1
|
Schubert FT, Schmidt NB. Nudging for improving mental health treatment-seeking. Curr Opin Psychol 2024; 59:101857. [PMID: 39163812 DOI: 10.1016/j.copsyc.2024.101857] [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: 04/15/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/22/2024]
Abstract
Underutilization of mental health services is a complex problem that requires the investigation of new strategies to facilitate treatment-seeking. Nudging is a relatively new approach which has shown promise in promoting healthy behaviors in a variety of domains, though little work has investigated how nudges may be applied to the initiation of mental health treatment. In this paper, we review the limited work examining nudging related to treatment initiation and discuss findings from a study evaluating the impact of nudges on treatment-seeking. Findings provide insights into the acceptability and efficacy of nudging as a strategy for increasing treatment, and implications for future work exploring this approach for improving treatment access are discussed.
Collapse
|
2
|
Dreischor F, Dancet EAF, Lambalk CB, van Lunsen HW, Besselink D, van Disseldorp J, Boxmeer J, Brinkhuis EA, Cohlen BJ, Hoek A, de Hundt M, Janssen CAH, Lambers M, Maas J, Nap A, Perquin D, Verberg M, Verhoeve HR, Visser J, van der Voet L, Mochtar MH, Goddijn M, Laan E, van Wely M, Custers IM. The web-based Pleasure&Pregnancy programme in the treatment of unexplained infertility: a randomized controlled trial. Hum Reprod 2024:deae220. [PMID: 39352942 DOI: 10.1093/humrep/deae220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 07/22/2024] [Indexed: 10/04/2024] Open
Abstract
STUDY QUESTION Does offering the Pleasure&Pregnancy (P&P) programme rather than expectant management improve naturally conceived ongoing pregnancy rates in couples diagnosed with unexplained infertility? SUMMARY ANSWER The P&P programme had no effect on the ongoing pregnancy rates of couples with unexplained infertility. WHAT IS KNOWN ALREADY Underpowered studies suggested that face-to-face interventions targeting sexual health may increase pregnancy rates. The impact of an eHealth sexual health programme had yet to be evaluated by a large randomized controlled trial. STUDY DESIGN, SIZE, DURATION This is a nationwide multi-centre, unblinded, randomized controlled superiority trial (web-based randomization programme, 1:1 allocation ratio). This RCT intended to recruit 1164 couples within 3 years but was put on hold after having included 700 couples over 5 years (2016-2021). The web-based P&P programme contains psychosexual information and couple communication, mindfulness and sensate focus exercises aiming to help maintain or improve sexual health, mainly pleasure, and hence increase pregnancy rates. The P&P programme additionally offers information on the biology of conception and enables couples to interact online with peers and via email with coaches. PARTICIPANTS/MATERIALS, SETTING, METHODS Heterosexual couples with unexplained infertility and a Hunault-prognosis of at least 30% chance of naturally conceiving a live-born child within 12 months were included, after their diagnostic work-up in 41 Dutch secondary and tertiary fertility centres. The primary outcome was an ongoing pregnancy, defined as a viable intrauterine pregnancy of at least 12 weeks duration confirmed by an ultrasound scan, conceived naturally within 6 months after randomization. Secondary outcomes were time to pregnancy, live birth, sexual health, and personal and relational well-being at baseline and after 3 and 6 months. The primary analyses were according to intention-to-treat principles. We calculated relative risks (RRs, pregnancy rates) and a risk difference (RD, pregnancy rates), Kaplan-Meier survival curves (live birth over time), and time, group, and interactive effects with mixed models analyses (sexual health and well-being). MAIN RESULTS AND THE ROLE OF CHANCE Totals of 352 (one withdrawal) and 348 (three withdrawals) couples were allocated to, respectively the P&P group and the expectant management group. Web-based tracking of the intervention group showed a high attrition rate (57% of couples) and limited engagement (i.e. median of 16 visits and 33 min total visitation time per couple). Intention-to-treat analyses showed that 19.4% (n = 68/351) of the P&P group and 22.6% (n = 78/345) of the expectant management group achieved a naturally conceived ongoing pregnancy (RR = 0.86; 95% CI = 0.64-1.15, RD = -3.24%; 95% CI -9.28 to 2.81). The time to pregnancy did not differ between the groups (Log rank = 0.23). Live birth occurred in 18.8% (n = 66/351) of the couples of the P&P group and 22.3% (n = 77/345) of the couples of the expectant management group (RR = 0.84; 95% CI = 0.63-1.1). Intercourse frequency decreased equally over time in both groups. Sexual pleasure, orgasm, and satisfaction of women of the P&P group improved while these outcomes remained stable in the expectant management group. Male orgasm, intercourse satisfaction, and overall satisfaction decreased over time with no differences between groups. The intervention did not affect personal and relational well-being. Non-compliance by prematurely starting medically assisted reproduction, and clinical loss to follow-up were, respectively, 15.1% and 1.4% for the complete study population. Per protocol analysis for the primary outcome did not indicate a difference between the groups. Comparing the most engaged users with the expectant management group added that coital frequency decreased less, and that male sexual desire improved in the intervention group. LIMITATIONS, REASONS FOR CAUTION The intended sample size of 1164 was not reached because of a slow recruitment rate. The achieved sample size was, however, large enough to exclude an improvement of more than 8% of the P&P programme on our primary outcome. WIDER IMPLICATIONS OF THE FINDINGS The P&P programme should not be offered to increase natural pregnancy rates but may be considered to improve sexual health. The attrition from and limited engagement with the P&P programme is in line with research on other eHealth programmes and underlines the importance of a user experience study. STUDY FUNDING/COMPETING INTEREST(S) Funded by The Netherlands Organisation for Health Research and Development (ZonMw, reference: 843001605) and Flanders Research Foundation. C.B.L. is editor-in-chief of Human Reproduction. H.W.L. received royalties or licences from Prometheus Publishers Springer Media Thieme Verlag. J.B. received support from MercK for attending the ESHRE course 'The ESHRE guideline on ovarian stimulation, do we have agreement?' J.v.D. reports consulting fees and lecture payments from Ferring, not related to the presented work, and support for attending ESHRE from Goodlife and for attending NFI Riga from Merck. A.H. reports consulting fees by Ferring Pharmaceutical company, The Netherlands, paid to institution UMCG, not related to the presented work. H.V. reports consulting fees from Ferring Pharmaceutical company, The Netherlands, and he is a member of the ESHRE guideline development group unexplained infertility and Chair of the Dutch guideline on unexplained infertility (unpaid). M.G. declares unrestricted research and educational grants from Ferring not related to the presented work, paid to their institution VU Medical Centre. The other authors have no conflicts to declare. TRIAL REGISTRATION NUMBER NTR5709. TRIAL REGISTRATION DATE 4 February 2016. DATE OF FIRST PATIENT’S ENROLMENT 27 June 2016.
Collapse
Affiliation(s)
- F Dreischor
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E A F Dancet
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics & Gynaecology, Amsterdam UMC Location VUMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H W van Lunsen
- Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - D Besselink
- Radboudumc, Department of Obstetrics & Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J van Disseldorp
- Department of Obstetrics and Gynaecology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - J Boxmeer
- Department of Gynaecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - E A Brinkhuis
- Department of Obstetrics and Gynaecology, Meander MC, Amersfoort, The Netherlands
| | - B J Cohlen
- Isala Fertility Centre, Isala Clinics, Zwolle, The Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, Section Reproductive Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M de Hundt
- Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - M Lambers
- Department of Obstetrics and Gynaecology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - J Maas
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
- Maastricht University GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - A Nap
- Radboudumc, Department of Obstetrics & Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D Perquin
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - M Verberg
- Fertility Clinic Twente, Twente, The Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
| | - J Visser
- Department of Obstetrics and Gynaecology, Amphia Ziekenhuis, Breda, The Netherlands
| | - L van der Voet
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - M H Mochtar
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - M Goddijn
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Reproductive Medicine, Department of Obstetrics & Gynaecology, Amsterdam UMC Location VUMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - E Laan
- Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - I M Custers
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Johnson E, Ismond K, Hyde A, Ezekowitz J, Wright G, Spiers J, Spence J, Thompson S, McNeely ML, Zheng Y, Round J, Tymchuk S, Lee-Baggley D, Isley S, Corrick S, Minckler H, Tandon P. eMPower: An online Mind-body wellness Program for adults living with chronic health conditions: A three-armed randomized controlled trial protocol. Contemp Clin Trials 2024; 145:107642. [PMID: 39079613 DOI: 10.1016/j.cct.2024.107642] [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: 04/12/2024] [Revised: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Symptoms of depression and anxiety are prevalent among adults with chronic health conditions, contributing to reduced quality of life, morbidity, and mortality. Mind-body wellness interventions (i.e. psychology programming, mindful movement, breathwork, meditation) may impact mental health symptoms, with online delivery offering access and scalability. Whether online mind-body wellness interventions are effective in improving patient outcomes across a broad range of chronic conditions remains uncertain. METHODS This three-armed, pragmatic, randomized controlled trial will use a nested mixed methods approach to assess the effectiveness of an online mind-body wellness intervention (eMPower), offered at two levels of personnel support, on symptoms of anxiety and depression in adults with chronic health conditions. Inclusion criteria require a self-reported chronic condition and access to an internet-connected device. Eligible participants will be randomized 1:1:1 to [1] waitlist control; [2] eMPower; [3] eMPower + weekly 1-to-1 check-in. The primary analysis will compare the Hospital and Anxiety Depression Scale (HADS) total score between eMPower + weekly 1-to-1 check-in versus controls, with secondary and exploratory outcomes including HADS subscales, health-related quality of life, fatigue, program engagement, and frailty. CONCLUSION With online intervention delivery, a range of outcomes, mixed method evaluation, and automated intervention tracking, findings are anticipated to enhance our understanding of how individuals living with chronic health conditions engage with and are impacted by online mind-body wellness programming. Six hundred and fifty-six participants have been enrolled as of April 5, 2024, and 598 patients have completed 12-week follow-up.
