COVID-19, mobile health and serious mental illness

Effects of web-based adapted physical activity on hippocampal plasticity, cardiorespiratory fitness, symptoms, and cardiometabolic markers in patients with schizophrenia: a randomized, controlled study

Among the lifestyle interventions, the physical activity (PA) has emerged as an adjuvant non-pharmacological treatment improving mental and physical health in patients with schizophrenia (SZPs) and increasing the hippocampus (HCP) volume. Previously investigated PA programs have been face-to-face, and not necessary adapted to patients' physiological fitness. We propose an innovative 16-week adapted PA program delivered by real-time videoconferencing (e-APA), allowing SZPs to interact with a coach and to manage their physical condition. The primary goal was to demonstrate a greater increase of total HCP volumes in SZPs receiving e-APA compared to that observed in a controlled group. The secondary objectives were to demonstrate the greater effects of e-APA compared to a controlled group on HCP subfields, cardiorespiratory fitness, clinical symptoms, cognitive functions, and lipidic profile. Thirty-five SZPs were randomized to either e-APA or a controlled group receiving a health education program under the same conditions (e-HE). Variables were assessed at pre- and post-intervention time-points. The dropout rate was 11.4%. Compared to the e-HE group, the e-APA group did not have any effect on the HCP total volumes but increased the left subiculum volume. Also, the e-APA group significantly increased cardiorespiratory fitness (VO2max), improved lipidic profile and negative symptoms but not cognitive functions. This study demonstrated the high feasibility and multiple benefits of a remote e-APA program for SZPs. e-APA may increase brain plasticity and improve health outcomes in SZPs, supporting that PA should be an add-on therapeutic intervention. ClinicalTrial.gov on 25 august 2017 (NCT03261817).

What Chinese Women Seek in Mental Health Apps: Insights from Analyzing Xiaohongshu User Posts during the COVID-19 Pandemic

Gender disparity poses a prominent obstacle to achieving effective mental health outcomes in digital healthcare. Despite women being more inclined to use mental health apps and seeking designs tailored to their specific needs, there is limited research on the factors influencing female users' engagement with these apps. The COVID-19 pandemic has further exacerbated its disproportionate impact on women's mental health. This study investigates female users' posts (n = 5538) about mental health apps during the pandemic, using data collected via a Python web crawler from Xiaohongshu, a popular female-centric social media platform in China. A mixed-methods approach used qualitative thematic analysis and quantitative descriptive statistics. Among these posts, therapeutic functionality emerged as the highest priority, followed by credibility and user experience, with specific design elements highlighted as particularly significant. These findings provide valuable insights for mental health researchers and developers, including you, aiming to create gender-tailored mobile solutions to address the mental health challenges faced by women, especially during future pandemics.

An e-Health Psychoeducation Program for Managing the Mental Health of People with Bipolar Disorder during the COVID-19 Pandemic: A Randomized Controlled Study

Background: Social rhythm dysregulation has been identified as a determining factor in bipolar disorder (BD) relapses. It directly impacts individuals' quality of life (QoL). This study aims to present preliminary data on the efficacy of an e-health psychoeducational intervention for BD for improving clinical outcomes. Methods: This study used an open-label, crossover, randomized controlled trial design. The inclusion criteria consisted of a BD diagnosis, affiliation with the Consultation Psychiatry and Psychosomatic Center at the University Hospital in Cagliari, Italy, age over 18, and the obtaining of informed consent. Anxiety and depressive symptoms, QoL, and social and biological rhythms were measured using standardized instruments validated in Italian. Results: A total of 36 individuals were included in the experimental group (EG) and 18 in the control group (CG). The final sample consisted of 25 in the EG and 14 in the CG. A statistically significant improvement in QoL was found in the EG post-treatment (p = 0.011). Significant correlations were found between QoL and the dysregulation of biorhythms in the EG at T0 (p = 0.0048) and T1 (p = 0.0014). Conclusions: This study shows that, during extreme distress, an e-health group psychoeducation intervention for people with BD could significantly improve the perception of QoL. The results must be confirmed by studies conducted with larger-sized samples.

The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care

Background: Mental health apps offer scalable care, yet clinical adoption is hindered by low user engagement and integration challenges into clinic workflows. Human support staff called digital navigators, trained in mental health technology, could enhance care access and patient adherence and remove workflow burdens from clinicians. While the potential of this role is clear, training staff to become digital navigators and assessing their impact are primary challenges. Methods: We present a detailed manual/framework for implementation of the Digital Navigator within a short-term, cognitive-behavioral therapy-focused hybrid clinic. We analyze patient engagement, satisfaction, and digital phenotyping data quality outcomes. Data from 83 patients, for the period spanning September 2022 to September 2023, included Digital Navigator satisfaction, correlated with demographics, mindLAMP app satisfaction, engagement, and passive data quality. Additionally, average passive data across 33 clinic patients from November 2023 to January 2024 were assessed for missingness. Results: Digital Navigator satisfaction averaged 18.8/20. Satisfaction was not influenced by sex, race, gender, or education. Average passive data quality across 33 clinic patients was 0.82 at the time this article was written. Digital Navigator satisfaction scores had significant positive correlation with both clinic app engagement and perception of that app. Conclusions: Results demonstrate preliminary support and patient endorsement for the Digital Navigator role and positive outcomes around digital engagement and digital phenotyping data quality. Through sharing training resources and standardizing the role, we aim to enable clinicians and researchers to adapt and utilize the Digital Navigator for their own needs.

