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 - Oehler, Caroline AU - Scholze, Katharina AU - Reich, Hanna AU - Sander, Christian AU - Hegerl, Ulrich PY - 2021/7/16 TI - Intervention Use and Symptom Change With Unguided Internet-Based Cognitive Behavioral Therapy for Depression During the COVID-19 Pandemic: Log Data Analysis of a Convenience Sample JO - JMIR Ment Health SP - e28321 VL - 8 IS - 7 KW - iCBT KW - internet-based cognitive behavioral therapy KW - internet-based treatment KW - internet- and mobile-based intervention KW - depression KW - guidance KW - unguided KW - COVID-19 N2 - Background: Internet- and mobile-based interventions are most efficacious in the treatment of depression when they involve some form of guidance, but providing guidance requires resources such as trained personnel, who might not always be available (eg, during lockdowns to contain the COVID-19 pandemic). Objective: The current analysis focuses on changes in symptoms of depression in a guided sample of patients with depression who registered for an internet-based intervention, the iFightDepression tool, as well as the extent of intervention use, compared to an unguided sample. The objective is to further understand the effects of guidance and adherence on the intervention?s potential to induce symptom change. Methods: Log data from two convenience samples in German routine care were used to assess symptom change after 6-9 weeks of intervention as well as minimal dose (finishing at least two workshops). A linear regression model with changes in Patient Health Questionnaire (PHQ-9) score as a dependent variable and guidance and minimal dose as well as their interaction as independent variables was specified. Results: Data from 1423 people with symptoms of depression (n=940 unguided, 66.1%) were included in the current analysis. In the linear regression model predicting symptom change, a significant interaction of guidance and minimal dose revealed a specifically greater improvement for patients who received guidance and also worked with the intervention content (?=?1.75, t=?2.37, P=.02), while there was little difference in symptom change due to guidance in the group that did not use the intervention. In this model, the main effect of guidance was only marginally significant (?=?.53, t=?1.78, P=.08). Conclusions: Guidance in internet-based interventions for depression is not only an important factor to facilitate adherence, but also seems to further improve results for patients adhering to the intervention compared to those who do the same but without guidance. UR - https://mental.jmir.org/2021/7/e28321 UR - http://dx.doi.org/10.2196/28321 UR - http://www.ncbi.nlm.nih.gov/pubmed/34115604 ID - info:doi/10.2196/28321 ER - TY - JOUR AU - Lukas, Aljoscha Christian AU - Eskofier, Bjoern AU - Berking, Matthias PY - 2021/7/20 TI - A Gamified Smartphone-Based Intervention for Depression: Randomized Controlled Pilot Trial JO - JMIR Ment Health SP - e16643 VL - 8 IS - 7 KW - smartphone technology KW - depression KW - cognitive behavioral therapy KW - approach/avoidance KW - gamification N2 - Background: Available smartphone-based interventions for depression predominantly use evidence-based strategies from cognitive-behavioral therapy (CBT), but patient engagement and reported effect sizes are small. Recently, studies have demonstrated that smartphone-based interventions combining CBT with gamified approach-avoidance bias modification training (AAMT) can foster patient engagement and reduce symptoms of several mental health problems. Objective: Based on these findings, we developed a gamified smartphone-based intervention, mentalis Phoenix (MT-Phoenix), and hypothesized the program would both engage patients and produce preliminary evidence for the reduction of depressive symptoms. Methods: To test this hypothesis, we evaluated MT-Phoenix in a randomized controlled pilot trial including 77 individuals with elevated depression scores (Patient Health Questionnaire-9 scores ?5). Participants were either instructed to train for 14 days with MT-Phoenix or assigned to a waitlist control condition. Engagement with the intervention was measured by assessing usage data. The primary outcome was reduction in depressive symptom severity at postassessment. Results: Data from this pilot trial shows that participants in the intervention group used the smartphone-based intervention for 46% of all days (6.4/14) and reported a significantly greater reduction of depressive symptoms than did participants in the control condition (F1,74=19.34; P=.001), with a large effect size (d=1.02). Effects were sustained at a 3-month follow-up. Conclusions: A gamified smartphone-based intervention combining CBT with AAMT may foster patient engagement and effectively target depressive symptoms. Future studies should evaluate the effectiveness of this intervention in a phase 3 trial using clinical samples. Moreover, the intervention should be compared to active control conditions. Trial Registration: German Clinical Trial Registry DRKS00012769; https://tinyurl.com/47mw8du7 UR - https://mental.jmir.org/2021/7/e16643 UR - http://dx.doi.org/10.2196/16643 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283037 ID - info:doi/10.2196/16643 ER - TY - JOUR AU - Gowarty, A. Minda AU - Longacre, R. Meghan AU - Vilardaga, Roger AU - Kung, J. Nathan AU - Gaughan-Maher, E. Ashley AU - Brunette, F. Mary PY - 2021/7/7 TI - Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study JO - JMIR Ment Health SP - e26873 VL - 8 IS - 7 KW - smoking cessation KW - mHealth KW - serious mental illness