Collapse
Affiliation(s)
- Emily Johnson
- Faculty of Medicine and Dentistry, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Kathleen Ismond
- Faculty of Medicine and Dentistry, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Ashley Hyde
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Justin Ezekowitz
- Faculty of Medicine and Dentistry, Division of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Gail Wright
- Canadian Primary Biliary Cholangitis (PBC) Society, 4936 Yonge St, North York, Ontario, Canada.
| | - Jude Spiers
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - John Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Stephanie Thompson
- Faculty of Medicine and Dentistry, Division of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Yinggan Zheng
- Faculty of Medicine and Dentistry, Division of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Jeff Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Sarah Tymchuk
- Faculty of Medicine and Dentistry, Department of Psychiatry University of Alberta, Edmonton, Alberta, Canada.
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Serena Isley
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Shaina Corrick
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Holly Minckler
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
4
|
Thompson M, Radunz M, Wade TD, Balzan RP. Bridging the gap: Can single session interventions help enhance mental health treatment delivery for young people in Australia? Aust N Z J Psychiatry 2024; 58:829-830. [PMID: 39152572 PMCID: PMC11420571 DOI: 10.1177/00048674241271964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Affiliation(s)
- Matthew Thompson
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
| | - Marcela Radunz
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Tracey D Wade
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Ryan P Balzan
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
5
|
Magnuson KI, Li K, Beuley G, Ryan-Pettes SR. The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e51273. [PMID: 39316435 DOI: 10.2196/51273] [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: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. OBJECTIVE This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. METHODS This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. RESULTS Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. CONCLUSIONS Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings.
Collapse
Affiliation(s)
- Katherine I Magnuson
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Kexin Li
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Grace Beuley
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Stacy R Ryan-Pettes
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| |
Collapse
|
6
|
Fitzpatrick S, Crenshaw AO, Donkin V, Collins A, Xiang A, Earle EA, Goenka K, Varma S, Bushe J, McFadden T, Librado A, Monson C. We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party? J Med Internet Res 2024; 26:e58198. [PMID: 39298760 DOI: 10.2196/58198] [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: 03/08/2024] [Revised: 07/22/2024] [Accepted: 08/10/2024] [Indexed: 09/22/2024] Open
Abstract
Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public's assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tara McFadden
- Atlas Institute for Veterans and Families, Ottawa, ON, Canada
| | - Andrea Librado
- Atlas Institute for Veterans and Families, Ottawa, ON, Canada
| | | |
Collapse
|
7
|
Alvarez-Jimenez M, Nicholas J, Valentine L, Liu P, Mangelsdorf S, Baker S, Gilbertson T, O'Loughlin G, McEnery C, McGorry PD, Gleeson JF, Cross SP. A national evaluation of a multi-modal, blended, digital intervention integrated within Australian youth mental health services. Acta Psychiatr Scand 2024. [PMID: 39260824 DOI: 10.1111/acps.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/08/2024] [Accepted: 08/17/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Youth mental health (YMH) services have been established internationally to provide timely, age-appropriate, mental health treatment and improve long-term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time-bound support. To bridge this gap, MOST was developed as a scalable, blended, multi-modal digital platform integrating real-time and asynchronous clinician-delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth-focused online community. The implementation of MOST within Australian YMH services has been publicly funded. OBJECTIVE The primary aim of this study was to evaluate the real-world engagement, outcomes, and experience of MOST during the first 32 months of implementation. METHOD Young people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing. RESULTS Five thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35-0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement. CONCLUSIONS MOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.
Collapse
Affiliation(s)
- M Alvarez-Jimenez
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | - J Nicholas
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | - L Valentine
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P Liu
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S Mangelsdorf
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S Baker
- Orygen Digital, Parkville, Australia
| | - T Gilbertson
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | | | - C McEnery
- Orygen Digital, Parkville, Australia
| | - P D McGorry
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| | - J F Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, School of Psychology, The Australian Catholic University, Melbourne, Australia
| | - S P Cross
- Orygen Digital, Parkville, Australia
- Melbourne, Centre for Youth Mental Health, The University of Melbourne, Australia
| |
Collapse
|
8
|
Catania J, Beaver S, Kamath RS, Worthington E, Lu M, Gandhi H, Waters HC, Malone DC. Evaluation of Digital Mental Health Technologies in the United States: Systematic Literature Review and Framework Synthesis. JMIR Ment Health 2024; 11:e57401. [PMID: 39213023 PMCID: PMC11399741 DOI: 10.2196/57401] [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: 02/15/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. OBJECTIVE A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. METHODS Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association's Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. RESULTS Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. CONCLUSIONS Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind.
Collapse
Affiliation(s)
| | | | | | | | - Minyi Lu
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
| | - Hema Gandhi
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
| | - Heidi C Waters
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
| | - Daniel C Malone
- Department of Pharmacotherapy, Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
9
|
Schaab BL, Cunha LF, Silveira DC, da Silva PC, Ballejos KG, Diaz GB, Kaiser V, Calvetti PÜ, Cazella SC, Barros HMT, Reppold CT. A pilot study of a new app based on self-compassion for the prevention and promotion of mental health among Brazilian college students. Front Psychol 2024; 15:1414948. [PMID: 39246316 PMCID: PMC11378092 DOI: 10.3389/fpsyg.2024.1414948] [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: 04/09/2024] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Epidemiological data suggest substantial issues on the mental health of university students worldwide. Self-compassion is associated with lower rates of psychological distress and better positive mental health. Thus, we have developed a app-based intervention based on self-compassion principles targeting the prevention and promotion of mental health in college students. The current pilot study assessed adherence to intervention, preliminary mental health benefits, and satisfaction and acceptability with the app among Brazilian college students. Methods The study employed a pre-experimental single-group design along with pre-test and post-test assessments (n = 23). A mixed methods approach was utilized to comprehensively assess the outcomes of the intervention. Results The overall adherence rate for the intervention was 37.87%, with 26.26% of participants successfully completing all modules. Among the 21 outcomes assessed, 15 exhibited statistically significant results. Notably, there was a substantial increase in self-compassion, demonstrating a large effect size (d = 1.15), and a moderate effect size reduction in stress (d = 0.62) and anxiety (d = 0.52). All satisfaction indicators for the intervention received scores above 7. The intervention was well-received by participants who completed it, although a potential barrier identified was the volume of text within the app and the need to adopt a more playful and concise format for the intervention. Discussion Despite a notable participant dropout, the adherence to intervention aligns with patterns observed in other online interventions conducted in real-world settings. The observed mental health benefits, high satisfaction levels, and positive acceptance underscore the rationale for pursuing a subsequent randomized clinical trial.
Collapse
Affiliation(s)
- Bruno Luis Schaab
- Psychological Assessment Laboratory, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Lara Finkler Cunha
- Department of Exact Sciences and Social Applied Science, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Desiree Cordoni Silveira
- Psychological Assessment Laboratory, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Pamela Carvalho da Silva
- Psychological Assessment Laboratory, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Kellen Greff Ballejos
- Psychological Assessment Laboratory, Rehabilitation Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gabriela Bertoletti Diaz
- Psychological Assessment Laboratory, Rehabilitation Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Vanessa Kaiser
- Psychological Assessment Laboratory, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Prisla Ücker Calvetti
- Psychological Assessment Laboratory, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Sílvio César Cazella
- Department of Exact Sciences and Social Applied Science, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Helena Maria Tannhauser Barros
- Department of Pharmacosciences, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Caroline Tozzi Reppold
- Psychological Assessment Laboratory, Health Sciences Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| |
Collapse
|
10
|
Vadhan NP, Padovano HT, Muench FJ, Levak S, Allen N. Self-reported alcohol consumption during participation in a text messaging-based online drinking moderation platform. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39177720 DOI: 10.1111/acer.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/15/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Many individuals with excessive alcohol consumption desire moderation but do not seek formalized treatment. Commercially available, technology-assisted options are flexible and highly accessible, yet often not empirically validated. METHODS Individuals desiring alcohol moderation (age 21+) self-selected to use Sunnyside®, a web application with tailored and adaptive text messaging. The evaluable dataset included 46,411 members who completed a baseline assessment, enrolled in the program, and tracked their drinking at least once. An adaptive and customizable weekly plan was generated from typical drinking patterns, goals, and weekly reported progress. Personalized daily messages included reminders for real-time drink tracking, plans, and available interactive messaging with peer coaches. Generalized mixed-effect growth models characterized change in drinks per week and daily drinking for 12 weeks after enrollment. Models allowed for nonlinear change and individual variability across members and weeks. RESULTS A majority (64.3%) of members reported typically drinking 7 of 7 days per week at baseline. During tracking, drinks per week decreased most in the initial weeks and slowed thereafter, with an overall 33% reduction in weekly drink counts. More severe alcohol-use patterns and concern over drinking at baseline were associated with greater relative benefit. CONCLUSIONS Drinking patterns appeared amenable to change during 12 weeks of daily drink tracking with Sunnyside®, a tailored web program to reduce drinking and improve overall wellness. Overall, the findings of this naturalistic study, one of the first of its kind, supplement data from randomized clinical trials and support the use of adaptive, technology-assisted tools for alcohol moderation.
