TY - JOUR AU - Conley, S. Colleen AU - Raposa, B. Elizabeth AU - Bartolotta, Kate AU - Broner, E. Sarah AU - Hareli, Maya AU - Forbes, Nicola AU - Christensen, M. Kirsten AU - Assink, Mark PY - 2022/7/29 TI - The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis JO - JMIR Ment Health SP - e34254 VL - 9 IS - 7 KW - meta-analysis KW - mental health KW - well-being KW - intervention KW - treatment KW - youth KW - technology KW - smartphone KW - mobile phone KW - app KW - mobile health N2 - Background: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. Conclusions: Overall, this study?s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings. UR - https://mental.jmir.org/2022/7/e34254 UR - http://dx.doi.org/10.2196/34254 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904845 ID - info:doi/10.2196/34254 ER - TY - JOUR AU - Bastien, Laurianne AU - Boke, Naz Bilun AU - Mettler, Jessica AU - Zito, Stephanie AU - Di Genova, Lina AU - Romano, Vera AU - Lewis, P. Stephen AU - Whitley, Rob AU - Iyer, N. Srividya AU - Heath, L. Nancy PY - 2022/7/22 TI - Peer-Presented Versus Mental Health Service Provider?Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e34168 VL - 9 IS - 7 KW - web-based mental health outreach KW - resilience building KW - university student KW - peer-presented KW - mental health service provider?presented KW - mental health KW - outreach KW - resilience KW - student KW - service provider KW - randomized controlled trial N2 - Background: University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students? mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. Objective: Thus, the overarching goal of this study was to evaluate a mental health service provider?presented versus peer-presented web-based mental health resilience?building video outreach program against a wait-list comparison group. Methods: Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider?presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider?presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). Results: Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider?presented and peer-presented programs were rated very highly and at comparable levels. Conclusions: Thus, findings suggest that a web-based mental health resilience?building video outreach program may be acceptable for university students regardless of it being mental health service provider?presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. Trial Registration: ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592 UR - https://mental.jmir.org/2022/7/e34168 UR - http://dx.doi.org/10.2196/34168 UR - http://www.ncbi.nlm.nih.gov/pubmed/35762935 ID - info:doi/10.2196/34168 ER - TY - JOUR AU - Spain, Debbie AU - Stewart, R. Gavin AU - Mason, David AU - Milner, Victoria AU - Fairhurst, Bryony AU - Robinson, Janine AU - Gillan, Nicola AU - Ensum, Ian AU - Stark, Eloise AU - Happe, Francesca PY - 2022/7/20 TI - Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals JO - JMIR Ment Health SP - e37901 VL - 9 IS - 7 KW - autism KW - COVID-19 pandemic KW - autism diagnostic assessment KW - telehealth KW - health professionals KW - clinical supervision KW - training KW - COVID-19 N2 - Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals? experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals? experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods. UR - https://mental.jmir.org/2022/7/e37901 UR - http://dx.doi.org/10.2196/37901 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857358 ID - info:doi/10.2196/37901 ER - TY - JOUR AU - Teferra, Gashaw Bazen AU - Borwein, Sophie AU - DeSouza, D. Danielle AU - Simpson, William AU - Rheault, Ludovic AU - Rose, Jonathan PY - 2022/7/8 TI - Acoustic and Linguistic Features of Impromptu Speech and Their Association With Anxiety: Validation Study JO - JMIR Ment Health SP - e36828 VL - 9 IS - 7 KW - mental health KW - generalized anxiety disorder KW - impromptu speech KW - acoustic features KW - linguistic features KW - mobile phone N2 - Background: The measurement and monitoring of generalized anxiety disorder requires frequent interaction with psychiatrists or psychologists. Access to mental health professionals is often difficult because of high costs or insufficient availability. The ability to assess generalized anxiety disorder passively and at frequent intervals could be a useful complement to conventional treatment and help with relapse monitoring. Prior work suggests that higher anxiety levels are associated with features of human speech. As such, monitoring speech using personal smartphones or other wearable devices may be a means to achieve passive anxiety monitoring. Objective: This study aims to validate the association of previously suggested acoustic and linguistic features of speech with anxiety severity. Methods: A large number of participants (n=2000) were recruited and participated in a single web-based study session. Participants completed the Generalized Anxiety Disorder 7-item scale assessment and provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test. Acoustic and linguistic speech features were a priori selected based on the existing speech and anxiety literature, along with related features. Associations between speech features and anxiety levels were assessed using age and personal income as covariates. Results: Word count and speaking duration were negatively correlated with anxiety scores (r=?0.12; P<.001), indicating that participants with higher anxiety scores spoke less. Several acoustic features were also significantly (P<.05) associated with anxiety, including the mel-frequency cepstral coefficients, linear prediction cepstral coefficients, shimmer, fundamental frequency, and first formant. In contrast to previous literature, second and third formant, jitter, and zero crossing rate for the z score of the power spectral density acoustic features were not significantly associated with anxiety. Linguistic features, including negative-emotion words, were also associated with anxiety (r=0.10; P<.001). In addition, some linguistic relationships were sex dependent. For example, the count of words related to power was positively associated with anxiety in women (r=0.07; P=.03), whereas it was negatively associated with anxiety in men (r=?0.09; P=.01). Conclusions: Both acoustic and linguistic speech measures are associated with anxiety scores. The amount of speech, acoustic quality of speech, and gender-specific linguistic characteristics of speech may be useful as part of a system to screen for anxiety, detect relapse, or monitor treatment. UR - https://mental.jmir.org/2022/7/e36828 UR - http://dx.doi.org/10.2196/36828 UR - http://www.ncbi.nlm.nih.gov/pubmed/35802401 ID - info:doi/10.2196/36828 ER -