevant. We summarized the data we extracted as answers to specific clinical questions. Results: Findings from this study are presented as both a short practical checklist for clinicians and detailed textboxes with a full summary of all the guidelines. The summary textboxes are also available on an open-access webpage, which is regularly updated. These findings reflected the strong evidence base for the use of telepsychiatry and included guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance, and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focused on practical implementation and US guidelines more expansive and detailed. Guidelines on possible combinations with other digital technologies such as apps (eg, from the US Food and Drug Administration, the National Health Service Apps Library, and the National Institute for Health and Care Excellence) are less detailed. Several key areas were not represented. Although some special populations such as child and adolescent, and older adult, and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder, and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, the initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines. Conclusions: We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organizations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organizational change in the short- and long-term. Providing easily accessible guidance is a first step but will need cultural change to implement as clinicians start to view telepsychiatry not just as a replacement but as a parallel and complementary form of delivering therapy with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post?COVID-19, and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment. UR - https://mental.jmir.org/2020/8/e21108 UR - http://dx.doi.org/10.2196/21108 UR - http://www.ncbi.nlm.nih.gov/pubmed/32658857 ID - info:doi/10.2196/21108 ER - TY - JOUR AU - Drissi, Nidal AU - Ouhbi, Sofia AU - Janati Idrissi, Abdou Mohammed AU - Fernandez-Luque, Luis AU - Ghogho, Mounir PY - 2020/8/28 TI - Connected Mental Health: Systematic Mapping Study JO - J Med Internet Res SP - e19950 VL - 22 IS - 8 KW - mental health KW - connected health KW - eHealth KW - mobile health KW - telehealth KW - mHealth KW - mobile phone KW - health informatics KW - review KW - interdisciplinary research KW - information technology KW - information systems N2 - Background: Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. Objective: The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. Methods: A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. Results: The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. Conclusions: CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues. UR - http://www.jmir.org/2020/8/e19950/ UR - http://dx.doi.org/10.2196/19950 UR - http://www.ncbi.nlm.nih.gov/pubmed/32857055 ID - info:doi/10.2196/19950 ER - TY - JOUR AU - Singla, Radha Daisy AU - Lemberg-Pelly, Sasha AU - Lawson, Andrea AU - Zahedi, Nika AU - Thomas-Jacques, Tyla AU - Dennis, Cindy-Lee PY - 2020/8/27 TI - Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective JO - JMIR Ment Health SP - e19271 VL - 7 IS - 8 KW - nonspecialist providers KW - task sharing KW - perinatal mental health KW - perinatal depression KW - telemedicine KW - psychological treatments N2 - Background: Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers?individuals with no formal training in mental health?have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery. Objective: The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider?delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective. Methods: This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups. Results: Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups. Conclusions: These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts. UR - http://mental.jmir.org/2020/8/e19271/ UR - http://dx.doi.org/10.2196/19271 UR - http://www.ncbi.nlm.nih.gov/pubmed/32852281 ID - info:doi/10.2196/19271 ER - TY - JOUR AU - Jain, Nikhil AU - Jayaram, Mahesh PY - 2020/8/21 TI - Comment on "Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow" JO - JMIR Ment Health SP - e23023 VL - 7 IS - 8 KW - telepsychiatry KW - COVID-19 KW - Australia UR - https://mental.jmir.org/2020/8/e23023 UR - http://dx.doi.org/10.2196/23023 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750003 ID - info:doi/10.2196/23023 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 - Tremain, Hailey AU - McEnery, Carla AU - Fletcher, Kathryn AU - Murray, Greg PY - 2020/8/7 TI - The Therapeutic Alliance in Digital Mental Health Interventions for Serious Mental Illnesses: Narrative Review JO - JMIR Ment Health SP - e17204 VL - 7 IS - 8 KW - mental health KW - mHealth KW - eHealth KW - telehealth KW - psychosis KW - bipolar disorder KW - mobile phone N2 - Background: Digital mental health interventions offer unique advantages, and research indicates that these interventions are effective for a range of mental health concerns. Although these interventions are less established for individuals with serious mental illnesses, they demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, whereas the nature of a digital therapeutic alliance and its relationship with outcomes requires further attention, particularly for individuals with serious mental illnesses. Objective: This narrative review aims