Young students' use of the Internet for mental health information and support

Critical review of self-diagnosis of mental health conditions using artificial intelligence

The advent of artificial intelligence (AI) has revolutionised various aspects of our lives, including mental health nursing. AI-driven tools and applications have provided a convenient and accessible means for individuals to assess their mental well-being within the confines of their homes. Nonetheless, the widespread trend of self-diagnosing mental health conditions through AI poses considerable risks. This review article examines the perils associated with relying on AI for self-diagnosis in mental health, highlighting the constraints and possible adverse outcomes that can arise from such practices. It delves into the ethical, psychological, and social implications, underscoring the vital role of mental health professionals, including psychologists, psychiatrists, and nursing specialists, in providing professional assistance and guidance. This article aims to highlight the importance of seeking professional assistance and guidance in addressing mental health concerns, especially in the era of AI-driven self-diagnosis.

A mixed methods analysis of youth mental health intervention feasibility and acceptability in a North American city: Perspectives from Seattle, Washington

In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This study aims to ascertain the kinds of support across the mental health care continuum recommended by young people and key stakeholders who could assist with implementation in Seattle. We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among youth. We complimented these data with a 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted a deductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ2 tests to summarize and compare participant characteristics stratified by age group. Qualitative informants attributed challenges to youth mental health to social isolation and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, and substance abuse prevention. Key informants and survey participants identified schools as the most important setting for mental health interventions. There were no significant differences among quantitative outcomes. Our findings highlight the need for interventions that reduce isolation and increase social connectedness to support youth mental health. As the city designs youth responsive interventions, schools and digital platforms should be prioritized. Engaging multiple stakeholders, particularly young people, tackling cultural stigma surrounding mental health, and improving access to safe community spaces are important considerations for youth mental health interventions.

Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review

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.

Mental health services for German university students: acceptance of intervention targets and preference for delivery modes

Introduction

Most university students with mental disorders remain untreated. Evaluating the acceptance of intervention targets in mental health treatment, promotion, and prevention, as well as mental health service delivery modes is crucial for reducing potential barriers, increasing healthcare utilization, and efficiently allocating resources in healthcare services.

Aim

The study aimed to evaluate the acceptance of various intervention targets and delivery modes of mental health care services in German first-year university students.

Methods

In total, 1,376 first-year students from two German universities from the 2017-2018 multi-center cross-sectional cohort of the StudiCare project, the German arm of the World Mental Health International College Student Survey initiative, completed a web-based survey assessing their mental health. Mental disorder status was based on self-reported data fulfilling the DSM-IV criteria. We report frequencies of accepted delivery modes [categories: group or in-person therapy with on or off campus services, self-help internet- or mobile-based intervention (IMI) with or without coaching, or a combination of a in-person and IMI (blended)]. In a multinomial logistic regression, we estimate correlates of the preference for in-person vs. IMI vs. a combination of both modes (blended) modalities. Additionally, we report frequencies of intervention targets (disorder specific: e.g., social phobia, depressive mood; study-related: test anxiety, procrastination; general well-being: sleep quality, resilience) their association with mental disorders and sex, and optimal combinations of treatment targets for each mental illness.

Results

German university students' acceptance is high for in-person (71%-76%), moderate for internet- and mobile-based (45%-55%), and low for group delivery modes (31%-36%). In-person treatment (72%) was preferred over IMI (19%) and blended modalities (9%). Having a mental disorder [odds ratio (OR): 1.56], believing that digital treatments are effective (OR: 3.2), and showing no intention to use services (OR: 2.8) were associated with a preference for IMI compared to in-person modes. Students with prior treatment experience preferred in-person modes (OR: 0.46). In general, treatment targets acceptance was higher among female students and students with mental disorders. However, this was not true for targets with the highest (i.e., procrastination) and the lowest (i.e., substance-use disorder) acceptance. If only two intervention targets were offered, a combination of study-related targets (i.e., procrastination, stress, time management) would reach 85%-88% of the students.

Conclusion

In-person services are preferred, yet half of the students consider using IMI, preferably aiming for a combination of at least two study-related intervention targets. Student mental health care services should offer a combination of accepted targets in different delivery modes to maximize service utilization.

Parents' acceptability of blended psychological interventions for children with emotional disorders

Objectives

This study aims to (1) describe parents' knowledge and use of online resources to address children's mental health issues and the family's general internet and technology usage patterns; (2) examine parents' acceptance of blended interventions for children with emotional disorders (ED); and (3) analyse the predictors of parents' intention to use a blended intervention if their children experienced an ED.

Method

The sample included 164 Portuguese parents (95.7 % mothers) of children between the ages of 6 and 13 years who completed an online survey. The study was disseminated through social networks, personal contacts of the researchers, and among parents participating in a randomized controlled trial investigating the efficacy of a psychological intervention for children with ED.

Results

Only 4.3 % of parents knew about online psychological interventions for children, and only 1.2 % had used them before. Most parents (73.2 %) reported that they would choose face-to-face individual therapy as their first option if their child had any ED, followed by blended therapy (14.8 %). Regression analyses showed that higher levels of parents' intention to use a blended intervention were predicted by their perceptions of the utility or efficacy of this type of delivery format.

Discussion/conclusion

These results suggest that although most parents show unfamiliarity with blended psychological interventions for children, they consider it a treatment modality to which they would resort if their children had emotional difficulties. Their intention to use such an intervention seems to be more likely if they perceive it as useful and effective.

Environmental Factors Influencing Help-seeking Behavior Among Japanese Adolescents

Objectives

Previous studies have demonstrated that adolescents do not tend to actively engage in help-seeking behaviors. Therefore, it is imperative to create an environment where adolescents can seek assistance on their own. However, no concrete method to create such environments has been established.

Design

We studied adolescents' help-seeking behaviors by administering a questionnaire that collected information on who offer help ("helpers"), how help is offered ("methods of help"), and where these interactions occur ("places of help").

Methods

We asked college students to recall their thoughts related to seeking help when they were 10-15 years old.

Results

Our results indicated that adolescents require trustworthy helpers who respect and understand them, face-to-face interactions, peer helpers of a similar age, mental health dialog, and safe and secure location outside of school for seeking help.

Conclusions

This study suggested a method to provide assistance in the field of child mental health, which is crucial for the development of the adolescents' ability to seek help and resolve mental health problems on their own.

Development and pilot testing of an online training program for better use of internet to learn about depression and anxiety (BUILDA)

BACKGROUND

Depression and anxiety are common issues among college students in the United States. Although college students routinely use the Internet for information regarding their mental health, they might lack the digital health literacy required to search, evaluate, and use Internet resources.

