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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
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Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Straand IJ, Følstad A, Bjørnestad JR. Exploring a Gaming-Based Intervention for Unemployed Young Adults: Thematic Analysis. JMIR Hum Factors 2024; 11:e44423. [PMID: 38236624 PMCID: PMC10835587 DOI: 10.2196/44423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/02/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Promoting positive psychologies that promote resilience such as a growth mindset could be beneficial for young, unemployed adults, as many lack the self-esteem and self-efficacy to cope with job search adversity. These young people may be reached at scale through the web-based delivery of self-administered positive psychology interventions. However, past studies report unsatisfying user experiences and a lack of user engagement. A gaming-based experience could be an approach to overcoming these challenges. OBJECTIVE Our research objective was to explore how young, unemployed adults experience a positive psychology intervention designed as a game to extract learning and principles for future intervention research and development. METHODS To respond to the research question, a team of researchers at the University of Stavanger worked with designers and developers to conceptualize and build a gaming-based intervention. Feedback from the users was collected through formative usability testing with 18 young adults in the target group. Retrospectively, recordings and notes were transcribed and subjected to thematic analysis to extract learnings for the purposes of this paper. RESULTS A total of 3 themes were identified that pinpoint what we consider to be key priorities for future gaming interventions for unemployed young adults: adaptation to user preferences (eg, need for responding to user preferences), empathic player interaction (eg, need for responsiveness to user inputs and a diverse set of interaction modes), and sensemaking of experience and context (eg, need for explicit presentation of game objectives and need for management of user expectations related to genre). CONCLUSIONS Feedback from end users in usability-testing sessions was vital to understanding user preferences and needs, as well as to inform ongoing intervention design and development. Our study also shows that game design could make interventions more entertaining and engaging but may distort the intervention if the game narrative is not properly aligned with the intervention intent and objectives. By contrast, a lack of adaptation to user needs may cause a less motivating user experience. Thus, we propose a structured approach to promote alignment between user preferences and needs, intervention objectives, and gameplay.
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Affiliation(s)
| | - Asbjørn Følstad
- Department of Sustainable Communication Technologies, SINTEF Digital, Oslo, Norway
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Fernandes CSF, Deng Y, Tran AH, Hieftje KD, Boomer TMP, Taylor CK, Fiellin LE. A Pilot Randomized Controlled Trial to Evaluate a Cognitive Behavioral Videogame Intervention: empowerED. Games Health J 2023; 12:42-52. [PMID: 36350349 PMCID: PMC10331148 DOI: 10.1089/g4h.2021.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: To design a cognitive behavioral videogame intervention and to evaluate its preliminary effect on improving youth's perceptions about themselves, their future, and their ability by incorporating skill development in cognitive reappraisal, an emotion regulation strategy to change perceptions. Materials and Methods: We conducted a pilot RCT to evaluate the preliminary efficacy of a videogame intervention, empowerED, in enhancing cognitive reappraisal skills. We also assessed beliefs/attitudes, self-efficacy, and emotional self-efficacy as well as user experience and feasibility. Youth (N = 100) aged 14-19 years from one school were enrolled in a pilot RCT assigned either to play empowerED or a control condition. Results: Improvements were noted in cognitive reappraisal in the empowerED group compared to the control group (LSM difference = 1.33, P = 0.01). There were no significant differences observed between treatment groups for beliefs/attitudes, self-efficacy, and emotional self-efficacy; however, the empowerED group reported improvements in beliefs/attitudes from pretest to posttest survey responses (M = 1.33, P = 0.01). Conclusion: Overall, the intervention was deemed easy to use and beneficial among youth, and feasibly delivered in a high school setting. Given the growing youth mental health needs in schools and the importance of school climate on healthy development, empowerED may offer an effective and innovative student-level approach to improve cognitive reappraisal and later empower youth to enact change in their school climate. Clinical Trials.gov Identifier: NCT04025294.
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Affiliation(s)
- Claudia-Santi F. Fernandes
- play2PREVENT Lab/Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Child Study Center, New Haven, Connecticut, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Alvin H. Tran
- Department of Health Administration and Policy, University of New Haven, West Haven, Connecticut, USA
| | - Kimberly D. Hieftje
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tyra M. Pendergrass Boomer
- play2PREVENT Lab/Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carolyn K. Taylor
- play2PREVENT Lab/Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lynn E. Fiellin
- play2PREVENT Lab/Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Child Study Center, New Haven, Connecticut, USA
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Tay JL. Online HOPE intervention on help-seeking attitudes and intentions among young adults in Singapore: A randomized controlled trial and process evaluation. Arch Psychiatr Nurs 2022; 41:286-294. [PMID: 36428062 DOI: 10.1016/j.apnu.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/28/2022] [Accepted: 09/11/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Despite the high prevalence of mental health disorders, professional help seeking was often unsought, worsening impairments in overall functioning among those who experienced them. AIM This study aimed to evaluate the online HOPE intervention on help-seeking attitudes and intentions among young adults 18 to 24 years old in a University in Singapore. The study also described the process evaluation of the online HOPE intervention. METHOD The study adopted a parallel two arms RCT. Outcome measurements measured at baseline, post-test and two-month follow-up were (1) recognition of depression, (2) barriers of help-seeking, (3) help-seeking intentions (4) attitudes about interventions, help sources, medications and (5) participants' perceptions about the intervention. RESULTS At post-test, intervention group had significantly lower acknowledgement of depression as stress. At two months, control group was significantly more concerned about side effects of medications. There were no significant differences in all barriers of help-seeking between groups, pre and post intervention. The intervention group had greater acknowledgement of antidepressants, tranquilisers and antipsychotics. Thematic analysis revealed four main themes. DISCUSSION There was high baseline recognition of depression. Improvements in help-seeking intentions were partially attributed to decreased help-seeking barriers. IMPLICATION FOR PRACTICE The online HOPE intervention could be promptly implemented for young adults to enhance the identification of mental health disorders, early help-seeking and recovery. Nurses played an important role in patient education, and online interventions are especially crucial during this Covid period which mandated social distancing. [NCT04266119].
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Affiliation(s)
- Jing Ling Tay
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
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6
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Johnson JA, Sanghvi P, Mehrotra S. Technology-Based Interventions to Improve Help-Seeking for Mental Health Concerns: A Systematic Review. Indian J Psychol Med 2022; 44:332-340. [PMID: 35949632 PMCID: PMC9301737 DOI: 10.1177/02537176211034578] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite the high prevalence of mental health disorders worldwide, a significant proportion of distressed individuals do not seek professional help. Digital technology can be a potential bridge to reduce the treatment gap for mental disorders. A systematic review was undertaken to examine the technology-based interventions aimed at improving help-seeking attitude, intention, or behavior for mental health concerns. METHODS The literature search was conducted in January-February 2020 through various e-databases using relevant keywords that targeted help-seeking interventions for mental health disorders via different technology modes. RESULTS 21 studies (15 randomized controlled trials and six non-randomized studies) were reviewed. The included studies were published between April 2006 to February 2020. Majority of the interventions led to an increase in the help-seeking variables. The crucial role of online delivery, participant involvement, and embedded links to professional services in encouraging help-seeking is highlighted. The review emphasizes the need for understanding utility of multicomponent interventions with personalized elements targeting help-seeking behavior, particularly in low-middle-income countries, and studies involving longer duration follow-ups. CONCLUSION This systematic review is the first of its kind to examine technology-based interventions to improve help-seeking for mental health and suggests that such interventions play a crucial role in positively impacting help-seeking. The complex interplay between the relevant variables such as mental health literacy, stigma, help-seeking attitude, intention and behavior, and the intervention components that may have a differential bearing on these variables are issues that merit urgent attention in further research.
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Affiliation(s)
- Jemimah A Johnson
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prachi Sanghvi
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seema Mehrotra
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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7
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Ferrari M, Sabetti J, McIlwaine SV, Fazeli S, Sadati SMH, Shah JL, Archie S, Boydell KM, Lal S, Henderson J, Alvarez-Jimenez M, Andersson N, Nielsen RKL, Reynolds JA, Iyer SN. Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion. Front Digit Health 2022; 4:814248. [PMID: 35465647 PMCID: PMC9021794 DOI: 10.3389/fdgth.2022.814248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.
