Use of Digital Mental Health for Marginalized and Underserved Populations

The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study

BACKGROUND

Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps.

OBJECTIVE

This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups.

METHODS

We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria.

RESULTS

The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement.

CONCLUSIONS

Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached.

TRIAL REGISTRATION

PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.

Nurses' perceptions of involving family members in the care of mental health care users

BACKGROUND

 Family involvement in mental health care is a therapeutic intervention in the management of mental illness. The global concern in long-term mental health is that families find it difficult to accept mental illness when their loved ones are admitted to receive care, treatment and rehabilitation.

OBJECTIVES

 To describe nurses' perceptions of involving family members in the care of mental health care users in long-term institutions.

METHOD

 A quantitative descriptive design was used. The population comprised nurses working at three mental health institutions (MHIs). Probability simple random sampling was used to select 360 respondents. Data were collected using self-administered questionnaires.

RESULTS

 The findings revealed that most (86.9%) of the nurses acknowledged that challenges affect families' involvement in mental health care. A total of 91.4% of nurses complained that family members' involvement was insufficient and (80.6%) indicated that poor family contact affects the provision of quality mental health care. Therefore, the respondents believed that the families' involvement has an impact on the management of mental illness.

CONCLUSION

 Engaging family members in mental health care helps both health professionals and families to participate in patient-centred care and mental health care services. However, MHCUs benefit when their families are involved.Contribution: The study contributed to mental health nursing as its results can be used to measure the quality of health services improvements, by involving the family members during hospitalisation of their loved ones for mental health care.

Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches

INTRODUCTION

It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion.

METHOD

Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen).

RESULTS

Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes).

DISCUSSION

Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups.

PUBLIC SIGNIFICANCE

This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.

Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review

INTRODUCTION

Health behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence and young adulthood (ages 10-25), a formative period shaping lifelong well-being. We will conduct a systematic review of just-in-time adaptive interventions (JITAIs) for health behaviour and well-being in adolescents and young adults (AYAs). A JITAI is an emerging digital health design that provides precise health support by monitoring and adjusting to individual, specific and evolving contexts in real time. Despite demonstrated potential, no published reviews have explored how JITAIs can dynamically adapt to intersectional health factors of diverse AYAs. We will identify the JITAIs' distal and proximal outcomes and their tailoring mechanisms, and report their effectiveness. We will also explore studies' considerations of health equity. This will form a comprehensive assessment of JITAIs and their role in promoting health behaviours of AYAs. We will integrate evidence to guide the development and implementation of precise, effective and equitable digital health interventions for AYAs.

METHODS AND ANALYSIS

In adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we will conduct a systematic search across multiple databases, including CENTRAL, MEDLINE and WHO Global Index Medicus. We will include peer-reviewed studies on JITAIs targeting health of AYAs in multiple languages. Two independent reviewers will conduct screening and data extraction of study and participant characteristics, JITAI designs, health outcome measures and equity considerations. We will provide a narrative synthesis of findings and, if data allows, conduct a meta-analysis.

ETHICS AND DISSEMINATION

As we will not collect primary data, we do not require ethical approval. We will disseminate the review findings through peer-reviewed journal publication, conferences and stakeholder meetings to inform participatory research.

PROSPERO REGISTRATION NUMBER

CRD42023473117.

Prevalence and factors associated with psychological distress among key populations in Nigeria

BACKGROUND

Stigmatization and discrimination within healthcare settings deter key populations (KPs) from seeking mental health and psychosocial support (MHPS). Consequently, understanding the prevalence, associated factors, and impact of the MHPSS intervention on psychological distress among Nigeria's KPs is crucial.

METHOD

This is a cross-sectional study focused on KPs, including Female Sex Workers (FSW), Men who have Sex with Men (MSM), and People Who Inject Drugs (PWID) enrolled in Heartland Alliance LTD/GTE across 17 One-Stop Shops (OSS) in six states of Nigeria. Data were extracted from the databases of the OSS. PD was assessed using the Mental Health Screening Form III (MHSF-III). Descriptive statistics and univariable and multivariable binary logistic regression models were done using IBM-SPSS version 28.

RESULTS

The prevalence of PD among the KPs was 9.7%. Higher rates were observed among FSWs (12.0%). Of the 22310 KPs, the prevalence of PD was 9.7%. The major dependants of PD include being a PWID with PD prevalence of 8.5% and AOR of 1.95 (95% CI: 0.60-0.98, p = 0.015), alcohol intake with PD prevalence of 97.7% and AOR of 21.83 (95% CI: 15.13-56.83, p<0.001), and having experienced gender-based violence with PD prevalence of 99.0% and AOR of 25.70(95% CI: 17.10-38.73, p<0.001). All Participants (100%) were given brief intervention, and 1595 of 2159 (73.8%) were referred for further psychological intervention. The services with the highest proportion were psychoeducation (21.20%), followed by coping skills training (17.70%) and motivational enhancement (12.90%).

CONCLUSION

The study highlights the critical need for targeted mental health interventions among KPs in Nigeria, primarily focusing on those with a history of substance abuse and gender-based violence. Despite universal brief interventions, the proportion enrolled in further Psychosocial support indicates a need to improve mental health service utilization among the KPs in Nigeria.

Remote consultations in community mental health: A qualitative study of clinical teams

WHAT IS KNOWN ON THE SUBJECT?: Mental health care can be delivered remotely through video and telephone consultations. Remote consultations may be cheaper and more efficient than in person consultations.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Accessing community mental health care through remote consultations is perceived as not possible or beneficial for all service users. Delivering remote consultations may not be practical or appropriate for all clinicians or community mental health teams. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Remote consultation cannot be a 'one-size-fits-all' model of community mental health care. A flexible approach is needed to offering remote consultation that considers its suitability for the service-user, service and clinician.

ABSTRACT

INTRODUCTION: Responding to COVID-19, community mental health teams in the UK NHS abruptly adopted remote consultations. Whilst they have demonstrable effectiveness, efficiency, and economic benefits, questions remain around the acceptability, feasibility and medicolegal implications of delivering community mental health care remotely.

AIM

To explore perceived advantages, challenges, and practice adaptations of delivering community mental health care remotely.

METHODS

Ten community mental health teams in an NHS trust participated in a service evaluation about remote consultation. Fifty team discussions about remote consultation were recorded April-December 2020. Data analysis used a framework approach with themes being coded within a matrix.

RESULTS

Three major horizontal themes of operations and team functioning, clinical pathways, and impact on staff were generated, with vertical themes of advantages, challenges, equity and adaptations.

