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Muller JL, Tomlin L, March S, Jackson B, Budden T, Law KH, Dimmock JA. Understanding parent perspectives on engagement with online youth-focused mental health programs. Psychol Health 2024; 39:613-630. [PMID: 35758102 DOI: 10.1080/08870446.2022.2090561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/12/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Online youth-focused health programs often include parent modules-that equip parents with skills to assist their child in improving their health-alongside youth-specific content. BRAVE Self-Help, an evidence-based program designed for children and teenagers with early signs of anxiety, is a popular Australian program that includes six parent modules. Despite its popularity and proven efficacy, BRAVE Self-Help shares the same challenge as many online self-help programs-that of low participant engagement. Using parents registered in BRAVE Self-Help as 'information rich' participants, we explored (a) factors that influenced parent engagement in online health programs, and (b) their recommendations for enhancing parent engagement. DESIGN AND OUTCOME MEASURE We conducted semi-structured interviews with 14 parents registered in BRAVE Self-Help. Data were analysed through reflexive thematic analysis. RESULTS Social-, family- and program-related factors drove parents' program engagement and recommendations. Social sub-themes related to the benefits of professional and community support in promoting more engagement. Family sub-themes included difficulties with program engagement due to competing priorities, perceptions that condition severity influenced engagement, and feelings that previously-acquired health knowledge reduced motivation to engage. Program sub-themes included perceived usefulness and ease-of-use. CONCLUSION Program designers could target support systems, include flexible delivery options, and use iterative design processes to enhance parent engagement.
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Affiliation(s)
- Jessica L Muller
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Luke Tomlin
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Sonja March
- School of Psychology and Counselling and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Timothy Budden
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Kwok Hong Law
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - James A Dimmock
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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Lemmer D, Moessner M, Arnaud N, Baumeister H, Mutter A, Klemm SL, König E, Plener P, Rummel-Kluge C, Thomasius R, Kaess M, Bauer S. The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial. J Med Internet Res 2024; 26:e54478. [PMID: 38656779 PMCID: PMC11079770 DOI: 10.2196/54478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. OBJECTIVE This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. METHODS This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. RESULTS No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. CONCLUSIONS Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. TRIAL REGISTRATION German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.
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Affiliation(s)
- Diana Lemmer
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Agnes Mutter
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah-Lena Klemm
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Elisa König
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Heidelberg, Germany
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Khan K, Hall CL, Babbage C, Dodzo S, Greenhalgh C, Lucassen M, Merry S, Sayal K, Sprange K, Stasiak K, Tench CR, Townsend E, Stallard P, Hollis C. Precision computerised cognitive behavioural therapy (cCBT) for adolescents with depression: a pilot and feasibility randomised controlled trial protocol for SPARX-UK. Pilot Feasibility Stud 2024; 10:53. [PMID: 38532490 DOI: 10.1186/s40814-024-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND A serious game called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), originally developed in New Zealand and incorporating cognitive behavioural therapy (CBT) principles, has been shown to help reduce symptoms of depression and anxiety in adolescents with mild to moderate depression in studies undertaken in Australasia. However, SPARX has never been trialled in the United Kingdom (UK), and there have been issues relating to low engagement when it has been used in a real-world context. AIMS To conduct the first pilot and feasibility randomised controlled trial (RCT) in England to explore the use of SPARX in different settings. The trial will explore whether SPARX supported by an e-coach (assistant psychologists) improves adherence and engagement compared with self-directed (i.e. self-help) use. The trial results will be used to inform the optimal mode of delivery (SPARX supported vs. SPARX self-directed), to calculate an appropriate sample size for a full RCT, and to decide which setting is most suitable. METHODS Following consultation with young people to ensure study suitability/appropriateness, a total of 120 adolescents (11-19 years) will be recruited for this three-arm study. Adolescents recruited for the study across England will be randomised to receive either SPARX with human support (from an e-coach), self-directed SPARX, or a waitlist control group. Assessments will be conducted online at baseline, week 4, and 8-10-week post-randomisation. The assessments will include measures which capture demographic, depression (Patient Health Questionnaire modified for adolescents [PHQ-A]) and anxiety (Revised Child Anxiety and Depression Scale [RCADS]) symptomatology, and health-related quality-of-life data (EQ-5D-Y and proxy version). Analyses will be primarily descriptive. Qualitative interviews will be undertaken with a proportion of the participants and clinical staff as part of a process evaluation, and the qualitative data gathered will be thematically analysed. Finally, feasibility data will be collected on recruitment details, overall study uptake and engagement with SPARX, participant retention, and youth-reported acceptability of the intervention. DISCUSSION The findings will inform the design of a future definitive RCT of SPARX in the UK. If the subsequent definitive RCT demonstrates that SPARX is effective, then an online serious game utilising CBT principles ultimately has the potential to improve the provision of care within the UK's health services if delivered en masse. TRIAL REGISTRATION ISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804 .
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Affiliation(s)
- K Khan
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK.
| | - C L Hall
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - C Babbage
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - S Dodzo
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - C Greenhalgh
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - M Lucassen
- School of Health and Psychological Sciences, University of London, London, UK
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - S Merry
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - K Sayal
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - K Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - K Stasiak
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - C R Tench
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Precision Imaging Beacon, Queen's Medical Centre, Nottingham, UK
| | - E Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - P Stallard
- Department for Health, University of Bath, Bath, UK
| | - C Hollis
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Yeo G, Reich SM, Liaw NA, Chia EYM. The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e51268. [PMID: 38421687 PMCID: PMC10941000 DOI: 10.2196/51268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/25/2023] [Accepted: 12/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. OBJECTIVE This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. METHODS We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. RESULTS Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. CONCLUSIONS For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.
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Affiliation(s)
- GeckHong Yeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Stephanie M Reich
- School of Education, University of California, Irvine, Irvine, CA, United States
| | - Nicole A Liaw
- SHINE Children and Youth Services, Singapore, Singapore, Singapore
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Cohen Rodrigues TR, Reijnders T, Breeman LD, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW. Use Intention and User Expectations of Human-Supported and Self-Help eHealth Interventions: Internet-Based Randomized Controlled Trial. JMIR Form Res 2024; 8:e38803. [PMID: 38358784 PMCID: PMC10905349 DOI: 10.2196/38803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 10/28/2023] [Accepted: 11/20/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Self-help eHealth interventions provide automated support to change health behaviors without any further human assistance. The main advantage of self-help eHealth interventions is that they have the potential to lower the workload of health care professionals. However, one disadvantage is that they generally have a lower uptake. Possibly, the absence of a relationship with a health care professional (referred to as the working alliance) could lead to negative expectations that hinder the uptake of self-help interventions. The Unified Theory of Acceptance and Use of Technology (UTAUT) identifies which expectations predict use intention. As there has been no previous research exploring how expectations affect the adoption of both self-help and human-supported eHealth interventions, this study is the first to investigate the impact of expectations on the uptake of both kinds of eHealth interventions. OBJECTIVE This study investigated the intention to use a self-help eHealth intervention compared to a human-supported eHealth intervention and the expectations that moderate this relationship. METHODS A total of 146 participants were randomly assigned to 1 of 2 conditions (human-supported or self-help eHealth interventions). Participants evaluated screenshots of a human-supported or self-help app-based stress intervention. We measured intention to use the intervention-expected working alliance and the UTAUT constructs: performance expectancy, effort expectancy, and social influence. RESULTS Use intention did not differ significantly between the 2 conditions (t142=-1.133; P=.26). Performance expectancy (F1,140=69.269; P<.001), effort expectancy (F1,140=3.961; P=.049), social influence (F1,140=90.025; P<.001), and expected working alliance (F1,140=26.435; P<.001) were positively related to use intention regardless of condition. The interaction analysis showed that performance expectancy (F1,140=4.363; P=.04) and effort expectancy (F1,140=4.102; P=.045) more strongly influenced use intention in the self-help condition compared to the human-supported condition. CONCLUSIONS As we found no difference in use intention, our results suggest that we could expect an equal uptake of self-help eHealth interventions and human-supported ones. However, attention should be paid to people who have doubts about the intervention's helpfulness or ease of use. For those people, providing additional human support would be beneficial to ensure uptake. Screening user expectations could help health care professionals optimize self-help eHealth intervention uptake in practice. TRIAL REGISTRATION OSF Registries osf.io/n47cz; https://osf.io/n47cz.
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Affiliation(s)
| | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Linda D Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderik A Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, Netherlands
- Vital10, Amsterdam, Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrea Wm Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, Leiden, Delft, Rotterdam, Netherlands
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7
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Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
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Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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8
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Kambara K, Matsumoto M, Hako S, Shigematsu J, Yokoyama S, Ogata A. An intervention to promote concrete thinking style in young adults: Effects on depressive symptoms and its protective factors. J Behav Ther Exp Psychiatry 2023; 81:101857. [PMID: 37031477 DOI: 10.1016/j.jbtep.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/21/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals with low concreteness-experiential thought (CET) tend to have exacerbated depressive symptoms. Interventions aimed at increasing CET have been shown to influence depressive symptoms. The present study examined the effects of increasing CET on depressive symptoms and its protective factors. METHODS A two-armed experimental intervention was conducted with 86 healthy university students in Japan. They were randomly allocated to the intervention and waitlist groups. Participants in the intervention group engaged in an unguided and web-based (UW) intervention to increase CET (UW-CET). This intervention included a one-off session, to explain the rationale behind increasing CET via a psychoeducation video, and a five-session training on CET over a week. We assessed depressive symptoms, thought styles, and protective factors, such as mindfulness and goal striving, both pre- and-post-assessment and at the one-month follow-up. RESULTS Participants in the intervention group had marginally increased CET in the follow-up assessments; however, participants in the waitlist group did not. Furthermore, participants in the intervention showed marginally increased mindfulness tendencies and strivings toward their personal goals, but their depressive symptoms were not affected. LIMITATIONS The present study did not include any active control conditions. Additionally, the sample consisted of only healthy university students. CONCLUSIONS The findings suggest that the UW-CET can marginally increase adaptive thinking, such as CET, and promote positive psychological aspects in healthy young adults; however, the effect is small. The findings may also help expand clinical implementations to prevent depression in young adults.