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Affiliation(s)
- Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- *Correspondence: Manuela Ferrari
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarah V. McIlwaine
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sahar Fazeli
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - S. M. Hani Sadati
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Jai L. Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katherine M. Boydell
- Black Dog Institute and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Lal
- Douglas Mental Health University Institute, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | | | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | | | | | - Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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8
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Jankowski S, Ferreira K, Mascayano F, Donovan E, Rahim R, Birnbaum ML, Yum-Chan S, Medoff D, Marcogliese B, Fang L, Nicholson T, Dixon L. A Serious Game for Young People With First Episode Psychosis (OnTrack>The Game): Qualitative Findings of a Randomized Controlled Trial. JMIR Ment Health 2022; 9:e33526. [PMID: 35384847 PMCID: PMC9021940 DOI: 10.2196/33526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have shown the benefits of coordinated specialty care (CSC) for individuals with first episode psychosis; however, pathways to care are marred by lack of knowledge, stigma, and difficulties with treatment engagement. Serious games or video interventions may provide a way to address these factors. OBJECTIVE This study focuses on qualitative results of a randomized controlled trial comparing OnTrack>The Game (OTG) with recovery videos (RVs) on engagement, stigma, empowerment, hope, recovery, and understanding of psychosis in clients receiving CSC. Clinicians are also interviewed regarding their perceptions of the interventions and suggestions for improvement. METHODS A total of 16 clients aged 16-30 years, with first episode psychosis attending a CSC program in New York State, and 9 clinicians participated in the qualitative interviews. Interviews were analyzed using the rapid identification of themes from audio recordings method. RESULTS For clients, themes included relatability of game content, an increased sense of hope and the possibility of recovery, decreased self-stigma and public stigma, increased understanding of the importance of social support, and increased empowerment in the OTG group. Clinicians had a preference for RV and provided suggestions for dissemination and implementation. CONCLUSIONS Themes that may help inform future research in this area, particularly regarding dissemination and implementation of OTG and RV, emerged. TRIAL REGISTRATION ClinicalTrials.gov NCT03390491; https://clinicaltrials.gov/ct2/show/NCT03390491.
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Affiliation(s)
- Samantha Jankowski
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Kathleen Ferreira
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Franco Mascayano
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Effy Donovan
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Reanne Rahim
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Michael L Birnbaum
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Sabrina Yum-Chan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bethany Marcogliese
- Department of Research and Evaluation, C4 Innovations, Needham, MA, United States
| | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Lisa Dixon
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
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9
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Finitsis DJ, Cruess DG, Pinnamaraju S, Robinson P, Woodruff TA. Brief, peer-delivered motivational interview promotes help seeking behavior among college students with needle anxiety: A randomized controlled trial. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:654-659. [PMID: 32569507 DOI: 10.1080/07448481.2020.1763365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/12/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Needle anxiety symptoms are prevalent among college students and predict lack of engagement in student health initiatives including influenza immunization programs. Most do not seek treatment for their anxiety. Objective: To develop and test a peer-delivered, brief motivational interview to promote help-seeking behaviors among college students with needle anxiety symptoms. Participants/Methods: 61 university students who reported needle anxiety symptoms and having avoided medical situations involving needles in the last year were randomized to intervention or control conditions. Analyses compared self-reported help seeking behaviors at three months post-intervention. Results: Intervention group participants were more than twice as likely to report help-seeking behavior at follow up (IR = 2.41; 95%CI = 1.29, 4.50; p=.006) than the control group. Participants also endorsed high levels of satisfaction with the intervention. Conclusions: This pilot intervention appears acceptable and feasible to implement using peers in the college setting. There is preliminary evidence for efficacy, with larger-scale replication needed.
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Affiliation(s)
- David J Finitsis
- Health Services Delivery Research, Hartford Hospital, Hartford, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dean G Cruess
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | | | - Paul Robinson
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Torri A Woodruff
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
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10
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Townsend C, Humpston C, Rogers J, Goodyear V, Lavis A, Michail M. The effectiveness of gaming interventions for depression and anxiety in young people: systematic review and meta-analysis. BJPsych Open 2022; 8:e25. [PMID: 34991767 PMCID: PMC8811791 DOI: 10.1192/bjo.2021.1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recent research has investigated the use of serious games as a form of therapeutic intervention for depression and anxiety in young people. AIMS To conduct a systematic review and meta-analysis into the effectiveness of gaming interventions for treating either depression or anxiety in individuals aged 12-25 years. METHOD An electronic search was conducted on the 30 March 2020, using PsycINFO, ISI Web of Science Core Collection, Medline and EMBASE databases. Standardised effect sizes (Hedge's g) were calculated for between-participant comparisons between experimental (therapeutic intervention) and control conditions, and within-participant comparisons between pre- and post-intervention time points for repeated measures designs. RESULTS Twelve studies (seven randomised controlled trials (RCTs) and five non-randomised studies) were included. For RCTs, there was a statistically significant and robust effect (g = -0.54, 95% CI -1.00 to -0.08) favouring the therapeutic intervention when treating youth depression. For non-RCTs, using a repeated measures design, the overall effect was also strong (g = -0.75, 95% CI -1.64 to 0.14) favouring therapeutic intervention, but this was not statistically significant. Interestingly, we found no statistically significant effect for treating youth anxiety. CONCLUSIONS There is preliminary evidence to suggest that gaming interventions are an effective treatment for youth depression, but not anxiety. Further research is warranted to establish the utility, acceptability and effectiveness of gaming interventions in treating mental health problems in young people.
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Affiliation(s)
| | - Clara Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jack Rogers
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Victoria Goodyear
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; and School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Anna Lavis
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; and Institute of Applied Health Research, College of Medical and Dental Sciences, UK
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
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11
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Naslund JA, Deng D. Addressing Mental Health Stigma in Low-Income and Middle-Income Countries: A New Frontier for Digital Mental Health. ETHICS, MEDICINE, AND PUBLIC HEALTH 2021; 19:100719. [PMID: 35083375 PMCID: PMC8786211 DOI: 10.1016/j.jemep.2021.100719] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Mental health stigma is a major barrier to seeking help, and leads to poor quality of life and social withdrawal for individuals living with mental illness. These concerns are especially severe in low-income and middle-income countries (LMICs) that face a disproportionate share of the global burden of mental illnesses. With growing access to digital technologies in LMICs, there may be new opportunities to address mental health stigma. This review considers the potential for emerging digital technologies to advance efforts to challenge mental health stigma in LMICs. METHODS Promising digital strategies to reduce mental health stigma were identified through searching the peer-reviewed literature. Drawing from the Mental Illness Stigma Framework, these studies of digital strategies were grouped into three categories: 1) protest; 2) education, and 3) contact. RESULTS These three categories align with established stigma reduction programs. Digital strategies could expand the reach of or complement existing efforts. There are challenges with digital stigma reduction strategies, including the need for cultural adaptation of these programs to diverse contexts and settings, consideration of reliable measurement of mental health related stigma, and risks that digital media could perpetuate the spread of misinformation and exacerbate concerns pertaining to mental health stigma. CONCLUSION This review highlights the promise of technology for addressing mental health stigma in LMICs. This is imperative in the face of growing demand for mental health services owing to the economic and social impacts of the COVID-19 pandemic, and the increasing reliance on digital platforms among individuals in most countries.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Davy Deng
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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12
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Alves MI, Felipe AOB, Moreira DDS. Integrative Community Therapy - interventive strategies in the reduction of depression symptoms in adolescents: A quasi-experimental study. Int J Ment Health Nurs 2021; 30 Suppl 1:1426-1436. [PMID: 34142419 DOI: 10.1111/inm.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the effects of Integrative Community Therapy on depression symptoms in adolescents in the school context. This is a quantitative, quasi-experimental, pre-, and post-test study that compared depression scores before and after the Integrative Community Therapy intervention was applied, conducted with 56 adolescent students. The guidelines recommended by the Standards for Quality Improvement Reporting Excellence were used to present this study. The instruments used for data collection were the following: Participants' characterization, Economic Classification, and the Children's Depression Inventory. This depression inventory was applied before and after the intervention was carried out. Most of the participants presented depressive symptoms (53.6%). Girls presented higher depression scores and were more likely to develop depression; to be working proved to be a protective factor for depression and adolescents with depression symptoms presented a higher proportion of suicidal ideation. The analysis of the depression variable indicated a reduction of the scores in the post-intervention period; however, in the gender analysis, there was a reduction in the depression scores only for the girls. The Integrative Community Therapy was an effective intervention in reducing depression scores, being a relevant strategy for healthcare services and schools in assisting adolescents to deal with their emotions, mitigate psycho-emotional suffering, and contribute as a support tool in the context of vulnerabilities inherent to the process of becoming an adolescent.