DISCUSSION

Remote consultation is an attractive model of community mental healthcare. Clinical staff note benefits at individual (staff and service-user), team, and service levels. However, it is not perceived as a universally beneficial or practical approach, and there are concerns relating to access equality.

IMPLICATIONS FOR PRACTICE

The suitability of remote consultation needs to be considered for each service-user, clinical population and clinical role. This requires a flexible and hybrid approach, attuned to safeguarding equality.

Symptom Reduction and Engagement in a Cognitive-Behavioral Mobile Phone App: A Study of User Profiling to Determine Prognostic Indicators

OBJECTIVE

We investigated the presence of latent transition profiles in a sample of users of a cognitive-behavioral mental health app for the general population. Users' baseline characteristics were used as predictors of the profiles. The role of engagement with the app in the transition profiles was examined.

METHOD

A total of 541 users completed the Patient Health Questionnaire-9 and the General Anxiety Disorder-7 when started using the app and 30 days after. Random-Intercept Latent Transition Analysis was implemented to identify users' profiles and transition patterns as classes. The age of the users and the Emotional Self-Awareness Scale-Revised (ESAS-R) were used as predictors of class membership at baseline. The Homework Rating Scale-Mobile Application (HRS-MA; as a measure of engagement) was used as a predictor of class membership at 30 days of app use.

RESULTS

A 3-class solution was obtained according to the severity of symptoms (from mild to moderately severe). Age and ESAS-R predicted class membership initially; the higher the age and ESAS-R, the higher the probability of starting using the app with lower distress levels. The HRS-MA predicted class membership at 30 days of app use; the higher the engagement for more symptomatic and younger users, the higher the probability of improvement. However, older users tended to engage less.

CONCLUSION

Our findings underpin the relevance of easily accessible digital interventions for young adults with mild to moderate mental health problems. Further studies and developments are required to enhance these apps for older cohorts.

Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework

BACKGROUND

Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development.

METHODS

We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles.

RESULTS

Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients' intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health.

CONCLUSION

It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems.

PROTOCOL REGISTRATION

The protocol is registered on PROSPERO, CRD42021276838.

Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review

BACKGROUND

There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature.

OBJECTIVE

Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence.

METHODS

Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures.

RESULTS

A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics.

CONCLUSIONS

It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.

Demographic and clinical characteristics associated with anxiety and depressive symptom outcomes in users of a digital mental health intervention incorporating a relational agent

BACKGROUND

Digital mental health interventions (DMHIs) may reduce treatment access issues for those experiencing depressive and/or anxiety symptoms. DMHIs that incorporate relational agents may offer unique ways to engage and respond to users and to potentially help reduce provider burden. This study tested Woebot for Mood & Anxiety (W-MA-02), a DMHI that employs Woebot, a relational agent that incorporates elements of several evidence-based psychotherapies, among those with baseline clinical levels of depressive or anxiety symptoms. Changes in self-reported depressive and anxiety symptoms over 8 weeks were measured, along with the association between each of these outcomes and demographic and clinical characteristics.

METHODS

This exploratory, single-arm, 8-week study of 256 adults yielded non-mutually exclusive subsamples with either clinical levels of depressive or anxiety symptoms at baseline. Week 8 Patient Health Questionnaire-8 (PHQ-8) changes were measured in the depressive subsample (PHQ-8 ≥ 10). Week 8 Generalized Anxiety Disorder-7 (GAD-7) changes were measured in the anxiety subsample (GAD-7 ≥ 10). Demographic and clinical characteristics were examined in association with symptom changes via bivariate and multiple regression models adjusted for W-MA-02 utilization. Characteristics included age, sex at birth, race/ethnicity, marital status, education, sexual orientation, employment status, health insurance, baseline levels of depressive and anxiety symptoms, and concurrent psychotherapeutic or psychotropic medication treatments during the study.

RESULTS

Both the depressive and anxiety subsamples were predominantly female, educated, non-Hispanic white, and averaged 38 and 37 years of age, respectively. The depressive subsample had significant reductions in depressive symptoms at Week 8 (mean change =-7.28, SD = 5.91, Cohen's d = -1.23, p < 0.01); the anxiety subsample had significant reductions in anxiety symptoms at Week 8 (mean change = -7.45, SD = 5.99, Cohen's d = -1.24, p < 0.01). No significant associations were found between sex at birth, age, employment status, educational background and Week 8 symptom changes. Significant associations between depressive and anxiety symptom outcomes and sexual orientation, marital status, concurrent mental health treatment, and baseline symptom severity were found.

CONCLUSIONS

The present study suggests early promise for W-MA-02 as an intervention for depression and/or anxiety symptoms. Although exploratory in nature, this study revealed potential user characteristics associated with outcomes that can be investigated in future studies.

TRIAL REGISTRATION

This study was retrospectively registered on ClinicalTrials.gov (#NCT05672745) on January 5th, 2023.

Language adaptations of mental health interventions: User interaction comparisons with an AI-enabled conversational agent (Wysa) in English and Spanish

Background

In recent times, digital mental health interventions (DMHIs) have been proven to be efficacious; however, most are available only for English speakers, leaving limited options for non-English languages like Spanish. Research shows that mental health services in one's dominant language show better outcomes. Conversational agents (CAs) offer promise in supporting mental health in non-English populations. This study compared a culturally adapted version of an artificial intelligence (AI)-led mental health app, called Wysa, in Spanish and English.

Objectives

To compare user engagement patterns on Wysa-Spanish and Wysa-English and to understand expressions of distress and preferred language in both versions of Wysa.

Methods

We adopted a cross-sectional retrospective exploratory design with mixed methods, analyzing users from 10 Spanish-speaking countries between 1 February and 1 August 2022. A quantitative sample A (n = 2767) was used for descriptive statistics, including user engagement metrics with a Wilcoxon test. A subset qualitative sample B (n = 338) was examined for word count differences based on valence, and a content analysis was conducted to examine idioms of distress.

Results

Compared to Wysa-English, Wysa-Spanish had more sessions (P < .001, d = 0.18) and a greater volume of disclosure of distress. In Wysa-Spanish, the average length of a conversation was significantly longer than in Wysa-English (P < .001, d = 0.44). Users preferred interventions with free text responses ("Thought recording") in Spanish (P < .01, d = 0.41), and Spanish messages were significantly longer (P < .01, d = 0.24). Wysa-Spanish saw more frequent expressions of negative emotions and feelings of self-harm and suicide.