Collapse
Affiliation(s)
- Nehal P Vadhan
- Northwell, New Hyde Park, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra University, Hempstead, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Hayley Treloar Padovano
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
| | - Frederick J Muench
- Northwell, New Hyde Park, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra University, Hempstead, New York, USA
- Clear30 LLC, Hastings on Hudson, New York, USA
| | - Svetlana Levak
- Northwell, New Hyde Park, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra University, Hempstead, New York, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | | |
Collapse
|
11
|
Yoon S, Goh H, Low XC, Weng JH, Heaukulani C. User perceptions and utilisation of features of an AI-enabled workplace digital mental wellness platform 'mindline at work '. BMJ Health Care Inform 2024; 31:e101045. [PMID: 39153756 PMCID: PMC11331828 DOI: 10.1136/bmjhci-2024-101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The working population encounters unique work-related stressors. Despite these challenges, accessibility to mental healthcare remains limited. Digital technology-enabled mental wellness tools can offer much-needed access to mental healthcare. However, existing literature has given limited attention to their relevance and user engagement, particularly for the working population. AIM This study aims to assess user perceptions and feature utilisation of mindline at work, a nationally developed AI-enabled digital platform designed to improve mental wellness in the working population. METHODS This study adopted a mixed-methods design comprising a survey (n=399) and semistructured interviews (n=40) with office-based working adults. Participants were asked to use mindline at work for 4 weeks. We collected data about utilisation of the platform features, intention for sustained use and perceptions of specific features. RESULTS Participants under 5 years of work experience reported lower utilisation of multimedia resources but higher utilisation of emotion self-assessment tools and the AI chatbot compared with their counterparts (p<0.001). The platform received a moderate level of satisfaction (57%) and positive intention for sustained use (58%). Participants regarded mindline at work as an 'essential' safeguard against workplace stress, valuing its secure and non-judgmental space and user anonymity. However, they wanted greater institutional support for office workers' mental wellness to enhance the uptake. The AI chatbot was perceived as useful for self-reflection and problem-solving, despite limited maturity. CONCLUSION Identifying the unique benefits of specific features for different segments of working adults can foster a personalised user experience and promote mental well-being. Increasing workplace awareness is essential for platform adoption.
Collapse
Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Population Health Research and Implementation, SingHealth, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | | | | |
Collapse
|
12
|
Fürtjes S, Al-Assad M, Kische H, Beesdo-Baum K. Mental health apps within the healthcare system: associations with stigma and mental health literacy. Arch Public Health 2024; 82:126. [PMID: 39152505 PMCID: PMC11328358 DOI: 10.1186/s13690-024-01362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Mental health apps (MHA) as a new form of self-help have gained popularity over the last years. Tentative evidence has suggested that MHA might also present a first step into the help-seeking process, because their anonymity circumvents stigma. Using MHA might also increase mental health literacy and reduce stigma through psychoeducation, which could encourage formal help-seeking. To date, it remains unclear how MHA usage relates to stigma, mental health literacy, and utilization of professional help within the public healthcare system. METHODS We conducted a cross-sectional survey with N = 1,263 individuals from the general population (mean age 32.56 ± 11.51, 58.2% female) and employed structural equation modeling to investigate associations between stigma (against individuals with psychological disorders and against help-seeking), mental health literacy, MHA usage, and service utilization within the public healthcare system for mental health problems. RESULTS MHA usage is high within the general population (40.5% of participants). Results indicate that higher stigma against help-seeking is associated with and increased likelihood of MHA usage, which in turn is positively associated with increased likelihood of service utilization. Symptoms of psychological disorder were associated with higher likelihood of service utilization, but not MHA usage. CONCLUSIONS It can be concluded that MHA appeal especially to individuals with higher stigma against help-seeking and therefore might provide an opportunity to reach underserviced individuals. At the current time, MHA usage appears to take place mostly in a preventative manner or as a supplement to treatment. Better integration into the public healthcare system might help to exploit both preventative and interventional benefits of MHA.
Collapse
Affiliation(s)
- Sophia Fürtjes
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, Dresden, 01187, Germany.
| | - Mariam Al-Assad
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, Dresden, 01187, Germany
| | - Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, Dresden, 01187, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, Dresden, 01187, Germany
| |
Collapse
|
13
|
Lintula S, Sourander A, Hinkka-Yli-Salomäki S, Ristkari T, Kinnunen M, Kurki M, Marjamäki A, Gyllenberg D, Kim H, Baumel A. Enrollment and completion rates of a nationwide guided digital parenting program for children with disruptive behavior before and during COVID-19. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02523-6. [PMID: 39141106 DOI: 10.1007/s00787-024-02523-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024]
Abstract
Our aim was to study enrollment and completion levels for the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention, for parents of young children with disruptive behavior before and after the COVID-19 lockdown period. Population-based screening was carried out on 39,251 children during routine check- ups at 4 years of age. The parents of children scoring at least 5 on the Strengths and Difficulties Questionnaire were assessed against inclusion and exclusion criteria. Associations with enrollment or completion were analyzed using logistic regression models. The effects of COVID-19 restrictions on these were estimated using interrupted timeseries analysis. Of 39,251 families, 4894 screened positive and met the eligibility criteria. Of those, 3068 (62.6%) decided to enroll in the SFSW program and 2672 (87.1%) of those families completed it. The highest level of disruptive behavior (OR 1.33, 95% CI 1.12-1.57, p < 0.001) and overall severity of difficulties (OR 2.22, 95% CI 1.91-2.57, p < 0.001) were independently associated with enrollment. Higher parental education was associated with enrollment and completion. Higher paternal age was associated with enrollment, and parent depressive symptoms with non-completion. The SFSW enrollment did not significantly change following the COVID-19 restrictions, while the completion rate increased (COVID-19 completion OR 1.75, 95% CI 1.22-2.50, p = 0.002). Guided digital parenting interventions increase the sustainability of services, by addressing the child mental health treatment gap and ensuring service consistency during crisis situations.
Collapse
Affiliation(s)
- Sakari Lintula
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland.
- INVEST Research Flagship Center, University of Turku, Turku, Finland.
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland.
| | - Susanna Hinkka-Yli-Salomäki
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Malin Kinnunen
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Marjo Kurki
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- ITLA Children's Foundation, Helsinki, Finland
| | - Altti Marjamäki
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - David Gyllenberg
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd Floor, 20014, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Helsinki University Hospital, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Hyoun Kim
- Department of Child and Family Studies, Yonsei University, Seoul, South Korea
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| |
Collapse
|
14
|
Rouvere J, Blanchard BE, Johnson M, Griffith Fillipo I, Mosser B, Romanelli M, Nguyen T, Rushton K, Marion J, Althoff T, Areán PA, Pullmann MD. Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study. JMIR Hum Factors 2024; 11:e57082. [PMID: 39110965 PMCID: PMC11339574 DOI: 10.2196/57082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/04/2024] [Accepted: 06/17/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. OBJECTIVE This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. METHODS Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). RESULTS Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. CONCLUSIONS Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement.
Collapse
Affiliation(s)
- Julien Rouvere
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Isabell Griffith Fillipo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Brittany Mosser
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Meghan Romanelli
- School of Social Work, University of Washington, Seattle, WA, United States
| | | | - Kevin Rushton
- Mental Health America, Alexandria, VA, United States
| | - John Marion
- Mental Health America, Alexandria, VA, United States
| | - Tim Althoff
- Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, United States
| | | | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
15
|
Hallford DJ, Austin DW, Takano K, Yeow JJ, Rusanov D, Fuller-Tyszkiewicz M, Raes F. Improving usual care outcomes in major depression in youth by targeting memory specificity: A randomized controlled trial of adjunct computerized memory specificity training (c-MeST). J Affect Disord 2024; 358:500-512. [PMID: 38663556 DOI: 10.1016/j.jad.2024.04.078] [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: 07/28/2023] [Revised: 02/11/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment. METHODS Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. RESULTS The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05). CONCLUSIONS c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.