to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses. Methods: A narrative review was conducted by combining 3 main areas of the literature: the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions, and the third surrounding practical considerations to enhance a digital therapeutic alliance. Results: Results indicated that a therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet-to-be-confirmed characteristics in digital contexts. In addition, a therapeutic alliance appears to be less directly associated with outcomes in digital interventions than with those in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, through which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features. Conclusions: More research is required to further understand the nature and specific role of a therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed several key research priorities to advance the therapeutic alliance in digital interventions. UR - https://mental.jmir.org/2020/8/e17204 UR - http://dx.doi.org/10.2196/17204 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763881 ID - info:doi/10.2196/17204 ER - TY - JOUR AU - Fortuna, L. Karen AU - Myers, L. Amanda AU - Walsh, Danielle AU - Walker, Robert AU - Mois, George AU - Brooks, M. Jessica PY - 2020/7/23 TI - Strategies to Increase Peer Support Specialists? Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study JO - JMIR Ment Health SP - e20429 VL - 7 IS - 7 KW - COVID-19 KW - peer support KW - telemental health KW - mental health KW - training N2 - Background: Prior to the outbreak of coronavirus disease (COVID-19), telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. For the first the time in history, peer support specialists are offering Medicaid-reimbursable telemental health services during the COVID-19 crisis; however, little effort has been made to train peer support specialists on telehealth practice and delivery. Objective: The aim of this study was to explore the impact of the Digital Peer Support Certification on peer support specialists? capacity to use digital peer support technology. Methods: The Digital Peer Support Certification was co-produced with peer support specialists and included an education and simulation training session, synchronous and asynchronous support services, and audit and feedback. Participants included 9 certified peer support specialists between the ages of 25 and 54 years (mean 39 years) who were employed as peer support specialists for 1 to 11 years (mean 4.25 years) and had access to a work-funded smartphone device and data plan. A pre-post design was implemented to examine the impact of the Digital Peer Support Certification on peer support specialists? capacity to use technology over a 3-month timeframe. Data were collected at baseline, 1 month, 2 months, and 3 months. Results: Overall, an upward trend in peer support specialists? capacity to offer digital peer support occurred during the 3-month certification period. Conclusions: The Digital Peer Support Certification shows promising evidence of increasing the capacity of peer support specialists to use specific digital peer support technology features. Our findings also highlighted that this capacity was less likely to increase with training alone and that a combinational knowledge translation approach that includes both training and management will be more successful. UR - http://mental.jmir.org/2020/7/e20429/ UR - http://dx.doi.org/10.2196/20429 UR - http://www.ncbi.nlm.nih.gov/pubmed/32629424 ID - info:doi/10.2196/20429 ER - TY - JOUR AU - Guisado-Fernandez, Estefania AU - Blake, Catherine AU - Mackey, Laura AU - Silva, Alexandra Paula AU - Power, Dermot AU - O'Shea, Diarmuid AU - Caulfield, Brian PY - 2020/7/23 TI - A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study JO - JMIR Aging SP - e15600 VL - 3 IS - 2 KW - Connected Health KW - dementia KW - informal caregiver KW - home care KW - home monitoring N2 - Background: Dementia is a neurodegenerative chronic condition characterized by a progressive decline in a person?s memory, thinking, learning skills, and the ability to perform activities of daily living. Previous research has indicated that there are many types of technology interventions available in the literature that have shown promising results in improving disease progression, disease management, and the well-being of people with dementia (PwD) and their informal caregiver, thus facilitating dementia care and living. Technology-driven home care interventions, such as Connected Health (CH), could offer a convenient and low-cost alternative to traditional home care, providing an informal caregiver with the support they may need at home while caring for a PwD, improving their physical and mental well-being. Objective: This study aimed (1) to create a multidimensional profile for evaluating the well-being progression of the PwD?informal caregiver dyad for a year during their use of a CH platform, designed for monitoring PwD and supporting their informal caregivers at home, and (2) to conduct a long-term follow-up using the proposed well-being profile at different time-interval evaluations. Methods: The PwD?informal caregiver well-being profile was created based on the World Health Organization International Classification of Functioning considering the following outcomes: functional status, cognitive status, and quality of life for the PwD and mental well-being, sleeping