MATERIALS AND METHODS

A web-based short training program with four modules aimed to improve mental health literacy and digital health literacy for Better Use of Internet to Learn about Depression and Anxiety (BUILDA). BUILDA was tested in a pilot study with 10 undergraduate students who completed the program and provided feedback via online surveys and exit interviews. Participants completed a pretest and a post-test, which included health literacy instruments and realistic case scenarios to assess student knowledge and ability to search and use Internet information on mental health topics. Descriptive analyses and paired t-tests were used.

RESULTS

Increased knowledge about mental health topics was observed in pilot participants, with improvement in mean values of depression literacy (P =. 01) and anxiety literacy (P =. 019) from pretest to post-test. Better Internet search performance was also observed as the number of participants who scored >90% in case scenarios increased from two pretest to five post-test. Students used more valid and reliable Internet resources after training, citing more government health agency websites (20% in the pretest and 25% in the post-test) and scholarly resources (6% in the pretest and 30% in the post-test). The pilot participants reported the BUILDA program was useful and provided minor suggestions regarding program improvement.

CONCLUSIONS

It was feasible to deliver a short training program via a simple website to help students develop mental health literacy and digital health skills.

Considering ChatGPT to be the first aid for young adults on mental health issues

Providing mental health support and interventions through artificial intelligence can open up more significant space for young people to get good services. ChatGPT's potential to provide first aid to young adults struggling with mental health issues is noteworthy. Despite its benefits and limitations, today's technology can be a valuable addition to the mental health support available to young adults.

Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study

BACKGROUND

Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students.

OBJECTIVE

This study aimed to discover university student preferences for a psychological intervention to improve sleep quality.

METHODS

Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses.

RESULTS

In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep.

CONCLUSIONS

Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.

Adolescent pursuit of health information online during the COVID-19 pandemic: The roles played by eHealth literacy and psychological distress

COVID-19 has led to an increase in mental health problems for adolescents. In this study, we examined the factors related to the eHealth literacy of adolescents and how that impacted their pursuit of health information and mental health information online during the COVID-19 pandemic. We analyzed data from the 2020 Taiwan Communication Survey, which involved a total of 1,250 national representative adolescents who completed an online questionnaire. The results showed that two-thirds of adolescents reported searching for health information online, and about half of them reported searching for mental health information online during the COVID-19 pandemic. Multivariate analysis results indicated that adolescents who spent more time learning online, had higher levels of bonding social capital and self-determination, and had higher levels of parental active internet mediation were more likely to have higher levels of eHealth literacy. In addition, multivariate analysis results showed that adolescents who had higher levels of eHealth literacy and had higher depression and anxiety were more likely to seek health information and mental health information online. In conclusion, the levels of eHealth literacy and psychological distress of adolescents played a crucial role in their pursuit of health information and mental health information online during the COVID-19 pandemic.

The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study

BACKGROUND

Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person.

OBJECTIVE

This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking.

METHODS

This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey.

RESULTS

The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3%), a school psychologist or school social worker (52/225, 23.1%), and the user's parents (45/225, 20.0%). Of the 247 users, 120 (48.6%) indicated that they contacted the recommended service or person, and of these, 87 (72.5%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0%), improvement of self-efficacy (55/120, 45.8%), and symptom recognition (40/120, 33.3%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2%), lack of mental health literacy (59/127, 46.5%), need for self-reliance and autonomy (53/127, 41.7%), and negative family beliefs regarding help services (53/127, 41.7%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being.

CONCLUSIONS

The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68.

College student preferences of telepsychiatry

OBJECTIVE

To identify differences in preferences related to telepsychiatry among college students who have and have not been diagnosed with a mental health condition in the last year.

PARTICIPANTS

Students (n = 537) at a medium-sized Midwestern university (M_age = 21 years; 71% female).

METHODS

A quantitative, causal-comparative design using an adapted version of the National College Health Assessment (NCHA). Differences in preferences among groups were analyzed by chi-square and Cramer's V analyses with a 95% confidence interval.

RESULTS

Students did not differ in their preferences or perceptions (confidentiality, time, cost, effectiveness) of face-to-face in-person compared to telecommunication treatment environments despite their mental health history. A majority of students (76%) would prefer seeing their regular provider if using telepsychiatry in the future.

CONCLUSIONS

Implementing a higher education telepsychiatry model, especially within college health centers, could help students' access much-needed services while breaking down barriers such as transportation and wait lists.

Using Web-Based Content to Connect Young People With Real-life Mental Health Support: Qualitative Interview Study

BACKGROUND

Young people experience high rates of mental health problems but make insufficient use of the formal services available to them. As young people are heavy users of the internet, there may be an untapped potential to use web-based content to encourage this hard-to-reach population to make better use of face-to-face mental health services. However, owing to the vast range of content available and the complexities in how young people engage with it, it is difficult to know what web-based content is most likely to resonate with this age group and facilitate their engagement with professional support.

OBJECTIVE

This study aimed to identify the types of web-based content young people identified as more likely to prompt youth engagement with mental health services.

METHODS

This study used a qualitative design conducted within a social constructionist epistemology that recognized the importance of youth empowerment in mental health. Digital interviews using WhatsApp instant messenger were conducted with 37 young people aged 16-23 years who participated as "expert informants" on the priorities and practices of youth in web-based spaces. The data were analyzed using reflexive thematic analysis to identify the types of web-based content that participants believed would encourage young people to reach out to a face-to-face mental health service for support.

RESULTS

The analysis generated 3 main themes related to the research question. First, participants noted that a lack of information about available services and how they worked prevented young people from engaging with face-to-face mental health services. They proposed web-based content that provided clear information about relevant mental health services and how to access them. They also suggested the use of both text and video to provide young people with greater insight into how face-to-face counseling might work. Second, participants recommended content dedicated to combating misconceptions about mental health and negative portrayals of mental health services and professionals that are prevalent in their web-based spaces. They suggested content that challenged the stigma surrounding mental health and help seeking and highlighted the value of mental health services. Finally, participants suggested that young people would be more likely to respond to "relatable" digital stories of using mental health services, recounted in the context of a personal connection with someone they trusted.

CONCLUSIONS

This study offers recommendations for professionals and service providers on how to better engage young people with real-life mental health support using web-based content. Web-based content can be used to challenge some of the barriers that continue to prevent young people from accessing face-to-face mental health services and underlines the importance of including young people's voices in the design of web-based mental health content.

Research on hotspots and evolution paths in the field of health information behavior: a comparison study of bibliometrics based on CNKI and WoS data

Purpose

This study aimed to examine the research hotspots and evolution paths in the field of health information behavior (HIB) in China and abroad, and conduct comparative analysis to better understand its development trajectory globally.