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Affiliation(s)
- Kohei Kambara
- Faculty of Psychology, Doshisha University, Kyotanabe City, Kyoto, Japan.
| | - Misuzu Matsumoto
- Graduate School of Education, Hiroshima University, Higashi-Hiroshima City, Hiroshima, Japan
| | - Suzuka Hako
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima City, Hiroshima, Japan
| | - Jun Shigematsu
- Department of Humanities, University of Toyama, Toyama City, Toyama, Japan
| | - Satoshi Yokoyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Akiko Ogata
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima City, Hiroshima, Japan
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Williams AJ, Freed M, Theofanopoulou N, Daudén Roquet C, Klasnja P, Gross J, Schleider J, Slovak P. Feasibility, Perceived Impact, and Acceptability of a Socially Assistive Robot to Support Emotion Regulation With Highly Anxious University Students: Mixed Methods Open Trial. JMIR Ment Health 2023; 10:e46826. [PMID: 37906230 PMCID: PMC10646679 DOI: 10.2196/46826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Mental health difficulties among university students have been rising rapidly over the last decade, and the demand for university mental health services commonly far exceeds available resources. Digital interventions are seen as one potential solution to these challenges. However, as in other mental health contexts, digital programs often face low engagement and uptake, and the field lacks usable, engaging, evidence-supported mental health interventions that may be used flexibly when students need them most. OBJECTIVE The aim of this study is to investigate the feasibility and acceptability of a new, in situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in situ support for emotion regulation (ER)-a well-known transdiagnostic construct-directly in the moments when individuals are facing emotionally challenging situations. A secondary aim is to consider the perceived impact of Purrble on youth mental health, as reported by students over a 7-week deployment. METHODS A mixed methods open trial was conducted with 78 under- and postgraduate students at Oxford University. Participants were recruited based on moderate to high levels of anxiety measured by Generalized Anxiety Disorder-7 at baseline (mean 16.09, SD 3.03). All participants had access to Purrble for 7 weeks during the spring term with data on their perceived anxiety, emotion dysregulation, ER self-efficacy, and engagement with the intervention collected at baseline (pre), week 4 (mid), and week 8 (postintervention). Qualitative responses were also collected at the mid- and postintervention points. RESULTS The findings demonstrated a sustained engagement with Purrble over the 7-week period, with the acceptability further supported by the qualitative data indicating that students accepted Purrble and that Purrble was well-integrated into their daily routines. Exploratory quantitative data analysis indicated that Purrble was associated with reductions in student anxiety (dz=0.96, 95% CI 0.62-1.29) and emotion dysregulation (dz=0.69, 95% CI 0.38-0.99), and with an increase in ER self-efficacy (dz=-0.56, 95% CI -0.86 to -0.26). CONCLUSIONS This is the first trial of a simple physical intervention that aims to provide ongoing ER support to university students. Both quantitative and qualitative data suggest that Purrble is an acceptable and feasible intervention among students, the engagement with which can be sustained at a stable level across a 7-week period while retaining a perceived benefit for those who use it (n=32, 61% of our sample). The consistency of use is particularly promising given that there was no clinician engagement or further support provided beyond Purrble being delivered to the students. These results show promise for an innovative intervention model, which could be complementary to the existing interventions.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, United Kingdom
| | - Maureen Freed
- Psychodynamic Studies, University of Oxford, Oxford, United Kingdom
| | | | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - James Gross
- Psychophysiology Laboratory, University of Stanford, Stanford, CA, United States
| | - Jessica Schleider
- Department of Psychology, Stony Brook University, New York, NY, United States
| | - Petr Slovak
- Department of Informatics, King's College London, London, United Kingdom
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10
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Yang Y, Wang H, Sha W, Guo X, Deng W, Wang J, Fu C. Short Video-Based Mental Health Intervention for Depressive Symptoms in Junior High School Students: A Cluster Randomized Controlled Trial. Psychol Res Behav Manag 2023; 16:4169-4181. [PMID: 37868654 PMCID: PMC10588807 DOI: 10.2147/prbm.s433467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Digital interventions for adolescent mental health are emerging in high-income countries, but have faced challenges and are scarce in China. This study investigated the effect of a short video-based mental health intervention on depressive symptoms in Chinese adolescents. Methods A three-arm cluster randomized controlled trial was conducted in four junior high schools in Shanghai from December 2020 to December 2021 with the measurement at baseline, 6 months after study entry, and 12 months. Outcomes were collected by self-completed questionnaires administered by teachers masked to allocation. The primary outcome was depressive symptoms assessed by the Depression Self-Rating Scale for Children (DSRSC). Mixed effects models were used to compare psychologist-led intervention (n=428 students) and teacher-led intervention (n=385) including six short video-based sessions to usual school provision (n=751). Results Using intention-to-treat analyses, psychologist-led intervention showed more reduction in depressive symptoms compared to usual school provision at 6 months (coefficient -1.00, 95% CI -1.94 to -0.05), but not at 12 months. Using per-protocol analyses among participants who watched at least three video episodes, both psychologist-led (-1.14, -2.20 to -0.09) and teacher-led intervention (-1.23, -2.45 to -0.02) reduced depressive symptoms compared to usual school provision at 6 months, and the effect of teacher-led intervention persisted at 12 months (-1.58, -3.13 to -0.03). Further exploration found that compared with urban students, the between-group differences for depressive symptoms in rural students were more significant (p<0.05 for interaction) and the effects were maintained at 12 months. Conclusion The short video-based mental health intervention showed potential to reduce depressive symptoms among Chinese adolescents, and the effects were more significant if the minimum video viewing frequency was reached.
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Affiliation(s)
- Yuting Yang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Hao Wang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Wen Sha
- Shanghai Municipal Center for Health Promotion, Shanghai, People’s Republic of China
| | - Xiaoqin Guo
- Songjiang District Center for Health Promotion, Shanghai, People’s Republic of China
| | - Wei Deng
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Jingyi Wang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Chaowei Fu
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
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11
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Ruehlman L, Karoly P. A pilot test of Internet-delivered brief interactive training sessions for depression: Evaluating dropout, uptake, adherence, and outcome. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2131-2139. [PMID: 34469262 DOI: 10.1080/07448481.2021.1961781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/31/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Uptake, adherence, and dropout rates for Internet-based programs for depression are in need of improvement. Excessive user burden (eg, heavy content, extended duration) may undermine engagement and precipitate dropout. To address this problem, an alternative format was proposed: Brief Interactive Training Sessions (BITS). BITS target a narrow behavioral health skill and require 3-4 hours to complete. A depression-focused version of BITS that provides training in cognitive distortion/restructuring was tested. PARTICIPANTS Fifty-two depressed college students were randomly assigned to BITS or to a wait-list. METHODS Students competed pre-and post-test (7 week) assessments of depression and cognitive distortions. RESULTS Uptake rate was 83%. Among study completers, adherence was 96%. The dropout rate did not improve. Compared to the control group, the experimental group reported a significant reduction in depression and in cognitive distortions. CONCLUSIONS The BITS format is a promising vehicle for improving uptake and adherence while achieving positive clinical outcomes.
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Affiliation(s)
| | - Paul Karoly
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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12
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Werner‐Seidler A, Li SH, Spanos S, Johnston L, O'Dea B, Torok M, Ritterband L, Newby JM, Mackinnon AJ, Christensen H. The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis. J Child Psychol Psychiatry 2023; 64:1324-1335. [PMID: 36991537 PMCID: PMC10952387 DOI: 10.1111/jcpp.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app-based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. METHODS We conducted a 2-arm single-blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12-16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app-delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post-intervention) and 14 weeks (post-baseline). Co-primary outcomes were symptoms of insomnia and depression at post-intervention (primary endpoint). Intent-to-treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178. RESULTS Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: -2.96 to -0.41, d = .41) and 14 weeks (95% CI: -3.34 to -0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: -3.46 to -0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported. CONCLUSIONS An app-delivered program for insomnia could be a practical, non-stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.
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Affiliation(s)
- Aliza Werner‐Seidler
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Sophie H. Li
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Samantha Spanos
- Australian Institute of Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Lara Johnston
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Bridianne O'Dea
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Michelle Torok
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Lee Ritterband
- School of MedicineUniversity of VirginiaCharlottesvilleVAUSA
| | - Jill M. Newby
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
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Litvin S, Saunders R, Jefferies P, Seely H, Pössel P, Lüttke S. The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial. JMIR Ment Health 2023; 10:e47285. [PMID: 37477955 PMCID: PMC10403802 DOI: 10.2196/47285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. OBJECTIVE This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. METHODS In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion. RESULTS A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. CONCLUSIONS Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.
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Affiliation(s)
- Silja Litvin
- Department Psychologie, Ludwig-Maximilians-Universität, München, Germany
| | - Rob Saunders
- Division of Psychology and Language Sciences, Clinical Education and Health Psychology, University College London, London, United Kingdom
| | - Philip Jefferies
- Resilience Research Centre, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Hayley Seely
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Kentucky, KY, United States
| | - Patrick Pössel
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Kentucky, KY, United States
| | - Stefan Lüttke
- Department für Klinische Psychologie und Psychotherapie, Institute für Psychologie, Universität Greifswald, Greifswald, Germany
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Geiger S, Steinbach J, Skoda EM, Jahre L, Rentrop V, Kocol D, Jansen C, Schüren L, Niedergethmann M, Teufel M, Bäuerle A. Needs and Demands for e-Mental Health Interventions in Individuals with Overweight and Obesity: User-Centred Design Approach. Obes Facts 2023; 16:173-183. [PMID: 36442465 PMCID: PMC10028369 DOI: 10.1159/000527914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Several studies indicate an association between mental disorders and overweight or obesity. E-Mental health interventions offer an effective way to overcome barriers to health care access for individuals with overweight and obesity. The objective of this study was to examine the needs and demands for e-mental health interventions among individuals with overweight and obesity. METHODS A cross-sectional study was conducted from 2020 to 2021 in Germany. A total of 643 participants were recruited through specialized social media platforms and the Alfried-Krupp hospital in Essen, Germany. Sociodemographic and medical data were analysed, as well as data on depressive symptoms and on the needs and demands for e-mental health interventions. RESULTS Contact with and recommendation by experts appear to be key aspects in the acceptance and use of e-mental health interventions. In summary, most participants preferred a 20-30-min weekly session via smartphone over a 4-month period. The highest preference in terms of features included practicing coping skills and being provided with information; in regard to desired topics, nutrition consultation, quality of life, and adapting to new life situations were considered most important. DISCUSSION e-Mental health interventions can be highly beneficial for individuals, especially when developed through a user-centred design approach. The results of the study indicate which content and design are preferred and, thereby, provide valuable information for consideration when developing a tailored e-mental health intervention.