Conclusion

Given the high engagement within the Spanish version of Wysa, the findings demonstrate the need for culturally adapted DMHIs among non-English populations, emphasizing the importance of considering linguistic and cultural differences in the development of DMHIs to improve accessibility for diverse populations.

Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis

BACKGROUND

Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth.

OBJECTIVE

This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression.

METHODS

We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms.

RESULTS

Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents.

CONCLUSIONS

Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people.

Development and codesign of flourish: A digital suicide prevention intervention for LGBTQ+ youth who have experienced online victimization

Background

LGBTQ+ youth experience disproportionately high rates of online victimization (OV), referring to harmful remarks, images, or behaviors in online settings, which is associated with suicidal risk. Current services have gaps in supporting LGBTQ+ youth facing OV events. To address these gaps, this study aims to develop Flourish, a digital suicide prevention intervention for LGBTQ+ youth who have experienced OV.

Methods

Qualitative interviews were conducted with 20 LGBTQ+ youth with past-year history of OV and lifetime history of suicidality, 11 of their parents, and 10 LGBTQ+-serving professionals. Subsequently, an iterative codesign process was conducted with 22 youth through individual and group design sessions, followed by usability testing. Data were recorded and transcribed. Qualitative interviews were analyzed using a qualitative description approach, and data from design sessions and usability testing were analyzed using rapid qualitative techniques.

Results

Interviews with youth, parents, and professionals suggested preferences for Flourish to be a partially automated, text message intervention leveraging web-based content that is a safe space for LGBTQ+ youth to seek support for OV through education, coping skills, and help-seeking resources. School and mental health services professionals considered the potential for implementing Flourish within youth services settings. Usability testing, assessed through the System Usability Scale, yielded an average rating of 91, indicating excellent perceived usability.

Conclusions

Flourish has potential to be an acceptable intervention to support LGBTQ+ youth following OV. Future steps will include testing the feasibility and efficacy of Flourish and further examining Flourish's potential for implementation within services for LGBTQ+ youth.

How Can Digital Mental Health Enhance Psychiatry?

The use of digital technologies is constantly growing around the world. The wider-spread adoption of digital technologies and solutions in the daily clinical practice in psychiatry seems to be a question of when, not if. We propose a synthesis of the scientific literature on digital technologies in psychiatry and discuss the main aspects of its possible uses and interests in psychiatry according to three domains of influence that appeared to us: 1) assist and improve current care: digital psychiatry allows for more people to have access to care by simply being more accessible but also by being less stigmatized and more convenient; 2) develop new treatments: digital psychiatry allows for new treatments to be distributed via apps, and practical guidelines can reduce ethical challenges and increase the efficacy of digital tools; and 3) produce scientific and medical knowledge: digital technologies offer larger and more objective data collection, allowing for more detection and prevention of symptoms. Finally, ethical and efficacy issues remain, and some guidelines have been put forth on how to safely use these solutions and prepare for the future.

Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups

BACKGROUND

Studies have reported positive outcomes of blended care therapy (BCT), which combines face-to-face care with internet modules. However, there is insufficient evidence of its effectiveness across racial and ethnic groups. This study evaluated outcomes of a BCT program, which combined video psychotherapy with internet cognitive-behavioral modules, across race and ethnicity.

METHODS

Participants were 6492 adults, with elevated anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) symptoms, enrolled in employer-offered BCT. Changes in anxiety (GAD-7) and depression (PHQ-9) symptoms during treatment were evaluated using individual growth curve models. Interaction terms of time with race and ethnicity tested for between-group differences. Treatment satisfaction was assessed using a Net Promoter measure (range = 1 (lowest satisfaction) to 5 (greatest satisfaction)).

RESULTS

Participants' self-reported race and ethnicity included Asian or Pacific Islander (27.5%), Black or African American (5.4%), Hispanic or Latino (9.3%), and White (47.2%). Anxiety symptoms decreased during treatment (p < 0.01), with greater reductions among Hispanic or Latino participants compared to White participants (p < 0.05). Depressive symptoms decreased across treatment (p < 0.01), with significantly greater decreases among some racial and ethnic groups compared to White participants. Declines in anxiety and depressive symptoms slowed across treatment (p's < 0.01), with statistically significant differences in slowing rates of depressive symptoms across some racial and ethnic groups. Among participants with responses (28.45%), average treatment satisfaction ranged from 4.46 (SD = 0.73) to 4.67 (SD = 0.68) across race and ethnicity (p = 0.001). Racial and ethnic differences in outcomes were small in magnitude.

CONCLUSIONS

BCT for anxiety and depression can be effective across diverse racial and ethnic groups.

Seeking help for mental health during the COVID-19 pandemic: A longitudinal analysis of adults' experiences with digital technologies and services

The COVID-19 pandemic brought about dramatic changes in how patients access healthcare from its outset. Lockdown restrictions and remote working led to a proliferation of digital technologies and services, which also impacted mental health provisions. Against the backdrop of new and changing support services, along with an unprecedented emphasis on mental health, relatively little is known about how adults sought out and received support for their mental health during this period. With a sample of 27,574 adults assessed longitudinally online over 12 months of the pandemic in the UK, we analysed reports of help-seeking for mental health, as well as sources of treatment or support and the perceived helpfulness of treatments received. We observed that the proportions of participants who reported seeking help remained relatively consistent throughout the 12-month period (ranging from 12.6% to 17.0%). Online talking therapies were among the most frequently sought sources (15.3%), whereas online self-guided treatments were among the least frequently sought sources (5%). Telephone lines, both NHS and non-governmental, had marked treatment 'gaps'. These treatment gaps, where individuals sought treatment but did not receive it, were especially evident for men and older adults. Our findings underscore online talking therapies as being a widely-sought and helpful source of mental health support. This is important given the current global need for accessible treatment options.

Real-World Adoption of Mental Health Support Among Adolescents: Cross-Sectional Analysis of the California Health Interview Survey

OBJECTIVE

We aim to examine: (a) the extent to which patterns of adoption of counseling services and digital mental health interventions (DMHIs) shifted in recent years (2019-2021); (b) the impact of distress on adoption of mental health support; and (c) reasons related to adolescents' low adoption of DMHIs when experiencing distress.

METHODS

Data were from three cohorts of adolescents aged 12-17 years (n = 847 in 2019; n = 1,365 in 2020; n = 1,169 in 2021) recruited as part of the California Health Interview Survey. We estimated logistic regression models to examine the likelihood of using mental health support as a function of psychological distress, sociodemographic characteristics, and cohorts. We also analyzed adolescents' self-reported reasons for not trying DMHIs as a function of distress.