External Validation of a Machine Learning Model for Schizophrenia Classification

Background and Objective: Excellent generalizability is the precondition for the widespread practical implementation of machine learning models. In our previous study, we developed the schizophrenia classification model (SZ classifier) to identify potential schizophrenia patients in the Japanese population. The SZ classifier has exhibited impressive performance during internal validation. However, ensuring the robustness and generalizability of the SZ classifier requires external validation across independent sample sets. In this study, we aimed to present an external validation of the SZ classifier using outpatient data. Methods: The SZ classifier was trained by using online survey data, which incorporate demographic, health-related, and social comorbidity features. External validation was conducted using an outpatient sample set which is independent from the sample set during the model development phase. The model performance was assessed based on the sensitivity and misclassification rates for schizophrenia, bipolar disorder, and major depression patients. Results: The SZ classifier demonstrated a sensitivity of 0.75 when applied to schizophrenia patients. The misclassification rates were 59% and 55% for bipolar disorder and major depression patients, respectively. Conclusions: The SZ classifier currently encounters challenges in accurately determining the presence or absence of schizophrenia at the individual level. Prior to widespread practical implementation, enhancements are necessary to bolster the accuracy and diminish the misclassification rates. Despite the current limitations of the model, such as poor specificity for certain psychiatric disorders, there is potential for improvement if including multiple types of psychiatric disorders during model development.

The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma

BACKGROUND

The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population.

AIMS

To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program.

METHODS

Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted.

RESULTS

Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming.

CONCLUSIONS

Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.

UPSIDES Mental Health Peer Support in Face of the COVID-19 Pandemic: Actions and Insights

The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19.

M-health Apps and Physical and Mental Health Outcomes of Sexual Minorities

Given the assigned health inequalities faced by sexual minorities, it is fitting to assess whether m-health could be associated with better health-related outcomes for these sexual minorities. The present study examines associations between m-physical and m-mental health apps and sexual minorities' physical and mental health status in Greece. The study utilized three waves of panel data collected in 2018, 2019, and 2020. The findings indicated associations between the use of m-physical and m-mental health apps and increased physical and mental health status for sexual minorities. The work concludes that m-health could enhance informational capabilities associated with increased levels of physical and mental health for sexual minorities. Indeed, the study found that, during the COVID-19 pandemic, sexual minorities experienced physical and mental health deteriorations. Interestingly, the estimates indicated that the association between the use of m-physical and m-mental health apps and increased mental health status for sexual minorities was stronger during the COVID-19 pandemic than before. The study suggests that tracking health-related information through m-health apps during periods of increased uncertainty could be associated with better health prevention and management. If m-health apps can alleviate adverse physical and mental health symptoms for sexual minorities, their potential should be considered.

Anxiety and depression played a central role in the COVID-19 mental distress: A network analysis

INTRODUCTION

Psychological, socio-demographics, and clinical factors play an important role in patients with COVID-19, but their relationship is complex. The network approach might be used to disentangle complex interactions in different systems. Using data from a multicentre, cross-sectional, survey among patients with COVID-19 in Spain (July-November 2020), we investigated the network structure of mental disorders symptoms, social support, and psychological resilience, and changes in network structures according to the presence of a pre-existing mental disorder or hospitalization for COVID-19.

METHODS

Subjects completed a survey to evaluate sociodemographic characteristics, COVID-19 infection status, resilience, social support, and symptoms of depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder. 2084 patients with COVID-19 were included in the analysis. Network analysis was conducted to evaluate network and bridge centrality, and the network properties were compared between COVID-19 patients with and without a history of lifetime mental disorder, and between hospitalized and non-hospitalized patients.

LIMITATIONS

Generalization of our findings may be difficult since differences in network connectivity may exist in different populations or samples.

RESULTS

Anxiety and depression showed high centrality in patients with COVID-19 and anxiety showed the highest bridge influence in the network. Resilience and social support showed a low influence on mental disorder symptoms. Global network estimations show no statistically significant changes between patients with and without pre-existing mental disorders or between hospitalized and non-hospitalized patients.

CONCLUSIONS

Anxiety might be a key treatment target in patients with COVID-19 since its treatment might prevent other mental health adverse outcomes.

Mobile health in the specific management of first-episode psychosis: a systematic literature review

Purpose

The purpose of this systematic literature review is to assess the therapeutic efficacy of mobile health methods in the management of patients with first-episode psychosis (FEP).

Method

The participants are patients with FEP. The interventions are smartphone applications. The studies assess the preliminary efficacy of various types of application.

Results

One study found that monitoring symptoms minimized relapses, visits to A&E and hospital admissions, while one study showed a decrease in positive psychotic symptoms. One study found an improvement in anxiety symptoms and two studies noted an improvement in psychotic symptoms. One study demonstrated its efficacy in helping participants return to studying and employment and one study reported improved motivation.

Conclusion

The studies suggest that mobile applications have potential value in the management of young patients with FEP through the use of various assessment and intervention tools. This systematic review has several limitations due to the lack of randomized controlled studies available in the literature.

A Mobile Application to Assist Alzheimer's Caregivers During COVID-19 Pandemic: Development and Evaluation

Introduction

Access to healthcare services for patients with Alzheimer's disease (AD) was limited during the COVID-19 pandemic. A mobile application (app) can help overcome this limitation for patients and caregivers. Our study aims to develop and evaluate an app to help caregivers of patients with AD during COVID-19.

Methods

The study was performed in three steps. First, a questionnaire of features required for the app design was prepared based on the interviews with caregivers of AD patients and neurologists. Then, questionnaire was provided to neurologists, medical informatics, and health information management specialists to identify the final features. Second, the app was designed using the information obtained from the previous phase. Third, the quality of the app and the level of user satisfaction were evaluated using the mobile app rating scale (MARS) and the questionnaire for user interface satisfaction (QUIS), respectively.

Results

The number of 41 data elements in four groups (patient's profile, COVID-19 management and control, AD management and control, and program functions) were identified for designing the app. The quality evaluation of the app based on MARS and user satisfaction evaluation based on QUIS showed the app was good.

Conclusion

This is the first study that focused on developing and evaluating a mobile app for assisting Alzheimer's caregivers during the COVID-19 pandemic. As the app was designed based on users' needs and covered both information about AD and COVID-19, it can help caregivers perform their tasks more efficiently.