Collapse
Affiliation(s)
- David John Hallford
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia.
| | - David W Austin
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Keisuke Takano
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstr. 13, Munich, Germany
| | - Joesph J Yeow
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Danielle Rusanov
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3712, 3000 Leuven, Belgium
| |
Collapse
|
16
|
Ross S, Wood MA, Johns D, Murphy J, Baird R, Alford B. Understanding Engagement With Forensic Smartphone Apps: The Service Design Engagement Model. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:1106-1123. [PMID: 35730559 DOI: 10.1177/0306624x221106323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Justice services have begun to integrate the use of mobile applications into treatment, support, and rehabilitative programs for forensic clients. One such application that been adopted to support forensic clients is "eRecovery": a smartphone application that provides clients recovering from a substance addiction with support for managing relapse. In this article, we report on evaluation findings from a trial of eRecovery in an Australian Community Justice Centre, and reflect on several issues relating to fostering and sustaining client engagement with similar applications within forensic and justice settings. We propose the Service Design Engagement Model to organize, visualize, and describe the stages and factors important to adoption, appropriation, and on-going routine use of the software by forensic clients. The model recognizes the role of contextual and environmental factors in supporting users through the early stages of engagement, and the importance of user agency in longer-term engagement with therapeutic apps.
Collapse
Affiliation(s)
| | | | | | - John Murphy
- Design4Use Pty. Ltd., Melbourne, VIC, Australia
| | - Ron Baird
- Victoria University, Melbourne, Australia
| | - Brooke Alford
- Neighbourhood Justice Centre, Collingwood, VIC, Australia
| |
Collapse
|
17
|
Goldberg SB, Bolt DM, Dahl CJ, Davidson RJ, Hirshberg MJ. Does it matter how meditation feels? An experience sampling study. J Consult Clin Psychol 2024; 92:531-541. [PMID: 39347788 PMCID: PMC11448736 DOI: 10.1037/ccp0000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
OBJECTIVE Meditation apps are the most widely used mental health apps. The precise mechanisms underlying their effects remain unclear. In particular, the degree to which affect experienced during meditation is associated with outcomes has not been established. METHOD We used the meditation app arm of a recently completed randomized controlled trial comparing a self-guided meditation app (Healthy Minds Program) to a waitlist control. Predominantly distressed public school employees (n = 243, 80.9% with clinically elevated depression and/or anxiety) reported positive and negative affect during meditation practice. Data were analyzed using two-level multivariate latent growth curve models (observations nested within participants) that simultaneously attended to both positive and negative affect. We examined whether positive and negative affect during meditation changed over time and whether these changes were associated with changes in psychological distress (parent trial's preregistered primary outcome) at posttest or 3-month follow-up. RESULTS On average, participants reported decreased negative affect but no change in positive affect during meditation over time. Increased positive affect and decreased negative affect during meditation were associated with improvements in distress at posttest and follow-up. Change in positive affect was a stronger predictor of distress at follow-up than change in negative affect. CONCLUSIONS Despite notions embedded within mainstream mindfulness meditation training that deemphasize the importance of the affective experience of practice (i.e., nonjudgmental awareness of present moment experience, regardless of valence), results indicate that these experiences contain signals associated with outcomes. Monitoring affect during meditation may be worthwhile to guide intervention delivery (i.e., measurement-based care, precision medicine). (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin–Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin–Madison, Madison, WI, USA
| | - Daniel M. Bolt
- Department of Educational Psychology, University of Wisconsin – Madison, Madison, WI, USA
| | - Cortland J. Dahl
- Center for Healthy Minds, University of Wisconsin–Madison, Madison, WI, USA
- Healthy Minds Innovations Inc., Madison, WI, USA
| | - Richard J. Davidson
- Center for Healthy Minds, University of Wisconsin–Madison, Madison, WI, USA
- Healthy Minds Innovations Inc., Madison, WI, USA
| | | |
Collapse
|
18
|
Ferguson I, George G, Narine KO, Turner A, McGhee Z, Bajwa H, Hart FG, Carter S, Beard C. Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial. JMIR Ment Health 2024; 11:e56758. [PMID: 39083330 PMCID: PMC11325113 DOI: 10.2196/56758] [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] [Received: 01/25/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals. OBJECTIVE This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. METHODS Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. RESULTS Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). CONCLUSIONS This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention.
Collapse
Affiliation(s)
- IreLee Ferguson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
| | - Grace George
- Department of Basic Neuroscience, McLean Hospital, Belmont, MA, United States
| | - Kevin O Narine
- Department of Clinical Psychology, William James College, Newton, MA, United States
| | - Amari Turner
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
| | - Zelda McGhee
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
| | - Harris Bajwa
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
| | - Frances G Hart
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, United States
| |
Collapse
|
19
|
Sacher PM, Fulton E, Rogers V, Wilson J, Gramatica M, Dent JE, Aarts EO, Eccleston D, Greve JW, Palm-Meinders I, Chuttani R. Impact of a Health Coach-Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study. JMIR Form Res 2024; 8:e54723. [PMID: 39083340 PMCID: PMC11325120 DOI: 10.2196/54723] [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: 11/21/2023] [Revised: 04/20/2024] [Accepted: 05/29/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. OBJECTIVE This study aims to assess whether a health coach-led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. METHODS This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ≥27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life-Lite-Clinical Trials Version, Loss of Control Over Eating Scale-Brief, Weight Efficacy Lifestyle Questionnaire-Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. RESULTS Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4 kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month 1) and Barriers to Being Active Quiz (improvements at months 3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. CONCLUSIONS This study provides evidence that the health coach-led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. TRIAL REGISTRATION ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606.
Collapse
Affiliation(s)
- Paul M Sacher
- Allurion Technologies Inc, Natick, MA, United States
| | - Emily Fulton
- Allurion Technologies Inc, Natick, MA, United States
| | | | - Julia Wilson
- Allurion Technologies Inc, Natick, MA, United States
| | | | | | | | | | - Jan Willem Greve
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis Ter Heide, Netherlands
| | - Inge Palm-Meinders
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis Ter Heide, Netherlands
| | - Ram Chuttani
- Allurion Technologies Inc, Natick, MA, United States
| |
Collapse
|
20
|
Fitzsimmons-Craft EE, Rackoff GN, Shah J, Strayhorn JC, D'Adamo L, DePietro B, Howe CP, Firebaugh ML, Newman MG, Collins LM, Taylor CB, Wilfley DE. Effects of Chatbot Components to Facilitate Mental Health Services Use in Individuals With Eating Disorders Following Online Screening: An Optimization Randomized Controlled Trial. Int J Eat Disord 2024. [PMID: 39072846 DOI: 10.1002/eat.24260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/10/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Few individuals with eating disorders (EDs) receive treatment. Innovations are needed to identify individuals with EDs and address care barriers. We developed a chatbot for promoting services uptake that could be paired with online screening. However, it is not yet known which components drive effects. This study estimated individual and combined contributions of four chatbot components on mental health services use (primary), chatbot helpfulness, and attitudes toward changing eating/shape/weight concerns ("change attitudes," with higher scores indicating greater importance/readiness). METHODS Two hundred five individuals screening with an ED but not in treatment were randomized in an optimization randomized controlled trial to receive up to four chatbot components: psychoeducation, motivational interviewing, personalized service recommendations, and repeated administration (follow-up check-ins/reminders). Assessments were at baseline and 2, 6, and 14 weeks. RESULTS Participants who received repeated administration were more likely to report mental health services use, with no significant effects of other components on services use. Repeated administration slowed the decline in change attitudes participants experienced over time. Participants who received motivational interviewing found the chatbot more helpful, but this component was also associated with larger declines in change attitudes. Participants who received personalized recommendations found the chatbot more helpful, and receiving this component on its own was associated with the most favorable change attitude time trend. Psychoeducation showed no effects. DISCUSSION Results indicated important effects of components on outcomes; findings will be used to finalize decision making about the optimized intervention package. The chatbot shows high potential for addressing the treatment gap for EDs.
Collapse
Affiliation(s)
| | - Gavin N Rackoff
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jillian C Strayhorn
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Laura D'Adamo
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Bianca DePietro
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carli P Howe
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| |
Collapse
|
21
|
Gray L, Marcynikola N, Barnett I, Torous J. The Potential for Digital Phenotyping in Understanding Mindfulness App Engagement Patterns: A Pilot Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38836506 DOI: 10.1089/jicm.2023.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Background: Low app engagement is a central barrier to digital mental health efficacy. With mindfulness-based mental health apps growing in popularity, there is a need for new understanding of factors influencing engagement. This study utilized digital phenotyping to understand real-time patterns of engagement around app-based mindfulness. Different engagement metrics are presented that measure both the total number of app-based activities participants completed each week, as well as the proportion of days that participants engaged with the app each week. Method: Data were derived from two iterations of a four-week study exploring app engagement in college students (n = 169). This secondary analysis investigated the relationships between general and mindfulness-based app engagement with passive data metrics (sleep duration, home time, and screen duration) at a weekly level, as well as the relationship between demographics and engagement. Additional clinically focused analysis was performed on three case studies of participants with high mindfulness activity completion. Results: Demographic variables such as gender, race/ethnicity, and age lacked a significant association with mindfulness app-based engagement. Passive data variables such as sleep and screen duration were significant predictors for different metrics of general and mindfulness-based app engagement at a weekly level. There was a significant interaction effect for screen duration between the number of mindfulness activities completed and whether or not the participant received a mindfulness notification. K-means clusters analyses using passive data features to predict mindfulness activity completion had low performance. Conclusions: While there are no simple solutions to predicting engagement with mindfulness apps, utilizing digital phenotyping approaches at a population and personal level offers new potential. The signal from digital phenotyping warrants more investigation; even small increases in engagement with mindfulness apps may have a tremendous impact given their already high prevalence of engagement, availability, and potential to engage patients across demographics.