RESULTS

The proportion of adolescents reporting elevated psychological distress (∼50%) was higher than those adopting counseling services (<20%) or DMHIs (<10%). A higher level of distress was associated with a greater likelihood of receiving counseling (OR = 1.15), and using DMHIs to connect with a professional (Odds ratio (OR) = 1.11) and for self-help (OR = 1.17). Among those experiencing high distress, adolescents' top reason for not adopting an online tool was a lack of perceived need (19.2%).

CONCLUSION

Adolescents' main barriers to DMHI adoption included a lack of perceived need, which may be explained by a lack of mental health literacy. Thoughtful marketing and dissemination efforts are needed to increase mental health awareness and normalize adoption of counseling services and DMHIs.

Serving the Underserved? Uptake, Effectiveness, and Acceptability of Digital SSIs for Rural American Adolescents

OBJECTIVE

Rural teens are less likely to access care for depression than urban teens. Evidence-based digital single-session interventions (SSIs), offered via social media advertisements, may be well suited to narrowing this gap in treatment access and increasing access to support for adolescents living in rural areas. We evaluated the viability of using social media-based advertisements to equitably recruit adolescents living in rural areas with elevated depression symptoms to digital SSIs; we sought to characterize and assess whether SSI completion rates and acceptability differed for adolescents living in rural versus more urban areas, across three intervention conditions (two active, evidence-based SSIs; one placebo control); and we tested whether digital SSIs differentially reduced depressive symptoms.

METHOD

We used pre-intervention and three-month follow up data from 13- to 16-year-old adolescents (N = 2,322; 88% female; 55% non-Hispanic White) within a web-based randomized control trial of three free, digital SSIs (ClinicalTrials.gov identifier: NCT04634903) collected eight months into the COVID-19 pandemic in the United States.

RESULTS

Digital SSIs reached adolescents at population-congruent rates; however, social media ads resulted in relative underrepresentation of youths from rural areas who hold minoritized racial/ethnic identities. Adolescents living in rural areas also completed digital SSIs at similar rates to their urban peers, found SSIs equivalently as acceptable, and reported comparable depression symptom reductions as youth living in urban areas.

CONCLUSION

Digital SSIs and their dissemination through social media may offer a promising means of narrowing the gap between access to evidence-based mental health support between adolescents living in rural and urban areas; however, targeted efforts are warranted to reach racially minoritized youths in rural U.S. counties.

Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components

Technology-enabled services (TESs) are clinical interventions that combine technological and human components to provide health services. TESs for mental health are efficacious in the treatment of anxiety and depression and are currently being offered as frontline treatments around the world. It is hoped that these interventions will be able to reach diverse populations across a range of identities and ultimately decrease disparities in mental health treatment. However, this hope is largely unrealized. TESs include both technology and human service components, and we argue that cultural responsivity must be considered in each of these components to help address existing treatment disparities. To date, there is limited guidance on how to consider cultural responsivity within these interventions, including specific targets for the development, tailoring, or design of the technologies and services within TESs. In response, we propose a framework that provides specific recommendations for targets based on existing models, both at the technological component level (informed by the Behavioral Intervention Technology Model) and the human support level (informed by the Efficiency Model of Support). We hope that integrating culturally responsive considerations into these existing models will facilitate increased attention to cultural responsivity within TESs to ensure they are ethical and responsive for everyone.

Engaging in the good with technology: a framework for examining positive technology use

The focus on the negative side of technology has become a prominent factor in the understanding of the interactions between humans and technology. However, there is a positive side to technology use that has been less investigated in scientific research. Well-being researchers have determined that it is not just the absence of negative emotions or experiences, but rather the presence and frequency of positive ones that matter most. Therefore, despite the scarcity of research on the positive side of technology, the present conceptual paper focuses on how technology may be used for the good to produce psychological benefits (e.g., greater happiness, lower loneliness, higher peer endorsement). Based on existing literature, we posit at least three directions for good interactions with technology: (1) "seeing good" by focusing on positive visual cues through technology use; (2) "feeling good" by focusing on good feelings that arise from technology use; and (3) "doing good" by focusing on positive actions that can be enacted via technology use. Based on the synthesis of these three components, we propose a framework for technology laden engagement in the good, dubbed as, the Engagement in the Good with Technology (EGT) Framework. Through this framework, we explain how these three distinct aspects of seeing, feeling, and doing good can co-occur and be interrelated, and in turn potentially lead to upward spirals of positive outcomes.

Opportunities for the Implementation of a Digital Mental Health Assessment Tool in the United Kingdom: Exploratory Survey Study

BACKGROUND

Every year, one-fourth of the people in the United Kingdom experience diagnosable mental health concerns, yet only a proportion receive a timely diagnosis and treatment. With novel developments in digital technologies, the potential to increase access to mental health assessments and triage is promising.

OBJECTIVE

This study aimed to investigate the current state of mental health provision in the United Kingdom and understand the utility of, and interest in, digital mental health technologies.

METHODS

A web-based survey was generated using Qualtrics XM. Participants were recruited via social media. Data were explored using descriptive statistics.

RESULTS

The majority of the respondents (555/618, 89.8%) had discussed their mental health with a general practitioner. More than three-fourths (503/618, 81.4%) of the respondents had been diagnosed with a mental health disorder, with the most common diagnoses being depression and generalized anxiety disorder. Diagnostic waiting times from first contact with a health care professional varied by diagnosis. Neurodevelopmental disorders (30/56, 54%), bipolar disorder (25/52, 48%), and personality disorders (48/101, 47.5%) had the longest waiting times, with almost half (103/209, 49.3%) of these diagnoses taking >6 months. Participants stated that waiting times resulted in symptoms worsening (262/353, 74.2%), lower quality of life (166/353, 47%), and the necessity to seek emergency care (109/353, 30.9%). Of the 618 participants, 386 (62.5%) stated that they felt that their mental health symptoms were not always taken seriously by their health care provider and 297 (48.1%) were not given any psychoeducational information. The majority of the respondents (416/595, 77.5%) did not have the chance to discuss mental health support and treatment options. Critically, 16.1% (96/595) did not find any treatment or support provided at all helpful, with 63% (48/76) having discontinued treatment with no effective alternatives. Furthermore, 88.3% (545/617) of the respondents) had sought help on the web regarding mental health symptoms, and 44.4% (272/612) had used a web application or smartphone app for their mental health. Psychoeducation (364/596, 61.1%), referral to a health care professional (332/596, 55.7%), and symptom monitoring (314/596, 52.7%) were the most desired app features. Only 6.8% (40/590) of the participants said that they would not be interested in using a mental health assessment app. Respondents were the most interested to receive an overall severity score of their mental health symptoms (441/546, 80.8%) and an indication of whether they should seek mental health support (454/546, 83.2%).