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Affiliation(s)
- Mariane Inaraí Alves
- Post-Graduate Nursing Program, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Denis da Silva Moreira
- Post-Graduate Nursing Program, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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13
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Tsui TYL, DeFrance K, Khalid-Khan S, Granic I, Hollenstein T. Reductions of Anxiety Symptoms, State Anxiety, and Anxious Arousal in Youth Playing the Videogame MindLight Compared to Online Cognitive Behavioral Therapy. Games Health J 2021; 10:330-338. [PMID: 34403591 DOI: 10.1089/g4h.2020.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Anxiety disorders are the most prevalent form of psychopathology among youth. Because demand for treatment far exceeds availability, there is a need for alternative approaches that are accessible, engaging, and incorporate practice to reach as many youth as possible. MindLight is a novel videogame intervention that combines evidence-based anxiety reduction techniques with neurofeedback mechanics that has been shown to reduce anxiety symptoms in youth. This study examined the effectiveness of MindLight compared with online cognitive behavioral therapy (CBT) to replicate and extend those findings by testing the reduction of reactivity to anxiety-eliciting laboratory stressors. Materials and Methods: A randomized controlled trial was conducted with laboratory assessments at pre-intervention, post-intervention, and 3-month follow-up. Participants were 117 anxious youth (66.7% female, 33.3% male; age range: 8.05-15.93 years) who were randomized into MindLight (n = 56) and CBT (n = 60) conditions. Both interventions were completed in five 1-hour sessions within a 3-week period. At each time point, anxiety symptoms were assessed through self-report, and state anxiety and anxious arousal were measured during laboratory stress tasks. Results: All measures of anxiety significantly decreased over time in both conditions (P < 0.05). Moreover, youth in the MindLight condition showed greater pre-to-post reductions in anxiety symptoms compared with youth in the CBT condition (P < 0.05). Conclusion: Findings demonstrate that the effects of MindLight and online CBT are not only associated with reductions in anxiety symptoms, but also impact how youth react to laboratory stressors in the moment. ClinicalTrials.gov Identifier: NCT02326545.
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Affiliation(s)
| | - Kalee DeFrance
- Department of Psychology, Concordia University, Montreal, Canada
| | | | - Isabela Granic
- Department of Developmental Psychopathology, Radboud University, Nijmegen, The Netherlands
| | - Tom Hollenstein
- Department of Psychology, Queen's University, Kingston, Canada
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14
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de la Barrera U, Mónaco E, Postigo-Zegarra S, Gil-Gómez JA, Montoya-Castilla I. EmoTIC: Impact of a game-based social-emotional programme on adolescents. PLoS One 2021; 16:e0250384. [PMID: 33861813 PMCID: PMC8051799 DOI: 10.1371/journal.pone.0250384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Technologies provide a brilliant opportunity to promote social-emotional competences, well-being and adjustment in adolescence. Game-based programmes and serious games are digital tools that pursue an educational goal in an attractive environment for adolescents. The purpose of this study was therefore to determine the effectiveness of emoTIC, a game-based social-emotional programme designed according to Mayer, Caruso, and Salovey's model of emotional intelligence. MATERIALS AND METHODS The participants were 119 adolescents between 11 and 15 years, randomly assigned to the experimental group and the control group. The adolescents completed questionnaires to assess their emotional intelligence, self-esteem, affect balance, difficulties, prosocial behaviour, depression, anxiety and stress. RESULTS The MANCOVA results showed that adolescents who completed the game-based programme had improved self-esteem, affect balance, emotional symptoms, behavioural problems, and hyperactivity (Wilks' λ = .77; F = 2.10; p = .035). Hierarchical multiple regression indicated that adolescents in the experimental group had a greater change in self-esteem and affect balance (positive β), while their emotional problems and hyperactivity decreased (negative β). Anxiety moderated the influence of the intervention on self-esteem (b = .04; t = -2.55; p ≤ .05; LLCI = -0.43, ULCI = -0.05). Adolescents with low or medium anxiety improved their self-esteem with the intervention, while those with high anxiety did not develop it. CONCLUSIONS The use of technology in social-emotional programmes could be the first step in increasing adolescents' interest in emotions and emoTIC could be considered a useful programme which influences their personal, emotional and social factors. TRIAL REGISTRATION Clinical Trial identifier: NCT04414449.
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Affiliation(s)
- Usue de la Barrera
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Universitat de València, Valencia, Spain
| | - Estefanía Mónaco
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Universitat de València, Valencia, Spain
| | - Silvia Postigo-Zegarra
- Department of Psychology, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
| | - José-Antonio Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Universitat de València, Valencia, Spain
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15
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Vajawat B, Varshney P, Banerjee D. Digital Gaming Interventions in Psychiatry: Evidence, Applications and Challenges. Psychiatry Res 2021; 295:113585. [PMID: 33303223 DOI: 10.1016/j.psychres.2020.113585] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
Human evolution has regularly intersected with technology. Digitalization of various services has brought a paradigm shift in consumerism. Treading this path, mental health practice has gradually moved to Digital Mental Health Interventions (DMHI), to improve service access and delivery. Applied games are one such innovation that has gained recent popularity in psychiatry. Based on the principles of gamification, they target psychosocial and cognitive domains, according to the deficits in various psychiatric disorders. They have been used to deliver cognitive behaviour therapy, cognitive training and rehabilitation, behavioural modification, social motivation, attention enhancement, and biofeedback. Research shows their utility in ADHD, autistic spectrum disorders, eating disorders, post-traumatic stress, impulse control disorders, depression, schizophrenia, dementia, and even healthy aging. Virtual reality and artificial intelligence have been used in conjunction with gaming interventions to improvise their scope. Even though these interventions hold promise in engagement, ease of use, reduction of stigma, and bridging the mental-health gap, there are pragmatic challenges, especially in developing countries. These include network quality, infrastructure, feasibility, socio-cultural adaptability, and potential for abuse. Keeping this in the background, this review summarizes the scope, promise, and evidence of digital gaming in psychiatric practice, and highlights the potential caveats in their implementation.
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Affiliation(s)
- Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru
| | - Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru.
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16
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Hong T, Cabrera J, Beaudoin CE. The Role of Enjoyment in a Serious Game for Binge Drinking Prevention: Pretest-Posttest Quasi-Experimental Study. J Med Internet Res 2020; 22:e21652. [PMID: 33252348 PMCID: PMC7735894 DOI: 10.2196/21652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 01/23/2023] Open
Abstract
Background Although binge drinking peaks at age 21 to 25 years, there is limited research on the effects of serious games in this population, as well as on the process by which playing serious games impacts alcohol-related outcomes. Designed with both health behavioral theory and game theory, One Shot is an online serious game that aims to prevent binge drinking. Objective This study utilized a conceptual model for serious video game processes. Using One Shot, the model assessed the following process stages: (1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C); (2) in-game factors of game time and risky alcohol decisions; (3) game enjoyment; and (4) postgame outcomes of intention to drink less and drinking refusal self-efficacy. Methods In a one-group pretest-posttest quasi-experimental design, a sample (N=550) of young adults (age 21-25 years) who reported recent binge drinking played the One Shot game. Intention to drink less and drinking refusal self-efficacy were measured at pregame and postgame, with their effects lagged in statistical analysis. Participants were presented with various scenarios in the game that pertained to risky alcohol decisions, which, along with game time, were unobtrusively recorded by the server. A structural equation model (SEM) was used to test the conceptual model, with assessments made to determine if enjoyment mediated the effects of game time and risky alcohol decisions on the 2 postgame alcohol-related outcomes. Results A well-fitting SEM demonstrated support for the multistep model, with AUDIT-C predicting risky alcohol decisions (β=.30). Risky alcohol decisions (β=−.22) and game time (β=.18) predicted enjoyment, which, in turn, predicted intention to drink less (β=.21) and drinking refusal self-efficacy (β=.16). Enjoyment significantly (P<.001) mediated the effects of game time and risky alcohol decision on intention to drink less and drinking refusal self-efficacy. Conclusions The results support a conceptual model in which staggered individual and in-game factors influence alcohol-related outcomes. Enjoyment is important for participants’ intentions to drink less and beliefs that they can refuse alcohol.