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Affiliation(s)
- Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
- *Sheila Geiger,
| | - Jasmin Steinbach
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Vanessa Rentrop
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lynik Schüren
- Department of General and Visceral Surgery, Alfried-Krupp Hospital Essen, Essen, Germany
| | - Marco Niedergethmann
- Department of General and Visceral Surgery, Alfried-Krupp Hospital Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
- **Martin Teufel,
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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15
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Hosseini B, Tremblay CL, Longo C, Glochi S, White JH, Quach C, Ste-Marie LG, Platt RW, Ducharme FM. Oral vitamin D supplemental therapy to attain a desired serum 25-hydroxyvitamin D concentration in essential healthcare teams. Trials 2022; 23:1019. [PMID: 36527143 PMCID: PMC9756469 DOI: 10.1186/s13063-022-06944-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The study objectives were to ascertain the efficacy of vitamin D supplementation in rapidly increasing serum vitamin D and of implementation of a hybrid (virtual and in-person) trial. METHODS In a randomized triple-blind controlled trial, healthcare workers were allocated to receive an oral bolus of 100,000 IU with 10,000 IU/week of vitamin D3 or placebo. The co-primary outcomes were the change from baseline in serum 25-hydroxyvitamin D [(Δ) 25(OH)D] and proportion with vitamin D sufficiency (25(OH)D ≥ 75 nmol/L), at endpoint. Adherence to supplements and procedures as well as adverse event rates were documented. RESULTS Thirty-four (19 intervention, 15 control) subjects were randomized, with 28 (41%) virtual visits. After 44.78 ± 11.00 days from baseline, a significant adjusted group difference of 44.2 (34.7, 53.8) nmol/L was observed in the Δ 25(OH)D (95% CI) in favor of supplementation; 77.8% of intervention, and 13.3% of control, patients were vitamin D sufficient (OR:6.11, 95% CI:1.6, 22.9). The adherence to intervention was 94.7% in the intervention and 100% in the control groups. Irrespective of visit type, high adherence was observed in sampling procedures and completion of fortnightly online questionnaire. No adverse events attributable to vitamin D were reported. CONCLUSION The vitamin D supplementation rapidly and safely raised 25(OH)D levels to sufficient levels for a biological effect. Similarly high adherence to study procedures was observed with virtual and in-person participation. TRIAL REGISTRATION This trial was registered at https://clinicaltrials.gov on July 23, 2020 (# NCT04483635 ).
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Affiliation(s)
- Banafshe Hosseini
- grid.411418.90000 0001 2173 6322Clinical Research and Knowledge Transfer Unit On Childhood Asthma, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Cécile L. Tremblay
- grid.14848.310000 0001 2292 3357Department of Microbiology, Infectious Disease and Immunology, Centre Hospitalier Universitaire de Montréal, University of Montreal, Quebec, Canada
| | - Cristina Longo
- grid.411418.90000 0001 2173 6322Clinical Research and Knowledge Transfer Unit On Childhood Asthma, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357Department of Pharmacy, University of Montreal, Montreal, QC Canada
| | - Shirin Glochi
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC Canada
| | - John H. White
- grid.14709.3b0000 0004 1936 8649Departments of Physiology and Medicine, McGill University, Montreal, QC Canada
| | - Caroline Quach
- grid.411418.90000 0001 2173 6322Department of Microbiology, Infectious Diseases and Immunology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Louis-Georges Ste-Marie
- grid.410559.c0000 0001 0743 2111Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montreal, QC Canada
| | - Robert W. Platt
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC Canada
| | - Francine M. Ducharme
- grid.411418.90000 0001 2173 6322Clinical Research and Knowledge Transfer Unit On Childhood Asthma, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357Departments of Pediatrics and of Social and Preventive Medicine, University of Montréal, Quebec, Canada
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Dallinger VC, Krishnamoorthy G, du Plessis C, Pillai-Sasidharan A, Ayres A, Waters L, Groom Y, Alston O, Anderson L, Burton L. Utilisation of Digital Applications for Personal Recovery Amongst Youth with Mental Health Concerns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16818. [PMID: 36554700 PMCID: PMC9779003 DOI: 10.3390/ijerph192416818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
There is an increasing population of youths that report mental health issues. Research has shown that youths are reluctant to seek help for various reasons. A majority of those who do seek help are using digital mental health supports. Subsequently, efforts to promote youth mental health have focused on the use of digital applications as a means of overcoming barriers related to factors including stigma and lack of available services. The worldwide move toward recovery-oriented care led to emerging research on personal recovery amongst youths with mental health concerns. This study sought to address the need for recovery-oriented digital resources for youths. It utilised a qualitative design methodology to develop a rich interpretation of how youths are using digital interventions to support their mental health recovery journey. It sought to understand how existing digital applications are useful for youth recovery and identified characteristics associated with recovery and engagement. The content analysis generated five categories that represent facilitators of youth recovery and the thematic analysis identified key elements of digital applications that support youth recovery. The results offer complimentary support and guidance for recovery-oriented care and the use of digital mental health interventions in the promotion of personal recovery amongst youths.
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Affiliation(s)
- Vicki C. Dallinger
- School of Psychology and Wellbeing, University of Southern Queensland (UniSQ), Darling Heights, QLD 4350, Australia
| | - Govind Krishnamoorthy
- School of Psychology and Wellbeing, University of Southern Queensland (UniSQ), Darling Heights, QLD 4350, Australia
| | - Carol du Plessis
- School of Psychology and Wellbeing, University of Southern Queensland (UniSQ), Darling Heights, QLD 4350, Australia
| | - Arun Pillai-Sasidharan
- Child and Youth Mental Health, Children’s Health Queensland, Queensland Health, Queensland Government, Brisbane, QLD 4000, Australia
| | - Alice Ayres
- Child and Youth Mental Health, Children’s Health Queensland, Queensland Health, Queensland Government, Brisbane, QLD 4000, Australia
| | - Lillian Waters
- Child and Youth Mental Health, Children’s Health Queensland, Queensland Health, Queensland Government, Brisbane, QLD 4000, Australia
| | - Yasmin Groom
- Child and Youth Mental Health, Children’s Health Queensland, Queensland Health, Queensland Government, Brisbane, QLD 4000, Australia
| | - Olivia Alston
- School of Psychology and Wellbeing, University of Southern Queensland (UniSQ), Darling Heights, QLD 4350, Australia
| | - Linda Anderson
- School of Psychology and Wellbeing, University of Southern Queensland (UniSQ), Darling Heights, QLD 4350, Australia
| | - Lorelle Burton
- School of Psychology and Wellbeing, University of Southern Queensland (UniSQ), Darling Heights, QLD 4350, Australia
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Deng S, Zhang C, Guo X, Lv H, Fan Y, Wang Z, Luo D, Duan X, Sun X, Wang F. Gaps in the Utilization of Community Health Services for the Elderly Population in Rural Areas of Mainland China: A Systematic Review Based on Cross-Sectional Investigations. Health Serv Insights 2022; 15:11786329221134352. [PMID: 36330309 PMCID: PMC9623352 DOI: 10.1177/11786329221134352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear. Methods Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model. Results Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted. Conclusions In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas.
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Affiliation(s)
- Shanshan Deng
- School of Nursing, Bengbu Medical
College, Bengbu, China
| | - Chenchen Zhang
- School of Nursing, Bengbu Medical
College, Bengbu, China
| | - Xing Guo
- School of Nursing, Bengbu Medical
College, Bengbu, China
| | - Hekai Lv
- School of Health Management, Bengbu
Medical College, Bengbu, China
| | - Yanyan Fan
- School of Nursing, Bengbu Medical
College, Bengbu, China
| | - Zhuoxin Wang
- School of Nursing, Bengbu Medical
College, Bengbu, China
| | - Dan Luo
- School of Public Foundation, Bengbu
Medical College, Bengbu, China
| | - Xiaoxia Duan
- School of Nursing, Bengbu Medical
College, Bengbu, China
| | - Xinying Sun
- Department of Social Medicine and
Health Education, School of Public Health, Peking University, Beijing, China
| | - Fuzhi Wang
- Department of Social Medicine and
Health Education, School of Public Health, Peking University, Beijing, China,School of Health Management, Innovation
Team of Health Information Management and Application Research (BYKC201913), Bengbu
Medical College, Bengbu, China,Fuzhi Wang, School of Health Management,
Innovation Team of Health Information Management and Application Research
(BYKC201913), Bengbu Medical College, Bengbu 233000, China; Department of Social
Medicine and Health Education, School of Public Health, Peking University,
Beijing, China.