CONCLUSIONS

Key gaps in current UK mental health care provision are highlighted. Assessment and treatment waiting times together with a lack of information regarding symptoms and treatment options translated into poor care experiences. The participants' responses provide proof-of-concept support for the development of a digital mental health assessment app and valuable recommendations regarding desirable app features.

Digital self-help for people experiencing intimate partner violence: a qualitative study on user experiences and needs including people with lived experiences and services providers

BACKGROUND

Intimate partner violence (IPV) is a prevalent public health issue associated with multiple physical and mental health consequences for survivors. Digital interventions can provide low-threshold support to those experiencing IPV, but existing digital interventions have limited efficacy in improving the safety and mental health of IPV survivors. Digitally adapting an integrative intervention with advocacy-based and psychological content holds promise for increasing the efficacy of digital interventions in the context of IPV.

METHODS

This study examines the needs, acceptability and usability of an integrative digital intervention for people affected by IPV. We used the think-aloud method and semi-structured interviews with a sample of six people with lived experiences of IPV and six service providers. We analyzed the data using thematic analysis.

RESULTS

We identified the increasing general acceptance of digital support tools and the limited capacity of the current support system as societal context factors influencing the acceptance of and needs regarding digital interventions in the context of IPV. An integrative digital self-help intervention offers several opportunities to complement the current support system and to meet the needs of people affected by IPV, including the reduction of social isolation, a space for self-reflection and coping strategies to alleviate the situation. However, potentially ongoing violence, varying stages of awareness and psychological capacities, and as well as the diversity of IPV survivors make it challenging to develop a digital intervention suitable for the target group. We received feedback on the content of the intervention and identified design features required for intervention usability.

CONCLUSION

An integrative digital self-help approach, with appropriate security measures and trauma-informed design, has the potential to provide well-accepted, comprehensive and continuous psychosocial support to people experiencing IPV. A multi-modular intervention that covers different topics and can be personalized to individual user needs could address the diversity of the target population. Providing guidance for the digital intervention is critical to spontaneously address individual needs. Further research is needed to evaluate the efficacy of an integrative digital self-help intervention and to explore its feasibility it in different settings and populations.

"The library is so much more than books": considerations for the design and implementation of teen digital mental health services in public libraries

Background

Adolescence is a vulnerable developmental period, characterized by high rates of mental health concerns, yet few adolescents receive treatment. Public libraries support adolescents by providing them with access to teen programming, technological resources, and have recently been providing mental health services. Digital mental health (DMH) services may help libraries provide scalable mental health solutions for their adolescent patrons and could be well positioned to address the mental health needs of historically underrepresented racial and ethnic (HURE) adolescents; however, little research has been conducted on the compatibility of DMH services with adolescent patron mental health needs or resource needs of library workers supporting them.

Methods

The research team formed a partnership with a public library, which serves a large HURE adolescent population. We conducted needs assessment and implementation readiness interviews with 17 library workers, including leadership, librarians, and workers with specialized areas of practice. Interview questions focused on library infrastructure, as well as library needs and preferences around the design and implementation of DMH services for adolescents. We used the Consolidated Framework for Implementation Research as guiding implementation determinant framework to code and analyze the interview transcripts.

Results

Our findings revealed library workers play an important role in guiding patrons to desired resources and share a goal of implementing adolescent DMH resources into the library and elevating marginalized adolescents' voices. Existing library resources, such as the library's role as a safe space for adolescents in the community, close relationships with external and community organizations, and availability of no-cost technological resources, could help facilitate the implementation of DMH services. Barriers related to community buy-in, mental health stigma, and library worker confidence in supporting adolescent mental health could affect service implementation.

Conclusions

Our findings suggest public libraries are highly promising settings to deploy DMH services for adolescents. We identified important determinants that may impact the implementation of DMH services in public library settings. Special considerations are needed to design services to meet the mental health needs of HURE adolescent populations and those adolescents' most experiencing health inequities.

Developing digital mental health tools for youth with diabetes: an agenda for future research

Youth living with diabetes face a concurrent challenge: managing a chronic health condition and managing the psychosocial and developmental changes that are characteristic of adolescence and young adulthood. Despite these unique challenges, psychological support is often difficult for youth with diabetes to access due to a lack of trained mental health professionals and other resource constraints. Digital wellbeing tools offer the potential to improve access to psychological support for this population. However, very few digital wellbeing tools exist for youth with diabetes. Of those that do exist, very few are evidence-based therapies, undermining their contribution to the field. Given the increasing global prevalence of diabetes in young people, the support necessitated by the challenges experienced by this population is not always accessible in a face-to-face setting and cannot be effectively scaled to meet demand. To support the health and wellbeing of youth with diabetes, there is a clear need to develop digital interventions that are widely accessible to users, but, more saliently, grounded in empirical evidence that supports their efficacy. Thus, the purpose of this paper is to offer an agenda for future research, including insights into which psychological techniques and behavioral change theories may be a good conceptual fit for digital mental health interventions, and how these tools may be best developed and utilized by the individuals that need them. Scalable, evidence-based wellbeing tools for this population are urgently required to improve psychological outcomes, and potentially, improve the equity of service access.

Provision of Digital Health Technologies for Opioid Use Disorder Treatment by US Health Care Organizations

Importance

Digital health technologies may expand organizational capacity to treat opioid use disorder (OUD). However, it remains unclear whether these technologies serve as substitutes for or complements to traditional substance use disorder (SUD) treatment resources in health care organizations.

Objective

To characterize the use of patient-facing digital health technologies for OUD by US organizations with accountable care organization (ACO) contracts.

Design, Setting, and Participants

This cross-sectional study analyzed responses to the 2022 National Survey of Accountable Care Organizations (NSACO), collected between October 1, 2021, and June 30, 2022, from US organizations with Medicare and Medicaid ACO contracts. Data analysis was performed between December 15, 2022, and January 6, 2023.

Exposures

Treatment resources for SUD (eg, an addiction medicine specialist, sufficient staff to treat SUD, medications for OUD, a specialty SUD treatment facility, a registry to identify patients with OUD, or a registry to track mental health for patients with OUD) and organizational characteristics (eg, organization type, Medicaid ACO contract).

Main Outcomes and Measures

The main outcomes included survey-reported use of 3 categories of digital health technologies for OUD: remote mental health therapy and tracking, virtual peer recovery support programs, and digital recovery support for adjuvant cognitive behavior therapy (CBT). Statistical analysis was conducted using descriptive statistics and multivariable logistic regression models.