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Affiliation(s)
- Traci Hong
- College of Communication, Boston University, Boston, MA, United States
| | - Joshua Cabrera
- MHMR Authority of Brazos Valley, Bryan, TX, United States
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17
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Wiljer D, Shi J, Lo B, Sanches M, Hollenberg E, Johnson A, Abi-Jaoudé A, Chaim G, Cleverley K, Henderson J, Isaranuwatchai W, Levinson A, Robb J, Wong HW, Voineskos A. Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial. J Med Internet Res 2020. [DOI: 10.2196/20790 pmid:33124984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background
Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.
Objective
The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.
Methods
A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.
Results
A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).
Conclusions
Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.
Trial Registration
ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461
International Registered Report Identifier (IRRID)
RR2-10.2196/resprot.6446
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18
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Wiljer D, Shi J, Lo B, Sanches M, Hollenberg E, Johnson A, Abi-Jaoudé A, Chaim G, Cleverley K, Henderson J, Isaranuwatchai W, Levinson A, Robb J, Wong HW, Voineskos A. Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial. J Med Internet Res 2020; 22:e20790. [PMID: 33124984 PMCID: PMC7665949 DOI: 10.2196/20790] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 01/29/2023] Open
Abstract
Background Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research. Objective The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada. Methods A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy. Results A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001). Conclusions Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy. Trial Registration ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.6446
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Affiliation(s)
- David Wiljer
- UHN Digital, University Health Network, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Brian Lo
- UHN Digital, University Health Network, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marcos Sanches
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gloria Chaim
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kristin Cleverley
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joanna Henderson
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research, St Michael's Hospital, Toronto, ON, Canada
| | - Andrea Levinson
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Janine Robb
- Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Howard W Wong
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
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19
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Stunden C, Zasada J, VanHeerwaarden N, Hollenberg E, Abi-Jaoudé A, Chaim G, Cleverley K, Henderson J, Johnson A, Levinson A, Lo B, Robb J, Shi J, Voineskos A, Wiljer D. Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study. J Med Internet Res 2020; 22:e18514. [PMID: 33016882 PMCID: PMC7573698 DOI: 10.2196/18514] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 01/29/2023] Open
Abstract
Background Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help. Objective The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada. Methods A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes. Results Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help. Conclusions Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth.
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Affiliation(s)
- Chelsea Stunden
- School of Population and Public Health, Simon Fraser University, Burnaby, BC, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Julie Zasada
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Nicole VanHeerwaarden
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrea Levinson
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janine Robb
- Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Education, Technology & Innovation, University Health Network, Toronto, ON, Canada
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20
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Lo B, Shi J, Hollenberg E, Abi-Jaoudé A, Johnson A, Wiljer D. Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review. JMIR Ment Health 2020; 7:e15942. [PMID: 32348261 PMCID: PMC7381002 DOI: 10.2196/15942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. OBJECTIVE This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). METHODS A scoping review was conducted using the Arksey and O'Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. RESULTS Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. CONCLUSIONS This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Education, Technology and Innovation, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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21
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Abstract
OBJECTIVE The use of serious games and gamification to promote learning has a long history. More recently, serious games and gamification have been used in clinical settings to promote treatment and recovery. Yet there is little evidence to support their use with populations that experience serious mental illness. METHODS A scoping review was used to answer the following research question, What is the current state of knowledge about how games and gamification are used to promote treatment of serious mental illness? Scoping reviews clarify, define, and develop conceptual boundaries within a topic area. Twenty studies were identified and reviewed by using thematic content analysis. RESULTS A range of game types, formats, and technology were assessed. Six themes emerged from analysis. Serious games and the use of gamification to promote treatment have potential to engage persons with serious mental illness in game content and promote treatment outcomes. Game design that supported clear instruction, a coherent narrative, a smooth interface between mechanics and play, and service user involvement early in the process of game design were important for the successful promotion of engagement and learning. Games reviewed offered the opportunity for problem solving, collaboration, and goal-oriented activity that supported the delivery of therapeutic outcomes. CONCLUSIONS The use of serious games and gamification to promote treatment of serious mental illness had high levels of feasibility and acceptability among both users and providers. The potential treatment value of games, however, is dependent on key features related to the games' design, operation, and rationale.
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Affiliation(s)
- Martin Fitzgerald
- School of Allied Health Professions and Midwifery, University of Bradford, Bradford, United Kingdom (Fitzgerald); Pennine Care National Health Service Foundation Trust, Lancashire, United Kingdom (Fitzgerald, Ratcliffe)
| | - Gemma Ratcliffe
- School of Allied Health Professions and Midwifery, University of Bradford, Bradford, United Kingdom (Fitzgerald); Pennine Care National Health Service Foundation Trust, Lancashire, United Kingdom (Fitzgerald, Ratcliffe)
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22
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Vázquez FL, Torres ÁJ, Otero P, Blanco V, López L, García-Casal A, Arrojo M. Cognitive-behavioral intervention via interactive multimedia online video game for active aging: study protocol for a randomized controlled trial. Trials 2019; 20:692. [PMID: 31815656 PMCID: PMC6902608 DOI: 10.1186/s13063-019-3859-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 10/26/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Due to the progressive aging of the population, programs to promote active aging have been recommended. However, older adults have difficulty accessing them. Interventions administered through online video games may increase their accessibility, and complementing these with a smartphone app will likely increase adherence and allow for ongoing professional monitoring. The objective of this study is to evaluate the efficacy of a cognitive-behavioral intervention for active aging administered through an online interactive multimedia video game that includes a smartphone app companion. The secondary objectives are to analyze the moderators and mediators of the change in the outcome variables and to evaluate the adherence to the intervention. METHODS/DESIGN A randomized controlled clinical trial will be conducted. Adults 45 years and older will be randomly assigned to a cognitive-behavioral intervention administered through an online multimedia video game that includes a smartphone app companion or to a control group that will receive online information on active aging (274 participants per group). The intervention will be administered in eight weekly 45-min modules. An investigator-blinded evaluation will be conducted using online self-administered tests at baseline, post-intervention, and 6- and 12-month follow-ups. The primary outcome will be mental health status as evaluated using the 36-item Short-Form Health Survey (SF-36) at post-intervention. Secondary outcomes will be emotional well-being, depressive symptoms, reinforcement, negative thoughts, self-reported memory, cognitive task performance, sleep hygiene behaviors, physical activity, eating habits, body mass index, social support, dropout, treatment adherence, and satisfaction with the intervention. DISCUSSION If the results are favorable, this study would involve the development of the first evidence-based active aging promotion intervention based on a video game that includes a smartphone app companion, providing evidence on its efficacy, accessibility, and clinical utility. TRIAL REGISTRATION ClinicalTrials.gov, NCT03643237. Registered 27 August 2018.
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Affiliation(s)
- Fernando L. Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángela J. Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Vanessa Blanco
- Department of Evolutive and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lara López
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio García-Casal
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain
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23
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Anttila K, Anttila M, Välimäki M. A web-based adolescent depression support system: feedback and implications for the future. Inform Health Soc Care 2019; 45:111-129. [PMID: 31684788 DOI: 10.1080/17538157.2019.1656206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim is to describe feedback from the adolescents on their use of a web-based depression support system. Web-based support systems can serve as an alternative to conventional treatment or to complement the current services. Mixed methods were used to approach the topic from multiple perspectives. Feedback was collected from adolescents with symptoms of depression or anxiety. Adolescents (n = 46) responded to a questionnaire after participating on the support system, and 24 adolescents did not provide feedback. The data were analyzed with quantitative descriptive statistics and qualitative thematic analysis. Out of 45 adolescents, 93% agreed that the web-based support system was targeted at them, and 89% felt it was reliable and safe. It was perceived as a good channel for reflecting thoughts. However, some adolescents felt it was difficult to use or that using it did not help them. Ideas for development were also offered. Depis.Net provided the adolescents with a reliable way to ease their condition at home. Using feedback from the adolescents on the support system makes it possible to identify those who are able to use this kind of system in daily practice.