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.

Protection Motivation Perspective Regarding the Use of COVID-19 Mobile Tracing Apps Among Public Users: Empirical Study

BACKGROUND

Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person's COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved.

OBJECTIVE

This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals' perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status.

METHODS

The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling.

RESULTS

After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5%) were male and 109 (33.5%) were female. Among the participants in the final data set, 72.6% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability (β=0.688; P<.001), self-efficacy (β=0.292; P<.001), and an individual's prior infection with COVID-19 (β=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (β=-0.360; P<.001), risk aversion (β=-0.150; P=.09), and a family member's prior infection with COVID-19 (β=-0.139; P=.02) had statistically significant negative influences on a person's intention to use mobile tracing apps.

CONCLUSIONS

This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement.

How did the Covid-19 pandemic affect individuals with schizophrenia from Turkey?

BACKGROUND

Serious mental illness, including schizophrenia, have been shown to be associated with psychosocial vulnerabilities in the face of adverse events. While individuals with schizophrenia might undergo many psychosocial difficulties during the COVID-19 pandemic, they might also not be affected, or report increased subjective well-being. This suggests that it is important to understand diverse impacts and further understand the unique experiences.

METHODS

To capture how the pandemic affected them and how they handled the challenges if there were any in the initial and more recent phases of the pandemic, 18 individuals with schizophrenia living in Turkey were interviewed.

RESULTS

Thematic analysis of interviews resulted in four superordinate themes for both time points. Three themes related to the impact of the pandemic (i.e. burdens of COVID-19, positive impacts of COVID-19, no impact of COVID-19) indicated that they shared a number of challenges with the general population. Themes about the positive impacts and no impact also replicated the previous findings in this clinical population. One last theme named as facilitators of coping implied that the participants tried to deal with the burdens by using available resources, adapt to the changes in their daily living, and benefit from social interaction and support.

CONCLUSIONS

To conclude, people with schizophrenia seem to be coping with challenges posed by the pandemic with diverse strategies and they seem to even experience psychological growth alongside with negative impacts. The individualized needs and potential for growth have pivotal implications for the management of the illness during the pandemic.

Understanding Post-Adoption Behavioral Intentions of Mobile Health Service Users: An Empirical Study during COVID-19

This study aims to understand the post-adoption behaviors of mobile health (m-Health) service users during the COVID-19 pandemic. Drawing on the stimulus-organism-response framework, we examined the effects of user personality traits, doctor characteristics, and perceived risks on user continuance intentions and positive word of mouth (WOM) when using m-Health, as mediated by cognitive and emotional trust. The empirical data were collected via an online survey questionnaire from 621 m-Health service users in China and were verified with partial least squares structural equation modeling. The results showed that personal traits and doctor characteristics were positively associated and the perceived risks were negatively associated with both cognitive and emotional trust. Both cognitive and emotional trust significantly influenced users' post-adoption behavioral intentions in terms of continuance intentions and positive WOM, with different magnitudes. This study provides new insights for the promotion of the sustainable development of m-Health businesses after or during the pandemic.

Effects of a Metacognitive Smartphone Intervention With Weekly Mentoring Sessions for Individuals With Schizophrenia: A Quasi-Experimental Study

Application (app)-based interventions using smartphones could provide effective alternatives to traditional treatment programs during and beyond the coronavirus disease 2019 pandemic. The current quasi-experimental study with a non-equivalent comparison group tested the effects of a smartphone app-based metacognitive intervention program with weekly mentoring sessions on the meta-cognitive beliefs, psychotic symptoms, and social functioning of individuals with schizophrenia from community psychosocial rehabilitation centers. The study was conducted with 20 participants with severe psychotic symptoms and low social functioning and 24 participants with relatively light psychotic symptoms and good social functioning as a comparison group. For the experimental group, the app-based intervention was combined with weekly contact mentoring sessions over 10 weeks. The comparison group received only the app-based intervention over 10 weekly sessions. No differences were observed between groups' total scores; however, the experimental group showed a tendency toward improved psychotic symptoms and social functioning over time, unlike the comparison group. These findings provide an empirical basis for managing schizophrenia symptoms with smartphone apps. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 27-37.].

Stuck Inside: How Social Functioning in Schizophrenia Changed During the COVID-19 Pandemic

Social distancing policies enacted during the COVID-19 pandemic altered our social interactions. People with schizophrenia, who already exhibit social deficits, may have been disproportionally impacted. In this pilot study, we a) compared prepandemic social functioning to functioning during the pandemic in people with schizophrenia ( n = 21) who had data at both time points; and b) examined if patterns of decline in schizophrenia differed from healthy controls ( n = 21) across a series of repeated-measures analyses of variance. We observed larger declines in social functioning in schizophrenia (η 2 = 0.07, medium effect size) during the pandemic compared with the control group. Between-group declines did not extend to other domains, suggesting that declines are specific to social functioning. Our findings signal that treatments focusing on reconnecting people with schizophrenia to their social networks should be prioritized. Future studies should continue tracking social functioning after the pandemic to illustrate patterns of recovery.

Coping with mental health issues via communicative action in the digital age: testing cybercoping models

BACKGROUND

Mental health issues have become critical social problems around the world. Individuals who are suffering from mental health problems tend to obtain health information and social support in the digital media environment. However, there has been little research on how information-seeking and information-forwarding behaviors affect sufferers' coping processes and outcomes. Based on communicative behaviors of people in online to solve health problmes, this study aims to apply two cybercoping modes proposed by previous reserach to mental health issues.

METHOD

Using anxiety and depression issues, this study conducted an online survey (N = 560) to examine two cybercoping models with data collected from an online crowdsourcing platform (Amazon's Mechanical Turk). Structural equation modeling (SEM) was conducted to test the cybercoping models in the context of mental health issues.