Results

Overall, 276 of 505 organizations responded to the NSACO (54.7% response rate), with a total of 304 respondents. Of these, 161 (53.1%) were from a hospital or health system, 74 (24.2%) were from a physician- or medical group-led organization, and 23 (7.8%) were from a safety-net organization. One-third of respondents (101 [33.5%]) reported that their organization used at least 1 of the 3 digital health technology categories, including remote mental health therapy and tracking (80 [26.5%]), virtual peer recovery support programs (46 [15.1%]), and digital recovery support for adjuvant CBT (27 [9.0%]). In an adjusted analysis, organizations with an addiction medicine specialist (average marginal effect [SE], 32.3 [4.7] percentage points; P < .001) or a registry to track mental health (average marginal effect [SE], 27.2 [3.8] percentage points; P < .001) were more likely to use at least 1 category of technology compared with otherwise similar organizations lacking these capabilities.

Conclusions and Relevance

In this cross-sectional study of 276 organizations with ACO contracts, organizations used patient-facing digital health technologies for OUD as complements to available SUD treatment capabilities rather than as substitutes for unavailable resources. Future studies should examine implementation facilitators to realize the potential of emerging technologies to support organizations facing health care practitioner shortages and other barriers to OUD treatment delivery.

Assessment of Traumatic Stress Symptoms During the Acute Posttrauma Period

A substantial majority of adults in the United States will experience a potentially traumatic event (PTE) in their lifetime. A considerable proportion of those individuals will go on to develop posttraumatic stress disorder (PTSD). Distinguishing between those who will develop PTSD and those who will recover, however, remains as a challenge to the field. Recent work has pointed to the increased potential of identifying individuals at greatest risk for PTSD through repeated assessment during the acute posttrauma period, the 30-day period after the PTE. Obtaining the necessary data during this period, however, has proven to be a challenge. Technological innovations such as personal mobile devices and wearable passive sensors have given the field new tools to capture nuanced in vivo changes indicative of recovery or nonrecovery. Despite their potential, there are numerous points for clinicians and research teams to consider when implementing these technologies into acute posttrauma care. The limitations of this work and considerations for future research in the use of technology during the acute posttrauma period are discussed.

Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses

BACKGROUND

Digital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts.

OBJECTIVE

This paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors.

METHODS

This study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework.

RESULTS

On the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate.

CONCLUSIONS

The successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor).

Examining Disparities in Ownership and Use of Digital Health Technology Between Rural and Urban Adults in the US: An Analysis of the 2019 Health Information National Trends Survey

BACKGROUND

Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHT adoption at the national level. Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care.

OBJECTIVE

 To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey.

METHODS

 Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics and sociodemographic factors.

RESULTS

The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs. Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797). However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers.

CONCLUSION

 We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.

Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis

BACKGROUND

Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment.

OBJECTIVE

This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample.

METHODS

Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit.

RESULTS

The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models.

CONCLUSIONS

The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored.

Effectiveness and implementation of a text messaging intervention to reduce depression and anxiety symptoms among Latinx and Non-Latinx white users during the COVID-19 pandemic

Text messaging interventions are increasingly used to help people manage depression and anxiety. However, little is known about the effectiveness and implementation of these interventions among U.S. Latinxs, who often face barriers to using mental health tools. The StayWell at Home (StayWell) intervention, a 60-day text messaging program based on cognitive behavioral therapy (CBT), was developed to help adults cope with depressive and anxiety symptoms during the COVID-19 pandemic. StayWell users (n = 398) received daily mood inquiries and automated skills-based text messages delivering CBT-informed coping strategies from an investigator-generated message bank. We conduct a Hybrid Type 1 mixed-methods study to compare the effectiveness and implementation of StayWell for Latinx and Non-Latinx White (NLW) adults using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using the PHQ-8 depression and GAD-7 anxiety scales, assessed before starting and after completing StayWell. Guided by RE-AIM, we conducted a thematic text analysis of responses to an open-ended question about user experiences to help contextualize quantitative findings. Approximately 65.8% (n = 262) of StayWell users completed pre-and-post surveys. On average, depressive (-1.48, p = 0.001) and anxiety (-1.38, p = 0.001) symptoms decreased from pre-to-post StayWell. Compared to NLW users (n = 192), Latinx users (n = 70) reported an additional -1.45 point (p < 0.05) decline in depressive symptoms, adjusting for demographics. Although Latinxs reported StayWell as relatively less useable (76.8 vs. 83.9, p = 0.001) than NLWs, they were more interested in continuing the program (7.5 vs. 6.2 out of 10, p = 0.001) and recommending it to a family member/friend (7.8 vs. 7.0 out of 10, p = 0.01). Based on the thematic analysis, both Latinx and NLW users enjoyed responding to mood inquiries and sought bi-directional, personalized text messages and texts with links to more information to resources. Only NLW users stated that StayWell provided no new information than they already knew from therapy or other sources. In contrast, Latinx users suggested that engagement with a behavioral provider through text or support groups would be beneficial, highlighting this group's unmet need for behavioral health care. mHealth interventions like StayWell are well-positioned to address population-level disparities by serving those with the greatest unmet needs if they are culturally adapted and actively disseminated to marginalized groups. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04473599.

Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).

Review: Can digital mental health interventions bridge the 'digital divide' for socioeconomically and digitally marginalised youth? A systematic review

BACKGROUND

Digital mental health interventions (DMHIs) have the potential to improve the efficiency, accessibility and effectiveness of mental health services for young people, with the potential to reach socioeconomically and digitally marginalised young people with mental health needs who would otherwise not seek help in person. This review aims to investigate the characteristics, acceptability and efficacy of DMHIs specifically developed for socioeconomically and digitally marginalised youth.

METHOD

Key databases were searched widely and systematically (EMBASE, MEDLINE, PsycINFO, OpenGrey). Final inclusion in this review required studies to evaluate DMHIs specifically targeting socioeconomically and digitally marginalised children and young people through a broad range of research designs.

RESULTS

Ten studies, describing seven DHMIs, were included in this review. Studies varied in terms of methodology, population, intervention, outcome measures, technologies used and methodological quality. Qualitative and quantitative results are synthesised across three key phenomena of interest: effectiveness, acceptability and feasibility. Findings suggest that there is moderate but limited evidence supporting DMHIs for improving mental health outcomes among these populations.