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Affiliation(s)
- Katriina Anttila
- Department of Nursing Science, University of Turku, Turku, Finland.,Child Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Development Unit, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Development Unit, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong, People's Republic of China
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24
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Gwyther K, Swann R, Casey K, Purcell R, Rice SM. Developing young men's wellbeing through community and school-based programs: A systematic review. PLoS One 2019; 14:e0216955. [PMID: 31107908 PMCID: PMC6527294 DOI: 10.1371/journal.pone.0216955] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/01/2019] [Indexed: 11/19/2022] Open
Abstract
Boys and young men have unique health-related needs that may be poorly met by existing programs and initiatives. The mismatch between the needs of boys and young men and current service offerings-driven largely by social determinants of health such as masculinity-may stymie health status. This is evidenced through high rates of self-stigma, accidental death or suicide, and low rates of help seeking and health literacy among populations of boys and young men. With growing interest in improving wellbeing and educational outcomes for all young people (including boys and young men), this systematic review aimed to evaluate community and school-based programs with specific focus on program features and outcomes directly relevant to young males aged 12-25 years. Five data-bases were searched; Medline, EMBASE, PsycInfo, ERIC, and ERAD. Articles were included if they evaluated an intervention or program with a general or at-risk sample of young men, and measured a psychological, psychosocial, masculinity, or educational outcome. The majority of the 40 included studies had high quality reporting (62.5%). Synthesised data included theoretical frameworks, intervention characteristics, outcomes, and key results. Of the included studies, 14 were male-focussed programs, with masculinity approaches directed towards program aims and content information. The emergent trend indicated that male-targeted interventions may be more beneficial for young men than gender-neutral programs, however, none of these studies incorporated masculine-specific theory as an overarching framework. Furthermore, only three studies measured masculine-specific variables. Studies were limited by a lack of replication and program refinement approaches. It is concluded that there is significant scope for further development of community and school-based health promotion programs that target young men through incorporation of frameworks that consider the impact of gendered social and environmental determinants of health. Evaluation of these programs will provide researchers and practitioners with the capacity for translating beneficial outcomes into best-practice policy.
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Affiliation(s)
- Kate Gwyther
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, the University of Melbourne, Victoria, Australia
| | - Ray Swann
- Crowther Centre, Brighton Grammar School, Melbourne, Victoria, Australia
| | - Kate Casey
- Crowther Centre, Brighton Grammar School, Melbourne, Victoria, Australia
| | - Rosemary Purcell
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, the University of Melbourne, Victoria, Australia
| | - Simon M. Rice
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, the University of Melbourne, Victoria, Australia
- Youth Mood Clinic, Orygen Youth Health, Melbourne, Victoria, Australia
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25
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Ferrari M, McIlwaine SV, Jordan G, Shah JL, Lal S, Iyer SN. Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games. JMIR Ment Health 2019; 6:e12418. [PMID: 31066703 PMCID: PMC6707601 DOI: 10.2196/12418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Video game playing is a daily activity for many youths that replaces other media forms (eg, television); it serves as an important source of knowledge and can potentially impact their attitudes and behaviors. Researchers are, thus, concerned with the impact of video gaming on youth (eg, for promoting prosocial or antisocial behavior). Studies have also begun to explore players' experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing and shaping of knowledge, and messages about mental illness. OBJECTIVE The aim of this review was to identify how mental illness, especially psychosis, is portrayed in commercial video games. METHODS We performed keyword searches on games made available between January 2016 and June 2017 on Steam (a popular personal computer gaming platform). A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained. RESULTS We used a game elements framework (characters, game environment/atmosphere, goals, etc) to describe and unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%, 97/100) portrayed mental illness in negative, misleading, and problematic ways (associating it with violence, fear, insanity, hopelessness, etc). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. Mental illness was associated with mystery, the unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo experimental treatment to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as an ongoing struggle and an endless battle with the mind and oneself. CONCLUSIONS The game elements of the identified commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings in relation to current evidence on the impact of media portrayals of mental illness and stigma. Furthermore, we reflect on the ability of serious video games to promote alternative messages about mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce the stigma associated with mental illness.
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Affiliation(s)
- Manuela Ferrari
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarah V McIlwaine
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gerald Jordan
- Yale Program for Recovery and Community Health, Yale University, New Haven, CT, United States
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Shalini Lal
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, QC, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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26
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Dowling K, Simpkin AJ, Barry MM. A Cluster Randomized-Controlled Trial of the MindOut Social and Emotional Learning Program for Disadvantaged Post-Primary School Students. J Youth Adolesc 2019; 48:1245-1263. [PMID: 31004264 DOI: 10.1007/s10964-019-00987-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
School-based social and emotional learning programs aim to provide students with the skills they need to deal with life challenges, thereby enhancing their social and emotional wellbeing, academic outcomes, and reducing their risk of mental health difficulties. While there is a robust evidence base on the effectiveness of these programs originating from the US, there is a relative paucity of research on how these programs impact young people in other county contexts, especially for older adolescents and those at higher risk. This study sets out to address this research gap by evaluating the effectiveness of a social emotional learning program designed for older adolescents in Ireland, the MindOut program. MindOut is a universal school-based social and emotional learning program designed for older adolescents in Ireland which was developed based on a common elements approach underpinned by CASEL's framework. Employing a cluster randomized-controlled trial, data on social and emotional skills, academic performance and mental health outcomes were collected from students (n = 497; 51.1% female) ages 15-18 years in 32 disadvantaged schools. There were significant improvements in intervention students' social and emotional skills including, reduced suppression of emotions (p = 0.035), use of more positive coping strategies [reduced avoidance coping p = < 0.001) and increased social support coping p = 0.044)]. Improvements in mental health and wellbeing were also found with significantly reduced levels of stress (p = 0.017) and depressive symptoms (p = 0.030) as well as reduced anxiety scores for females students (p = 0.044). These short-term evaluation findings support the positive impact of school-based social and emotional learning programs, such as MindOut, when designed to be both age and culturally appropriate and delivered to older adolescents in disadvantaged schools.
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Affiliation(s)
- Katherine Dowling
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Margaret M Barry
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
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27
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Gaming- a bane or a boon-a systematic review. Asian J Psychiatr 2019; 42:12-17. [PMID: 30939393 DOI: 10.1016/j.ajp.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/08/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022]
Abstract
Recent trends show online/video games, have shifted from being just recreational in nature, to hazardous even resulting in the gamer's death like the blue whale game. The aim of the study is to examine associations between video/online gaming and its implication on the biopsychosocial domains of the user. Online databases were studied on gaming and its effect on behaviour, general and mental health from 1997-2017. The PICO guidelines, PRISMA flow diagram and the Rayyan software was used in identifying relevant studies. Cross referencing was done with the co-authors. A total of 41 studies were included in the final analysis. The choice of the video game is influenced by age, gender, parental mediation, as well as the players' and the game's characteristics. Excessive gaming affects both the individual himself and their interpersonal relationships, with 'internet addiction' being added as a diagnosis under DSM V. Despite its several negative consequences, over the past decade, researchers have now started to acknowledge the benefits of gamification in social, educational and even in the health sector, irrespective of the individual's age. There is a need to develop cross cultural database to understand the impact of addictive and/or promotive use of games on the biopsychosocial factors of the gamer.
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28
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Tay JL, Tay YF, Klainin-Yobas P. Effectiveness of information and communication technologies interventions to increase mental health literacy: A systematic review. Early Interv Psychiatry 2018; 12:1024-1037. [PMID: 29897166 DOI: 10.1111/eip.12695] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/03/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Most mental health conditions affect adolescent and young adults. The onset of many mental disorders occurs in the young age. This is a critical period to implement interventions to enhance mental health literacy (MHL) and to prevent the occurrence of mental health problems. This systematic review examined the effectiveness of information and communication technologies interventions on MHL (recognition of conditions, stigma and help-seeking). METHODS The authors searched for both published and unpublished studies. RESULTS Nineteen studies were included with 9 randomized controlled trials and 10 quasi-experimental studies. Informational interventions were useful to enhance MHL of less-known disorders such as anxiety disorder and anorexia, but not depression. Interventions that were effective in enhancing depression MHL comprised active component such as videos or quizzes. Interventions that successfully elevated MHL also reduced stigma. Elevated MHL levels did not improve help-seeking, and reduction in stigma levels did not enhance help-seeking behaviours. CONCLUSIONS Future good quality, large-scale, multi-sites randomized controlled trials are necessary to evaluate MHL interventions.