Collapse
Affiliation(s)
- Lucy Gray
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Natalia Marcynikola
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ian Barnett
- Division of Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
22
|
Stecher C, Pagni BA, Cloonan S, Vink S, Hill E, Ogbeama D, Delaney S, Braden BB. App-based meditation habits maintain reductions in depression symptoms among autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1487-1502. [PMID: 37837362 DOI: 10.1177/13623613231200679] [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] [Indexed: 10/16/2023]
Abstract
LAY ABSTRACT Existing research has identified an increased risk of depression among autistic adults, which can negatively impact their adaptive functioning abilities and socioeconomic outcomes. Mobile app-based meditation is a feasible, accessible, and effective self-care solution for depression among neurotypical adults, but there is limited evidence for the long-term benefits of app-based meditation among autistic adults. Habits are a key behavioral strategy for maintaining behavior change, and anchoring is one effective habit formation intervention that has yet to be tested among autistic adults. This study demonstrates that it is both feasible and effective to integrate the anchoring habit formation strategy into an app-based meditation intervention for establishing meditation habits among autistic adults. In addition, the study shows that app-based meditation habits were successful at maintaining reductions in depressive symptoms over 6 months. These results demonstrate the power of anchoring-based habit formation interventions for establishing healthy habits among autistic adults, which offers a promising behavioral intervention technique for establishing other healthy habits among autistic adults. The study also shows that app-based meditation habits are an effective long-term self-care solution for managing depressive symptoms among autistic adults that should be used by mental health providers and policymakers. Future research should test this combined anchoring and app-based meditation intervention technique among larger samples of autistic adults and over longer durations to better understand the mechanisms underlying the success of this intervention.
Collapse
|
23
|
Alon N, Perret S, Cohen A, Partiquin M, LeMelle S, Boyd C, Aguilera J, Reat C, Hough E, Walsh J, Dwyer B, Hogan J, Smith AH, Torous J. Digital Navigator Training to Increase Access to Mental Health Care in Community-Based Organizations. Psychiatr Serv 2024; 75:608-611. [PMID: 38595120 DOI: 10.1176/appi.ps.20230391] [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] [Indexed: 04/11/2024]
Abstract
Providing human support for users of behavioral health technology can help facilitate the necessary engagement and clinical integration of digital tools in mental health care. A team conducted digital navigator training that taught participants how to promote patrons' digital literacy, evaluate and recommend health apps, and interpret smartphone data. The authors trained 80 participants from 21 organizations, demonstrating this training's feasibility, acceptability, and need. Case studies explore the implementation of this training curriculum. As technology's potential in mental health care expands, training can empower digital navigators to ensure that the use of digital tools is informed, equitable, and clinically relevant.
Collapse
Affiliation(s)
- Noy Alon
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Sarah Perret
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Amy Cohen
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Michelle Partiquin
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Stephanie LeMelle
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Chasee Boyd
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Jacqueline Aguilera
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Cristen Reat
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Elise Hough
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Jessica Walsh
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Bridget Dwyer
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Julianna Hogan
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - Ashley Helm Smith
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston (Alon, Perret, Dwyer, Torous); Clinical Support System for Serious Mental Illness, American Psychiatric Association, Washington, D.C. (Cohen); The Menninger Clinic, Houston (Partiquin, Boyd); Easter Seals Greater Houston, Houston (Partiquin, Reat, Hough); Columbia University Medical Center and New York State Psychiatric Institute, New York City (LeMelle); Mayor's Office for Adult Literacy, Houston (Aguilera); Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston (Walsh, Hogan, Smith)
| |
Collapse
|
24
|
Milne-Ives M, Homer S, Andrade J, Meinert E. The conceptualisation and measurement of engagement in digital health. Internet Interv 2024; 36:100735. [PMID: 38558760 PMCID: PMC10979253 DOI: 10.1016/j.invent.2024.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Digital tools are an increasingly important component of healthcare, but their potential impact is commonly limited by a lack of user engagement. Digital health evaluations of engagement are often restricted to system usage metrics, which cannot capture a full understanding of how and why users engage with an intervention. This study aimed to examine how theory-based, multifaceted measures of engagement with digital health interventions capture different components of engagement (affective, cognitive, behavioural, micro, and macro) and to consider areas that are unclear or missing in their measurement. We identified and compared two recently developed measures that met these criteria (the Digital Behaviour Change Intervention Engagement Scale and the TWente Engagement with Ehealth Technologies Scale). Despite having similar theoretical bases and being relatively strongly correlated, there are key differences in how these scales aim to capture engagement. We discuss the implications of our analysis for how affective, cognitive, and behavioural components of engagement can be conceptualised and whether there is value in distinguishing between them. We conclude with recommendations for the circumstances in which each scale may be most useful and for how future measure development could supplement existing scales.
Collapse
Affiliation(s)
- Madison Milne-Ives
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Sophie Homer
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jackie Andrade
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Edward Meinert
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, University of Plymouth, Plymouth, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
25
|
Cohen A, Joshi D, Bondre A, Chand PK, Chaturvedi N, Choudhary S, Dutt S, Khan A, Langholm C, Kumar M, Gupta S, Nagendra S, Reddy PV, Rozatkar A, Sen Y, Shrivastava R, Singh R, Thirthalli J, Tugnawat DK, Bhan A, Naslund JA, Vaidyam A, Patel V, Keshavan M, Mehta UM, Torous J. Digital phenotyping correlates of mobile cognitive measures in schizophrenia: A multisite global mental health feasibility trial. PLOS DIGITAL HEALTH 2024; 3:e0000526. [PMID: 38941349 PMCID: PMC11213313 DOI: 10.1371/journal.pdig.0000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/04/2024] [Indexed: 06/30/2024]
Abstract
Traditional cognitive assessments in schizophrenia are time-consuming and necessitate specialized training, making routine evaluation challenging. To overcome these limitations, this study investigates the feasibility and advantages of utilizing smartphone-based assessments to capture both cognitive functioning and digital phenotyping data and compare these results to gold standard measures. We conducted a secondary analysis of data from 76 individuals with schizophrenia, who were recruited across three sites (one in Boston, two in India) was conducted. The open-source mindLAMP smartphone app captured digital phenotyping data and Trails A/B assessments of attention / memory for up to 12 months. The smartphone-cognitive tasks exhibited potential for normal distribution and these scores showed small but significant correlations with the results from the Brief Assessment of Cognition in Schizophrenia, especially the digital span and symbol coding tasks (r2 = 0.21). A small but significant correlation (r2 = 0.29) between smartphone-derived cognitive scores and health-related behaviors such as sleep duration patterns was observed. Smartphone-based cognitive assessments show promise as cross-cultural tools that can capture relevant data on momentary states among individuals with schizophrenia. Cognitive results related to sleep suggest functional applications to digital phenotyping data, and the potential of this multimodal data approach in research.
Collapse
Affiliation(s)
- Asher Cohen
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Devayani Joshi
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | | | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Soumya Choudhary
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Siddharth Dutt
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Carsten Langholm
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Mohit Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India
| | - Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India
| | - Srilakshmi Nagendra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Preethi V. Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhijit Rozatkar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India
| | | | | | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aditya Vaidyam
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- National Institute of Advanced Studies, Bangalore, India
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| |
Collapse
|
26
|
Chen K, Lane E, Burns J, Macrynikola N, Chang S, Torous J. The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care. Telemed J E Health 2024; 30:e1963-e1970. [PMID: 38574251 DOI: 10.1089/tmj.2024.0023] [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] [Indexed: 04/06/2024] Open
Abstract
Background: Mental health apps offer scalable care, yet clinical adoption is hindered by low user engagement and integration challenges into clinic workflows. Human support staff called digital navigators, trained in mental health technology, could enhance care access and patient adherence and remove workflow burdens from clinicians. While the potential of this role is clear, training staff to become digital navigators and assessing their impact are primary challenges. Methods: We present a detailed manual/framework for implementation of the Digital Navigator within a short-term, cognitive-behavioral therapy-focused hybrid clinic. We analyze patient engagement, satisfaction, and digital phenotyping data quality outcomes. Data from 83 patients, for the period spanning September 2022 to September 2023, included Digital Navigator satisfaction, correlated with demographics, mindLAMP app satisfaction, engagement, and passive data quality. Additionally, average passive data across 33 clinic patients from November 2023 to January 2024 were assessed for missingness. Results: Digital Navigator satisfaction averaged 18.8/20. Satisfaction was not influenced by sex, race, gender, or education. Average passive data quality across 33 clinic patients was 0.82 at the time this article was written. Digital Navigator satisfaction scores had significant positive correlation with both clinic app engagement and perception of that app. Conclusions: Results demonstrate preliminary support and patient endorsement for the Digital Navigator role and positive outcomes around digital engagement and digital phenotyping data quality. Through sharing training resources and standardizing the role, we aim to enable clinicians and researchers to adapt and utilize the Digital Navigator for their own needs.
