The Contribution of the Internet to Promoting Mental Health for Older Adults: Cross-Sectional Survey in China

BACKGROUND

Health is an important topic for everyone and essential to high-quality economic and social development. Recently, some researchers have suggested that older adults' internet use may have a health effect.

OBJECTIVE

This study specifically aims to clarify the relationship between internet use and the mental health of older adults, for which other surveys present contradictory results.

METHODS

Data were obtained from the China Longitudinal Aging Social Survey conducted in 2018. A total of 6648 participants were included. Mental health was assessed by the 12-item Center for Epidemiological Studies Depression Scale. Ordinary least squares regression was adopted to explore the relationship between internet use (independent variable) and the mental health of older adults. Robustness analysis, sensitivity analysis, and heterogeneity analysis were conducted in detail to verify the empirical result. A mediating effect analysis was further conducted to discover the effect mechanism between the dependent and independent variables.

RESULTS

It was found that internet use and smartphone use can significantly improve the mental health of older adults (ordinary least squares, β=.075; P<.001). After endogenous and robustness tests were conducted, the aforementioned conclusion remained robust. In particular, participation in voluntary activities played a mediating role in the relationship between internet use and the mental health of older adults. In addition, younger subjective age enhanced the positive effect of internet use on the mental health of older adults.

CONCLUSIONS

Internet users showed higher levels of mental health among Chinese older adults. To improve the mental health of older adults, the government should not only cultivate the ability to use the internet but also encourage greater participation in voluntary activities among older adults.

Connected Mental Health Solutions: Global Attitudes, Preferences, and Concerns

Background: Connected mental health (CMH) presents several technology-based solutions, which can help overcome many mental care delivery barriers. However, attitudes toward the use of CMH are diverse and differ from a cohort to another. Objective: The purpose of this study is to investigate the global attitudes toward CMH use and assess the use of technology for mental care. Methods: This study presents a synthesis of literature available in Scopus, Science Direct, and PubMed digital libraries, investigating attitudes toward CMH in different cohorts from different countries, based on a systematic review of relevant publications. This study also analyzes technology use patterns of the cohorts investigated, the reported preferred criteria that should be considered in CMH, and issues and concerns regarding CMH use. Results: One hundred and one publications were selected and analyzed. These publications were originated from different countries, with the majority (n = 23) being conducted in Australia. These studies reported positive attitudes of investigated cohorts toward CMH use and high technology use and ownership. Several preferred criteria were reported, mainly revolving around providing blended care functionalities, educational content, and mental health professionals (MHPs) support. Whereas concerns and issues related to CMH use addressed technical problems related to access to technology and to CMH solutions, the digital divide, lack of knowledge and use of CMH, and general reservations to use CMH. Concerns related to institutional and work barriers were also identified. Conclusions: Attitudes toward CMH show promising results from users and MHP views. However, factors such as providing blended care options and considering technical concerns should be taken into consideration for the successful adoption of CMH.

The contribution of the smartphone use to reducing depressive symptoms of Chinese older adults: The mediating effect of social participation

Background

Depression is a prevalent mental health disorder. Although Internet use has been associated with depression, there is limited data on the association between smartphone use and depressive symptoms. The present study aimed to investigate the relationship between smartphone use and depressive symptoms among older individuals in China.

Methods

5,244 Chinese older individuals over the age of 60 were selected as the sample from the China Longitudinal Aging Social Survey (CLASS) 2018 dataset. The dependent variable "depression symptoms" was measured using the 9-item Center for Epidemiologic Studies-Depression (CES-D) scale. The study employed multiple linear regression to investigate the relationship between smartphone use (independent variable) and depressive symptoms in older people. Thorough analyses of robustness, sensitivity, and heterogeneity were conducted to ensure the robustness and sensitivity of the findings. Additionally, mediating effect analysis was performed to elucidate the mechanism through which the dependent and independent variables were related.

Results

Empirical study indicated that smartphone use had a negative impact on depressive symptoms among older adults, specifically leading to a reduction in such symptoms. The above-mentioned result was verified through endogenous and robustness tests. The heterogeneity analysis revealed that older individuals aged 70 years and above, male, and residing in urban areas exhibited a stronger association between smartphone use and depressive symptoms. Furthermore, the mediating effect model indicated that political participation, voluntary participation, and active leisure participation mediated the relationship between smartphone use and lower levels of depression symptoms among the older adults. However, passive leisure participation had a suppressing effect on the relationship between smartphone use and reduced depressive symptoms among the older adults.

Limitations

The causal relationship between variables required further investigation with a longitudinal design.

Conclusion

These findings suggested that smartphone use may be considered an intervention to reduce depression symptoms among older people by increasing levels of political participation, voluntary participation, and active leisure participation.