Design/methodology/approach

A keyword search of the relevant literature included in the China National Knowledge Infrastructure (CNKI) database and Web of Science (WoS) core collection database was conducted, using the visualized analysis tool CiteSpace V for bibliometric analyses.

Findings

The common research hotspots in China and abroad can be divided into related research on HIB, research on its influencing factors and health information research. Among these, health information-seeking behavior has been the focus of domestic and foreign scholars. From the subdivision perspective, the focus of Chinese and foreign research hotspots differs. In terms of evolutionary path, the initial stage of HIB research in China and abroad revolves around health information and health information-seeking behavior, followed by the influencing factors of HIB; however, the research breakthrough point is the reverse. Then, domestic and foreign research was conducted on different types of HIBs. Regarding the selection of research objects, Chinese and foreign research objects were increasingly diversified.

Research limitations/implications

This study also has several limitations. First, the literature sample only selected the literature in the WoS and CNKI databases, and there may be many HIB-related works published in other databases. Therefore, future research should include other databases. Second, in terms of language, this study selected only Chinese and English literature, but in many countries, important research results on certain topics are usually published in native language, and future research should expand the language selection. Third, this study only conducted national and institutional collaboration network analysis, keyword co-occurrence analysis, cluster analysis and timeline chart analysis.

Practical implications

The implication of practice can be divided into the following three points. (1) Analyzing the domestic and foreign literature on HIB and identifying highly cooperative institutions and countries in the field of HIB can reveal the research situation of HIB and help researchers establish new research networks in the future. (2) Analyzing the research hotspots and evolutionary paths of HIB at home and abroad is helpful for quickly understanding the development context of this field and grasping the emerging research directions such as HIB of people in close contact with patients, health information exchange behavior, health information avoidance behavior and health information discontinuation behavior, which can help researchers to explore the future research direction in this field, so as to determine the topic and fill the research gap. (3) Combining the analysis of HIB-related research at home and abroad is helpful for professionals to understand the characteristics and rules of HIB of users, consumers and other groups to further optimize and improve health information services.

Originality/value

Comparing and summarizing the research status of HIB in China and globally, and presenting the findings visually, will help researchers better grasp the research overview and hotspot changes in this field, as well as provide a follow-up reference.

How do digital lives affect resident mental health in the digital era? Empirical evidence based on Chinese general social survey

Having good mental health means we are better able to connect, function, cope and thrive. The widespread application of digital technology in daily life provides new ways and promising tools for residents to maintain their mental health. Given the importance of mental health for everyone, and the fact that mental health problems are prevalent worldwide, this study discusses how digital lives affects the mental health of residents. The results suggest that digital lives are significantly and positively associated with mental health. Mechanisms analysis identifies personal perceptions (self-rated physical exercise and subjective wellbeing) as the important paths for digital lives to promote mental health, while social perceptions (social trust and social fairness) play a suppressing effect on the relationship between them. The results of further discussion show that the degree of the influence of digital lives on mental health of individuals is heterogeneous among different regions. Due to the difference in development level, the positive impact of digital lives is greater in urban areas than in rural areas, and it is stronger in western regions than in eastern and central regions. This study enriches the nascent research stream of digitalization, explores new paths of harnessing digital technologies for mental health, and offers useful insights for the government to guide them in formulating digital development strategies and achieving the Healthy China Strategy.

Developing, Deploying, and Evaluating Digital Mental Health Interventions in Spaces of Online Help- and Information-Seeking

The internet is frequently the first point of contact for people seeking support for their mental health symptoms. Digital interventions designed to be deployed through the internet have significant promise to reach diverse populations who may not have access to, or are not yet engaged in, treatment and deliver evidence-based resources to address symptoms. The liminal nature of online interactions requires designing to prioritize needs detection, intervention potency, and efficiency. Real-world implementation, data privacy and safety are equally important and can involve transparent partnerships with stakeholders in industry and non-profit organizations. This commentary highlights challenges and opportunities for research in this space, grounded in learnings from multiple research projects and teams aligned with this effort.

The Current Quality of Web-Based Information on the Treatment of Bipolar Disorder: A Systematic Search

Background: An important aspect of managing chronic disorders like bipolar disorder is to have access to relevant health information. This study investigates and compares the quality of information on the treatments of bipolar disorder that is available on English websites, as an international language, and on Italian websites, as a popular local language. Methods: A systematic review search was obtained from four search engines. We excluded unrelated materials, scientific papers, and duplicates. We analyzed popularity with PageRank; technological quality with Nibbler; readability with the Flesh Reading Ease test and Gulpease index; quality of information with the DISCERN scale, the JAMA benchmark criteria, and on the extent of adherence to the HONCode. Results: 35 English and 31 Italian websites were included. The English websites were found to have a higher level of quality information and technological quality than the Italian ones. Overall, the websites were found to be difficult to read, requiring a high level of education. Conclusions: These results can be important to inform guidelines for the improvement of health information and help users to reach a higher level of evidence on the websites. Users should find the benefits of treatment, support for shared decision-making, the sources used, the medical editor’s supervision, and the risk of postponing treatment.

Mental health outcomes and help-seeking behaviours among Egyptian medical students: A cross-sectional study

AIM

Approximately half of the population in Egypt is under the age of 25. Globally, mental illness represents the highest burden of disease in this age group. Yet in Egypt, there is still no youth-specific mental health system in place and the vast majority of young people do not have access to any professional mental health support. The objective of this study was to describe the mental health needs of Egyptian youth and the resources they use when seeking help.

METHODS

An online cross-sectional survey was distributed among medical students at Tanta University in Egypt. Of the 707 individuals who completed the survey (90.9% response rate), 60.5% were female, 62.0% lived in urban and suburban areas, and the mean age of the sample was 20.5 (±1.8) years old.

RESULTS

More than half (54%) of the students reported that they had been affected by mental health problems at some point in their lives. Anxiety and depression were the most common problems. Regarding help-seeking behaviours, participants mainly searched the web or spoke to peers and relatives; few reported approaching medical professionals. The majority of participants (59.7%) reported being disappointed with the current mental health care system in Egypt.

CONCLUSIONS

There is a high prevalence of mental challenges among Egyptian youth and the health care system is not adequately prepared to respond to their needs. E-Mental Health and online interventions seem to be a promising solution that could increase access to mental health services for Egyptian youth.