RESULTS

Results of the first cybercoping model showed that information seeking was positively associated with coping outcomes, whereas information forwarding was not significant. While information seeking in the second cybercoping model was significantly associated with other factors, information forwarding was not significant. The second model revealed that coping processes fully mediate between information seeking and cybercoping outcomes.

CONCLUSIONS

This study contributes to the theoretical building of cybercoping models in the context of mental health issues by illustrating the effects of information seeking on cybercoping outcomes. Health care practitioners may use these results to better understand which communicative processes in online mental health communication are positively associated with specific coping processes and outcomes.

Are remote psychotherapy/remediation efforts accessible and feasible in patients with schizophrenia? A narrative review

Background

Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings.

Results

We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations.

Conclusions

Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making.

Hybrid and Remote Psychosocial Interventions Focused on Weight and Sedentary Behavior Management Among Patients with Severe Mental Illnesses: a Systematic Review

Severe mental illness could be defined through its diagnosis, disability, and duration, and one of their main characteristics is the high prevalence of some clinical conditions such as obesity and metabolic syndrome. Although the promotion of a healthier lifestyle has been demonstrated as an effective strategy to reduce both body mass index and abdominal circumference in this population, there is a lack of studies focusing on digital intervention in this population. The aim of this systematic review was to evaluate the efficacy of studies that used digital technologies to reduce weight, body mass index (BMI) and abdominal circumference in individuals with severe mental illness. This current review also compared remote and hybrid interventions, the effects of those interventions in metabolic biomarkers as well as in the development of a healthier lifestyle. The main findings included the following: (a) the use of digital devices or strategies might be feasible and useful to reduce sedentary behavior among individuals with severe mental illnesses, 2) most interventions used digital pedometers and mobile phone communication (either text messages or phone calls) as main strategies, 3) all remote interventions and six of nine hybrid interventions found significant outcomes in favor of their interventions. In conclusion, even with a limited number of studies promoting healthier lifestyle through digital interventions among individuals with severe mental illnesses, evidence from studies included in this review showed that they might be useful to improve a healthier lifestyle and increase the frequency of physical activity behavior.

Did Usage of Mental Health Apps Change during COVID-19? A Comparative Study Based on an Objective Recording of Usage Data and Demographics

This paper aims to objectively compare the use of mental health apps between the pre-COVID-19 and during COVID-19 periods and to study differences amongst the users of these apps based on age and gender. The study utilizes a dataset collected through a smartphone app that objectively records the users' sessions. The dataset was analyzed to identify users of mental health apps (38 users of mental health apps pre-COVID-19 and 81 users during COVID-19) and to calculate the following usage metrics; the daily average use time, the average session time, the average number of launches, and the number of usage days. The mental health apps were classified into two categories: guidance-based and tracking-based apps. The results include the increased number of users of mental health apps during the COVID-19 period as compared to pre-COVID-19. Adults (aged 24 and above), compared to emerging adults (aged 15-24 years), were found to have a higher usage of overall mental health apps and guidance-based mental health apps. Furthermore, during the COVID-19 pandemic, males were found to be more likely to launch overall mental health apps and guidance-based mental health apps compared to females. The findings from this paper suggest that despite the increased usage of mental health apps amongst males and adults, user engagement with mental health apps remained minimal. This suggests the need for these apps to work towards improved user engagement and retention.

Developing the Workforce of the Digital Future: Leveraging Technology to Train Community-Based Mobile Mental Health Specialists

Challenges in training, dissemination, and implementation have impeded the ability of providers to integrate promising digital health tools in real-world services. There is a need for generalizable strategies to rapidly train real-world providers at scale to support the adoption of digital health. This study describes the development of principles guiding rapid training of community-based clinicians in the support of digital health. This training approach was developed in the context of an ongoing trial examining implementation strategies for FOCUS, a mobile mental health intervention designed for people with serious mental illness. The SAIL (Simple, Accessible, Inverted, Live) model introduces how digital tools can be leveraged to facilitate rapid training of community agency-based personnel to serve as digital mental health champions, promoters, and providers. This model emphasizes simple and flexible principles of intervention delivery, accessible materials in a virtual learning environment, inverted or "flipped" live training structure, and live consultation calls for ongoing support. These initial insights lay the groundwork for future work to test and replicate generalizable training strategies focused on real-world delivery of digital mental health services. These strategies have the potential to remove key obstacles to the implementation and dissemination of digital health interventions for mental health.

Remote group therapies for cognitive health in schizophrenia-spectrum disorders: Feasible, acceptable, engaging

Severe cognitive impairments and cognitive distortions are core to schizophrenia-spectrum disorders (SSDs) and are associated with deteriorated social functioning. Despite well-established efficacy of group psychosocial therapies targeting cognitive health in SSDs, dissemination of these programs remains limited. Remote delivery offers a promising strategy for increasing the programs' accessibility. Yet, little research has evaluated group therapies for cognitive health delivered in this way. Thus, we aimed to assess, from participants' and therapists' perspectives, the feasibility, acceptability, as well as levels and process of engagement in a videoconference delivery of group psychosocial therapies for SSD patients' cognitive health. Participants, outpatients, attended Action Based Cognitive Remediation or Metacognitive Training, both adapted for videoconference. Then, participants and therapists completed post-therapy questionnaires. Of the 28 participants attending at least one session, 75% completed more than half of sessions and seven dropped out. Technology did not appear to significantly hinder participation in the programs. All completing participants reported a positive experience with therapy, 67% were not bothered by the distance from the therapist, and 77% trusted that the information shared was kept confidential. Therapist-rated levels of attention M = 7.5/9 (SD = 1.04), participation M = 6.91/9 (SD = 1.32), and social interactions M = 5.31/9 (SD = 1.96) were satisfactory. Nonetheless, participants indicated that they would have appreciated more social interactions with group members. These positive results validate the earliest stage in the implementation process for remote group therapies targeting cognitive health in SSDs. Remote delivery promises to improve access to therapies targeting cognitive health and, ultimately, facilitate functional recovery for SSD patients.