CONCLUSIONS

While there is moderate evidence suggesting that digitally delivered interventions can be effective in improving mental health outcomes among socioeconomically and digitally marginalised youth, more high-quality research is needed in order to determine whether DMHIs can fully bridge the so-called 'digital divide'.

"I don't think they're as culturally sensitive": a mixed-method study exploring e-mental health use among culturally diverse populations

BACKGROUND

Culturally diverse populations (CDPs), such as visible minorities, face challenges, such as lack of culturally tailored resources, when accessing mental health services. These barriers may be addressed by e-mental health (eMH) technologies. However, little attention has been devoted to understanding the cultural responsiveness of these services among CDPs.

AIMS

This study explores CDPs experience of eMH for anxiety and depressive disorders in an urban area and gauge its cultural responsiveness.

METHODS

In this mixed methods study, participants (N = 136) completed a survey regarding their eMH use, mental health status, and socio-demographic characteristics. Subsequently, participants (N = 14) shared their experiences through semi-structured focus groups.

RESULTS

The majority of participants (68%) indicated that the eMH resources used were not culturally tailored. However, most participants (65%) agreed that the resource was available in their preferred language. Focus group discussions revealed key experiences around limited language diversity, cultural representation and cultural competency, and culturally linked stigma. eMH recommendations suggested by participants focused on including culturally tailored content, graphics and phrases, and lived experiences of CDPs.

CONCLUSIONS

The findings showcase the need for more culturally responsive eMH beyond language translation, while providing healthcare professionals with a greater and nuanced understanding of treatment needs in cultural groups.

Ethical considerations for developing pediatric mhealth interventions for teens with socially complex needs

TOPIC

Mobile Health (mHealth) stands as a potential means to better reach, assess, and intervene with teens with socially complex needs. These youth often face overlapping adversities including medical illness and a history of experiencing adverse childhood experiences (ACEs). Clinicians are faced with navigating ethical decisions when developing mHealth tools for teens who have socially complex needs. Many tools have been developed for adults from the general population. However, despite the development of thousands of mHealth interventions, developers tend to focus on designing for usability, engagement, and efficacy, with less attention on the ethical considerations of making such tools.

PURPOSE

To safely move mHealth interventions from research into clinical practice, ethical standards must be met during the design phase. In this paper we adapt the Four Box Model (i.e., medical indications, preferences of patients, quality of life, and contextual features) to guide mHealth developers through ethical considerations when designing mHealth interventions for teens who present with a medical diagnosis and a history of ACEs.

SOURCES

A review of language, inclusive features, data sharing, and usability is presented using both the Four Box Model and potential scenarios to guide each consideration.

CONCLUSIONS

To better support designers of mHealth tools we present a framework for evaluating applications to determine overlap with ethical design and are well suited for use in clinical practice with underserved pediatric patients.

Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data

BACKGROUND

In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals.

OBJECTIVE

We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web.

METHODS

We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons.

RESULTS

We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10^-12).

CONCLUSIONS

This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care.

Digital Mental Health Interventions for Young People in Rural South Africa: Prospects and Challenges for Implementation

Globally, most young people living with mental health conditions lack access to mental health care but have access to a mobile device. The growing access to mobile devices in South Africa has the potential to increase access to mental health care services through digital platforms. However, uptake of digital mental health interventions may be hampered by several factors, such as privacy, confidentiality, informed consent, and affordability. This study identified the prospects and challenges of implementing a mobile phone-based mental health intervention for young people in Ingwavuma area. Data were collected from 93 young people in three villages purposefully selected in Ingwavuma area. Participants included in the study were aged 16-24. Data were collected through a questionnaire. Thematic and descriptive analysis was performed on the qualitative and quantitative data, respectively. Mental health education was low, with only 22% of participants having received prior education on mental health. About 50% of the participants had come across a mental health app, but none of them had used any of these apps; 87% of participants had Internet access; 60% preferred to use social media to contact a health worker; and 92% suggested that use of digital apps would improve mental health literacy among young people. Barriers to access of digital mental health interventions were identified as the high cost of data, restrictive religious beliefs, limited privacy, lack of native languages on most digital platforms, low digital literacy, and complicated user interface. In uMkhanyakude, uptake of digital mental health apps among the young people was low. We recommend that, developers create context-specific digital applications catered for young people from different cultural backgrounds. Socio-economic issues such as affordability also need to be addressed in developing these tools.

User experience with a parenting chatbot micro intervention

Background

The use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country.

Methods

A sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed.

Results

66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]).

Conclusions

Overall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.

Intervention development to improve foster youth mental health by targeting coping self-efficacy and help-seeking

This study articulates the iterative development of an intervention called Strengthening Youth Networks and Coping (SYNC), which is designed to target coping self-efficacy and help-seeking intentions and behaviors among youth in foster care. The overarching goal is to design an intervention that will be a feasible and acceptable enhancement to existing child welfare services, and that will address modifiable determinants among adolescents involved in child welfare system that are related to elevated risk for mental health challenges, limited support network capacity, and service disengagement after exiting foster care. In this paper, we describe our initial needs assessment, explain how we selected proximal intervention mechanisms (i.e., intermediate outcomes) to target, and outline the preliminary intervention development process, including ongoing insights we received from a research advisory group including members with lived experience. Next, we report and discuss the initial acceptability pre-testing data collected from youth (N = 30) as well as feasibility data collected from providers (N = 82), results from which were used to refine the SYNC intervention framework prior to robust efficacy testing. Findings highlight the need and importance of targeting youth coping and help-seeking, integrating programming within existing transition services, delivering this content in a group-based format that includes near-peer mentors and facilitators with lived experience, and developing options that work for the heterogeneous population of young people in foster care. The results also highlight the key objective of capturing youth's interests prior to enrolling in the program (e.g., language used in recruitment materials), holding their interest throughout the program (e.g., creating opportunities for youth to engage with other youth with similar experiences), and suggestions to encourage youth's engagement and participation. This paper articulates the value of this intervention development approach, and the sequential phases of this intervention development process as well as the results, which may be useful to applied researchers and practitioners working with youth in foster care and other priority populations.

Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations

BACKGROUND

Online health interventions increase access to care, are acceptable to end users and effective for treating mental and physical health disorders. However, less is known about interventions to prevent and treat perinatal mood and anxiety disorders (PMADs). This review synthesizes existing research on PMAD prevention and treatment by exploring the treatment modalities and efficacy of online interventions and examining the inclusion of underserved populations in PMAD research.