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18
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Amarti K, Schulte MHJ, Kleiboer A, Van Genugten CR, Oudega M, Sonnenberg C, Gonçalves GC, Rocha A, Riper H. Feasibility of Digital Cognitive Behavioral Therapy for Depressed Older Adults With the Moodbuster Platform: Protocol for 2 Pilot Feasibility Studies. JMIR Res Protoc 2022; 11:e41445. [PMID: 36282565 PMCID: PMC9644251 DOI: 10.2196/41445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce, and little is known about their feasibility and effectiveness. Objective To present the design of 2 studies aiming to assess the feasibility of internet-based cognitive behavioral treatment for older adults with depression. We will assess the feasibility of an online, guided version of the Moodbuster platform among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in a specialized mental health care outpatient clinic. Methods A single-group, pretest-posttest design will be applied in both settings. The primary outcome of the studies will be feasibility in terms of (1) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8), (2) usability (measured with the System Usability Scale), and (3) engagement (measured with the Twente Engagement with eHealth Technologies Scale). Secondary outcomes include (1) the severity of depressive symptoms (measured with the 8-item Patient Health Questionnaire depression scale), (2) participant and therapist experience with the digital technology (measured with qualitative interviews), (3) the working alliance between patients and practitioners (from both perspectives; measured with the Working Alliance Inventory–Short Revised questionnaire), (4) the technical alliance between patients and the platform (measured with the Working Alliance Inventory for Online Interventions–Short Form questionnaire), and (5) uptake, in terms of attempted and completed modules. A total of 30 older adults with mild to moderate depressive symptoms (Geriatric Depression Scale 15 score between 5 and 11) will be recruited from the general population. A total of 15 older adults with moderate to severe depressive symptoms (Geriatric Depression Scale 15 score between 8 and 15) will be recruited from a specialized mental health care outpatient clinic. A mixed methods approach combining quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be further explored with individual semistructured interviews and synthesized descriptively. Descriptive statistics (reported as means and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a 2-tailed, paired-sample t test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis. Results The studies were funded in October 2019. Recruitment started in September 2022. Conclusions The results of these pilot studies will show whether this platform is feasible for use by the older adult population in a blended, guided format in the 2 settings and will represent the first exploration of the size of the effect of Moodbuster in terms of decreased depressive symptoms. International Registered Report Identifier (IRRID) PRR1-10.2196/41445
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Affiliation(s)
- Khadicha Amarti
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mieke H J Schulte
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Annet Kleiboer
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Claire Rosalie Van Genugten
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mardien Oudega
- Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Public Health Research Institute and Neuroscience Amsterdam, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Caroline Sonnenberg
- Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Public Health Research Institute and Neuroscience Amsterdam, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Gonçalo C Gonçalves
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Artur Rocha
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Heleen Riper
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
- Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
- Faculty of Medicine, University of Turku, Turku, Finland
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19
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Dallinger VC, Krishnamoorthy G, Burton LJ, du Plessis C, Pillai-Sasidharan A, Ayres A. Internet-based interventions to support recovery in youth: A systematic review. Digit Health 2022; 8:20552076221129094. [PMID: 36211796 PMCID: PMC9537499 DOI: 10.1177/20552076221129094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
Personal recovery represents a paradigm shift in how individuals are seen to benefit from mental health interventions, from a narrow view of symptom reduction to a holistic, multi-dimensional view of well-being, functional gains and rehabilitation. Although there is a large body of evidence supporting the use of recovery-oriented care in adults, research on personal recovery amongst youth with mental health concerns is an emerging area of research. Efforts to promote youth mental health have also focussed on the use of digital applications and platforms as a means of overcoming barriers related to factors including stigma and lack of available services. This systematic review aims to review the literature on existing internet-based, youth mental health interventions with regard to (a) identifying elements of the programs that align with the personal recovery and (b) outcome measures utilised in assessing personal recovery. Eleven papers were identified that met the inclusion criteria. Five of the programs reviewed from these eleven papers showed efficacy for recovery processes. The results offer preliminary support and guidance for the use of internet-based mental health interventions in the promotion of personal recovery amongst youth. Future research and practice are suggested to further develop understanding in this area.
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Affiliation(s)
- Vicki C Dallinger
- University of Southern Queensland
(USQ), Toowoomba, QLD 4350, Australia,Vicki C Dallinger, Department of Psychology
and Counselling, University of Southern Queensland, West Street Toowoomba QLD
4350, Australia.
| | | | - Lorelle J Burton
- University of Southern Queensland
(USQ), Toowoomba, QLD 4350, Australia
| | - Carol du Plessis
- University of Southern Queensland
(USQ), Ipswich, QLD 4350, Australia
| | - Arun Pillai-Sasidharan
- Jacaranda Place Queensland Adolescent Extended Treatment Centre,
Chermside, QLD 4032, Australia
| | - Alice Ayres
- Jacaranda Place Queensland Adolescent Extended Treatment Centre,
Chermside, QLD 4032, Australia
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20
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Babbage CM, Jackson GM, Davies EB, Nixon E. Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review. JMIR Ment Health 2022; 9:e25716. [PMID: 36018675 PMCID: PMC9463613 DOI: 10.2196/25716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/29/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. OBJECTIVE The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. METHODS A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. RESULTS Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. CONCLUSIONS The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. TRIAL REGISTRATION PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz.
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Affiliation(s)
- Camilla M Babbage
- National Institute for Health and Care Research (NIHR) MindTech Medtech Co-operative, Mental Health & Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Georgina M Jackson
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - E Bethan Davies
- National Institute for Health and Care Research (NIHR) MindTech Medtech Co-operative, Mental Health & Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Elena Nixon
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
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21
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Li SH, Achilles MR, Werner-Seidler A, Beames JR, Subotic-Kerry M, O'Dea B. Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review. JMIR Ment Health 2022; 9:e37640. [PMID: 35976180 PMCID: PMC9434387 DOI: 10.2196/37640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. OBJECTIVE This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. METHODS A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. RESULTS There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. CONCLUSIONS Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. TRIAL REGISTRATION PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram.
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Affiliation(s)
- Sophie H Li
- Black Dog Institute and School of Psychology, The University of New South Wales, Randwick, Australia
| | - Melinda R Achilles
- Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute and School of Psychology, The University of New South Wales, Randwick, Australia
| | - Joanne R Beames
- Black Dog Institute, The University of New South Wales, Randwick, Australia
| | | | - Bridianne O'Dea
- Black Dog Institute, The University of New South Wales, Randwick, Australia
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22
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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23
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A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Adolescence is associated with heightened vulnerability to symptoms of depression and anxiety. In-person and computerised cognitive behavioural therapy (CBT) are effective treatment options, yet uptake and engagement remain low. Smartphone delivery of CBT offers an alternative, highly accessible method of delivering CBT. However, there is no freely available CBT smartphone application (app) specifically designed to reduce depression and anxiety symptoms in adolescents. The aim of this study was to design a new CBT smartphone app (ClearlyMe) that targets depressive and anxiety symptoms in adolescents. We engaged in a rigorous co-design process with adolescents (n=36), parents (n=15), and mental health professionals (n=32). Co-design involved: (1) discovery of users’ needs, views and preferences by conducting focus groups, (2) defining app features through ideation workshops and user consultations, (3) designing therapeutic CBT content and visual features, and (4) testing prototypes. Users were involved at every step and the process was iterative, with findings carried forward to ensure continued refinement of concepts and features. We found a preference for vibrant, cheerful colours and illustrations and non-endorsement of gamification and chatbots, which contrasted with findings from other studies. Preferences were largely consistent between the three user groups. However, adolescents preferred an app that could be used autonomously without professional support, whereas mental health professionals desired a product for use as a therapy adjunct to support CBT skill development. The importance of co-design, and particularly the inclusion of all stakeholders throughout the entire co-design process, is discussed in relation to the design of ClearlyMe.
Key learning aims
(1)
To understand the co-design process that underpins the development of a new CBT smartphone app for youth with elevated symptoms of depression and anxiety.
(2)
To understand adolescent, parent and mental health professionals’ key preferences regarding the features and functionality of a CBT smartphone app for adolescents with elevated symptoms of depression and anxiety.
(3)
To understand how ClearlyMe has been designed as both a therapy adjunct and stand-alone program, and how it can be incorporated into day-to-day clinical practice.
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24
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Musiat P, Johnson C, Atkinson M, Wilksch S, Wade T. Impact of guidance on intervention adherence in computerised interventions for mental health problems: a meta-analysis. Psychol Med 2022; 52:229-240. [PMID: 34802474 DOI: 10.1017/s0033291721004621] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [g = 0.29, 95% confidence interval (CI) 0.18-0.40] and the proportion of intervention completers [log odds ratio (OR) = 0.50, 95% CI 0.34-0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.
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Affiliation(s)
- Peter Musiat
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine Johnson
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | | | - Simon Wilksch
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Tracey Wade
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
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25
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Gan DZQ, McGillivray L, Larsen ME, Christensen H, Torok M. Technology-supported strategies for promoting user engagement with digital mental health interventions: A systematic review. Digit Health 2022; 8:20552076221098268. [PMID: 35677785 PMCID: PMC9168921 DOI: 10.1177/20552076221098268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Although digital mental health interventions (DMHIs) offer a potential solution for increasing access to mental health treatment, their integration into real-world settings has been slow. A key reason for this is poor user engagement. A growing number of studies evaluating strategies for promoting engagement with DMHIs means that a review of the literature is now warranted. This systematic review is the first to synthesise evidence on technology-supported strategies for promoting engagement with DMHIs. Methods MEDLINE, EmbASE, PsycINFO and PubMed databases were searched from 1 January 1995 to 1 October 2021. Experimental or quasi-experimental studies examining the effect of technology-supported engagement strategies deployed alongside DMHIs were included, as were secondary analyses of such studies. Title and abstract screening, full-text coding and quality assessment were performed independently by two authors. Narrative synthesis was used to summarise findings from the included studies. Results 24 studies (10,266 participants) were included. Engagement strategies ranged from reminders, coaching, personalised information and peer support. Most strategies were disseminated once a week, usually via email or telephone. There was some empirical support for the efficacy of technology-based strategies towards promoting engagement. However, findings were mixed regardless of strategy type or study aim. Conclusions Technology-supported strategies appear to increase engagement with DMHIs; however, their efficacy varies widely by strategy type. Future research should involve end-users in the development and evaluation of these strategies to develop a more cohesive set of strategies that are acceptable and effective for target audiences, and explore the mechanism(s) through which such strategies promote engagement.