QoS-Aware Smart Phone-Based User Tracking Application to Prevent Outbreak of COVID-19 in Saudi Arabia

Diverse variants of COVID-19 are repeatedly making everyday living unstable. In reality, the conclusive retort of this highly contagious virus still is in incognito mode. The health experts' primary guideline on the possible prevention of this disease outbreak, including a list of restrictions and confinements, is insufficient in case of any public congregation. As a result, the demand for precise and upgraded real-time COVID-19 tracking and prevention-based applications increases. However, most of the existing android-based applications face a lack of data security and reliability that cannot satisfy the additional quality of service (QoS) requirements. This paper proposes an easy-to-operate android-based multifunctional application to track individuals' health situations, allow uploading scanning report by the authorized organization like universities, mosques, school, and hospitals and helps the users to maintain guidelines via manageable steps. This article offers a three-layered QoS aware service-oriented task scheduling model upon multitasking android-based frontend focusing the cognitive-based AI applications in healthcare with a continual learning paradigm. Designed model is competent to optimize heterogeneous service scheduling and can minimize data delivery time, as well as the resource cost.

Telemedicine Use in Refugee Primary Care: Implications for Care Beyond the COVID-19 Pandemic

The expansion of telemedicine during the COVID-19 pandemic offers an opportunity to reach vulnerable refugee communities with limited access to healthcare; however, there are limited data on characteristics of refugee patients that are associated with telemedicine use. We examined primary care encounters between March 2020 and February 2021. We compared telemedicine encounters among refugee and non-refugee patients and examined patient characteristics associated with telemedicine use in refugee patients. Overall, refugees used telemedicine less (aOR = 0.59, p < .001). Among refugee patients, telemedicine encounters were more likely if the patient had hypertension or diabetes, had an activated patient portal, carried private insurance and spoke English as their primary language. Telemedicine may be a useful modality of care management for refugee patients who require many follow-up visits; however, language barriers remain a concern. This is important to consider as telemedicine efforts continue and are expanded.

Peer Support Specialists and Service Users' Perspectives on Privacy, Confidentiality, and Security of Digital Mental Health

As the digitalization of mental health systems progresses, the ethical and social debate on the use of these mental health technologies has seldom been explored among end-users. This article explores how service users (e.g., patients and users of mental health services) and peer support specialists understand and perceive issues of privacy, confidentiality, and security of digital mental health interventions. Semi-structured qualitative interviews were conducted among service users (n = 17) and peer support specialists (n = 15) from a convenience sample at an urban community mental health center in the United States. We identified technology ownership and use, lack of technology literacy including limited understanding of privacy, confidentiality, and security as the main barriers to engagement among service users. Peers demonstrated a high level of technology engagement, literacy of digital mental health tools, and a more comprehensive awareness of digital mental health ethics. We recommend peer support specialists as a potential resource to facilitate the ethical engagement of digital mental health interventions for service users. Finally, engaging potential end-users in the development cycle of digital mental health support platforms and increased privacy regulations may lead the field to a better understanding of effective uses of technology for people with mental health conditions. This study contributes to the ongoing debate of digital mental health ethics, data justice, and digital mental health by providing a first-hand experience of digital ethics from end-users' perspectives.

Telehealth and Artificial Intelligence Insights into Healthcare during the COVID-19 Pandemic

Soon after the coronavirus disease 2019 pandemic was proclaimed, digital health services were widely adopted to respond to this public health emergency, including comprehensive monitoring technologies, telehealth, creative diagnostic, and therapeutic decision-making methods. The World Health Organization suggested that artificial intelligence might be a valuable way of dealing with the crisis. Artificial intelligence is an essential technology of the fourth industrial revolution that is a critical nonmedical intervention for overcoming the present global health crisis, developing next-generation pandemic preparation, and regaining resilience. While artificial intelligence has much potential, it raises fundamental privacy, transparency, and safety concerns. This study seeks to address these issues and looks forward to an intelligent healthcare future based on best practices and lessons learned by employing telehealth and artificial intelligence during the COVID-19 pandemic.

Experiences of Persons With Serious Mental Illness During the COVID-19 Pandemic

OBJECTIVE

This study aimed to characterize the experiences of persons with serious mental illness during the COVID-19 pandemic.

METHODS

Adults with schizophrenia, bipolar disorder, major depression, or no psychiatric disorder (N=195) were interviewed between July 2020 and January 2021. All were previously enrolled in a cohort study. The interviews focused on mental distress and suicidal thoughts, the impact of the pandemic and pandemic-related worries, tobacco and alcohol use, and access to care. Responses of persons with serious mental illness were compared with responses of those without a psychiatric disorder by using multivariate ordered logistic regression analyses. For a subset of participants, responses about suicidal ideation were compared with their responses prior to the pandemic.

RESULTS

Compared with participants with no psychiatric disorder, individuals with schizophrenia were more likely to endorse that they felt overwhelmed or anxious, had difficulty concentrating, or were concerned about medical bills and having enough food; they also reported significantly increased tobacco smoking. Individuals with bipolar disorder also reported more COVID-19-related worries than did participants without a psychiatric disorder. Overall, those with a psychiatric disorder reported more frequent mental distress and more recent missed medical visits and medications than did those with no psychiatric disorder. However, participants with serious mental illness did not report a higher rate of suicidal thoughts compared with their prepandemic responses.

CONCLUSIONS

The pandemic poses significant challenges to individuals with serious mental illness in terms of COVID-19-related distress. Psychiatric services should proactively address the emotional distress and worries associated with the pandemic.