Psychological Help-Seeking Among College Students: Applying the Multi-Theory Model of Health Behavior Change in Assessing Telehealth Use for Psychological Help-Seeking

Background

Due to the deleterious effects on psychological health and wellbeing spurred by the pandemic, utilization of telehealth-based care increased over the past few years. The rapid transition from in-person to telehealth-based health service delivery has yet to be fully understood. The aim of the current study was to examine telehealth use for psychological help-seeking among college students using the Multi-theory Model of health behavior change (MTM) as a theoretical framework.

Methods

A cross-sectional and survey-based study was conducted among students at a large US university (N = 356). Valid and reliable scales were used to measure domains of psychological distress and MTM constructs. Participants were grouped based on past 12-month utilization of telehealth for any mental, emotional, or substance use problems.

Results

Roughly 67% of the sample reported that they needed help dealing with psychological distress, and 56.1%,43.3%, and 38.7% screened positive for anxiety, depression, and suicidal ideation, respectively. Depression, anxiety, and suicidal ideation were positively associated with past 12-month telehealth-based help-seeking. Past 12-month telehealth users reported greater advantages, confidence, and emotion direction toward telehealth-based psychological help-seeking than their counterparts. Participants also perceived higher exhibition of behavioral skills and greater social support to aid help-seeking than their counterparts. Advantages and disadvantages as well as behavioral confidence predicted intentions for telehealth-based help-seeking after controlling for anxiety, depression, suicidal ideation, perceived stigma, and perceived need for help among both groups.

Conclusion

The MTM theoretical framework is a valuable framework for predicting telehealth-based psychological help-seeking among college students. Such framework can be used to design and implement mental health programing.

The mental health information needs of Chinese university students and their use of online resources: a holistic model

Purpose

This research aims to explore the nature of Chinese students' mental health information needs and to identify the online resources they use to meet those needs.

Design/methodology/approach

Data was collected from three Chinese research-oriented universities using semi-structured interviews and a survey. Twenty-five university students with varied backgrounds were selected for semi-structured interviews to explore the triggers and nature of their needs. Then, printed and online questionnaires were distributed to undergraduate and postgraduate students and 541 valid responses were processed for descriptive statistical analysis and variance analysis.

Findings

The following findings were incurred. First, the triggers of university students' mental health information needs mainly are mental health being in the news, personal interest in gaining mental health knowledge, mental health issues, required formal learning and preparation for mental health counselling. Second, eleven types of information are used, with an emphasis on employment pressure, study stress and self-understanding. Third, mental health information needs differ with mental health status and some social-demographic factors (including gender, urban or rural origin and educational stage). Fourth, information needs can be characterized as dynamic; complex and diverse but concentrated on a few types; ambiguous and hard for participants to define; private; stigmatized; self-dependent and substitutable. Fifth, Internet sources used to meet such needs are mainly search engines, Question and Answer platforms, public social media platforms. Finally, a model of mental health information needs was built based on the above findings to map the whole process from what triggers a need, to the content and characteristics of information need, and online resources used to meet those needs.

Practical implications

The paper provides suggestions for university mental health services in developing more tailored knowledge contents via effective delivery methods to meet diverse needs of student groups.

Originality/value

This research is novel in using empirical data to build a holistic model that captures the context and the nature of mental health information needs of university students.

Single-Session Interventions Embedded Within Tumblr: Acceptability, Feasibility, and Utility Study

Background

Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms.

Objective

We aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)—embedded as Koko minicourses on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior.

Methods

We used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed t tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program.

Results

The SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed t tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (P<.001, Cohen d_z=−0.81, 95% CI −0.85 to −0.77) and REFRAME (P<.001, Cohen d_z=−0.88, 95% CI −0.96 to −0.80). Self-hate significantly decreased (P<.001, Cohen d_z=−0.67, 95% CI −0.74 to −0.60), and the desire to stop self-harm significantly increased (P<.001, Cohen d_z=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research.

Conclusions

Very brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports.

Attitudes toward innovative mental health treatment approaches in Germany: E-mental health and home treatment

E-mental health and home treatment are treatment approaches that have proven to be effective, but are only slowly implemented in the German health care system. This paper explores the attitudes toward these innovative treatment approaches. Data was collected in two large, non-clinical samples representative of the German population in spring 2020 (N = 2,503) and winter 2020/2021 (N = 2,519). Statistical associations between variables were examined using two-tailed tests. Binary and multinomial logistic regressions were performed to predict attitudes toward online-based treatment concepts and home treatment approaches. Only few (<20%) people preferred online-based treatment approaches, while a larger proportion (~50%) could imagine being treated at home. Overall, younger subjects were more open to online-therapy approaches, while people with lower education preferred more often a traditional therapy setting. Acceptance of online-therapy did not raise significantly during the first months of the COVID-19 pandemic. When different online-based treatment options were available, the probability of accepting home treatment significantly increased with increasing levels of therapeutic support. Further promotion of acceptance for online-therapy and home treatment seems to be necessary. In the future, more information on innovative treatment approaches should be actively provided.

The Relationship between Intimate Partner Violence and Online Help-Seeking: A Moderated Mediation Model of Emotion Dysregulation and Perceived Anonymity

During the COVID-19 pandemic, lockdowns and isolation have limited the availability of face-to-face support services for victims of intimate partner violence (IPV). Despite the growing need for online help in supporting IPV victims, far less is known about the underlying mechanisms between IPV and online help-seeking. We studied the mediating role of emotion dysregulation (ED) and the moderating role of perceived anonymity (PA) on the internet to explain IPV victims’ willingness of online help-seeking (WOHS). Through a PROCESS analysis of the questionnaire data (n = 510, 318 female, 192 male, M_age = 22.41 years), the results demonstrate that: (1) ED has been linked with the experience of IPV, and IPV significantly induces ED. (2) When IPV victims realize the symptoms of ED, they have a strong willingness to seek external intervention to support themselves. ED mediates the relationship between IPV and online help-seeking. (3) For youth growing up in the era of social networking sites (SNS), personal privacy protection is an important factor when seeking online help. The anonymity of the internet has a positive effect on victims who experience IPV and ED, and it increases WOHS. This study introduces a new perspective on the psychological mechanism behind IPV victims’ help-seeking behaviors, and it suggests that the improvement of anonymity in online support can be an effective strategy for assisting IPV victims.

How Technologies Can Support Self-Injury Self-Management: Perspectives of Young Adults With Lived Experience of Nonsuicidal Self-Injury

Background

There is growing interest in the design of digital interventions to improve conditions for young people who engage in high-risk behaviors, like nonsuicidal self-injury (NSSI). However, few studies have focused on how young people self-manage NSSI, or their existing, and historic, use of technologies to support their goals related to NSSI behavior change. Such an understanding has the potential to inform the design of digital interventions that meet this population's unique needs.