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Affiliation(s)
- Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Australia
| | | | - Mark E Larsen
- Black Dog Institute, University of New South Wales, Australia
| | | | - Michelle Torok
- Black Dog Institute, University of New South Wales, Australia
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26
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Philippi P, Baumeister H, Apolinário-Hagen J, Ebert DD, Hennemann S, Kott L, Lin J, Messner EM, Terhorst Y. Acceptance towards digital health interventions - Model validation and further development of the Unified Theory of Acceptance and Use of Technology. Internet Interv 2021; 26:100459. [PMID: 34603973 PMCID: PMC8463857 DOI: 10.1016/j.invent.2021.100459] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/23/2022] Open
Abstract
Internet- and mobile-based interventions (IMI) offer an effective way to complement health care. Acceptance of IMI, a key facilitator of their implementation in routine care, is often low. Based on the Unified Theory of Acceptance and Use of Technology (UTAUT), this study validates and adapts the UTAUT to digital health care. Following a systematic literature search, 10 UTAUT-grounded original studies (N = 1588) assessing patients' and health professionals' acceptance of IMI for different somatic and mental health conditions were included. All included studies assessed Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions and acceptance as well as age, gender, internet experience, and internet anxiety via self-report questionnaires. For the model validation primary data was obtained and analyzed using structural equation modeling. The best fitting model (RMSEA = 0.035, SRMR = 0.029) replicated the basic structure of UTAUT's core predictors of acceptance. Performance Expectancy was the strongest predictor (γ = 0.68, p < .001). Internet anxiety was identified as an additional determinant of acceptance (γ = -0.07, p < .05) and moderated the effects of Social Influence (γ = 0.07, p < .05) and Effort Expectancy (γ = -0.05, p < .05). Age, gender and experience had no moderating effects. Acceptance is a fundamental prerequisite for harnessing the full potential of IMI. The adapted UTAUT provides a powerful model identifying important factors - primarily Performance Expectancy - to increase the acceptance across patient populations and health professionals.
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Affiliation(s)
- Paula Philippi
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Jennifer Apolinário-Hagen
- Institute for Occupational, Social and Environmental Medicine, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
| | - David Daniel Ebert
- Department of Sport and Health Science, Technical University Munich, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes-Gutenberg-University Mainz, Germany
| | - Leonie Kott
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Jiaxi Lin
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
- Department of Research Methods, Institute of Psychology and Education, Ulm University, Germany
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Nordgreen T, Nordby ES, Myklebost SB, Flobak E, Kahlon S. In Case of an Emergency: The Development and Effects of a Digital Intervention for Coping With Distress in Norway During the COVID-19 Pandemic. Front Psychol 2021; 12:705383. [PMID: 34880803 PMCID: PMC8645549 DOI: 10.3389/fpsyg.2021.705383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 pandemic and its consequences has been found to negatively affect the general population's psychological well-being. Objective: The objectives of this paper are to report on the development and clinical effects of a self-guided Internet-delivered intervention for adults in Norway who suffer from mild to moderate psychological distress during the COVID-19 pandemic. Methods: The participants, recruited between April and December 2020, were randomized to receive a new treatment module either every third or every fifth day. The clinical outcomes were self-reported depressive and anxiety symptoms and change in positive and negative emotions. Results: A total of 1256 individuals accessed the pre-screening survey, 407 were eligible and 92 provided contact information, where 82 were included in the study, n = 44 in the 3-day group and n = 38 in the 5-day group. Overall, the statistical analyses showed a significant decrease in depressive and anxiety symptoms and an increase in positive emotions, with small and moderate within group effect sizes. No significant differences between the groups were identified in clinical outcomes or adherence. Conclusion: These findings indicate that psychological distress in the general population during the COVID-19 pandemic may be reduced through the use of a scalable self-guided Internet-delivered intervention. Furthermore, the lack of significant differences between the 5-day and 3-day group may indicate that the intervention can be delivered at a more intensive pace without negatively affecting treatment outcomes. The results need to be interpreted with caution as the sample was self-selected, as well as the lack of passive control group. Hence the results may be attributed to external factors.
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Affiliation(s)
- Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Emilie Sektnan Nordby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Sunniva Burok Myklebost
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eivind Flobak
- Department of Information Science and Media Studies, Faculty of Social Sciences, University of Bergen, Bergen, Norway
| | - Smiti Kahlon
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Micaux C, Wiklander M, Eriksson LE, Wettergren L, Lampic C. Efficacy of Fex-Can Fertility, a web-based psychoeducational intervention for young adults with fertility-related distress following cancer: a randomized controlled trial. (Preprint). JMIR Cancer 2021; 8:e33239. [PMID: 35348459 PMCID: PMC9006131 DOI: 10.2196/33239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/18/2021] [Accepted: 02/07/2022] [Indexed: 01/02/2023] Open
Affiliation(s)
- Claire Micaux
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Lena Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
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Hämäläinen T, Kaipainen K, Lappalainen P, Puolakanaho A, Keinonen K, Lappalainen R, Kiuru N. Usage activity, perceived usefulness, and satisfaction in a web-based acceptance and commitment therapy program among Finnish ninth-grade adolescents. Internet Interv 2021; 25:100421. [PMID: 34401380 PMCID: PMC8350586 DOI: 10.1016/j.invent.2021.100421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/07/2023] Open
Abstract
Understanding adolescent usage activity and experiences in web-based psychological intervention programs helps in developing universal programs that can be adopted for promotion of adolescent well-being and prevention of mental health problems. This study examined the usage activity, perceived usefulness (i.e., learning of mindfulness, acceptance and value-related skills), and program satisfaction of 157 Finnish ninth-grade adolescents, who participated in a school-based five-week universal acceptance and commitment therapy web intervention called Youth Compass. Individual and growth environment-related antecedents were measured before the five-week intervention, adolescents' usage activity during the intervention, and perceived usefulness and satisfaction after the intervention. The results showed that female adolescents and adolescents with high self-regulation were more active program users and had more positive experiences of the program. Most of the adolescents used the program on at least a moderate level and perceived it to be moderately or highly useful and satisfactory. Four subgroups of adolescents were identified based on their usage activity, perceived usefulness, and satisfaction: adolescents in the satisfied group (41%) had average activity and high perceived usefulness and intervention satisfaction, the dissatisfied group (18%) had low activity and very low perceived usefulness and intervention satisfaction, the active group (8%) had very high activity and average perceived usefulness and intervention satisfaction, and the moderate group (33%) had average activity, perceived usefulness and intervention satisfaction. Gender, academic achievement, closeness to mother and teacher, and conflict with teacher were significantly related to subgroup membership. The results suggested that adolescent usage activity, perceived usefulness, and satisfaction with the Youth Compass program may to some extent be predicted based on different factors.
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Affiliation(s)
- Tetta Hämäläinen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland,Corresponding author at: Department of Psychology, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Kirsikka Kaipainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland,Faculty of Information Technology and Communication Sciences, Tampere University, Finland
| | - Päivi Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Anne Puolakanaho
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Katariina Keinonen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Raimo Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Noona Kiuru
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
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Facilitating improvements in young people's social relationships to prevent or treat depression: A review of empirically supported interventions. Transl Psychiatry 2021; 11:305. [PMID: 34021113 PMCID: PMC8139977 DOI: 10.1038/s41398-021-01406-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/04/2023] Open
Abstract
Interpersonal difficulties are often implicated in the onset of depressive disorders, and typically exacerbate depressive symptoms. This is particularly true for young people, given rapid changes in, and the increased importance of, their social relationships. The purpose of this narrative review was to identify empirically supported interventions that aim to prevent or treat depression in young people by facilitating improvements in their social environment. We conducted a search of controlled trials, systematic reviews and meta-analyses of such interventions, published between 1980 and June 2020. Our literature search and interpretation of results was informed by consultations with clinical experts and youth consumers and advocates. A number of promising approaches were identified with respect to prevention and treatment. Preliminary evidence was identified suggesting that school- and Internet-based approaches present a viable means to prevent the worsening of depressive symptoms in young people. Notably, delivering interpersonal psychotherapy-adolescent skills training (IPT-AST) in schools appears to be a promising early intervention strategy for young people at risk of full-threshold depressive disorder. In terms of treating depressive disorders in young people, there is strong evidence for the efficacy of interpersonal psychotherapy for adolescents (IPT-A), and preliminary evidence in favour of attachment-based family therapy (ABFT). Results are discussed with respect to recommendations for future research and practice.
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31
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Lehtimaki S, Martic J, Wahl B, Foster KT, Schwalbe N. Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview. JMIR Ment Health 2021; 8:e25847. [PMID: 33913817 PMCID: PMC8120421 DOI: 10.2196/25847] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. OBJECTIVE This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). METHODS We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. RESULTS In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. CONCLUSIONS Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.