quality, and burden for the informal caregiver. Over a year, comprehensive assessments of these outcomes were conducted every 3 months to evaluate the well-being of PwD?informal caregivers, using international and standardized validated questionnaires. Participants? demographic information was analyzed using descriptive statistics and presented as means and SDs. A nonparametric Friedman test was used to analyze the outcome changes and the progression in the PwD-caregiver dyads and to determine if those changes were statistically significant. Results: There were no significant changes in the well-being of PwD or their caregivers over the year of follow-up, with the majority of the PwD-caregiver dyads remaining stable. The only instances in which significant changes were observed were the functional status in the PwD and sleep quality in their caregivers. In each of these measures, post hoc pairwise comparisons did not indicate that the changes observed were related to the deployment of the CH platform. Conclusions: The follow-up of this population of PwD and their informal caregivers has shown that disease progression and physical and mental well-being do not change significantly during the time, being a slow and gradual process. The well-being profile created to analyze the potential impact of the CH platform on the PwD?informal caregiver dyad well-being, once validated, could be used as a future tool to conduct the same analyses with other CH technologies for this population. International Registered Report Identifier (IRRID): RR2-10.2196/13280 UR - http://aging.jmir.org/2020/2/e15600/ UR - http://dx.doi.org/10.2196/15600 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706650 ID - info:doi/10.2196/15600 ER - TY - JOUR AU - Hoffmann, Mariell AU - Wensing, Michel AU - Peters-Klimm, Frank AU - Szecsenyi, Joachim AU - Hartmann, Mechthild AU - Friederich, Hans-Christoph AU - Haun, W. Markus PY - 2020/6/18 TI - Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study JO - J Med Internet Res SP - e17569 VL - 22 IS - 6 KW - video consultations KW - videoconferencing KW - telehealth KW - integrated care KW - mental health KW - health services research KW - qualitative study KW - preimplementation N2 - Background: Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists? acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective: The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods: We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results: Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. Conclusions: While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients? and therapists? engagement. Trial Registration: German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one UR - http://www.jmir.org/2020/6/e17569/ UR - http://dx.doi.org/10.2196/17569 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554369 ID - info:doi/10.2196/17569 ER - TY - JOUR AU - Linden, Brooke AU - Tam-Seto, Linna AU - Stuart, Heather PY - 2020/6/17 TI - Adherence of the #Here4U App ? Military Version to Criteria for the Development of Rigorous Mental Health Apps JO - JMIR Form Res SP - e18890 VL - 4 IS - 6 KW - mental health services KW - telemedicine KW - mHealth KW - chatbot KW - e-solutions KW - Canadian Armed Forces KW - military health KW - mobile phone N2 - Background: Over the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military. Objective: The goal of the #Here4U App ? Military Version is to provide evidence-informed mental health support to members of Canada?s military community, leveraging artificial intelligence in the form of IBM Canada?s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate. Methods: As the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016. Results: The #Here4U App ? Military Version met the majority of Bakker and colleagues? criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward. Conclusions: The #Here4U App ? Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery. UR - https://formative.jmir.org/2020/6/e18890 UR - http://dx.doi.org/10.2196/18890 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554374 ID - info:doi/10.2196/18890 ER - TY - JOUR AU - Goodman-Casanova, Marian Jessica AU - Dura-Perez, Elena AU - Guzman-Parra, Jose AU - Cuesta-Vargas, Antonio AU - Mayoral-Cleries, Fermin PY - 2020/5/22 TI - Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study JO - J Med Internet Res SP - e19434 VL - 22 IS - 5 KW - telehealth KW - confinement KW - coronavirus KW - COVID-19 KW - well-being KW - emergency response KW - public health KW - mental health KW - physical health KW - elderly KW - older adults KW - cognitive impairment KW - dementia N2 - Background: The public health emergency of coronavirus disease (COVID-19) is rapidly evolving worldwide; some countries, including Spain, have implemented restrictive measures. Populations that are vulnerable to this outbreak and its physical and mental health effects include community-dwelling older adults with mild cognitive impairment or mild dementia. Telehealth is a potential tool to deliver health care and decrease exposure risk. Objective: The aims of this study were to explore the impact of confinement on the health and well-being of community-dwelling older adults with mild cognitive impairment or mild dementia, to provide television-based and telephone-based health and social support, and to study the effects of a television-based assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive Integrated Service to supporT European adults living with mild DEMentia or mild cognitive impairment). Methods: A telephone-based survey was administered in Spain to 93 participants in the TV-AssistDem clinical trial from March 25 to April 6, 2020. Results: Of the respondents, 60/93 (65%) were women. The mean age was 73.34 (SD 6.07), and 69/93 (74%) lived accompanied. Lockdown measures forced 17/93 respondents (18%) to change their living arrangements. Health status was found to be optimal in 89/93 respondents (96%), with no COVID-19 symptoms. Grocery and pharmacy outings were performed by family members of 68/93 participants (73%); 57 (61%) reported overall well-being, and 65 (70%) maintained their sleep quality. However, participants living alone reported greater negative feelings and more sleeping problems. Regarding leisure activities, 53/93 respondents (57%) took walks, 32 (35%) played memory games, 55 (60%) watched television, and 91 (98%) telephoned relatives. 58/93 (64%) respondents reported accessing moderate or too much COVID-19 information, 89 (97%) received it from television, and 56 (62%) stated that their understanding of the information was extreme. 39/93 (39%) respondents had contacted health and social services, while 29 (31%) requested information regarding these services during the telephone call. There were no significant differences in health and well-being between the intervention and control groups. Respondents with TV-AssistDem performed more memory exercises (24/93, 52% vs 8/93, 17.4%; P<.001) than control respondents. Conclusions: Our findings suggest that during COVID-19 confinement, the physical and mental health and well-being was optimal for the majority of our vulnerable population. However, those living alone reported greater negative psychological effects and sleeping problems. Measures adopted to address the negative experiences of confinement included keeping informed about the situation, accessing health and social services, having a support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, a daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with cognitive stimulation exercises, and ensuring social connectedness using technology. Television sets were preferred technological devices to access COVID-19 information, watch television as a recreational activity, and perform memory exercises as an intellectual activity. Television-based telehealth support using TV-AssistDem demonstrated potential for cognitive stimulation. Trial Registration: ClinicalTrials.gov NCT03653234; https://clinicaltrials.gov/ct2/show/NCT03653234 UR - http://www.jmir.org/2020/5/e19434/ UR - http://dx.doi.org/10.2196/19434 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401215 ID - info:doi/10.2196/19434 ER - TY - JOUR AU - Hong, Zhen AU - Li, Nian AU - Li, Dajiang AU - Li, Junhua AU - Li, Bing AU - Xiong, Weixi AU - Lu, Lu AU - Li, Weimin AU - Zhou, Dong PY - 2020/5/8 TI - Telemedicine During the COVID-19 Pandemic: Experiences From Western China JO - J Med Internet Res SP - e19577 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus disease KW - medical education KW - pandemics KW - teleteaching KW - tele-education KW - telemedicine UR - http://www.jmir.org/2020/5/e19577/ UR - http://dx.doi.org/10.2196/19577 UR - http://www.ncbi.nlm.nih.gov/pubmed/32349962 ID - info:doi/10.2196/19577 ER - TY - JOUR AU - Kemp, Jessica AU - Zhang, Timothy AU - Inglis, Fiona AU - Wiljer, David AU - Sockalingam, Sanjeev AU - Crawford, Allison AU - Lo, Brian AU - Charow, Rebecca AU - Munnery, Mikayla AU - Singh Takhar, Shuranjeet AU - Strudwick, Gillian PY - 2020/3/6 TI - Delivery of Compassionate Mental Health Care in a Digital Technology?Driven Age: Scoping Review JO - J Med Internet Res SP - e16263 VL - 22 IS - 3 KW - compassion KW - mental health KW - medical informatics KW - psychiatry KW - health information technology KW - nursing informatics N2 - Background: Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. Objective: This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. Methods: We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. Results: Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. Conclusions: Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care. UR - https://www.jmir.org/2020/3/e16263 UR - http://dx.doi.org/10.2196/16263 UR - http://www.ncbi.nlm.nih.gov/pubmed/32141833 ID - info:doi/10.2196/16263 ER - TY - JOUR AU - Hamatani, Sayo AU - Numata, Noriko AU - Matsumoto, Kazuki AU - Sutoh, Chihiro AU - Ibuki, Hanae AU - Oshiro, Keiko AU - Tanaka, Mari AU - Setsu, Rikukage AU - Kawasaki, Yohei AU - Hirano, Yoshiyuki AU - Shimizu, Eiji PY - 2019/10/23 TI - Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial JO - JMIR Form Res SP - e15738 VL - 3 IS - 4 KW - bulimia nervosa KW - binge-eating disorder KW - cognitive behavioral therapy KW - internet-based cognitive behavioral therapy KW - videoconference N2 - Background: A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan. Objective: The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods: Seven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory?Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95% confidence intervals using the paired t test. Results: Although the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen d=?0.76), there was no significant reduction in the combined episodes (EDE 16D ?41; 95% CI ?2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment. Conclusions: ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration: UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419 UR - http://formative.jmir.org/2019/4/e15738/ UR - http://dx.doi.org/10.2196/15738 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647472 ID - info:doi/10.2196/15738 ER - TY - JOUR AU - Hoffmann, Mariell AU - Hartmann, Mechthild AU - Wensing, Michel AU - Friederich, Hans-Christoph AU - Haun, W. Markus PY - 2019/08/19 TI - Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians JO - J Med Internet Res SP - e13382 VL - 21 IS - 8 KW - video consultations KW - videoconferencing KW - integrated behavioral health KW - primary care KW - health services research KW - mental health N2 - Background: Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective: This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods: In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results: Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions: By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487 UR - http://www.jmir.org/2019/8/e13382/ UR - http://dx.doi.org/10.2196/13382 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429419 ID - info:doi/10.2196/13382 ER - TY - JOUR AU - Chalmers, Alexander John AU - Sansom-Daly, Margaret Ursula AU - Patterson, Pandora AU - McCowage, Geoffrey AU - Anazodo, Antoinette PY - 2018/08/29 TI - Psychosocial Assessment Using Telehealth in Adolescents and Young Adults With Cancer: A Partially Randomized Patient Preference Pilot Study JO - JMIR Res Protoc SP - e168 VL - 7 IS - 8 KW - telehealth KW - videoconferencing KW - psychosocial KW - psychological assessment KW - adolescent and young adult KW - cancer N2 - Background: Adolescent and young adults with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of inpatient face-to-face psychosocial care might limit the capacity for clinicians to provide timely and personalized assessment and intervention for this group. Telehealth offers a promising alternative toward increasing access to the provision of evidence-based psychosocial assessment and treatment for adolescent and young adults with cancer. Objective: This pilot study aimed to assess the feasibility and acceptability for both patients and clinicians of providing a psychosocial assessment via telehealth to adolescents and young adults currently receiving treatment for cancer, relative to face-to-face delivery. Methods: We included patients who were aged 15-25 years, currently receiving treatment, could speak English well, and medically stable. Patients were recruited from oncology clinics or wards from 5 hospitals located across Sydney and Canberra, Australia, and allocated them to receive psychosocial assessment (Adolescent and Young Adult Oncology Psychosocial Assessment Measure) with a clinical psychologist or social worker through face-to-face or telehealth modalities using a partially randomized patient preference model. Patients completed a pre- and postassessment questionnaire comprising validated and purposely designed feasibility and acceptability indices, including the impact of technical difficulties, if patients had their own devices; number of patients who were content with their group allocation; self-reported preference of modality; Treatment Credibility and Expectations Questionnaire; and Working Alliance Inventory. Clinicians also completed a postassessment questionnaire rating their impressions of the acceptability and feasibility of intervention delivery by each modality. Results: Of 29 patients approached, 23 consented to participate (response rate: 79%). Participants were partially randomized to either telehealth (8/23, 35%; mean age 16.50 years, range 15-23 years; females: 4/8, 50%) or face-to-face (11/23, 62%; mean age 17 years, range 15-22 years; females: 8/11, 72%) conditions. Four participants withdrew consent because of logistical or medical complications (attrition rate: 17.4%). Most participants (6/8, 75%) in the telehealth group used their computer or iPad (2 were provided with an iPad), with minor technical difficulties occurring in 3 of 8 (37.5%) assessments. Participants in both groups rated high working alliance (Working Alliance Inventory; median patient response in the telehealth group, 74, range 59-84 and face-to-face group, 63, range 51-84) and reported positive beliefs regarding the credibility and expectations of their treatment group. Postassessment preferences between face-to-face or telehealth modalities varied. Most patients in the telehealth group (5/8, 63%) reported no preference, whereas 6 of 11 (55%) in the face-to-face group reported a preference for the face-to-face modality. Conclusions: Telehealth is acceptable as patient comfort was comparable across modalities, with no significant technological barriers experienced. However, patients varied in their preferred interview modality, highlighting the need to tailor the treatment to patient preference and circumstances. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001142628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366609 (Archived by WebCite at http://www.webcitation.org/721889HpE) UR - http://www.researchprotocols.org/2018/8/e168/ UR - http://dx.doi.org/10.2196/resprot.8886 UR - http://www.ncbi.nlm.nih.gov/pubmed/30158103 ID - info:doi/10.2196/resprot.8886 ER -