Objectives

This study aims to (a) understand the self-management practices of young adults who engage in NSSI, (b) explore how they currently use technologies for self-injury self-management, and (c) identify the ways they can envision an app-based technology supporting their self-management.

Methods and Materials

Twenty young adults (aged 18-24) with lived experience of NSSI, and who were not currently enrolled in therapy, were recruited from online venues. Participants completed baseline measures to assess mental health and NSSI characteristics, followed by a virtual 1-h semi-structured interview where they were invited to share their experience of self-management, their goals, and their thoughts on supportive technology. Interview scripts were transcribed and analyzed via thematic analysis.

Results

Themes and sub-themes are organized under two broad domain areas: (1) How young adults self-manage NSSI thoughts and behaviors and (2) Opportunities and challenges for digital interventions to assist young adults in their recovery process. We found that young adults had varied experiences with, and goals related to, NSSI. Participants reported a lack of effective strategies to reduce NSSI urges and a desire for an app-based technology to track patterns and deliver personalized suggestions for self-management. Participants reported existing use of technologies as part of self-management, as well as early information and support seeking for NSSI online.

Conclusions

This study contributes a greater understanding of young people's experiences with self-injury, their self-management practices, and their desire to engage with technology. Our findings highlight the need for design flexibility in developing digital interventions that support individual goals, unique presentations of NSSI, and needs at different phases of recovery. Implications for the design of highly personalized and relevant digital interventions to address NSSI are discussed.

Information Seeking and MSM's Beliefs about PrEP and Condoms

This study examined how frequently men who have sex with men (MSM) used a selection of sources, including news media, social media, health organizations, and dating/hookup apps, for HIV information. Additionally, the study explored the extent to which MSM's efficacy beliefs about pre-exposure prophylaxis (PrEP) and perceptions of condom importance could be predicted by the sources they used. A sample of MSM (N= 969) were surveyed online. Results showed that respondents obtained information about HIV most often from HIV organizations, LGBT organizations, and dating/hookup apps, particularly the apps Growlr, Scruff, and Grindr. Use of the app Scruff was the strongest source-based predictor of beliefs about both PrEP and condoms. Implications for health promotion are discussed.

Seeking and Sharing Mental Health Information on Social Media During COVID-19: Role of Depression and Anxiety, Peer Support, and Health Benefits

This study conducted a cross-sectional online survey (N = 865) to determine whether self-ratings of depression and anxiety, perceived peer support, and perceived health benefits of social media predicted mental health–related information seeking and sharing behaviors during the COVID-19 pandemic. Hierarchical regression models showed only depression self-ratings, anxiety self-ratings, and perceived health benefits predicted information seeking, whereas depression self-ratings, anxiety self-ratings, perceived peer support, and perceived health benefits all predicted information sharing. There was a statistically significant positive interaction of anxiety self-ratings and perceived peer support on information sharing. Participants’ experience of COVID-19 predicted both information seeking and sharing. Mental health–related information seeking and sharing differed across social media platforms, with YouTube, Facebook, and Instagram used most for information seeking and Facebook, Instagram, and Twitter used most for information sharing. Findings suggest social media mental health–related seeking and sharing behaviors have the potential to facilitate coping surrounding mental health.

"I Wanted to See How Bad it Was": Online Self-screening as a Critical Transition Point Among Young Adults with Common Mental Health Conditions

Young adults have high rates of mental health conditions, yet they are the age group least likely to seek traditional treatment. They do, however, seek information about their mental health online, including by filling out online mental health screeners. To better understand online self-screening, and its role in help-seeking, we conducted focus groups with 50 young adults who voluntarily completed a mental health screener hosted on an advocacy website. We explored (1) catalysts for taking the screener, (2) anticipated outcomes, (3) reactions to the results, and (4) desired next steps. For many participants, the screener results validated their lived experiences of symptoms, but they were nevertheless unsure how to use the information to improve their mental health moving forward. Our findings suggest that online screeners can serve as a transition point in young people's mental health journeys. We discuss design implications for online screeners, post-screener feedback, and digital interventions broadly.

Egyptian Students Open to Digital Mental Health Care: Cross-Sectional Survey

Background

In Egypt, the shortage of mental health services, particularly for adolescents and young adults, is apparent. Electronic mental health (EMH) has been proposed as a solution to bridge the gap and better address the needs of young people. However, EMH is new to Egypt and its acceptability among target populations is crucial to its implementation and success.

Objective

The objective of this study is to explore the interest of Egyptian youth in EMH, identify perceived barriers to EMH, and inform the design of EMH tools to best address the needs of youth.

Methods

A web-based cross-sectional survey was distributed among medical students at Tanta University in Egypt. Chi-square and one-way analysis of variance tests were performed for inferential analyses using a significance level of .05.

Results

Of the 707 individuals who completed the survey (90.9% response rate), 60.5% (428) were female, 62% (438) lived in urban and suburban areas, and the mean age of the sample was 20.5 (SD 1.8) years. The vast majority of participants (522/707, 73.8%) had already used the internet to find information about mental health problems, but the information was unsatisfactory for about half of them (386/707, 54.6%). Almost all students reported that they would prefer web-based therapy if EMH were available through a trustworthy national web-based platform for youth mental health (601/707, 85%). Students believed that emotional difficulties, social support, and coping strategies were the main topics that EMH should help with. The most common perceived barriers for EMH use in Egypt were concerns about privacy (382/707, 54%) and a lack of technology literacy and unfamiliarity with EMH (352/707, 50%).

Conclusions

EMH is a promising strategy for addressing gaps in the mental health care for young people. To construct and implement a digital system of care that addresses the unique needs and preferences of youth, adolescents and young adults should be involved in the co-development and design.

Feasibility and Acceptability of Internet-based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis Abstract (Preprint)

Background

Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care.

Objective

This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women.

Methods

Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women’s experiences. Data were analyzed for emerging themes, which were identified and coded.

Results

A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app.

Conclusions

This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care.