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Affiliation(s)
| | - Jana Martic
- Spark Street Advisors, New York, NY, United States
| | - Brian Wahl
- Spark Street Advisors, New York, NY, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine T Foster
- Department of Psychology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nina Schwalbe
- Spark Street Advisors, New York, NY, United States
- Heilbrunn Department of Population and Family Health, Columbia Mailman School of Public Health, New York, NY, United States
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
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32
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Harrer M, Apolinário-Hagen J, Fritsche L, Salewski C, Zarski AC, Lehr D, Baumeister H, Cuijpers P, Ebert DD. Effect of an internet- and app-based stress intervention compared to online psychoeducation in university students with depressive symptoms: Results of a randomized controlled trial. Internet Interv 2021; 24:100374. [PMID: 33718001 PMCID: PMC7932886 DOI: 10.1016/j.invent.2021.100374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Depression is highly prevalent among university students. Internet-based interventions have been found to be effective in addressing depressive symptoms, but it is open if this also applies to interventions directed at academic stress. It is also largely unclear if the techniques employed in such programs provide significant additional benefits when controlling for non-specific intervention effects. A sample of N = 200 students with elevated levels of depression (CES-D ≥ 16) of a large distance-learning university were randomly assigned to either an Internet- and App-based stress intervention group (IG; n = 100) or an active control group (CG; n = 100) receiving an Internet-based psychoeducational program of equal length. Self-report data was assessed at baseline, post-treatment (7 weeks) and three-month follow-up. The primary outcome was depression (CES-D) post-treatment. Secondary outcomes included mental health outcomes, modifiable risk factors, and academic outcomes. We found significant between-group effects on depressive symptom severity (d = 0.36; 95% CI: 0.08-0.64), as well as behavioral activation (d = 0.61; 95% CI: 0.30-0.91), perceived stress (d = 0.45; 95% CI: 0.18-0.73), anxiety (d = 0.35; 95% CI: 0.03-0.67) and other secondary outcomes post-treatment. Effects on depression were sustained at three-month follow-up. Response rates for depressive symptoms were significantly higher in the IG (26%) than the CG (14%) at post-test (χ 2=4.5, p = 0.04), but not at three-month follow-up (p = 0.454). We also found significant effects on relevant academic outcomes, including work impairment (follow-up; d = 0.36), work output (post-treatment; d = 0.27) and work cutback (follow-up; d = 0.36). The intervention was more effective for depressive symptoms compared to the CG, and so controlling for unspecific intervention effects. This suggests that specific techniques of the intervention may provide significant additional benefits on depressive symptoms. Trial registration: German Clinical Trial Registration (DRKS): DRKS00011800 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011800).
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Affiliation(s)
- Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lara Fritsche
- Department of Health Psychology, Institute for Psychology, University of Hagen, Hagen, Germany
| | - Christel Salewski
- Department of Health Psychology, Institute for Psychology, University of Hagen, Hagen, Germany
| | - Anna-Carlotta Zarski
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Dirk Lehr
- Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David Daniel Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Phillips EA, Himmler SF, Schreyögg J. Preferences for e-Mental Health Interventions in Germany: A Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:421-430. [PMID: 33641777 DOI: 10.1016/j.jval.2020.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Recent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment. METHODS Using a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents' demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level. RESULTS A total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site. DISCUSSION Our results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.
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Affiliation(s)
- Elena A Phillips
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.
| | - Sebastian F Himmler
- Erasmus School of Health Policy & Management Health Economics, Rotterdam, The Netherlands
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
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34
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Suresh R, Alam A, Karkossa Z. Using Peer Support to Strengthen Mental Health During the COVID-19 Pandemic: A Review. Front Psychiatry 2021; 12:714181. [PMID: 34322045 PMCID: PMC8310946 DOI: 10.3389/fpsyt.2021.714181] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The coronavirus (COVID-19) pandemic has had a significant impact on society's overall mental health. Measures such as mandated lockdowns and physical distancing have contributed to higher levels of anxiety, depression, and other metrics indicating worsening mental health. Peer support, which is peer-to-peer provided social and emotional support, is an underutilized and effective mental health resource that can potentially be used to ameliorate mental health during these times. Objective: This review aims to summarize the toll that this pandemic has had on society's mental health as found in peer-reviewed literature from October 2019 to March 2021, as well as suggest the utility of peer support to address these needs. Methods: References for this review were chosen through searches of PubMed, Web of Science, and Google Scholar for articles published between October 2019 and March 2021 that used the terms: "coronavirus," "COVID-19," "mental health," "anxiety," "depression," "isolation," "mental health resources," "peer support," "online mental health resources," and "healthcare workers." Articles resulting from these searches and relevant references cited in those articles were reviewed. Articles published in English, French and Italian were included. Results: This pandemic has ubiquitously worsened the mental health of populations across the world. Peer support has been demonstrated to yield generally positive effects on the mental health of a wide variety of recipients, and it can be provided through numerous accessible mediums. Conclusions: Peer support can overall be beneficial for improving mental health during the COVID-19 pandemic and may be an effective tool should similar events arise in the future, although the presence of a few conflicting studies suggests the need for additional research.
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Affiliation(s)
- Rahul Suresh
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, QC, Canada.,Peer Support Centre, McGill University, Montreal, QC, Canada
| | - Armaghan Alam
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zoe Karkossa
- Peer Support Centre, McGill University, Montreal, QC, Canada
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Reis S, Matthews EL, Grenyer BFS. Characteristics of effective online interventions: implications for adolescents with personality disorder during a global pandemic. ACTA ACUST UNITED AC 2020; 23:488. [PMID: 33585296 PMCID: PMC7875074 DOI: 10.4081/ripppo.2020.488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
In recent years, the necessity of providing online interventions for adolescents, as an alternative to face-to-face interventions, has become apparent due to several barriers some adolescents face in accessing treatment. This need has become more critical with the coronavirus disease 2019 (COVID-19) global pandemic impacting the delivery of psychotherapy and limiting accessibility of face-to-face therapy. Whilst it has been established that face-to-face psychotherapy for adolescents with personality disorder can be effective in reducing the impact these complex mental illnesses have on functioning, online interventions for adolescents are rare, and to our knowledge there are no empirically validated online interventions for personality disorder. The development of novel online interventions are therefore necessary. To inform the development of online interventions for adolescents with personality disorder or symptoms of emerging personality disorder, a two-phase rapid review was conducted. Phase one consisted of a search and examination of existing online mental health programs for adolescents with symptoms of personality disorder, to understand how to best use online platforms. Phase two consisted of a rapid review of empirical literature examining online interventions for adolescents experiencing symptoms of personality disorder to identify characteristics that promote efficacy. There were no online programs specific to personality disorder in adolescence. However, 32 online mental health programs and 41 published empirical studies were included for analysis. Common intervention characteristics included timeframes of one to two months, regular confidential therapist contact, simple interactive online components and modules, and the inclusion of homework or workbook activities to practice new skills. There is an urgent need for online interventions targeting personality dysfunction in adolescence. Several characteristics of effective online interventions for adolescents were identified. These characteristics can help inform the development and implementation of novel online treatments to prevent and reduce the burden and impact of personality disorder, or symptoms of emerging personality disorder, in adolescents. This has implications for the COVID-19 pandemic when access to effective online interventions has become more urgent.
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Affiliation(s)
| | | | - Brin F S Grenyer
- School of Psychology.,Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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36
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Hall CL, Sanderson C, Brown BJ, Andrén P, Bennett S, Chamberlain LR, Davies EB, Khan K, Kouzoupi N, Mataix-Cols D, McKenzie C, Murphy T, Townsend M, Hollis C, Murray E. Opportunities and challenges of delivering digital clinical trials: lessons learned from a randomised controlled trial of an online behavioural intervention for children and young people. Trials 2020; 21:1011. [PMID: 33298127 PMCID: PMC7724811 DOI: 10.1186/s13063-020-04902-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite being the gold standard of research to determine effectiveness, randomised controlled trials (RCTs) often struggle with participant recruitment, engagement and retention. These issues may be exacerbated when recruiting vulnerable populations, such as participants with mental health issues. We aimed to update understanding of the scope of these problems in trials of health technology and identify possible solutions through reflecting on experiences from an exemplar trial (Online Remote Behavioural Intervention for Tics; ORBIT). METHOD We extracted anonymised data on recruitment, retention and requests for more funding and time from trials funded by the largest funder of health technology trials in the UK (the National Institute of Health Research Health Technology Assessment) between 2010 and 2020, and compared these with data from a recent, successful trial (ORBIT). ORBIT aimed to assess the clinical- and cost-effectiveness of blended online and human behavioural therapy for tics in young people. Many of the trial procedures, including recruitment, the intervention and data collection, were undertaken online. RESULTS Data were extracted on 51 trials conducted between 2010 and 2020. Sixty per cent of trials failed to reach their original recruitment target and only 44% achieved their follow-up in the specified time frame. In contrast, ORBIT recruited to target and achieved 90% follow-up. We posit that these achievements are related to (a) judicious use of digital technology for trial procedures and (b) adequate numbers of highly trained and motivated trial staff. We provide details of both these to help other research teams plan and cost for successful trials. CONCLUSION An approach combining human and online methods may be advantageous in facilitating trial delivery, particularly in paediatric mental health services. Given the importance of successful clinical trials in advancing healthcare delivery and the waste of human and economic resources associated with unsuccessfully delivered trials, it is imperative that trials are appropriately costed and future research focusses on improving trial design and delivery. TRIAL REGISTRATION The ORBIT trial is registered with ISRTCN ( ISRCTN70758207 ) Registered on March 20, 2018. and ClinicalTrials.gov ( NCT03483493 ). Registered on March 30, 2018.
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Affiliation(s)
- Charlotte L. Hall
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Charlotte Sanderson
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Beverly J. Brown
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sophie Bennett
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Liam R. Chamberlain
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - E. Bethan Davies
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Kareem Khan
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Natalie Kouzoupi
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Caitlin McKenzie
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Tara Murphy
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Mark Townsend
- National Institute for Health Research, University of Southampton, Alpha House, Enterprise Road, Southampton, UK
| | - Chris Hollis
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
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Mukhiya SK, Wake JD, Inal Y, Pun KI, Lamo Y. Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review. J Med Internet Res 2020; 22:e21066. [PMID: 33245285 PMCID: PMC7732710 DOI: 10.2196/21066] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Internet-delivered psychological treatments (IDPTs) are built on evidence-based psychological treatment models, such as cognitive behavioral therapy, and are adjusted for internet use. The use of internet technologies has the potential to increase access to evidence-based mental health services for a larger proportion of the population with the use of fewer resources. However, despite extensive evidence that internet interventions can be effective in the treatment of mental health disorders, user adherence to such internet intervention is suboptimal. OBJECTIVE This review aimed to (1) inspect and identify the adaptive elements of IDPT for mental health disorders, (2) examine how system adaptation influences the efficacy of IDPT on mental health treatments, (3) identify the information architecture, adaptive dimensions, and strategies for implementing these interventions for mental illness, and (4) use the findings to create a conceptual framework that provides better user adherence and adaptiveness in IDPT for mental health issues. METHODS The review followed the guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research databases Medline (PubMed), ACM Digital Library, PsycINFO, CINAHL, and Cochrane were searched for studies dating from January 2000 to January 2020. Based on predetermined selection criteria, data from eligible studies were analyzed. RESULTS A total of 3341 studies were initially identified based on the inclusion criteria. Following a review of the title, abstract, and full text, 31 studies that fulfilled the inclusion criteria were selected, most of which described attempts to tailor interventions for mental health disorders. The most common adaptive elements were feedback messages to patients from therapists and intervention content. However, how these elements contribute to the efficacy of IDPT in mental health were not reported. The most common information architecture used by studies was tunnel-based, although a number of studies did not report the choice of information architecture used. Rule-based strategies were the most common adaptive strategies used by these studies. All of the studies were broadly grouped into two adaptive dimensions based on user preferences or using performance measures, such as psychometric tests. CONCLUSIONS Several studies suggest that adaptive IDPT has the potential to enhance intervention outcomes and increase user adherence. There is a lack of studies reporting design elements, adaptive elements, and adaptive strategies in IDPT systems. Hence, focused research on adaptive IDPT systems and clinical trials to assess their effectiveness are needed.