Impact of the COVID-19 Pandemic on Healthcare Resource Utilization in Individuals with Major Depressive Disorder

Objective

To estimate the impact COVID-19 pandemic on healthcare resource utilization (HCRU) among individuals with major depressive disorder (MDD).

Method

A retrospective cohort study was conducted to compare HCRU in the twelve months prior to and six months following pandemic onset among 1,318,709 individuals with MDD and propensity-score matched controls. Outcomes were monthly rates of all-cause and MDD-specific outpatient, inpatient, and prescription medication HCRU. Piecewise random effects models were used to adjust for patient-level clustering, trends over time, and pre-pandemic factors.

Results

In the first month following onset, outpatient HCRU declined with primary care visits down 25.1%. Following this initial decline, outpatient HCRU increased, exceeding pre-pandemic rates within three months. By April 2020, three quarters of all psychotherapy sessions were delivered by telehealth, followed by psychiatry (62.3%), and primary care visits (30.1%). The use of telehealth remained highest for psychotherapy and psychiatry (representing 67.6% and 54.2% of visits, respectively, in September 2020). All-cause partial-day hospitalizations declined 50.5% and remained depressed through July 2020 (down 18.3%). Beginning in the first month post-onset, prescription medication HCRU increased for all antidepressant and antipsychotic medication classes: serotonin modulators ( + 11.8%), bupropion ( + 10.4%), SSRIs ( + 9.0%), SNRIs ( + 8.6%), and atypical antipsychotics ( + 7.5%).

Conclusions

Following pandemic onset, individuals with MDD realized an immediate, but short-lived, reduction in primary care HCRU. Telehealth use remained elevated through the first six months. The most significant and sustained reduction in HCRU was noted for partial-day hospitalizations and all-cause ED visits.

Phenomenology of the COVID-19 Pandemic Experience in Patients Suffering from Chronic Schizophrenia-A Qualitative Analysis

Many studies have shown that the COVID-19 pandemic can have a great influence on mental health. However, there is still not enough research to fully understand how people suffering from schizophrenia experience crisis situations such as a pandemic. This qualitative study aims to explore this subject. Ten outpatients suffering from schizophrenia were interviewed in a semi-structured format using an interview designed by the authors for the purpose of this study. The interviews were transcribed, and a conventional qualitative content analysis was conducted. The general themes identified in the content analysis were organized into four categories: first reactions to information about the pandemic; subjective assessment of the pandemic’s impact on patients’ mental health; patients’ attitudes towards the temporary limitations and lockdowns; psychiatric treatment and psychotherapy during the pandemic. A variety of different experiences were observed, but the general conclusion arising from the study suggests that the majority of the interviewed patients coped quite well with the pandemic and that the observed reactions were similar to the reactions of other groups described in the literature. The study also confirmed the importance of the continuity of psychiatric care for patients with schizophrenia.

Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study

BACKGROUND

Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services.

OBJECTIVE

This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work.

METHODS

The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment.

RESULTS

Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design.

CONCLUSIONS

This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34591.

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis

BACKGROUND

The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the "new normal."

OBJECTIVE

The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis.

METHODS

We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords.

RESULTS

A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors.

CONCLUSIONS

COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.

Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: A Retrospective Observational Study

BACKGROUND

The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with the reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced.

OBJECTIVE

This study aimed to report the system design and post-introductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination.

METHODS

The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1,500 outpatients. The system, which links the hospital's electronic medical record database with patients' mobile devices, has the following two functions: 1) GPS-based examination check-in processing and 2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatient, implemented a user questionnaire and polling the average time required for patients to respond to call notifications about their turn.

RESULTS

The 3 months average of TR2 users 9 months after the TR 2 system introduction was 17.9% (81,066 of 14,536 patients). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7% (144 of 166 patients) said that the system help reduce the burden of waiting time.

CONCLUSIONS

The app allowed 17.9% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as the coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times.

CLINICALTRIAL

Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping

Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.

Socio-Demographic Variables, Fear of COVID-19, Anxiety, and Depression: Prevalence, Relationships and Explanatory Model in the General Population of Seven Latin American Countries

The COVID-19 pandemic has gravely impacted Latin America. A model was tested that evaluated the contribution of socio-demographic factors and fear of COVID-19 on anxiety and depression in samples of residents in seven Latin American countries (Argentina, Ecuador, Mexico, Paraguay, Uruguay, Colombia, and El Salvador). A total of 4,881 individuals, selected by convenience sampling, participated in the study. Moderate and severe levels of depressive symptoms and anxiety were identified, as well as a moderate average level of fear of COVID-19. In addition, it was observed that about a quarter of the participants presented symptoms of generalized anxiety disorder and a major depressive episode. Fear of COVID-19 significantly and positively predicted anxiety and depressive symptoms, whereas the effects of socio-demographic variables are generally low [χ2(287) = 5936.96, p < 0.001; RMSEA = 0.064 [0.062, 0.065]; CFI = 0.947; and SRMR = 0.050]. This suggests the need for the implementation of preventive actions in the general population of these countries, with the aim of reducing the prevalence of depressive, anxious and fearful symptoms related to COVID-19.

Online mental health care during the COVID-19 pandemic

OBJECTIVE

Identify users, services, and reasons for seeking online mental health care during the COVID-19 pandemic.

METHODS

A descriptive, retrospective study, with documentary analysis of medical records of users served between April and July 2020.

RESULTS

Of the 258 accesses, 159 were complete, and 99 were offline messages. Although there were 61 (38.36%) consultations in May, in April, there were 49 (30.82%) in 18 days of reception. More than 89% of accesses were women between 40 and 59 years. Among the motivations in the search for care, anxiety, fear, depression, sadness, crying, stress, and suicidal ideation stand out.

FINAL CONSIDERATIONS

Chat is a quick, early and short-wait intervention opportunity for people in need of mental health care. Therefore, the study emphasizes the importance of investing in the training of nursing professionals to act in mental health.