KW - smartphone application KW - digital health KW - psychiatric illness KW - tobacco treatment KW - mobile phone N2 - Background: Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute?s [NCI?s] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. Objective: The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI?QuitGuide and quitSTART?among young adult tobacco users with SMI. Methods: We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. Results: Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps? feedback. Conclusions: Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues. UR - https://mental.jmir.org/2021/7/e26873 UR - http://dx.doi.org/10.2196/26873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255699 ID - info:doi/10.2196/26873 ER - TY - JOUR AU - Treanor, J. Charlene AU - Kouvonen, Anne AU - Lallukka, Tea AU - Donnelly, Michael PY - 2021/7/6 TI - Acceptability of Computerized Cognitive Behavioral Therapy for Adults: Umbrella Review JO - JMIR Ment Health SP - e23091 VL - 8 IS - 7 KW - computerized/internet cognitive behavioral therapy KW - cCBT KW - iCBT KW - acceptability KW - mental health KW - umbrella review N2 - Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34% of guided and 36% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8%-74% of the participants, while 94% completed one module and 67%-84% completed some modules. Unguided cCBT was completed in full by 16%-66% of participants, while 95% completed one module and 54%-93% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one?s own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users? preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that ?one size did not fit all? regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health. UR - https://mental.jmir.org/2021/7/e23091 UR - http://dx.doi.org/10.2196/23091 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255714 ID - info:doi/10.2196/23091 ER - TY - JOUR AU - Sung, Y. Jenna AU - Mumper, Emma AU - Schleider, Lee Jessica PY - 2021/7/6 TI - Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation JO - JMIR Ment Health SP - e29538 VL - 8 IS - 7 KW - acceptability KW - adolescent mental health KW - adolescent KW - anxiety KW - avoidance KW - behavior KW - child mental health KW - children KW - digital mental health KW - intervention KW - mental health KW - parent KW - prevention KW - young adult N2 - Background: A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions?particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children?for instance, by mitigating known anxiety risk factors?remains unexplored. Objective: This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods: In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results: Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions: Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration: ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9 UR - https://mental.jmir.org/2021/7/e29538 UR - http://dx.doi.org/10.2196/29538 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255718 ID - info:doi/10.2196/29538 ER - TY - JOUR AU - Ben-Zeev, Dror AU - Meller, Suzanne AU - Snyder, Jaime AU - Attah, A. Dzifa AU - Albright, Liam AU - Le, Hoa AU - Asafo, M. Seth AU - Collins, Y. Pamela AU - Ofori-Atta, Angela PY - 2021/7/2 TI - A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study JO - JMIR Ment Health SP - e28526 VL - 8 IS - 7 KW - mobile phone KW - low- and middle-income country KW - schizophrenia KW - bipolar disorder N2 - Background: The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. Objective: The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. Results: A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable. Conclusions: This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses. UR - https://mental.jmir.org/2021/7/e28526 UR - http://dx.doi.org/10.2196/28526 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255712 ID - info:doi/10.2196/28526 ER - TY - JOUR AU - Vornholt, Piper AU - De Choudhury, Munmun PY - 2021/7/12 TI - Understanding the Role of Social Media?Based Mental Health Support Among College Students: Survey and Semistructured Interviews JO - JMIR Ment Health SP - e24512 VL - 8 IS - 7 KW - college mental health KW - social media KW - social support KW - mobile phone N2 - Background: Mental illness is a growing concern within many college campuses. Limited access to therapy resources, along with the fear of stigma, often prevents students from seeking help. Introducing supportive interventions, coping strategies, and mitigation programs might decrease the negative effects of mental illness among college students. Objective: Many college students find social support for a variety of needs through social media platforms. With the pervasive adoption of social media sites in college populations, in this study, we examine whether and how these platforms may help meet college students? mental health needs. Methods: We first conducted a survey among 101 students, followed by semistructured interviews (n=11), of a large public university in the southeast region of the United States to understand whether, to what extent, and how students appropriate social media platforms to suit their struggle with mental health concerns. The interviews were intended to provide comprehensive information on students? attitudes and their perceived benefits and limitations of social media as platforms for mental health support. Results: Our survey revealed that a large number of participating students (71/101, 70.3%) had recently experienced some form of stress, anxiety, or other mental health