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Affiliation(s)
| | | | | | - Ka I Pun
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Yngve Lamo
- Western Norway University of Applied Sciences, Bergen, Norway
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Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A, Linney C, McManus MN, Borwick C, Crawley E. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry 2020; 59:1218-1239.e3. [PMID: 32504808 PMCID: PMC7267797 DOI: 10.1016/j.jaac.2020.05.009] [Citation(s) in RCA: 1206] [Impact Index Per Article: 301.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents. METHOD For this rapid review, we searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29, 2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance. RESULTS A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n = 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias, although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time at which loneliness was measured and between 0.25 and 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness. CONCLUSION Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.
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Affiliation(s)
| | | | | | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Bergin AD, Vallejos EP, Davies EB, Daley D, Ford T, Harold G, Hetrick S, Kidner M, Long Y, Merry S, Morriss R, Sayal K, Sonuga-Barke E, Robinson J, Torous J, Hollis C. Preventive digital mental health interventions for children and young people: a review of the design and reporting of research. NPJ Digit Med 2020; 3:133. [PMID: 33083568 PMCID: PMC7562906 DOI: 10.1038/s41746-020-00339-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023] Open
Abstract
Digital health interventions (DHIs) have frequently been highlighted as one way to respond to increasing levels of mental health problems in children and young people. Whilst many are developed to address existing mental health problems, there is also potential for DHIs to address prevention and early intervention. However, there are currently limitations in the design and reporting of the development, evaluation and implementation of preventive DHIs that can limit their adoption into real-world practice. This scoping review aimed to examine existing evidence-based DHI interventions and review how well the research literature described factors that researchers need to include in their study designs and reports to support real-world implementation. A search was conducted for relevant publications published from 2013 onwards. Twenty-one different interventions were identified from 30 publications, which took a universal (n = 12), selective (n = 3) and indicative (n = 15) approach to preventing poor mental health. Most interventions targeted adolescents, with only two studies including children aged ≤10 years. There was limited reporting of user co-design involvement in intervention development. Barriers and facilitators to implementation varied across the delivery settings, and only a minority reported financial costs involved in delivering the intervention. This review found that while there are continued attempts to design and evaluate DHIs for children and young people, there are several points of concern. More research is needed with younger children and those from poorer and underserved backgrounds. Co-design processes with children and young people should be recognised and reported as a necessary component within DHI research as they are an important factor in the design and development of interventions, and underpin successful adoption and implementation. Reporting the type and level of human support provided as part of the intervention is also important in enabling the sustained use and implementation of DHIs.
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Affiliation(s)
- Aislinn D. Bergin
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health and Technology Theme, University of Nottingham, Nottingham, UK
| | - Elvira Perez Vallejos
- NIHR Nottingham Biomedical Research Centre, Mental Health and Technology Theme, University of Nottingham, Nottingham, UK
| | - E. Bethan Davies
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health and Technology Theme, University of Nottingham, Nottingham, UK
| | - David Daley
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gordon Harold
- Faculty of Education, University of Cambridge, Cambridge, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Orygen, University of Melbourne, Parkville, Australia
| | - Megan Kidner
- The Children and Young People’s Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Yunfei Long
- Horizon Digital Economy Research Institute, University of Nottingham, Nottingham, UK
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Sally Merry
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Richard Morriss
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health and Technology Theme, University of Nottingham, Nottingham, UK
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- NIHR Applied Research Centre East Midlands, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Centre East Midlands, Nottingham, UK
| | - Edmund Sonuga-Barke
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | - Jo Robinson
- Orygen, University of Melbourne, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health and Technology Theme, University of Nottingham, Nottingham, UK
- NIHR Applied Research Centre East Midlands, Nottingham, UK
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Müssener U, Thomas K, Bendtsen P, Bendtsen M. High School Students' Preferences and Design Recommendations for a Mobile Phone-Based Intervention to Improve Psychological Well-Being: Mixed Methods Study. JMIR Pediatr Parent 2020; 3:e17044. [PMID: 32673268 PMCID: PMC7381011 DOI: 10.2196/17044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Young adults' mental health is characterized by relatively high rates of stress and anxiety and low levels of help-seeking behavior. Mobile health (mHealth) interventions could offer a cost-effective and readily available avenue to provide personalized support to young adults. More research needs to be directed at the development of mHealth interventions targeting youths specifically, as well as at determining how to reach young people and how to effectively intervene to improve psychological well-being. OBJECTIVE The objective was to gather perceptions from high school students to inform the development of a prototype mHealth intervention aiming to promote psychological well-being. METHODS A mixed methods design was used to (1) investigate high school students' perceptions about stress and its consequences in daily life, as well as their ability to cope with stress, and (2) explore their preferences and design recommendations for an mHealth intervention to improve psychological well-being. Students from two high schools in the southeast of Sweden were invited to take part in the study. Recruitment of high school students was completed over a 6-week period, between October 25 and December 7, 2018. Recruitment entailed inviting students to complete a stress test (ie, screening and feedback) on their mobile phones. After completing the stress test, all participants were invited to complete a follow-up questionnaire and take part in telephone interviews. RESULTS A total of 149 high school students completed the stress test, of which 68 completed the questionnaire. There were 67 free-text comments distributed across the items. The majority of participants (55/68, 81%) stated that they coped with stress better or in the same way after engaging in the stress test, due to time management, dialogue with others, and self-refection. A total of 4 out of 68 participants (6%)-3 female students (75%) and 1 male student (25%)-took part in telephone interviews. Three main themes were identified from the interview data: perceptions about stress, design features, and intervention features. CONCLUSIONS Stress was described by the students as a condition caused by high demands set by oneself and the social environment that impacted their physical health, personal relationships, school performance, and emotional well-being. Participants claimed that mHealth interventions need to be clearly tailored to a young age group, be evidence based, and offer varied types of support, such as information about stress, exercises to help organize tasks, self-assessment, coping tools, and recommendations of other useful websites, literature, blogs, self-help books, or role models. Mobile phones seemed to be a feasible and acceptable platform for the delivery of an intervention.
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Affiliation(s)
- Ulrika Müssener
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Lo B, Shi J, Hollenberg E, Abi-Jaoudé A, Johnson A, Wiljer D. Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review. JMIR Ment Health 2020; 7:e15942. [PMID: 32348261 PMCID: PMC7381002 DOI: 10.2196/15942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. OBJECTIVE This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). METHODS A scoping review was conducted using the Arksey and O'Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. RESULTS Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. CONCLUSIONS This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Education, Technology and Innovation, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Lin J, Wurst R, Paganini S, Hohberg V, Kinkel S, Göhner W, Ramsenthaler C, Fuchs R. A group- and smartphone-based psychological intervention to increase and maintain physical activity in patients with musculoskeletal conditions: study protocol for a randomized controlled trial ("MoVo-App"). Trials 2020; 21:502. [PMID: 32513291 PMCID: PMC7278049 DOI: 10.1186/s13063-020-04438-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/20/2020] [Indexed: 11/26/2022] Open
Abstract
Abstract Background Interventions designed to increase the level of physical activity are crucial in the treatment of patients with musculoskeletal conditions. The psychological group-based intervention MoVo-LISA based on the Motivation-Volition (MoVo) Process Model has been shown to effectively promote physical activity. The aim of this study is to evaluate whether a MoVo-based app (MoVo-App) subsequent to MoVo-LISA during orthopedic inpatient care can support people to increase and maintain their amount of physical activity. Methods/design In this parallel-group randomized controlled trial, patients with musculoskeletal disorders will be randomized to either (a) a combination of the group-based intervention program MoVo-LISA to promote physical activity plus the MoVo-App or (b) the group-based intervention program alone without the app. The intervention group will receive the MoVo-App after discharge from inpatient rehabilitation. They receive help to increase and maintain their level of physical activity (initiated by the group program) by tracking their health goals, activity plans, major barriers, and barrier management that were developed during the group-based program. We will recruit 224 initially minimally active participants during orthopedic rehabilitation care. Outcomes are assessed at clinic admission; discharge; 6 weeks; and 3 (post-treatment), 6, and 12 months after discharge (follow-up). The primary outcome is sport activity (active/inactive and minutes of activity) at 6-month follow-up. Secondary outcomes are movement activity, cognitive mediators of behavioral change (e.g., self-efficacy, action planning), and health-related variables (e.g., pain intensity, depression). To evaluate intervention effects, linear mixed effects models (both on intention-to-treat basis with an additional per-protocol analysis) will be conducted with each outcome variable and with time as the within-subjects factor and group as the between-subjects factor, along with all two-way interactions and accounting for covariates as fixed effects. Discussion This is the first evaluation of the effectiveness of an app in combination with a face-to-face group intervention to promote physical activity. The approach of using an app in addition to an effective face-to-face intervention program, both based on the MoVo model, might sustain positive intervention effects introduced in routine health care. Trial registration The trial “A group- and smartphone-based psychological intervention to increase physical activity in patients with musculoskeletal conditions: A randomized controlled trial” is registered at the World Health Organization International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS), DRKS00014814. Registered on 18 October 2018; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014814.