Implementation case study: Multifamily group intervention in first-episode psychosis programs

AIM

Family interventions are a core component of first-episode psychosis (FEP) treatment; however, low implementation rates are consistently reported. As such, work is needed to understand the factors impacting real-world treatment delivery. The present paper describes the implementation of the McFarlane-model multifamily psychoeducational groups (MFG) in established FEP early intervention programs within a single state. The aims were to examine (a) training participation and implementation of MFG, (b) barriers and facilitators to implementation, and (c) modifications made to MFG.

METHODS

Practitioners from six established FEP early intervention programs received in-person training and ongoing consultation in MFG. Training participation data were obtained via attendance and implementation outcomes were obtained from practitioner reports. Fifteen months following the initial training, practitioners reported on clinic-specific barriers, facilitators, and modifications across four categories (context, intervention, practitioner, and recipient).

RESULTS

Twenty-three practitioners across six clinics received in-person training and were offered ongoing consultation to support implementation. Difficulties in starting MFG were salient as the earliest group was run 7 months after the initial training, thereby resulting in low overall frequency of groups. A number of barriers spanning context, intervention, practitioner, and recipient domains were noted, the majority of which were clinic-specific. Despite challenges, practitioners identified several facilitators and made modifications to the intervention and its delivery in service of implementation.

CONCLUSIONS

Results from this implementation case study highlighted the challenges of delivering MFG in real-world FEP early intervention programs. Further, this paper emphasizes the value in identifying and addressing clinic-specific factors when implementing MFG.

Further Adaptations and Reflections by an Assertive Community Treatment Team to Serve Clients with Severe Mental Illness During COVID-19

In September of 2020, Guan and colleagues wrote about their experience of an Assertive Community Psychiatry Program responding to the COVID-19 pandemic. We describe our own experience as an Assertive Community Treatment team in Minnesota responding to challenges of effectively and safely delivering service to clients. As the pandemic has progressed since last year, so has the literature, and updated references are highlighted. Common threads are woven between our experience, the experience of Guan and colleagues, and others to suggest the beginnings of a template to adapt services to a new post-pandemic world.

Digital Community Inclusion of Individuals With Serious Mental Illness: A National Survey to Map Digital Technology Use and Community Participation Patterns in the Digital Era

BACKGROUND

Despite the growing interest in developing and using mobile health (mHealth) and digital technologies in mental health, little is known about the scope and nature of virtual community inclusion.

OBJECTIVE

The overarching goal of this study was to understand and conceptualize virtual community inclusion of individuals with serious mental illness (SMI). Specific objectives of this study were as follows: (1) mapping the prevalence, trends, and experiences related to mHealth and digital technology use among individuals with SMI; (2) comparing patterns of technology use by individuals with and those without SMI; and (3) examining whether use of mHealth and digital technologies predicts recovery among individuals with SMI.

METHODS

A web-based survey of technology use and virtual participation was developed and distributed among adults with and those without SMI via social media, national email discussion lists, nonprofit organizations, and advocacy groups.

RESULTS

A total of 381 adults aged 18 years or older participated in the survey, of whom 199 (52%) identified as having a SMI. Participants with SMI reported significantly greater access to technology and significantly fewer days of face-to-face participation in community activities than those without SMI. Among participants with SMI, greater technology use was positively associated with positive emotions and significantly predicted recovery.

CONCLUSIONS

This study is the first to explore, map, and conceptualize virtual community inclusion among adults with SMI. Our findings indicate a gap in the literature and research on community inclusion and participation, and emphasize the need for virtual community inclusion, particularly during the COVID-19 pandemic and its future implications.

Engagement with a digital therapeutic for smoking cessation designed for persons with psychiatric illness fully mediates smoking outcomes in a pilot randomized controlled trial

Understanding the mechanisms of change of digital therapeutics is a critical step to improve digital health outcomes and optimize their development. Access to and engagement with digital content is arguably a core mechanism of change of these interventions. However, the mediational role of app engagement has been largely unexamined. To evaluate the mediational effect of engaging with a digital therapeutic for smoking cessation designed for adults with psychiatric disorders. Secondary analysis of a pilot clinical trial of 62 adults with serious mental illness who were randomized to receive either a tailored digital therapeutic (Learn to Quit) or a digital therapeutic for the general public (NCI QuitGuide). Engagement was captured using background analytics of app utilization, including (a) number of interactions with app content, (b) minutes/day of app use, and (c) number of days used. The main outcome was reductions in cigarettes per day from baseline to the four-month endpoint. Mediational analysis followed the Preacher and Hayes bootstrap method. Number of application interactions fully mediated reductions in cigarettes per day in the Learn to Quit application but not in QuitGuide (Average Causal Mediation Effect = .31, p = .02). Minutes/day of app use played an uncertain role, and number of days used was not a significant mediator. Results suggest that one of the mechanisms of action of the Learn to Quit device, engagement with theory-based content, functioned as intended. Future research of digital therapeutics should emphasize granular approaches to evaluating apps' mechanisms of action.

A Systematic Review of Prevention and Intervention Strategies for Smartphone Addiction in Students: Applicability During the COVID-19 Pandemic

"During this coronavirus (COVID-19) pandemic, smartphones play an important role in online classes, study, and entertainment. However, excessive use may lead to smartphone addiction (SPA). The incidence of SPA among students has increased with the spread of COVID-19 and threatens to impair home-based students’ learning efficiency and physical and mental health. This study aimed to provide a comprehensive overview of the latest achievements in SPA prevention and treatment, and a theoretical basis for future experimental research and clinical treatment, while considering their applicability during the current pandemic. We researched the core literature in Chinese, English, and Korean databases from 2000 to 2021; 3208 articles were identified. After reading the titles, abstracts, and full texts, 53 articles were selected. Research on SPA interventions was relatively limited; we identified six types of prevention and treatment measures: psychotherapies, cognitive training, behavioral intervention, application restriction, social intervention, and complementary and alternative medicine. They can be implemented by students, parents, or online experts. Future research should focus on developing early measures to identify and prevent SPA and enhance students’ change motivation."