Collapse
Affiliation(s)
- Kelly Chen
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Erlend Lane
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James Burns
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Macrynikola
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Chang
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Oesterle TS, Hall-Flavin DK, Bormann NL, Loukianova LL, Fipps DC, Breitinger SA, Gilliam WP, Wu T, da Costa SC, Arndt S, Karpyak VM. Therapeutic Content of Mobile Phone Applications for Substance Use Disorders: An Umbrella Review. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2024; 2:192-206. [PMID: 38983444 PMCID: PMC11232654 DOI: 10.1016/j.mcpdig.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Mobile phone applications (MPAs) for substance use disorder (SUD) treatment are increasingly used by patients. Although pilot studies have shown promising results, multiple previous systematic reviews noted insufficient evidence for MPA use in SUD treatment-many of the previously published reviews evaluated different trials. Subsequently, we aimed to conduct an umbrella review of previously published reviews investigating the efficacy of MPAs for SUD treatment, excluding nicotine/tobacco because umbrella reviews have been done in this population and the nicotine/tobacco MPA approach often differs from SUD-focused MPAs. No previous reviews have included a statistical meta-analysis of clinical trials to quantify an estimated overall effect. Seven reviews met inclusion criteria, and 17 unique studies with available data were taken from those reviews for the meta-analysis. Overall, reviews reported a lack of evidence for recommending MPAs for SUD treatment. However, MPA-delivered recovery support services, cognitive behavioral therapy, and contingency management were identified across multiple reviews as having promising evidence for SUD treatment. Hedges g effect size for an MPA reduction in substance use-related outcomes relative to the control arm was insignificant (0.137; 95% CI, -0.056 to 0.330; P=.16). In subgroup analysis, contingency management (1.29; 95% CI, 1.088-1.482; τ 2=0; k=2) and cognitive behavioral therapy (0.02; 95% CI, 0.001-0.030; τ 2=0; k=2) were significant. Although contingency management's effect was large, both trials were small (samples of 40 and 30). This review includes an adapted framework for the American Psychiatric Association's MPA guidelines that clinicians can implement to review MPAs critically with patients.
Collapse
Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Daniel K Hall-Flavin
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Larissa L Loukianova
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - David C Fipps
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Tiffany Wu
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Sabrina Correa da Costa
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Stephan Arndt
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| |
Collapse
|
28
|
Schläpfer S, Schneider F, Santhanam P, Eicher M, Kowatsch T, Witt CM, Barth J. Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial. JMIR Cancer 2024; 10:e52386. [PMID: 38819907 PMCID: PMC11179041 DOI: 10.2196/52386] [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: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. OBJECTIVE This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. METHODS The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). RESULTS In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. CONCLUSIONS The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels.
Collapse
Affiliation(s)
- Sonja Schläpfer
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Fabian Schneider
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
29
|
González-Spinoglio L, Monistrol-Mula A, Vindrola-Padros C, Aguilar-Ortiz S, Carreras B, Haro JM, Felez-Nobrega M. Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study. J Med Internet Res 2024; 26:e47546. [PMID: 38809605 PMCID: PMC11170039 DOI: 10.2196/47546] [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: 03/24/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. OBJECTIVE This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. METHODS We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. RESULTS The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. CONCLUSIONS More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees' well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic.
Collapse
Affiliation(s)
- Leticia González-Spinoglio
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, Barcelona, Spain
| | - Anna Monistrol-Mula
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, Barcelona, Spain
- Centre for Biomedical Research on Mental Health, Madrid, Spain
| | | | - Salvatore Aguilar-Ortiz
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, Barcelona, Spain
| | - Bernat Carreras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, Barcelona, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, Barcelona, Spain
- Centre for Biomedical Research on Mental Health, Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Mireia Felez-Nobrega
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, Barcelona, Spain
- Centre for Biomedical Research on Mental Health, Madrid, Spain
| |
Collapse
|
30
|
Kleinau E, Lamba T, Jaskiewicz W, Gorentz K, Hungerbuehler I, Rahimi D, Kokota D, Maliwichi L, Jamu E, Zumazuma A, Negrão M, Mota R, Khouri Y, Kapps M. Effectiveness of a chatbot in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic: A randomized, controlled trial. PLoS One 2024; 19:e0303370. [PMID: 38805444 PMCID: PMC11132445 DOI: 10.1371/journal.pone.0303370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/12/2024] [Indexed: 05/30/2024] Open
Abstract
We conducted a randomized, controlled trial (RCT) to investigate our hypothesis that the interactive chatbot, Vitalk, is more effective in improving mental wellbeing and resilience outcomes of health workers in Malawi than the passive use of Internet resources. For our 2-arm, 8-week, parallel RCT (ISRCTN Registry: trial ID ISRCTN16378480), we recruited participants from 8 professional cadres from public and private healthcare facilities. The treatment arm used Vitalk; the control arm received links to Internet resources. The research team was blinded to the assignment. Of 1,584 participants randomly assigned to the treatment and control arms, 215 participants in the treatment and 296 in the control group completed baseline and endline anxiety assessments. Six assessments provided outcome measures for: anxiety (GAD-7); depression (PHQ-9); burnout (OLBI); loneliness (ULCA); resilience (RS-14); and resilience-building activities. We analyzed effectiveness using mixed-effects linear models, effect size estimates, and reliable change in risk levels. Results support our hypothesis. Difference-in-differences estimators showed that Vitalk reduced: depression (-0.68 [95% CI -1.15 to -0.21]); anxiety (-0.44 [95% CI -0.88 to 0.01]); and burnout (-0.58 [95% CI -1.32 to 0.15]). Changes in resilience (1.47 [95% CI 0.05 to 2.88]) and resilience-building activities (1.22 [95% CI 0.56 to 1.87]) were significantly greater in the treatment group. Our RCT produced a medium effect size for the treatment and a small effect size for the control group. This is the first RCT of a mental health app for healthcare workers during the COVID-19 pandemic in Southern Africa combining multiple mental wellbeing outcomes and measuring resilience and resilience-building activities. A substantial number of participants could have benefited from mental health support (1 in 8 reported anxiety and depression; 3 in 4 suffered burnout; and 1 in 4 had low resilience). Such help is not readily available in Malawi. Vitalk has the potential to fill this gap.
Collapse
Affiliation(s)
- Eckhard Kleinau
- University Research Co. (URC), Chevy Chase, Maryland, United States of America
| | - Tilinao Lamba
- Dept. of Psychology, University of Malawi–Chancellor College, Zomba, Malawi
| | - Wanda Jaskiewicz
- Global Health Division, Chemonics International, Washington, District of Columbia, United States of America
| | - Katy Gorentz
- Global Health Division, Chemonics International, Washington, District of Columbia, United States of America
| | | | - Donya Rahimi
- Global Health Division, Chemonics International, Washington, District of Columbia, United States of America
| | - Demoubly Kokota
- Dept. of Psychology, University of Malawi–Chancellor College, Zomba, Malawi
| | - Limbika Maliwichi
- Dept. of Psychology, University of Malawi–Chancellor College, Zomba, Malawi
| | - Edister Jamu
- Dept. of Psychology, University of Malawi–Chancellor College, Zomba, Malawi
| | - Alex Zumazuma
- Department of Mental Health, Kamuzu University of Health Sciences (KUHES), Blantyre, Malawi
| | | | | | | | | |
Collapse
|
31
|
Danese A, Martsenkovskyi D, Remberk B, Khalil MY, Diggins E, Keiller E, Masood S, Awah I, Barbui C, Beer R, Calam R, Gagliato M, Jensen TK, Kostova Z, Leckman JF, Lewis SJ, Lorberg B, Myshakivska O, Pfeiffer E, Rosner R, Schleider JL, Shenderovich Y, Skokauskas N, Tolan PH, Caffo E, Sijbrandij M, Ougrin D, Leventhal BL, Weisz JR. Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00243-0. [PMID: 38735431 DOI: 10.1016/j.jaac.2024.02.017] [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: 08/07/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions. METHOD Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network. RESULTS The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear. CONCLUSION There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions. DIVERSITY & INCLUSION STATEMENT We actively worked to promote sex and gender balance in our author group. STUDY PREREGISTRATION INFORMATION Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.