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Affiliation(s)
- Jing Ling Tay
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Yi Fen Tay
- National University of Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yoo Loo Lin School of Medicine, National University of Singapore, Singapore
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29
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30
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Dekker MR, Williams AD. The Use of User-Centered Participatory Design in Serious Games for Anxiety and Depression. Games Health J 2017; 6:327-333. [DOI: 10.1089/g4h.2017.0058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Maria R. Dekker
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Alishia D. Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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31
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Affiliation(s)
| | - Markus Schott
- Faculty of Psychology, Sigmund Freud Privat University, Vienna, Austria
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32
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Wiljer D, Abi-Jaoude A, Johnson A, Ferguson G, Sanches M, Levinson A, Robb J, Heffernan O, Herzog T, Chaim G, Cleverley K, Eysenbach G, Henderson J, Hoch JS, Hollenberg E, Jiang H, Isaranuwatchai W, Law M, Sharpe S, Tripp T, Voineskos A. Enhancing Self-Efficacy for Help-Seeking Among Transition-Aged Youth in Postsecondary Settings With Mental Health and/or Substance Use Concerns, Using Crowd-Sourced Online and Mobile Technologies: The Thought Spot Protocol. JMIR Res Protoc 2016; 5:e201. [PMID: 27815232 PMCID: PMC5116103 DOI: 10.2196/resprot.6446] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Seventy percent of lifetime cases of mental illness emerge prior to age 24. While early detection and intervention can address approximately 70% of child and youth cases of mental health concerns, the majority of youth with mental health concerns do not receive the services they need. Objective The objective of this paper is to describe the protocol for optimizing and evaluating Thought Spot, a Web- and mobile-based platform cocreated with end users that is designed to improve the ability of students to access mental health and substance use services. Methods This project will be conducted in 2 distinct phases, which will aim to (1) optimize the existing Thought Spot electronic health/mobile health intervention through youth engagement, and (2) evaluate the impact of Thought Spot on self-efficacy for mental health help-seeking and health literacy among university and college students. Phase 1 will utilize participatory action research and participatory design research to cocreate and coproduce solutions with members of our target audience. Phase 2 will consist of a randomized controlled trial to test the hypothesis that the Thought Spot intervention will show improvements in intentions for, and self-efficacy in, help-seeking for mental health concerns. Results We anticipate that enhancements will include (1) user analytics and feedback mechanisms, (2) peer mentorship and/or coaching functionality, (3) crowd-sourcing and data hygiene, and (4) integration of evidence-based consumer health and research information. Conclusions This protocol outlines the important next steps in understanding the impact of the Thought Spot platform on the behavior of postsecondary, transition-aged youth students when they seek information and services related to mental health and substance use.
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Affiliation(s)
- David Wiljer
- University Health Network, Toronto, ON, Canada.,Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Andrew Johnson
- Centre for Mental Health and Addiction, Toronto, ON, Canada
| | | | - Marcos Sanches
- Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Andrea Levinson
- Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | | | - Tyson Herzog
- Centre for Mental Health and Addiction, Toronto, ON, Canada
| | - Gloria Chaim
- Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Kristin Cleverley
- Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Gunther Eysenbach
- University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Toronto, ON, Canada
| | - Joanna Henderson
- Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Jeffrey S Hoch
- University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, ON, Canada.,Department of Public Health Sciences, University of California, Davis, CA, United States
| | | | - Huan Jiang
- University of Toronto, Toronto, ON, Canada.,Cancer Care Ontario, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, ON, Canada
| | - Marcus Law
- University of Toronto, Toronto, ON, Canada.,Michael Garron Hospital, Toronto, ON, Canada
| | | | - Tim Tripp
- Centre for Mental Health and Addiction, Toronto, ON, Canada
| | - Aristotle Voineskos
- Centre for Mental Health and Addiction, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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33
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Thabrew H, Stasiak K, Garcia-Hoyos V, Merry SN. Game for health: How eHealth approaches might address the psychological needs of children and young people with long-term physical conditions. J Paediatr Child Health 2016; 52:1012-1018. [PMID: 27529150 DOI: 10.1111/jpc.13271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/08/2016] [Accepted: 04/04/2016] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to describe the psychological experiences of children and young people with long term physical conditions, their families and clinicians and to explore if these may be improved using eHealth interventions, including online information, support and e-therapy. METHODS Totally 11 children (7-12 years), 11 young people (13-18 years), 7 parents, 11 paediatricians and 10 general practitioners participated in a series of seven semi-structured digitally recorded focus groups. A general inductive approach was used to analyse interview data. RESULTS Feedback consisted of five main themes: (i) the experience of long-term physical conditions as an anxiety-provoking journey, (ii) limited access to information and eHealth-related interventions to support this journey, (iii) desires for interventions that assist with multiple aspects of the illness experience, (iv) diversity of preferences regarding the format and vehicle of such interventions, (v) the importance of trust regarding the source of interventions for children, young people and families and the sustainability of new interventions for clinicians. CONCLUSIONS eHealth interventions are currently being used in a limited manner by children and young people with long-term physical conditions and their families. Despite some concern expressed mainly by clinicians, there is overall support from all groups for the future development of eHealth interventions to address psychological issues for this audience, particularly anxiety. Relatable content, technological appeal and ease of access/referral to such interventions are likely to improve the uptake of these relatively new interventions.
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Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vanessa Garcia-Hoyos
- Department of Health Psychology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sally N Merry
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Child and Adolescent Psychiatry, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Lerman BI, Lewis SP, Lumley M, Grogan GJ, Hudson CC, Johnson E. Teen Depression Groups on Facebook: A Content Analysis. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558416673717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Major depressive disorder (MDD) is one of the most frequently diagnosed disorders in early adolescence and can lead to a multitude of negative life outcomes, highlighting the need for early and effective intervention to mitigate depressive symptoms. Recognizing the preference of youth to seek informal sources of help for mental health issues, which may include the Internet, the social networking site Facebook was investigated as a potential source of support and help for youth suffering depressive symptoms or disorder. This study examined the content of online Facebook support groups targeting adolescents with depression. A total of 508 posts from six Facebook groups were analyzed. The majority of post content on these Facebook groups consisted of self-disclosure (32.48%), feedback between posters (24.80%), and offers and recommendations of help (24.61%). Posters seem to utilize adolescent Facebook depression groups mainly to connect with those who might share a similar experience and to share information about mental health resources. Future studies should investigate the potential to use the information exchange that occurs in these groups to promote traffic to online and offline evidence-based mental health resources.
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Pezaro S, Clyne W, Gerada C. Confidentiality, anonymity and amnesty for midwives in distress seeking online support - Ethical? Nurs Ethics 2016; 25:481-504. [PMID: 27377890 DOI: 10.1177/0969733016654315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support. RESEARCH DESIGN Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach. FINDINGS Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified. DISCUSSION Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery. CONCLUSION In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.
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Brijnath B, Protheroe J, Mahtani KR, Antoniades J. Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review. J Med Internet Res 2016; 18:e165. [PMID: 27323907 PMCID: PMC4932246 DOI: 10.2196/jmir.5463] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/04/2016] [Accepted: 05/19/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated. OBJECTIVE Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness. METHODS We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings. RESULTS Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included "active ingredients" such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning. CONCLUSIONS Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant improvements in health outcomes, especially for individuals with mild to moderate depression. The most promising interventions suited to this cohort appear to be MoodGYM and BluePages, 2 interventions from Australia. However, the relationship between MHL and formal and informal help seeking is less clear; self-stigma appears to be an important mediator with results showing that despite improvements in MHL and community attitudes to mental illness, individuals with mental illness still seek help at relatively low rates. Overall, the Internet is a viable method to improve MHL. Future studies could explore how new technology interfaces (eg, mobile phones vs computers) can help improve MHL, mental health outcomes, and reduce stigma.