Trial Registration

ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796

“Where There Is Light, There Is Also Darkness”: Discussing Young Adults’ Willingness to Disclose Data to Use Wearables and Health Applications—Results from a Focus Group Study

In recent years, the Internet of Medical Things (IoMT) has gained momentum. This development has only been intensified by the current COVID-19 crisis, which promotes the development of applications that can help stop the virus from spreading by monitoring people’s movements and their social contacts. At the same time, it has become increasingly difficult for individuals to control the use of their private data by commercial companies. While Internet users claim to be highly interested in protecting their privacy, their behaviors indicate otherwise. This phenomenon is discussed in literature as the so-called privacy paradox. The existence of the privacy paradox has also been confirmed by previous studies, which found individuals’ claims and actions to contradict one another. The present study investigates the following research questions: (1) What significance do individuals attribute to protecting their privacy, with a special focus on the health sector? (2) To what extent are they willing to grant commercial parties access to their data in order to use applications in general and health applications in particular? Results from seven focus groups with 40 respondents aged 20–30 years were conducted in an urban setting in Austria in late 2019. The respondents’ inputs are meant to provide answers to these questions. The results indicate that, overall, the young generation is well-informed about the growing data collection and is quite critical of it. As such, their willingness to share information in the health context is only moderately pronounced. Thus, only a moderately pronounced privacy paradox can be detected for the health sector when compared to other sectors. In conclusion, implications and directions for further research are addressed.

Impact of a Digital Intervention for Literacy in Depression among Portuguese University Students: A Randomized Controlled Trial

Digital interventions are important tools to promote mental health literacy among university students. “Depression in Portuguese University Students” (Depressão em Estudantes Universitários Portugueses, DEEP) is an audiovisual intervention describing how symptoms can be identified and what possible treatments can be applied. The aim of this study was to evaluate the impact of this intervention. A random sample of 98 students, aged 20–38 years old, participated in a 12-week study. Participants were recruited through social media by the academic services and institutional emails of two Portuguese universities. Participants were contacted and distributed into four study groups (G1, G2, G3 and G4): G1 received the DEEP intervention in audiovisual format; G2 was given the DEEP in text format; G3 received four news articles on depression; G4 was the control group. A questionnaire was shared to collect socio-demographic and depression knowledge data as a pre-intervention method; content was then distributed to each group following a set schedule; the depression knowledge questionnaire was then administered to compare pre-intervention, post-intervention and follow-up literacy levels. Using the Scheffé and Least Significant Difference (LSD) multiple comparisons test, it was found that G1, which received the DEEP audiovisual intervention, differed significantly from the other groups, with higher depression knowledge scores in post-intervention stages. The DEEP audiovisual intervention, compared to the other formats used (narrative text format; news format), proved to be an effective tool for increasing depression knowledge in university students.

Use of YouTube to watch health-related videos and participation in online support groups among US adults with heart disease, diabetes, and hypertension

Objective

Social media use has grown over time. However, it is unclear how people with a self-reported history of cardiovascular disease or cardiovascular disease-related risk factors such as diabetes and hypertension use social media.

Methods

Data from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4) were analyzed (N = 3865). Only respondents with complete data for all variables of interest were included in the analyses, resulting in 306 respondents with a heart condition, 1291 with hypertension, and 608 with diabetes. We explored associations between two dependent variables: (1) participated in an online forum or support group and (2) watched a health-related video on YouTube, and sociodemographic factors and patient-provider communication. Analyses were conducted separately by medical condition. Odds ratios, 95% confidence intervals, and p-values were calculated.

Results

In respondents with a heart condition, hypertension, or diabetes, 5.4%, 8.4%, and 10.3% had participated in an online support group and 29.6%, 40.4%, and 36.6% had watched health-related videos on YouTube, respectively. Univariately, the odds of using online support groups was associated with younger age (vs. > = 65) in people with a heart condition and hypertension, but not diabetes. Regarding YouTube, younger age was associated with watching health-related videos across all three medical conditions, with additional gender and education associations observed in those with hypertension. There were no associations between social media use and patient-provider communication.

Conclusions

These findings may inform the selection of social media platforms for behavioral interventions depending on the intended patient population and goals (e.g. social support vs. video-based health education).

Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis

BACKGROUND

Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited.

OBJECTIVE

The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years.

METHODS

A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework.

RESULTS

Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (-25.6%, 95% CI -0.352 to -0.160; P<.001) and anxiety (-15.1%, 95% CI -0.251 to -0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted.

CONCLUSIONS

D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

Young People’s Coping Strategies When Dealing With Their Own and a Friend’s Symptoms of Poor Mental Health: A Qualitative Study

Young people struggle to seek help for their mental health, despite having different resources available. As the coping process is very complex, and elements such as trust and availability of resources have been said to influence it, this study aimed to understand how young people cope with their own or a friend’s symptoms of poor mental health. Eleven young people (13–15 years old) were interviewed. Thematic Analysis of the interviews showed that participants reported different coping strategies for dealing with their own hypothetical symptoms and those of a friend. Participants identified the social impact of experiencing symptoms of poor mental health and choice of resources as the main factors influencing their coping strategies. For their own symptoms, young people expressed concern about being judged and that they would only disclose to someone they trust. Participants would not disclose a friend’s symptoms because they did not want to break their trust. Finally, choice of resources was mainly influenced by the severity of symptoms being experienced, especially when it comes to asking for professional help. This study contributes to a better understanding of the different ways in which young people cope with their own symptoms and symptoms experienced by a friend.

Students' perceptions of an online mental health intervention: a qualitative interview study

BACKGROUND

University students are at a heightened risk of developing mental health disorders. Online interventions are becoming increasingly popular in this target group, both to prevent the development of mental health disorders and to treat existing ones. The PLUS (Personality and Living of University Students) programme is a web-based targeted prevention intervention which has been tested across two European countries. Completion of this programme has been relatively poor. Understanding university students' opinions, experiences and perceptions of the PLUS programme can lead to future improvements in intervention design, engagement and dissemination.

METHODS

Semistructured interviews were conducted with university students from the UK (n = 10) and Austria (n = 14) who had previously had access to PLUS. Students were asked about their perception and experiences of the programme, and how it could be improved. Results were analysed using thematic analysis.

RESULTS

Experience of online prevention programmes in general were limited and as a result of this, few had specific expectations of the PLUS programme before signing up. The lack of guidance and accountability due to the online nature of the programme made engagement challenging for many, however, frequent reminder emails helped mitigate this. In terms of positives of the programme, participants found the flexibility suitable for students and many noticed that the programme created change in how they thought or behaved.

CONCLUSION

Overall, the PLUS programme was well received by students, despite study retention being poor. Although PLUS was viewed as a useful tool to integrate into the university setting, several improvements were suggested to increase engagement. By considering this feedback, uptake and intervention completion can be improved for future preventative interventions.