Collapse
Affiliation(s)
- Andrea Danese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
| | - Dmytro Martsenkovskyi
- Bogomolets National Medical University, Kyiv, Ukraine; SI Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine, Kyiv, Ukraine; National Children's Specialized Hospital OHMATDYT, Kyiv, Ukraine
| | | | | | - Emma Diggins
- University of Leeds, Leeds, United Kingdom; Leeds Community Healthcare NHS Trust, Leeds, United Kingdom
| | - Eleanor Keiller
- Queen Mary University of London, London, UK; East London NHS Foundation Trust, London, United Kingdom
| | - Saba Masood
- Queen Mary University of London, London, UK; East London NHS Foundation Trust, London, United Kingdom
| | - Isang Awah
- University of Oxford, Oxford, United Kingdom
| | | | - Renée Beer
- EMDR Europe Association, Lausanne, Switzerland
| | - Rachel Calam
- University of Manchester, Manchester, United Kingdom
| | - Marcio Gagliato
- The Mental Health and Psychosocial Support Network - MHPSS.net; Fordham University, New York City, New York
| | - Tine K Jensen
- University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Zlatina Kostova
- University of Massachusetts Chan Medical School, Worcester, Massachusetts. Prof. Leckman is with
| | | | - Stephanie J Lewis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Boris Lorberg
- University of Massachusetts Chan Medical School, Worcester, Massachusetts. Prof. Leckman is with
| | - Olha Myshakivska
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | | | - Rita Rosner
- Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | | | - Yulia Shenderovich
- Cardiff University, Cardiff, United Kingdom; University of Oxford, Oxford, United Kingdom
| | | | | | - Ernesto Caffo
- University of Modena and Reggio Emilia, Italy; Foundation Child; and the Foundation SOS Il Telefono Azzurro ONLUS
| | | | - Dennis Ougrin
- Queen Mary University of London, London, UK; East London NHS Foundation Trust, London, United Kingdom
| | | | - John R Weisz
- Harvard University, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
32
|
Ahmed S, Trimmer C, Khan W, Tuck A, Rodak T, Agic B, Kavic K, Wadhawan S, Abbott M, Husain MO, Husain MI, McKenzie K, Quintana Y, Naeem F. A mixed methods analysis of existing assessment and evaluation tools (AETs) for mental health applications. Front Public Health 2024; 12:1196491. [PMID: 38774052 PMCID: PMC11106355 DOI: 10.3389/fpubh.2024.1196491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Mental health Applications (MH Apps) can potentially improve access to high-quality mental health care. However, the recent rapid expansion of MH Apps has created growing concern regarding their safety and effectiveness, leading to the development of AETs (Assessment and Evaluation Tools) to help guide users. This article provides a critical, mixed methods analysis of existing AETs for MH Apps by reviewing the criteria used to evaluate MH Apps and assessing their effectiveness as evaluation tools. Methods To identify relevant AETs, gray and scholarly literature were located through stakeholder consultation, Internet searching via Google and a literature search of bibliographic databases Medline, APA PsycInfo, and LISTA. Materials in English that provided a tool or method to evaluate MH Apps and were published from January 1, 2000, to January 26, 2021 were considered for inclusion. Results Thirteen relevant AETs targeted for MH Apps met the inclusion criteria. The qualitative analysis of AETs and their evaluation criteria revealed that despite purporting to focus on MH Apps, the included AETs did not contain criteria that made them more specific to MH Apps than general health applications. There appeared to be very little agreed-upon terminology in this field, and the focus of selection criteria in AETs is often IT-related, with a lesser focus on clinical issues, equity, and scientific evidence. The quality of AETs was quantitatively assessed using the AGREE II, a standardized tool for evaluating assessment guidelines. Three out of 13 AETs were deemed 'recommended' using the AGREE II. Discussion There is a need for further improvements to existing AETs. To realize the full potential of MH Apps and reduce stakeholders' concerns, AETs must be developed within the current laws and governmental health policies, be specific to mental health, be feasible to implement and be supported by rigorous research methodology, medical education, and public awareness.
Collapse
Affiliation(s)
- Sarah Ahmed
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Chris Trimmer
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Wishah Khan
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kelsey Kavic
- Mental Health Commission of Canada, Ottawa, ON, Canada
| | | | | | - M. Omair Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuri Quintana
- Harvard Medical School, Harvard University, Boston, MA, United States
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Farooq Naeem
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
33
|
Goldberg SB, Jiwani Z, Bolt DM, Riordan KM, Davidson RJ, Hirshberg MJ. Evidence for Bidirectional, Cross-Lagged Associations Between Alliance and Psychological Distress in an Unguided Mobile-Health Intervention. Clin Psychol Sci 2024; 12:517-525. [PMID: 38863442 PMCID: PMC11164554 DOI: 10.1177/21677026231184890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Bidirectional associations between changes in symptoms and alliance are established for in-person psychotherapy. Alliance may play an important role in promoting engagement and effectiveness within unguided mobile health (mHealth) interventions. Using models disaggregating alliance and psychological distress into within- and between-person components (random intercept cross-lagged panel model), we report bidirectional associations between alliance and distress over the course of a 4-week smartphone-based meditation intervention (n=302, 80.0% elevated depression/anxiety). Associations were stable across time with effect sizes similar to those observed for psychotherapy (βs=-.13 to -.14 and -.09 to -.10, for distress to alliance and alliance to distress, respectively). Alliance may be worth measuring to improve the acceptability and effectiveness of mHealth tools. Further empirical and theoretical work characterizing the role and meaning of alliance in unguided mHealth is warranted.
Collapse
Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, UW-Madison, Madison, WI, USA
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
| | - Zishan Jiwani
- Department of Counseling Psychology, UW-Madison, Madison, WI, USA
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, UW-Madison, Madison, WI, USA
| | - Kevin M Riordan
- Department of Counseling Psychology, UW-Madison, Madison, WI, USA
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
| | - Richard J Davidson
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
- Department of Psychology, UW-Madison, Madison, WI, USA
- Department of Psychiatry, UW-Madison, Madison, WI, USA
| | | |
Collapse
|
34
|
Torous J, Smith KA, Hardy A, Vinnikova A, Blease C, Milligan L, Hidalgo-Mazzei D, Lambe S, Marzano L, Uhlhaas PJ, Ostinelli EG, Anmella G, Zangani C, Aronica R, Dwyer B, Cipriani A. Digital health interventions for schizophrenia: Setting standards for mental health. Schizophr Res 2024; 267:392-395. [PMID: 38640849 DOI: 10.1016/j.schres.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA.
| | - Katharine A Smith
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, London, UK
| | | | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Experimental Psychology, University of Oxford, UK
| | - Sinead Lambe
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; Department of Experimental Psychology, University of Oxford, UK
| | - Lisa Marzano
- School of Science and Technology, Middlesex University, UK
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK; Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Edoardo G Ostinelli
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Caroline Zangani
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Rosario Aronica
- Fondazione IRCCS Ca' Granda- Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bridget Dwyer
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | - Andrea Cipriani
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| |
Collapse
|
35
|
Youn SJ, Jaso B, Eyllon M, Sah P, Hoyler G, Barnes JB, Jarama K, Murillo L, O'Dea H, Orth L, Pennine M, Rogers E, Welch G, Nordberg SS. Leveraging Implementation Science to Integrate Digital Mental Health Interventions as part of Routine Care in a Practice Research Network. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:348-357. [PMID: 37615809 DOI: 10.1007/s10488-023-01292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
The supply / demand issue in behavioral health care is a well-established fact, and the mental health toll of the COVID-19 pandemic continues to add challenges to an already taxed system. Existing healthcare models are not set up to adequately address the increasing mental health related needs. As such, innovative models are needed to provide patients with access to appropriate, evidence-based behavioral health care within routine clinical care. This paper introduces Precision Behavioral Health (PBH) as an example of such a model. PBH is an innovative, digital first care delivery model that provides an ecosystem of evidence-based digital mental health interventions to patients as a frontline behavioral health treatment within routine care in a large multispecialty group medical center in the United States. This paper describes the implementation of PBH within a practice research network set-up as part of an integrated behavioral health department. We will present how our team leveraged the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance; "What is RE-AIM?," n.d.) implementation science framework, which emphasizes the design, dissemination, and implementation processes at the individual, staff, and organizational levels, to prioritize key implementation constructs to enhance the successful integration of PBH within routine care. We describe how each of these constructs were operationalized to aid data gathering for rapid evaluation and lessons learned. We discuss the benefits of these types of initiatives across multiple stakeholders including patients, providers, organizations, payers, and digital intervention vendors.
Collapse
Affiliation(s)
- Soo Jeong Youn
- Reliant Medical Group, OptumCare, Harvard Medical School, Worcester, MA, USA.
| | - Brittany Jaso
- Reliant Medical Group, OptumCare, Worcester, MA, USA
| | - Mara Eyllon
- Reliant Medical Group, OptumCare, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Pratha Sah
- Reliant Medical Group, OptumCare, Worcester, MA, USA
| | - Georgia Hoyler
- Corporate Office of Strategy & Innovation, United Health Group, Minnetonka, MN, USA
| | - John Ben Barnes
- Reliant Medical Group, OptumCare, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kevin Jarama
- Corporate Office of Strategy & Innovation, United Health Group, Minnetonka, MN, USA
| | - Lily Murillo
- Reliant Medical Group, OptumCare, Worcester, MA, USA
| | - Heather O'Dea
- Reliant Medical Group, OptumCare, Worcester, MA, USA
| | - Laura Orth
- Reliant Medical Group, OptumCare, Worcester, MA, USA
| | | | | | - George Welch
- Reliant Medical Group, OptumCare, Worcester, MA, USA
| | | |
Collapse
|
36
|
Wilhelm S, Bernstein EE, Bentley KH, Snorrason I, Hoeppner SS, Klare D, Greenberg JL, Weingarden H, McCoy TH, Harrison O. Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App-Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial. JMIR Ment Health 2024; 11:e53998. [PMID: 38592771 DOI: 10.2196/53998] [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: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. OBJECTIVE This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. METHODS This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. RESULTS Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants' depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. CONCLUSIONS The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329.
Collapse
Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily E Bernstein
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kate H Bentley
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ivar Snorrason
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Susanne S Hoeppner
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Dalton Klare
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer L Greenberg
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hilary Weingarden
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas H McCoy
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | |
Collapse
|
37
|
Embaye J, de Wit M, Snoek F. A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands. JMIR Diabetes 2024; 9:e52923. [PMID: 38568733 PMCID: PMC11024740 DOI: 10.2196/52923] [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: 09/19/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability. OBJECTIVE This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands. METHODS Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the "Problem Areas in Diabetes" (PAID-11) questionnaire (diabetes distress), the "World Health Organization Well-being Index" (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the "Checklist Individual Strength" (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback. RESULTS In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization. CONCLUSIONS Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial.