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Affiliation(s)
- Bianca Brijnath
- Curtin University, School of Occupational Therapy and Social Work, Perth, Australia.
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Welsh J, Strazdins L, Ford L, Friel S, O'Rourke K, Carbone S, Carlon L. Promoting equity in the mental wellbeing of children and young people: a scoping review. Health Promot Int 2016; 30 Suppl 2:ii36-76. [PMID: 26420811 DOI: 10.1093/heapro/dav053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
There is increasing emphasis on wellbeing as a target for mental health promotion, especially during the formative period of childhood. Despite growing research on the importance of mental wellbeing, there is little information on how to effectively promote it or how to promote it equitably. This article presents a scoping review of interventions which seek to promote mental wellbeing and reduce inequities in children and young people living in high income countries. We used Fair Foundations: The VicHealth framework for health equity (VicHealth (2013) Melbourne, Australia: The Victorian Health Promotion Foundation) to identify points of entry at three layers of influence: (i) socioeconomic, cultural and political contexts, (ii) daily living conditions, and (iii) individual and family health-related factors. We identified more than 1000 interventions which aimed to prevent or treat childhood mental illness, but there were far fewer that aimed to promote children's or young people's mental wellbeing. The interventions we studied were either universal or specifically targeted children from disadvantaged families: none explicitly used an equity framework to guide their design or evaluation or addressed social gradients in wellbeing. Most interventions remained focused on proximate factors, although we also identified a handful of interventions that sought to address children's access to services and their educational and neighbourhood environments. However, we found encouraging evidence that interventions in family and educational settings were successful in building children's strengths and supporting positive parenting, universally and within disadvantaged groups. Such positive programme evaluations signal the potential for using a proportionate universalism approach that emphasizes equity in the promotion of mental wellbeing.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Laura Ford
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Sharon Friel
- Regulatory Institutions Network (RegNet), Australian National University, Canberra, ACT 2601, Australia
| | - Kerryn O'Rourke
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
| | - Stephen Carbone
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
| | - Leanne Carlon
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC 3053, Australia
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Vara MD, Baños RM, Rasal P, Rodríguez A, Rey B, Wrzesien M, Alcañiz M. A game for emotional regulation in adolescents: The (body) interface device matters. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2015.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Payne HE, Moxley VB, MacDonald E. Health Behavior Theory in Physical Activity Game Apps: A Content Analysis. JMIR Serious Games 2015; 3:e4. [PMID: 26168926 PMCID: PMC4526993 DOI: 10.2196/games.4187] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/10/2015] [Accepted: 05/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Physical activity games developed for a mobile phone platform are becoming increasingly popular, yet little is known about their content or inclusion of health behavior theory (HBT). Objective The objective of our study was to quantify elements of HBT in physical activity games developed for mobile phones and to assess the relationship between theoretical constructs and various app features. Methods We conducted an analysis of exercise and physical activity game apps in the Apple App Store in the fall of 2014. A total of 52 apps were identified and rated for inclusion of health behavior theoretical constructs using an established theory-based rubric. Each app was coded for 100 theoretical items, containing 5 questions for 20 different constructs. Possible total theory scores ranged from 0 to 100. Descriptive statistics and Spearman correlations were used to describe the HBT score and association with selected app features, respectively. Results The average HBT score in the sample was 14.98 out of 100. One outlier, SuperBetter, scored higher than the other apps with a score of 76. Goal setting, self-monitoring, and self-reward were the most-reported constructs found in the sample. There was no association between either app price and theory score (P=.5074), or number of gamification elements and theory score (P=.5010). However, Superbetter, with the highest HBT score, was also the most expensive app. Conclusions There are few content analyses of serious games for health, but a comparison between these findings and previous content analyses of non-game health apps indicates that physical activity mobile phone games demonstrate higher levels of behavior theory. The most common theoretical constructs found in this sample are known to be efficacious elements in physical activity interventions. It is unclear, however, whether app designers consciously design physical activity mobile phone games with specific constructs in mind; it may be that games lend themselves well to inclusion of theory and any constructs found in significant levels are coincidental. Health games developed for mobile phones could be potentially used in health interventions, but collaboration between app designers and behavioral specialists is crucial. Additionally, further research is needed to better characterize mobile phone health games and the relative importance of educational elements versus gamification elements in long-term behavior change.
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Affiliation(s)
- Hannah E Payne
- Computational Health Science Research Group, Department of Health Science, Brigham Young University, Provo, UT, United States.
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Younes N, Chollet A, Menard E, Melchior M. E-mental health care among young adults and help-seeking behaviors: a transversal study in a community sample. J Med Internet Res 2015; 17:e123. [PMID: 25979680 PMCID: PMC4468604 DOI: 10.2196/jmir.4254] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/09/2015] [Accepted: 03/14/2015] [Indexed: 11/21/2022] Open
Abstract
Background The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. Objective In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Methods Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen’s behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents’ income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Results Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03). Conclusions E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care.
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Affiliation(s)
- Nadia Younes
- Centre Hospitalier de Versailles, Le Chesnay, France.
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41
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Rainbow SPARX: A Novel Approach to Addressing Depression in Sexual Minority Youth. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2013.12.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cheek C, Fleming T, Lucassen MF, Bridgman H, Stasiak K, Shepherd M, Orpin P. Integrating Health Behavior Theory and Design Elements in Serious Games. JMIR Ment Health 2015; 2:e11. [PMID: 26543916 PMCID: PMC4607397 DOI: 10.2196/mental.4133] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/11/2015] [Accepted: 03/16/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. OBJECTIVE To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. METHODS We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. RESULTS A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. CONCLUSIONS This study's method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user's sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose.
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Affiliation(s)
- Colleen Cheek
- Rural Clinical School School of Medicine University of Tasmania Burnie Australia
| | - Theresa Fleming
- Werry Centre for Child and Adolescent Mental health Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Mathijs Fg Lucassen
- Werry Centre for Child and Adolescent Mental health Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Heather Bridgman
- Centre for Rural Health University of Tasmania Launceston Australia
| | - Karolina Stasiak
- Werry Centre for Child and Adolescent Mental health Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Matthew Shepherd
- School of Counselling Human Services and Social Work University of Auckland Auckland New Zealand
| | - Peter Orpin
- Centre for Rural Health University of Tasmania Launceston Australia
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Supporting a whole-school approach to mental health promotion and wellbeing in post-primary schools in Ireland. SCHOOL MENTAL HEALTH 2015. [DOI: 10.1017/cbo9781107284241.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abbott JAM, Klein B, McLaren S, Austin DW, Molloy M, Meyer D, McLeod B. Out & Online; effectiveness of a tailored online multi-symptom mental health and wellbeing program for same-sex attracted young adults: study protocol for a randomised controlled trial. Trials 2014; 15:504. [PMID: 25534310 PMCID: PMC4308019 DOI: 10.1186/1745-6215-15-504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Same-sex attracted young adults have been found to experience higher rates of mental health problems and greater difficulties in accessing specialist mental health care services compared to their heterosexual peers. Internet-based mental health interventions have the potential to be more engaging and accessible to young adults compared to those delivered face-to-face. However, they are rarely inclusive of lesbian women and gay men. Thus, the current study aims to evaluate the effectiveness of an online mental health and wellbeing program, Out & Online (http://www.outandonline.org.au), in comparison to a wait-list control group, for reducing anxiety and depressive symptoms in same-sex attracted young adults aged between 18 and 25 years. METHODS/DESIGN We are recruiting, through media and community organisations, 200 same-sex attracted young adults with anxiety and/or depressive symptoms and mild to moderate psychological distress (Kessler-10 score between 16 to 21). Participants will be randomly allocated to the intervention (the online program) or the wait-list control group based on a permuted blocked randomisation method to allow for stratification by gender. Participants in the intervention group will receive a tailored program for up to three types of mental health difficulties simultaneously. The primary outcome of anxiety and/or depressive symptoms, and secondary outcomes related to psychological distress, wellbeing and health behaviour will be measured at pre-intervention (0 week), post-intervention (8 weeks) and at a 3-month follow-up (20 weeks). DISCUSSION This online mental health and wellbeing program will be one of the first online interventions to be designed specifically to be relevant for same-sex attracted individuals. If the program is found to be effective it will improve access to specialist same-sex attracted-relevant mental health services for young adults and will facilitate wellbeing outcomes for these individuals. This program will also be a significant development in the delivery of tailored interventions that target multiple types of mental health conditions simultaneously. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12611000700932. Date registered: 7 July 2011.