Leveraging Text Mining Approach to Identify What People Want to Know About Mental Disorders From Online Inquiry Platforms

Online inquiry platforms, which is where a person can anonymously ask questions, have become an important information source for those who are concerned about social stigma and discrimination that follow mental disorders. Therefore, examining what people inquire about regarding mental disorders would be useful when designing educational programs for communities. The present study aimed to examine the contents of the queries regarding mental disorders that were posted on online inquiry platforms. A total of 4,714 relevant queries from the two major online inquiry platforms were collected. We computed word frequencies, centralities, and latent Dirichlet allocation (LDA) topic modeling. The words like symptom, hospital and treatment ranked as the most frequently used words, and the word my appeared to have the highest centrality. LDA identified four latent topics: (1) the understanding of general symptoms, (2) a disability grading system and welfare entitlement, (3) stressful life events, and (4) social adaptation with mental disorders. People are interested in practical information concerning mental disorders, such as social benefits, social adaptation, more general information about the symptoms and the treatments. Our findings suggest that instructions encompassing different scopes of information are needed when developing educational programs.

Effective use of online depression information and associated literacies among US college students

Mental health issues, such as depression, are rising among young people, who may benefit from online depression-related information. However, the competencies required to search for health information on the Internet and evaluate it before use may be poor among this population. This research aimed to investigate how college students use the Internet for solving problems in realistic case scenarios relevant to depression and to understand whether various literature-indicated literacies and factors may predict effective utilization of relevant online resources. We designed a web-based questionnaire survey including four depression-related case scenarios. A total of 218 undergraduate students who were enrolled in a Northeastern public US university were invited to participate in the survey in 2016, with 192 completed responses being included in this analysis (response rate = 88%; the participants' median age = 20; 79% female). Approximately half of the participants (47%) answered the depression-related questions in the case scenarios with 90% or higher accuracy. In a multiple linear regression model, prior depression knowledge and eHealth information literacy significantly predicted the effective use of online depression information. However, medical literacy and critical health literacy were not significant predictors. A few additional demographic and experience related factors were positively associated with the effective Internet use (e.g. female, non-Hispanic, psychology or health science major and prior experience with depression). These findings identify a need for college students to develop domain-specific knowledge and literacies in order to facilitate effective use of online information about depression.

First-Person, Third-Person, or Bystander? Exploring the Persuasive Influence of Perspective in Mental Health Narratives

As evidence suggests that college students are particularly vulnerable to mental health distress and illness, guidance for designing messages that inspire help-seeking behavior is needed. The purpose of this study was to evaluate the influence of perspective of storytelling on health message involvement and persuasion. A controlled experiment (N= 430) compared the influence of online mental health narratives targeted to college students that featured a bystander perspective to those that used first- and third-person perspectives. Evidence suggests that the bystander perspective was more effective for producing persuasive outcomes, including mental health information recall and beliefs. Results also indicate that self-referencing mediated the effects of message involvement on outcomes across all message conditions. People with experience with mental illness became involved with and were influenced by mental health narratives in different ways.

The relationship between screen time and mental health in young people: A systematic review of longitudinal studies

An increase in time spent on screen-based technologies has been suggested to underlie recent increases in mental health problems among young people. However, this hypothesis has primarily been based on the findings of cross-sectional studies. The aim of the current review was to provide a comprehensive overview of longitudinal studies examining the relationship between screen time and internalising mental health symptoms. PsycINFO, PubMed/Medline and EMBASE were systematically searched for articles published up to August 2020. Thirty-five studies, with sample sizes ranging from 126 to 12,866 participants, met inclusion criteria. The association between screen time and subsequent depressive symptoms was found to be small to very small in size. There was limited evidence of any reverse association between depressive symptoms and subsequent screen time. The association between screen time and depressive symptoms varied between different devices and uses. In contrast to depressive symptoms, evidence to support longitudinal associations between screen time and other internalising mental health symptoms, including anxiety, self-esteem, and general internalising problems, was lacking. Together, these results suggest that the impact of increased screen time on the prevalence of mental health problems among young people is likely to be negligible or small. Further longitudinal studies that examine screen content and motivations underlying screen use are required to better discern any relationship between screen time and internalising mental health symptoms.

Mechanisms of change in Internet- and mobile-based interventions for PTSD: a systematic review and meta-analysis

Background: While Internet- and mobile-based interventions (IMIs) are potential options to increase the access to evidence-based therapies for post-traumatic stress disorder (PTSD), comprehensive knowledge on their working mechanisms is still scarce. Objective: We aimed to evaluate studies investigating the efficacy and mechanisms of change in IMIs for adults with PTSD. Method: In this systematic review and meta-analysis (PROSPERO CRD42019130314), five databases were consulted to identify relevant studies, complemented by forward (i.e. citation search) and backward (i.e. review of reference lists from included studies) searches. Randomized controlled trials (RCTs) investigating the efficacy of IMIs compared to active controls, as well as component and mediation studies were included. Two independent reviewers extracted the data and assessed the risk of bias and requirements for process research. Random-effects meta-analyses on PTSD symptom severity as primary outcome were conducted and further information was synthesized qualitatively. Results: In total, 33 RCTs were included (N = 5421). The meta-analysis comparing IMIs to non-bonafide active controls yielded a significant standardized mean difference (SMD) of -0.36 (95%CI -0.53 to -0.19) favouring IMIs. Although meta-analytic pooling was not possible for the component and mediation studies, evidence suggests no differential effects regarding PTSD symptom reduction between different levels of support and personalization and between different types of exposure. Moreover, mediation studies revealed significant intervening variable effects for self-efficacy beliefs, perceived physical impairment, social acknowledgement, and trauma disclosure. Conclusions: Results indicate that IMIs for PTSD are superior to active controls. Furthermore, findings may contribute to the development of new interventions by outlining important directions for future research (e.g. regarding requirements for process research) and highlighting potential mechanisms of change (i.e. self-efficacy, perceived physical impairment, social acknowledgement, and trauma disclosure).

Feasibility and acceptability of a guided internet-based stress management intervention for university students with high levels of stress: Protocol for an open trial

More than half of university students have high levels of stress. Stress management programs can help students improve coping skills and prevent psychological distress. However, studies have generally targeted all university students regardless of whether they experience high levels of stress or not, and thus more studies are needed to examine the feasibility and acceptability of e-health interventions for students with elevated stress. The present open trial aims to examine the feasibility and acceptability of a guided internet-based stress management program for university students with high levels of stress. In this study, participants are recruited via e-mail, newsletters, and flyers from four universities in the Netherlands to participate in a guided internet-based stress management program. Guidance is delivered by e-coaches who provide weekly asynchronous text-based motivational feedback after each module is completed. Primary outcomes are satisfaction with the intervention, assessed by the Client Satisfaction Scale (CSQ-8), and usability, assessed by the System Usability Scale (SUS-10). Secondary outcomes are perceived stress, quality of life, and depression, assessed by the Perceived Stress Scale (PSS-10), the EuroQol- 5 Dimension- 5 Level Scale (EQ- 5D- 5L), and the Patient Health Questionnaire (PHQ-9) respectively. Adherence rates to the program are assessed by examining the number of completed modules, time spent on the platform, and completed exercises. The Caring Universities Project was funded in (September 2019). In June 2020, the project was officially announced to the students and recruitment began immediately. As of October 2020, recruitment continues. The expected date of the publication of the results is in 2021. It is expected that the results of the proposed study will be informative for designing and implementing e-health interventions in higher education. Moreover, it is assumed that the findings will contribute to the growing literature on internet interventions by yielding preliminary evidence related to the feasibility and acceptability of an online stress management program.