METHODS

Using PRISMA guidelines, authors conducted a systematic review of peer-reviewed literature published between 2008 and 2018 on online interventions aimed to prevent or treat PMADs. The authors also assessed quality. Eligible articles included perinatal women participating in preventive studies or those aimed to reduce symptoms of PMADs and utilized a Web-based, Internet, or smartphone technology requiring an online component. This study excluded telephone-based interventions that required one-on-one conversations or individualized, text-based responses without a Web-based aspect.

RESULTS

The initial search yielded 511 articles, and the final analysis included 23 articles reporting on 22 interventions. Most studies used an experimental design. However, no study achieved an excellent or good quality rating. Psychoeducation and cognitive-behavioral therapies (CBTs) were most common. Several interventions using CBT strategies significantly decreased depression or anxiety. Four studies recruited and enrolled mainly people identifying as low-income or of a racial or ethnic minority group. Attrition was generally high across studies.

DISCUSSION

More research using rigorous study designs to test PMAD interventions across all perinatal times is needed. Future research needs to engage diverse populations purposefully.

Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation

BACKGROUND

The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic.

OBJECTIVE

The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California.

METHODS

A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6-week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up.

RESULTS

Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19-related behavior changes (β=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19-related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2≥3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (β=-.62, 95% CI -1.04 to -0.20; P=.004). The main predictor of GAD2≥3 at follow-up was baseline GAD2≥3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004).

CONCLUSIONS

Ethnicity/language and COVID-19-related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources.

Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review

Background

Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking.

Objective

This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity.

Methods

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years.

Results

Of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation.

Conclusions

Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations.

Trial Registration

PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f

A Hybrid Ecological Momentary Compassion–Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial

Background

Young people are a target population for mental health–related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed.

Objective

This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants’ baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants’ sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants’ sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates.

Methods

We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study’s manual, a scoping review of existing literature and manuals, exchange with experts, the team’s clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention.

Results

A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95% CI 0.00-0.22), general psychopathology (B=0.08, 95% CI −0.01 to 0.16), and clinical stage (B=1.50, 95% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=−2.83, 95% CI −5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes.

Conclusions

The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial.

Trial Registration

German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265

International Registered Report Identifier (IRRID)

RR2-10.2196/27462

Culturally Responsive Telepsychology & mHealth Interventions for Racial-Ethnic Minoritized Youth: Research Gaps and Future Directions

Telepsychology and mHealth (TPmH) services for youth and their families have become increasingly prevalent in recent years. However, significant limitations in theory, research, and policy introduce questions about the effectiveness of such interventions, particularly for racial-ethnic minoritized youth and their families, who already contend with inequities in mental health treatment access and outcomes. Although TPmH have the potential to reduce barriers to mental health services in ways that may benefit racial-ethnic minoritized youth and their families, the mental health field must first grapple with limitations in culturally responsive TPmH work to avoid perpetuating existing mental health inequities. As such, this article begins by briefly reviewing extant literature on (1) TPmH for youth, (2) culturally adapted or culturally responsive evidence-based interventions for racial-ethnic minoritized youth and families, and (3) the intersection of TPmH and culturally responsive interventions. Informed by the gaps identified by this review, we provide recommendations for future directions in culturally responsive TPmH for racial-ethnic minoritized youth and families. These recommendations have been organized into four overarching categories: (1) conceptual and theoretical recommendations, (2) research priorities, (3) practice and policy recommendations, and (4) engagement and access recommendations. These recommendations offer novel ideas for researchers, clinicians, funding agencies, policy-makers, and other key stakeholders and are intended to facilitate equity in TPmH for racial-ethnic minoritized youth and their families.

Predicting non-initiation of care and dropout in a blended care CBT intervention: Impact of early digital engagement, sociodemographic, and clinical factors

Objective

This study examines predictors of non-initiation of care and dropout in a blended care CBT intervention, with a focus on early digital engagement and sociodemographic and clinical factors.

Methods

This retrospective cohort analysis included 3566 US-based individuals who presented with clinical levels of anxiety and depression and enrolled in a blended-care CBT (BC-CBT) program. The treatment program consisted of face-to-face therapy sessions via videoconference and provider-assigned digital activities that were personalized to the client's presentation. Multinomial logistic regression and Cox proportional hazard survival analysis were used to identify predictors of an increased likelihood of non-initiation of therapy and dropout.

Results

Individuals were more likely to cancel and/or no-show to their first therapy session if they were female, did not disclose their ethnicity, reported poor financial status, did not have a college degree, endorsed more presenting issues during the onboarding triage assessment, reported taking antidepressants, and had a longer wait time to their first appointment. Of those who started care, clients were significantly more likely to drop out if they did not complete the digital activities assigned by their provider early in treatment, were female, reported more severe depressive symptoms at baseline, reported taking antidepressants, and did not disclose their ethnicity.

Conclusions

Various sociodemographic and clinical predictors emerged for both non-initiation of care and for dropout, suggesting that clients with these characteristics may benefit from additional attention and support (especially those with poor early digital engagement). Future research areas include targeted mitigation efforts to improve initiation rates and curb dropout.

Digital headache self-management interventions for patients with a primary headache disorder: A systematic review of randomized controlled trials

OBJECTIVE

This article systematically reviews the empirical literature examining the efficacy of digital headache management interventions for patients with a primary headache disorder.

BACKGROUND

Digital headache management interventions provide opportunities to improve access to behavioral headache interventions to underserved groups.

METHODS

A systematic search of PubMed, Scopus, and EBSCO (PsycInfo, Education Research Complete, ERIC, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection) and reference review was conducted. Included studies had to recruit a sample with a primary headache diagnosis, be a randomized controlled trial including a digital component, assess a headache outcome (i.e., frequency, duration, severity, intensity, disability) or quality of life, and be published in English. Two authors independently extracted data for included studies. The methodological quality of studies was assessed using the revised Cochrane risk-of-bias tool.

RESULTS

Thirteen studies with unique interventions met inclusion criteria. More than half of the studies were pilots; however, nearly 70% (9/13) demonstrated significant between-group or within-group improvements on one or more headache-related outcomes. All interventions included some form of relaxation training and the majority were delivered via interactive website. While fewer than half the studies report participant race and/or ethnicity, of those that do, 83% (5/6) reported a predominately White/Caucasian sample.

CONCLUSIONS

Efficacy testing of digital headache interventions is in its infancy with the majority of these studies relying on pilot studies with small samples comprised of homogenous patient populations. Interactive websites were the most common digital medium to deliver digital headache management interventions and have demonstrated promising results. Further testing using large-scale randomized controlled trials and exploration of other digital tools is warranted. Future studies with more diverse samples are needed to inform health equity of digital headache interventions.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.