challenges related to college life. Half of them (52/101, 51.5%) also reported having appropriated some social media platforms for self-disclosure or help, indicating the pervasiveness of this practice. Through our interviews, we obtained deeper insights into these initial observations. We identified specific academic, personal, and social life stressors; motivations behind social media use for mental health needs; and specific platform affordances that helped or hindered this use. Conclusions: Students recognized the benefits of social media in helping connect with peers on campus and promoting informal and candid disclosures. However, they argued against complete anonymity in platforms for mental health help and advocated the need for privacy and boundary regulation mechanisms in social media platforms supporting this use. Our findings bear implications for informing campus counseling efforts and in designing social media?based mental health support tools for college students. UR - https://mental.jmir.org/2021/7/e24512 UR - http://dx.doi.org/10.2196/24512 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255701 ID - info:doi/10.2196/24512 ER - TY - JOUR AU - Sukunesan, Suku AU - Huynh, Minh AU - Sharp, Gemma PY - 2021/7/9 TI - Examining the Pro-Eating Disorders Community on Twitter Via the Hashtag #proana: Statistical Modeling Approach JO - JMIR Ment Health SP - e24340 VL - 8 IS - 7 KW - Twitter KW - infodemiology KW - eating disorders KW - proana KW - thinspo KW - hashtags KW - transient KW - cybersectarianism N2 - Background: There is increasing concern around communities that promote eating disorders (Pro-ED) on social media sites through messages and images that encourage dangerous weight control behaviors. These communities share group identity formed through interactions between members and can involve the exchange of ?tips,? restrictive dieting plans, extreme exercise plans, and motivating imagery of thin bodies. Unlike Instagram, Facebook, or Tumblr, the absence of adequate policy to moderate Pro-ED content on Twitter presents a unique space for the Pro-ED community to freely communicate. While recent research has identified terms, themes, and common lexicon used within the Pro-ED online community, very few have been longitudinal. It is important to focus upon the engagement of Pro-ED online communities over time to further understand how members interact and stay connected, which is currently lacking. Objective: The purpose of this study was to explore beyond the common messages of Pro-ED on Twitter to understand how Pro-ED communities get traction over time by using the hashtag considered to symbolize the Pro-ED movement, #proana. Our focus was to collect longitudinal data to gain a further understanding of the engagement of Pro-ED communities on Twitter. Methods: Descriptive statistics were used to identify the preferred tweeting style of Twitter users (either as mentioning another user in a tweet or without) as well as their most frequently used hashtag, in addition to #proana. A series of Mann Whitney U tests were then conducted to compare preferred posting style across number of followed, followers, tweets, and favorites. This was followed by linear models using a forward step-wise approach that were applied for Pro-ED Twitter users to examine the factors associated with their number of followers. Results: This study reviewed 11,620 Pro-ED Twitter accounts that posted using the hashtag #proana between September 2015 and July 2018. These profiles then underwent a 2-step screening of inclusion and exclusion criteria to reach the final sample of 967 profiles. Over 90% (10,484/11,620) of the profiles were found to have less than 6 tweets within the 34-month period. Most of the users were identified as preferring a mentioning style of tweeting (718/967, 74.3%) over not mentioning (248/967, 25.7%). Further, #proana and #thinspo were used interchangeably to propagate shared themes, and there was a reciprocal effect between followers and the followed. Conclusions: Our analysis showed that the number of accounts followed and number of Pro-ED tweets posted were significant predictors for the number of followers a user has, compared to likes. Our results could potentially be useful to social media platforms to understand which features could help or otherwise curtail the spread of ED messages and activity. Our findings also show that Pro-ED communities are transient in nature, engaging in superficial discussion threads but resilient, emulating cybersectarian behavior. UR - https://mental.jmir.org/2021/7/e24340 UR - http://dx.doi.org/10.2196/24340 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255707 ID - info:doi/10.2196/24340 ER - TY - JOUR AU - Sommers-Spijkerman, Marion AU - Austin, Judith AU - Bohlmeijer, Ernst AU - Pots, Wendy PY - 2021/7/19 TI - New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials JO - JMIR Ment Health SP - e28168 VL - 8 IS - 7 KW - mindfulness KW - mental health KW - intervention KW - online KW - meta-analysis KW - mobile phone N2 - Background: There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. Objective: This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. Methods: We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. Results: The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. Conclusions: Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements. UR - https://mental.jmir.org/2021/7/e28168 UR - http://dx.doi.org/10.2196/28168 UR - http://www.ncbi.nlm.nih.gov/pubmed/34279240 ID - info:doi/10.2196/28168 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 -