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Affiliation(s)
- Jiaxi Lin
- Department of Psychiatry and Psychotherapy Medical Center, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany.
| | - Vivien Hohberg
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany
| | - Stephan Kinkel
- Schwarzwaldkliniken Bad Krozingen, Bad Krozingen, Germany
| | - Wiebke Göhner
- Department of Health Psychology, Catholic University of Applied Sciences, Freiburg, Germany
| | - Christina Ramsenthaler
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany
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Achilles MR, Anderson M, Li SH, Subotic-Kerry M, Parker B, O'Dea B. Adherence to e-mental health among youth: Considerations for intervention development and research design. Digit Health 2020; 6:2055207620926064. [PMID: 32547775 PMCID: PMC7249594 DOI: 10.1177/2055207620926064] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 03/15/2020] [Indexed: 12/20/2022] Open
Abstract
E-mental health programmes have great potential to provide young people with
access to mental health support. However, it is commonly reported that adherence
to these programmes is low. Low adherence can be problematic, particularly if
young people do not receive the full benefits of a programme. In a research
trial setting, non-adherence to treatment recommendations can prevent
researchers from drawing strong conclusions about effectiveness. Although
adherence has been recognised as an issue in need of attention, many of the
reviews available are focused on adults and lack clear direction towards what
strategies to employ. This paper presents a broad review of the adherence
literature, focusing on factors associated with improving adherence to e-mental
health among youth. Our view on the key elements to improve adherence identified
from the existing literature are presented, and key recommendations for e-mental
health intervention design are provided. These include: developing and
communicating adherence guidelines based on individuals’ needs and symptom
severity, including customisable features to provide a tailored experience and
promote a sense of agency, including engagement checks and adopting a
user-centred approach by utilising strategies such as co-design. This paper
provides guidance to intervention designers and researchers by outlining
recommendations and considerations for intervention development and research
design.
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Affiliation(s)
| | | | - Sophie H Li
- Black Dog Institute, Prince of Wales Hospital, Australia.,School of Psychology, University of New South Wales, Australia
| | | | - Belinda Parker
- Black Dog Institute, Prince of Wales Hospital, Australia
| | - Bridianne O'Dea
- Black Dog Institute, Prince of Wales Hospital, Australia.,School of Psychology, University of New South Wales, Australia
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Topooco N, Byléhn S, Dahlström Nysäter E, Holmlund J, Lindegaard J, Johansson S, Åberg L, Bergman Nordgren L, Zetterqvist M, Andersson G. Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13393. [PMID: 31682572 PMCID: PMC6858617 DOI: 10.2196/13393] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (P<.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants’ age and baseline depression severity are of interest in relation to used study methods. Trial Registration ClinicalTrials.gov NCT02363205; https://clinicaltrials.gov/ct2/show/NCT02363205
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Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Center for m2Health, Palo Alto, CA, United States
| | - Sandra Byléhn
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Jenny Holmlund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Johanna Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sanna Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linnea Åberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lise Bergman Nordgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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45
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Petrozzi MJ, Leaver A, Ferreira PH, Rubinstein SM, Jones MK, Mackey MG. Addition of MoodGYM to physical treatments for chronic low back pain: A randomized controlled trial. Chiropr Man Therap 2019; 27:54. [PMID: 31673330 PMCID: PMC6814139 DOI: 10.1186/s12998-019-0277-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background Low back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability. Methods A multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 ± 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone. Results No statistically significant between group differences were observed for either disability at post-treatment (Effect size (standardised mean difference) 95% CI) RMD - 0.06 (- 0.45,0.31), 6-months RMD 0.01 (- 0.38,0.39) and 12-months - 0.20 (- 0.62,0.17) or self-efficacy at post-treatment PSEQ 0.06 (- 0.31,0.45), 6-months 0.02 (- 0.36,0.41) and 12-months 0.21 (- 0.16,0.63). Conclusion There was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months. Trial registration This trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.
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Affiliation(s)
- M. John Petrozzi
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Andrew Leaver
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Paulo H. Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Mairwen K. Jones
- Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Martin G. Mackey
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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46
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Bennett SD, Cuijpers P, Ebert DD, McKenzie Smith M, Coughtrey AE, Heyman I, Manzotti G, Shafran R. Practitioner Review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis. J Child Psychol Psychiatry 2019; 60:828-847. [PMID: 30775782 DOI: 10.1111/jcpp.13010] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Abstract
Mental health problems are common in children and adolescents, yet evidence-based treatments are hard to access. Self-help interventions can increase such access. The aim of this paper was to conduct a systematic review and meta-analysis of the use of guided and unguided self-help for children and young people with symptoms of common mental health disorders. In contrast to previous reviews of self-help in children, all types of self-help and multiple mental health disorders were investigated in order to increase power to investigate potential moderators of efficacy. Importantly, studies with control arms as well as those comparing against traditional face-to-face treatments were included. Fifty studies (n = 3396 participants in self-help/guided self-help conditions) met the inclusion criteria. Results demonstrated a moderate positive effect size for guided and unguided self-help interventions when compared against a control group (n = 44; g = 0.49; 95% CI: 0.37 to 0.61, p < .01) and a small but significant negative effect size when compared to other therapies (n = 15; g = -0.17; 95% CI: -0.27 to -0.07, p < .01). Few potential moderators had a significant effect on outcome. Most comparisons resulted in significant heterogeneity and therefore results are interpreted with caution.
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Affiliation(s)
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Grazia Manzotti
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
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47
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Impact of a Web Program to Support the Mental Wellbeing of High School Students: A Quasi Experimental Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142473. [PMID: 31336738 PMCID: PMC6679030 DOI: 10.3390/ijerph16142473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
Little effort has been made to investigate the potential of web programs aimed to support the mental wellbeing of adolescents in school environments in middle-income countries. A quasi-experimental feasibility study was conducted in Thailand with adolescents (N = 180) in three conveniently sampled high schools and with teachers (N = 12) who acted as program tutors. The web program was used in small groups, independently, or it was not used at all. No statistically significant changes were found between the groups regarding depression, stress, or satisfaction. Differences between program users (n = 61) and non-users (n = 48) were not significant. Acceptance was higher among adolescents who used the program independently (n = 40, 73% vs. n = 21, 39%; p = 0.001). Usability feedback did not differ between the groups. Support should be provided in order for programs to be potentially used. More information is needed regarding factors associated with the use of web programs.
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48
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Rahmadiana M, Karyotaki E, Passchier J, Cuijpers P, van Ballegooijen W, Wimbarti S, Riper H. Guided internet-based transdiagnostic intervention for Indonesian university students with symptoms of anxiety and depression: A pilot study protocol. Internet Interv 2019; 15:28-34. [PMID: 30568878 PMCID: PMC6290259 DOI: 10.1016/j.invent.2018.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is an increasing prevalence of mental health problems among university student populations. In Indonesia, treatment rates are low among university students because of the high cost of treatment, stigma and the limited availability of mental care services. Internet-based interventions have been found to be effective in treating anxiety and depression in Western countries. However, little is known about the effectiveness of Internet-based interventions in low- and middle-income countries (LMICs) such as Indonesia. In this paper, we describe how we culturally adapted an Internet-based intervention to meet the needs of Indonesian students with depression and anxiety based on the theoretical framework of Barrera et al. (2013). METHOD We culturally adapted a Western Internet-based student intervention for depression and anxiety. This intervention consists of 8 guided online sessions. 50 students from Universitas Gadjah Mada Yogyakarta who have mild to moderate depression or anxiety as assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), will participate in a feasibility study in which we will test participants' satisfaction, system usability and uptake. Secondary outcomes include assessment of participants' depression, anxiety and quality of life. Outcomes will be measured pre and post intervention. DISCUSSION The present paper presents the protocol of a pilot study aimed at assessing the feasibility and acceptability of a culturally adapted intervention for Indonesian university students with depression and anxiety. The results from the feasibility study will further guide the development of the intervention and may inform the protocol of a future randomized controlled trial (RCT) examining the effectiveness of the Internet-based intervention.
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Affiliation(s)
- Metta Rahmadiana
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Psychiatry, Vrije University Medical Centre/GGZ inGeest, Amsterdam, the Netherlands
| | - Supra Wimbarti
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Heleen Riper
- Department of Clinical, Neuro and Development Psychology. Section of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Psychiatry, Vrije University Medical Centre/GGZ inGeest, Amsterdam, the Netherlands
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49
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Garrido S, Millington C, Cheers D, Boydell K, Schubert E, Meade T, Nguyen QV. What Works and What Doesn't Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People. Front Psychiatry 2019; 10:759. [PMID: 31798468 PMCID: PMC6865844 DOI: 10.3389/fpsyt.2019.00759] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users. Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions. Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed. Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen's d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen's d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen's d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen's d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches. Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.
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Affiliation(s)
- Sandra Garrido
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Milperra, NSW, Australia.,Translational Health Institute, Western Sydney University, Campbelltown, NSW, Australia.,School of Social Sciences & Psychology, Western Sydney University, Milperra, NSW, Australia
| | - Chris Millington
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Milperra, NSW, Australia
| | - Daniel Cheers
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Milperra, NSW, Australia.,NSW Health, Sydney, NSW, Australia
| | | | - Emery Schubert
- School of Arts & Humanities, University of New South Wales, Kensington, NSW, Australia
| | - Tanya Meade
- School of Social Sciences & Psychology, Western Sydney University, Milperra, NSW, Australia
| | - Quang Vinh Nguyen
- School of Computing & Engineering, Western Sydney University, Parramatta, NSW, Australia
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50
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Ebert DD, Harrer M, Apolinário-Hagen J, Baumeister H. Digital Interventions for Mental Disorders: Key Features, Efficacy, and Potential for Artificial Intelligence Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:583-627. [PMID: 31705515 DOI: 10.1007/978-981-32-9721-0_29] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people's lives in the future.
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Affiliation(s)
- David Daniel Ebert
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1881 BT, Amsterdam, The Netherlands.
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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