Internet Use, Cultural Engagement, and Multi-Dimensional Health of Older Adults: A Cross-Sectional Study in China

With the rapid expansion of the Internet, it continuously penetrates the life of older adults around the world. This study aims to explore the effect of Internet use on the multi-dimensional health of the elderly with the mediating role of cultural engagement. Using data from the Chinese General Social Survey (CGSS) in 2015 and 2017, this study adopts logistic regression and a single-step multiple mediation model to investigate how Internet use affects the multi-dimensional health of older adults in China. The results show that Internet use has positive effects on the self-rated health, physical health, and mental health of the elderly. Endogenous tests, robustness analysis, and sensitivity analysis show that the above conclusions remain robust. Additionally, the mediating effect analysis shows that cultural engagement plays a mediating role in the relationship between Internet use and the three health-related responses. Therefore, to improve the elderly's health level, the government should not only cultivate the ability to use the Internet but also encourage greater cultural engagement amongst the aged.

A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study

Background

Connected mental health (CMH) is a field presenting information and communications technology–based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people’s attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption.

Objective

The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature.

Methods

A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework.

Results

On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users’ health and data safety considerations, including users’ suitability testing, confidentiality, and ensuring MHP integrity.

Conclusions

CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects.

The Relationship Between Internet Use and Mental Health Among Older Adults in China: The Mediating Role of Physical Exercise

Objective

Affected by internet applications, mental health among older adults has become an important public health issue in China. This study aimed to use cross-sectional data to explore how internet use affects mental health among older adults in China, along with the moderating role of physical exercise in the above relationship.

Methods

This study employed data from the Chinese General Social Survey (CGSS) conducted in 2017. In addition, OLS regression was adopted to explore the impacts of internet use on the mental health of older adults in China.

Results

Results from the cross-sectional data model showed that internet use had a statistically significant and positive correlation with the mental health of older adults. The regression result of the full sample showed that the regression coefficient of the influence of internet use on the mental health of the elderly was 0.114, which was significant at the 1% level. Furthermore, this study used mediating analysis to explore the possible underlying mechanism by which internet use influenced mental health status through physical exercise. Physical exercise played a mediating role in the relationship between internet use and mental health; the ratio of the indirect effect to total effect mediated was 0.272. It is important to note that the effect size of the indirect effect through physical exercise was quite large.

Conclusion

Our findings suggested that internet use was significantly associated with better mental health status for older Chinese residents, mediated by higher physical exercise frequency, which was consistent with China’s recent efforts to promote health governance with the “Internet Plus Exercise” campaign. Consequently, the government must encourage the development of more internet applications suitable for the elderly to increase their exercise frequency and ultimately improve their mental health. These results also provided insights for clinical solutions.

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Correlates of expected eMental Health intervention uptake among Filipino domestic workers in China

BACKGROUND

Transnational migrant populations face critical barriers to mental health service utilization that perpetuate mental health disparities globally. Overseas Filipino workers (OFWs) number over 2 million globally and 25% are female domestic workers. Structural barriers prevent equitable access to mental health services for this population. Electronic mental health (eMental Health) intervention is a scalable alternative to face-to-face treatment. The current study sought to identify key correlates of intention to use eMental Health within a community of female Filipino domestic workers living and working in Macao (SAR), China.

METHODS

Respondent-driven sampling implemented at a community field site was used to reach a sample of 1364 female domestic workers. A multivariable adjusted partial proportional-odds (PPO) model was used to assess relevant correlates of intent to use eMental Health.

RESULTS

The majority (62.8%) reported being likely to utilize eMental Health. The adjusted PPO model showed that younger age (18-25, 26-35, 36-45 v. over 55), longer time as an OFW, being likely (v. neutral and unlikely) to seek professional services, willingness to pay for services (v. not), belief that mental health services are a priority (v. low priority), having access to Wi-Fi outside the employer's home (v. not), and higher levels of social support were associated with increased odds of intent to use eMental Health.

CONCLUSIONS

eMental Health is a promising intervention with high potential for uptake among OFWs. The majority of the study population owned a smartphone and were able to connect to the Internet or Wi-Fi. Future work will rigorously evaluate eMental Health programs for use among OFWs.

Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research

BACKGROUND

Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services.

OBJECTIVE

We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base.

METHODS

Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance.

RESULTS

The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed.

CONCLUSIONS

Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary.

The impact of routine assessment of past or current mental health on help-seeking in the perinatal period

BACKGROUND

Clinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial.

AIM

The current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum.

METHODS

A subsample of women drawn from the Australian Longitudinal Study on Women's Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N=398) or in the 12 months following birth (N=380) participated in the study.

RESULTS

Multivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR=0.09, 95%CI: 0.04-0.24) and the postpartum (adjOR=0.07, 95%CI: 0.02-0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR=0.26, 95%CI: 0.15-0.45; postnatal: adjOR=0.14, 95%CI: 0.07-0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident.

CONCLUSION

This study demonstrates that enquiry by a health professional about women's past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.