Factors Associated With Psychological Disturbances During the COVID-19 Pandemic: Multicountry Online Study

BACKGROUND

Accumulating evidence suggests that the COVID-19 pandemic has negatively impacted the mental health of individuals. However, the susceptibility of individuals to be impacted by the pandemic is variable, suggesting potential influences of specific factors related to participants' demographics, attitudes, and practices.

OBJECTIVE

We aimed to identify the factors associated with psychological symptoms related to the effects of the first wave of the pandemic in a multicountry cohort of internet users.

METHODS

This study anonymously screened 13,332 internet users worldwide for acute psychological symptoms related to the COVID-19 pandemic from March 29 to April 14, 2020, during the first wave of the pandemic amidst strict lockdown conditions. A total of 12,817 responses were considered valid. Moreover, 1077 participants from Europe were screened a second time from May 15 to May 30, 2020, to ascertain the presence of psychological effects after the ease down of restrictions.

RESULTS

Female gender, pre-existing psychiatric conditions, and prior exposure to trauma were identified as notable factors associated with increased psychological symptoms during the first wave of COVID-19 (P<.001). The same factors, in addition to being related to someone who died due to COVID-19 and using social media more than usual, were associated with persistence of psychological disturbances in the limited second assessment of European participants after the restrictions had relatively eased (P<.001). Optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise were related to fewer psychological symptoms in both assessments (P<.001).

CONCLUSIONS

This study highlights the significant impact of the COVID-19 pandemic at the worldwide level on the mental health of internet users and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, certain personality traits, and attitudes toward COVID-19.

Impact of Covid-19 on Mental Health: An Overview

BACKGROUND

The COVID-19 (2019-nCoV) pandemic is a major threat to public health worldwide; it has been identified as originating in Wuhan, Hubei province, China. It has spread across the globe, causing an outbreak of acute infectious pneumonia. Such a global outbreak is associated with adverse effects on mental health. Fear, stress and anxiety seem more definitely an outcome of mass quarantine.

METHODS

Keeping this pandemic situation in mind, existing literature on the COVID-19 crisis relevant to mental health was redeemed via a literature search from the PubMed database. Collected published articles were summarized according to their overall themes.

RESULTS

Preliminary evidence suggests that symptoms of self-reported stress, anxiety and depression have a common psychological impact due to the pandemic, and may be associated with disrupted sleep. Regional, state and National-international borders have almost been shut down, economies crashed, and billions of people quarantined or isolated at their own homes and quarantine centers. In this situational frame of covid-19, patients, frontline health-care professionals anf geriatric population with existing psychiatric conditions may be encountering further suffering.

CONCLUSION

COVID-19 will continue to affect mental health, which plays an important role in battling the epidemic. With the scare of the COVID-19 pandemic on the rise, it is time that psychiatrists should try to integrate the health-care services keeping mental health at prime.

Barriers to the Use of Web-Based Mental Health Programs for Preventing Depression: Qualitative Study

Background

Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence.

Objective

The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs.

Methods

BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e–mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth—the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7%). Semistructured interviews were performed with the participants (70/847, 8.3%) and analyzed using content analysis.

Results

There were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants’ engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms.

Conclusions

There are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention.

Feasibility and acceptability of remotely accessed cognitive remediation for schizophrenia in public health settings

Cognitive remediation (CR) is an evidence-based therapy used to improve cognition in people with schizophrenia. However, it often requires multiple in-person clinic sessions per week, which can limit scalability. This mixed methods study considered the feasibility and acceptability of a hybrid approach, which allowed for half the sessions to be conducted remotely as homework, without the clinician present. Individuals with schizophrenia were randomized to either all in-clinic or hybrid conditions and completed questionnaires and individual interviews about their experience. CR clinicians provided feedback in complement. Because of limited access to technology, most Hybrid CR participants had to come to clinic to access computers and often sought clinician support to do their homework. Participants in the two conditions were equally satisfied per the Client Satisfaction Questionnaire, and the majority reported perceived benefit and enjoyment. Both CR participants and clinicians identified access to technology as a barrier to program feasibility, while availability of clinician support positively impacted acceptability. Suggestions to improve CR highlighted adopting a flexible approach to providing CR that accounts for participant access to technology, potential benefit from peer interaction, and need for clinician support.

Client, clinician, and administrator factors associated with the successful acceptance of a telehealth comprehensive recovery service: A mixed methods study

The coronavirus disease 2019 SARS-CoV-2 (COVID-19) crisis and subsequent social distancing recommendations resulted in increased use of telehealth within recovery-oriented behavioral health services (RS). Populations with serious mental illness (SMI) rely on psychosocial treatment, care coordination, and pharmacotherapy to achieve recovery goals and increase community engagement. This program evaluation of a group-based RS used mixed methods to better understand the multiple factors that contributed to successful telehealth conversion. Clients' service utilization over an 18-week period was collected to determine acceptance and the client characteristics associated with utilization (n = 72). Clients completed a treatment satisfaction questionnaire that was distributed ten weeks following telehealth conversion. Qualitative interviews explored staff perspectives on factors that impacted conversion, acceptance, and utilization. Initial staff skepticism gave way to acceptance, while the demands of resourcefulness, flexibility, and competency were emphasized. Clients' treatment utilization remained stable, while the number of missed/cancelled sessions were less frequent over time, especially for clients with a history of psychosis. Clients reported high overall satisfaction, but a preference for in-person treatment. Within this clinic serving middle to high socioeconomic status (SES) clients, clinicians and clients alike found the virtual group-based RS to be feasible and acceptable while in-person treatment was not an option.