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Affiliation(s)
- Jo-Anne M Abbott
- />National eTherapy Centre, Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria Australia
- />National eTherapy Centre, Faculty of Health, Arts and Design, Swinburne University of Technology, Mail H99, P.O. Box 218, Hawthorn, 3122 Australia
| | - Britt Klein
- />National eTherapy Centre, Brain and Psychological Sciences Research Centre, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria Australia
- />DVC-Research & Innovation Portfolio, School of Health Sciences and Psychology, and the Collaborative Research Network, Federation University Australia, Ballarat, Victoria Australia
- />National Institute for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory Australia
| | - Suzanne McLaren
- />School of Health Sciences and Psychology, Faculty of Health, Federation University Australia, Ballarat, Victoria Australia
| | - David W Austin
- />School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria Australia
| | - Mari Molloy
- />School of Health Sciences and Psychology, Faculty of Health, Federation University Australia, Ballarat, Victoria Australia
| | - Denny Meyer
- />Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Bronte McLeod
- />Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria Australia
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Clarke AM, Kuosmanen T, Barry MM. A systematic review of online youth mental health promotion and prevention interventions. J Youth Adolesc 2014; 44:90-113. [PMID: 25115460 DOI: 10.1007/s10964-014-0165-0] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/26/2014] [Indexed: 11/29/2022]
Abstract
The rapid growth in the use of online technologies among youth provides an opportunity to increase access to evidence-based mental health resources. The aim of this systematic review is to provide a narrative synthesis of the evidence on the effectiveness of online mental health promotion and prevention interventions for youth aged 12-25 years. Searching a range of electronic databases, 28 studies conducted since 2000 were identified. Eight studies evaluating six mental health promotion interventions and 20 studies evaluating 15 prevention interventions were reviewed. The results from the mental health promotion interventions indicate that there is some evidence that skills-based interventions presented in a module-based format can have a significant impact on adolescent mental health, however, an insufficient number of studies limits this finding. The results from the online prevention interventions indicate the significant positive effect of computerized cognitive behavioral therapy on adolescents' and emerging adults' anxiety and depression symptoms. The rates of non-completion were moderate to high across a number of studies. Implementation findings provide some evidence that participant face-to-face and/or web-based support was an important feature in terms of program completion and outcomes. Additional research examining factors affecting exposure, adherence and outcomes is required. The quality of evidence across the studies varied significantly, thus highlighting the need for more rigorous, higher quality evaluations conducted with more diverse samples of youth. Although future research is warranted, this study highlights the potential of online mental health promotion and prevention interventions in promoting youth wellbeing and reducing mental health problems.
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Affiliation(s)
- Aleisha M Clarke
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland,
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Wright S, Twardzicki M, Gomez F, Henderson C. Evaluation of a comedy intervention to improve coping and help-seeking for mental health problems in a women's prison. Int Rev Psychiatry 2014; 26:423-9. [PMID: 25137108 DOI: 10.3109/09540261.2014.924096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rates of mental illness and self-harm are very high among women prisoners. Questionnaires assessed prisoners' knowledge of and attitudes towards mental health problems, and relevant behavioural intentions before and after the intervention, to evaluate the effectiveness of a comedy show in a women's prison to reduce mental health stigma and improve coping and help-seeking for mental health problems. The intervention appeared to have been successful in improving some aspects of prisoners' knowledge about the effectiveness of psychotherapy (Z = - 2.304, p = 0.021) and likelihood of recovery from mental health problems (Z = - 2.699, p = 0.007). There were significant post-intervention increases in the proportion who stated they would discuss or disclose mental health problems with all but one of the sources of help in the questionnaire, which was consistent with the increases in the number of prisoners who rated themselves as likely to start using different sources of help or prison activities. There was no improvement in intentions to associate with people with a mental health problem. The intervention appeared effective in improving factors that might increase help-seeking and improve coping, but not those that would change behaviour towards others with a mental health problem.
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Affiliation(s)
- Steve Wright
- Health Service & Population Research Department, Institute of Psychiatry, King's College London , Denmark Hill, London
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Li J, Theng YL, Foo S. Game-based digital interventions for depression therapy: a systematic review and meta-analysis. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2014; 17:519-27. [PMID: 24810933 DOI: 10.1089/cyber.2013.0481] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to review the existing literature on game-based digital interventions for depression systematically and examine their effectiveness through a meta-analysis of randomized controlled trials (RCTs). Database searching was conducted using specific search terms and inclusion criteria. A standard meta-analysis was also conducted of available RCT studies with a random effects model. The standard mean difference (Cohen's d) was used to calculate the effect size of each study. Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis. Four types of game interventions-psycho-education and training, virtual reality exposure therapy, exercising, and entertainment-were identified, with various types of support delivered and populations targeted. The meta-analysis revealed a moderate effect size of the game interventions for depression therapy at posttreatment (d=-0.47 [95% CI -0.69 to -0.24]). A subgroup analysis showed that interventions based on psycho-education and training had a smaller effect than those based on the other forms, and that self-help interventions yielded better outcomes than supported interventions. A higher effect was achieved when a waiting list was used as the control. The review and meta-analysis support the effectiveness of game-based digital interventions for depression. More large-scale, high-quality RCT studies with sufficient long-term data for treatment evaluation are needed.
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Affiliation(s)
- Jinhui Li
- Wee Kim Wee School of Communication and Information, Nanyang Technological University , Singapore
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Cunningham CE, Walker JR, Eastwood JD, Westra H, Rimas H, Chen Y, Marcus M, Swinson RP, Bracken K. Modeling mental health information preferences during the early adult years: a discrete choice conjoint experiment. JOURNAL OF HEALTH COMMUNICATION 2014; 19:413-40. [PMID: 24266450 PMCID: PMC3996536 DOI: 10.1080/10810730.2013.811324] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Although most young adults with mood and anxiety disorders do not seek treatment, those who are better informed about mental health problems are more likely to use services. The authors used conjoint analysis to model strategies for providing information about anxiety and depression to young adults. Participants (N = 1,035) completed 17 choice tasks presenting combinations of 15 four-level attributes of a mental health information strategy. Latent class analysis yielded 3 segments. The virtual segment (28.7%) preferred working independently on the Internet to obtain information recommended by young adults who had experienced anxiety or depression. Self-assessment options and links to service providers were more important to this segment. Conventional participants (30.1%) preferred books or pamphlets recommended by a doctor, endorsed by mental health professionals, and used with a doctor's support. They would devote more time to information acquisition but were less likely to use Internet social networking options. Brief sources of information were more important to the low interest segment (41.2%). All segments preferred information about alternative ways to reduce anxiety or depression rather than psychological approaches or medication. Maximizing the use of information requires active and passive approaches delivered through old-media (e.g., books) and new-media (e.g., Internet) channels.
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Affiliation(s)
- Charles E. Cunningham
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - John R. Walker
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John D. Eastwood
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Henny Westra
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Heather Rimas
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Yvonne Chen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Madalyn Marcus
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Richard P. Swinson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Keyna Bracken
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Kauer SD, Mangan C, Sanci L. Do online mental health services improve help-seeking for young people? A systematic review. J Med Internet Res 2014; 16:e66. [PMID: 24594922 PMCID: PMC3961801 DOI: 10.2196/jmir.3103] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 12/20/2022] Open
Abstract
Background Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. Objective This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. Results Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. Conclusions Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people.
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Affiliation(s)
- Sylvia Deidre Kauer
- Department of General Practice, University of Melbourne, Carlton, Australia.
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Argenton L, Schek E, Mantovani F. Serious Games as Positive Technologies. VIRTUAL, AUGMENTED AND MIXED REALITY. APPLICATIONS OF VIRTUAL AND AUGMENTED REALITY 2014. [DOI: 10.1007/978-3-319-07464-1_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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