TRIAL REGISTRATION

Netherlands Trial Register NL8686; https://www.trialregister.nl/trial/8686.

Traditional and Nontraditional Mental Healthcare Services: Usage and Preferences Among Adolescents and Younger Adults

In recent years, nontraditional mental healthcare services and tools (e.g., mobile apps, peer counselors, online support groups) have been developed to increase access to and utilization of behavioral health services. This study investigates how adolescents and younger adults use and perceive various nontraditional mental healthcare services in comparison to traditional services and in comparison to each other. A questionnaire-based study was conducted that included 203 participants between the ages of 17 and 37 (M = 25.01, SD = 5.04). Results showed that while usage rates of nontraditional mental health services were considerably high, the highest rates were reported for traditional services. Similarly, participants reported high levels of willingness to use nontraditional services, yet the highest levels of willingness were reported for traditional services. These findings suggest that the integration of nontraditional services with traditional services may be particularly impactful for young people.

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial

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

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial

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 (F_2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F_2,877=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

User-centered design of a web-based crowdsourcing-integrated semantic text annotation tool for building a mental health knowledge base

BACKGROUND

One in five U.S. adults lives with some kind of mental health condition and 4.6% of all U.S. adults have a serious mental illness. The Internet has become the first place for these people to seek online mental health information for help. However, online mental health information is not well-organized and often of low quality. There have been efforts in building evidence-based mental health knowledgebases curated with information manually extracted from the high-quality scientific literature. Manual extraction is inefficient. Crowdsourcing can potentially be a low-cost mechanism to collect labeled data from non-expert laypeople. However, there is not an existing annotation tool integrated with popular crowdsourcing platforms to perform the information extraction tasks. In our previous work, we prototyped a Semantic Text Annotation Tool (STAT) to address this gap.

OBJECTIVE

We aimed to refine the STAT prototype (1) to improve its usability and (2) to enhance the crowdsourcing workflow efficiency to facilitate the construction of evidence-based mental health knowledgebase, following a user-centered design (UCD) approach.

METHODS

Following UCD principles, we conducted four design iterations to improve the initial STAT prototype. In the first two iterations, usability testing focus groups were conducted internally with 8 participants recruited from a convenient sample, and the usability was evaluated with a modified System Usability Scale (SUS). In the following two iterations, usability testing was conducted externally using the Amazon Mechanical Turk (MTurk) platform. In each iteration, we summarized the usability testing results through thematic analysis, identified usability issues, and conducted a heuristic evaluation to map identified usability issues to Jakob Nielsen's usability heuristics. We collected suggested improvements in the usability testing sessions and enhanced STAT accordingly in the next UCD iteration. After four UCD iterations, we conducted a case study of the system on MTurk using mental health related scientific literature. We compared the performance of crowdsourcing workers with two expert annotators from two aspects: efficiency and quality.

RESULTS

The SUS score increased from 70.3 ± 12.5 to 81.1 ± 9.8 after the two internal UCD iterations as we improved STAT's functionality based on the suggested improvements. We then evaluated STAT externally through MTurk in the following two iterations. The SUS score decreased to 55.7 ± 20.1 in the third iteration, probably because of the complexity of the tasks. After further simplification of STAT and the annotation tasks with an improved annotation guideline, the SUS score increased to 73.8 ± 13.8 in the fourth iteration of UCD. In the evaluation case study, on average, the workers spent 125.5 ± 69.2 s on the onboarding tutorial and the crowdsourcing workers spent significantly less time on the annotation tasks compared to the two experts. In terms of annotation quality, the workers' annotation results achieved average F1-scores ranged from 0.62 to 0.84 for the different sentences.

CONCLUSIONS

We successfully developed a web-based semantic text annotation tool, STAT, to facilitate the curation of semantic web knowledgebases through four UCD iterations. The lessons learned from the UCD process could serve as a guide to further enhance STAT and the development and design of other crowdsourcing-based semantic text annotation tasks. Our study also showed that a well-organized, informative annotation guideline is as important as the annotation tool itself. Further, we learned that a crowdsourcing task should consist of multiple simple microtasks rather than a complicated task.

Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study

BACKGROUND

Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students.

OBJECTIVE

This qualitative study aims to better understand college students' perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM).

METHODS

A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator's guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students' perceptions and attitudes toward MySSP.

RESULTS

The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence.

CONCLUSIONS

The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students.

Treatment Delivery Preferences Associated With Type of Mental Disorder and Perceived Treatment Barriers Among Mexican University Students

PURPOSE

Although Internet-based electronic health (eHealth) interventions could potentially reduce mental health disparities, especially in college students in under-resourced countries, little is known about the relative acceptability of eHealth versus in-person treatment modalities and the treatment barriers associated with a preference for one type over the other.

METHODS

Participants were from the 2018-2019 cohort of the University Project for Healthy Students (PUERTAS), a Web-based survey of incoming first-year students in Mexico and part of the World Mental Health International College Student Survey initiative. A total of 7,849 first-year students, 54.73% female, from five Mexican universities participated. We estimated correlates of preference for eHealth delivery over in-person modalities with a multivariate logistic regression.

RESULTS

Thirty-eight percent of students prefer in-person services, 36% showed no preference for in-person over eHealth, 19% prefer not to use services of any kind, and 7% preferred eHealth over in-person treatment delivery. Being embarrassed, worried about harm to one's academic career, wanting to handle problems on one's own, beliefs about treatment efficacy, having depression, and having attention-deficient hyperactivity disorder were associated with a clear preference for eHealth delivery methods with odds ratios ranging from 1.47 to 2.59.

CONCLUSIONS

Although more students preferred in-person services over eHealth, those reporting attitudinal barriers (i.e., embarrassment, stigma, wanting to handle problems on one's own, and beliefs about treatment efficacy) and with depression or attention-deficit hyperactivity disorder had a greater preference for eHealth interventions suggesting these are students to whom eHealth interventions could be targeted to alleviate symptoms and/or as a bridge to future in-person treatment.