Collapse
Affiliation(s)
- Jiska Embaye
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
38
|
Stade EC, Stirman SW, Ungar LH, Boland CL, Schwartz HA, Yaden DB, Sedoc J, DeRubeis RJ, Willer R, Eichstaedt JC. Large language models could change the future of behavioral healthcare: a proposal for responsible development and evaluation. NPJ MENTAL HEALTH RESEARCH 2024; 3:12. [PMID: 38609507 PMCID: PMC10987499 DOI: 10.1038/s44184-024-00056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/30/2024] [Indexed: 04/14/2024]
Abstract
Large language models (LLMs) such as Open AI's GPT-4 (which power ChatGPT) and Google's Gemini, built on artificial intelligence, hold immense potential to support, augment, or even eventually automate psychotherapy. Enthusiasm about such applications is mounting in the field as well as industry. These developments promise to address insufficient mental healthcare system capacity and scale individual access to personalized treatments. However, clinical psychology is an uncommonly high stakes application domain for AI systems, as responsible and evidence-based therapy requires nuanced expertise. This paper provides a roadmap for the ambitious yet responsible application of clinical LLMs in psychotherapy. First, a technical overview of clinical LLMs is presented. Second, the stages of integration of LLMs into psychotherapy are discussed while highlighting parallels to the development of autonomous vehicle technology. Third, potential applications of LLMs in clinical care, training, and research are discussed, highlighting areas of risk given the complex nature of psychotherapy. Fourth, recommendations for the responsible development and evaluation of clinical LLMs are provided, which include centering clinical science, involving robust interdisciplinary collaboration, and attending to issues like assessment, risk detection, transparency, and bias. Lastly, a vision is outlined for how LLMs might enable a new generation of studies of evidence-based interventions at scale, and how these studies may challenge assumptions about psychotherapy.
Collapse
Affiliation(s)
- Elizabeth C Stade
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Institute for Human-Centered Artificial Intelligence & Department of Psychology, Stanford University, Stanford, CA, USA.
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Lyle H Ungar
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Cody L Boland
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - H Andrew Schwartz
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - David B Yaden
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - João Sedoc
- Department of Technology, Operations, and Statistics, New York University, New York, NY, USA
| | - Robert J DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robb Willer
- Department of Sociology, Stanford University, Stanford, CA, USA
| | - Johannes C Eichstaedt
- Institute for Human-Centered Artificial Intelligence & Department of Psychology, Stanford University, Stanford, CA, USA.
| |
Collapse
|
39
|
Schueller SM, Wasil AR, Bunyi J, DeRubeis RJ, Weisz JR. Mental Health Apps for Children and Adolescents: A Clinician-Friendly Review. J Am Acad Child Adolesc Psychiatry 2024; 63:389-392.e1. [PMID: 38123125 DOI: 10.1016/j.jaac.2023.07.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 07/03/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
Mobile apps for mental health and wellness (MH apps) have the potential to support youth mental health, expanding access to the large proportion of youth with mental health concerns who do not access formal treatment. Survey data suggest that young people are highly interested in MH apps, with minoritized youth (eg, LGBTQ individuals) and youth with elevated depressive symptoms reporting especially high rates of downloading MH apps.1 In addition, systematic reviews and meta-analyses suggest that MH apps can be effective.2 Although many popular MH apps do not have direct empirical evidence supporting their efficacy,3 they often include elements of empirically supported treatments for children and adolescents.4 The MH app space moves at a fast pace, making it difficult to stay up-to-date. More than 10,000 MH apps exist, with hundreds released each year.5 Even interested clinicians may, understandably, not have time to sort through the large number of apps, scientific papers, and app directories. Furthermore, these resources are rarely designed to offer clear, actionable advice for clinicians. Clinicians could benefit from information and guidance to help patients safely navigate MH apps and to best use MH apps in treatment. Here, we provide 3 key points about youth MH apps ("takeaways"), each with an actionable implication for clinicians ("action items"). We also provide examples of specific questions for clinicians to support their use of MH apps with children and adolescents (Table 1). More information regarding where we derived these recommendations is available in Supplement 1, available online.
Collapse
Affiliation(s)
| | - Akash R Wasil
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Bunyi
- University of California - Irvine, California; University of Southern California, Los Angeles, California
| | | | | |
Collapse
|
40
|
Ahuvia IL, Sung JY, Dobias ML, Nelson BD, Richmond LL, London B, Schleider JL. College student interest in teletherapy and self-guided mental health supports during the COVID-19 pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:940-946. [PMID: 35427460 DOI: 10.1080/07448481.2022.2062245] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 01/24/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
Objective The COVID-19 pandemic has worsened college students' mental health while simultaneously creating new barriers to traditional in-person care. Teletherapy and online self-guided mental health supports are two potential avenues for addressing unmet mental health needs when face-to-face services are less accessible, but little is known about factors that shape interest in these supports. Participants: 1,224 U.S. undergraduate students (mean age = 20.7; 73% female; 40% White) participated. Methods: Students completed an online questionnaire assessing interest in teletherapy and self-guided supports. Predictors included age, sex, race/ethnicity, sexual minority status, and anxiety and depression symptomatology. Results: Interest rates were 20% and 25% for at-cost supports (teletherapy and online self-help, respectively) and 70% and 72% for free supports (teletherapy and online self-help, respectively). Patterns emerged by age, anxiety symptom severity, and race/ethnicity. Conclusions: Results may inform universities' efforts to optimize students' engagement with nontraditional, digital mental health supports, including teletherapy and self-guided programs. The SARS-CoV2 (COVID-19) pandemic has taken a severe toll on public health, with effects reaching far beyond unprecedented illness and mortality. Levels of mental health difficulties appear to be rising broadly as the pandemic has progressed, both in the general U.S. population and among college students specifically.1,2 The COVID-19 pandemic and its repercussions may undermine college student mental health in myriad ways.2 Concurrently, students now face the potential for serious illness, loss of loved ones, financial strain, social isolation, loss of on-campus resources, and sudden disruption of routines-creating a "perfect storm" for the emergence or exacerbation of psychological distress.
Collapse
Affiliation(s)
- Isaac L Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Mallory L Dobias
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Lauren L Richmond
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Bonita London
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
41
|
Clement A, Ravet M, Stanger C, Gabrielli J. Feasibility, usability, and acceptability of MobileCoach-Teen: A smartphone app-based preventative intervention for risky adolescent drinking behavior. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209275. [PMID: 38110119 PMCID: PMC11027171 DOI: 10.1016/j.josat.2023.209275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Older adolescence (ages 15-18) is a critical period for experimentation with substance use, especially alcohol. Adolescent drinking poses hazards to physical and mental health, amplifies risk associated with other activities typically initiated during this life stage (e.g., driving, sexual activity), and is associated with adverse outcomes in adolescence and adulthood. Existing preventative interventions are expensive and have questionable long-term efficacy. Digital interventions may represent an accessible and personalized approach to providing preventative intervention content to youth. METHODS This study recruited 29 adolescents aged 16-18 (M = 17.24, SD = 0.74) for a pilot feasibility trial of the MobileCoach-Teen (MC-Teen) smartphone app-based intervention. The study team randomized participants to receive either the alcohol intervention (MC-Teen) or attention control pseudo-intervention (MC-Fit). MC-Teen participants received 12 weeks of content adapted from a prior Swiss-based trial of a preventative alcohol intervention. Participants provided qualitative and quantitative feedback at baseline, via six biweekly surveys during and post-intervention. RESULTS Both groups rated the application as easy to download (M = 4.31, SD = 0.93; 5-point Likert). All participants completed the baseline survey in less than the estimated time of 10 min (M = 7:42, SD = 2:15) and rated the survey as easy to complete (M = 4.69, SD = 0.60; 5-point Likert). MC-Teen participants favorably assessed application user experience, message user experience, and digital working alliance with application. Qualitative themes included a desire for increased rate/amount and diversity of content, greater representation via coach options, user interface/user experience improvements, and additional features. CONCLUSION The MC-Teen intervention is feasible and acceptable based on a pilot feasibility trial with a sample of U.S. adolescents.
Collapse
Affiliation(s)
- Alex Clement
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, United States of America.
| | - Mariah Ravet
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America
| | - Catherine Stanger
- Geisel School of Medicine, Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, United States of America
| | - Joy Gabrielli
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America
| |
Collapse
|
42
|
de Azevedo Cardoso T, Kochhar S, Torous J, Morton E. Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions. JMIR Ment Health 2024; 11:e58631. [PMID: 38557724 PMCID: PMC11019420 DOI: 10.2196/58631] [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: 03/20/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Bipolar disorder (BD) impacts over 40 million people around the world, often manifesting in early adulthood and substantially impacting the quality of life and functioning of individuals. Although early interventions are associated with a better prognosis, the early detection of BD is challenging given the high degree of similarity with other psychiatric conditions, including major depressive disorder, which corroborates the high rates of misdiagnosis. Further, BD has a chronic, relapsing course, and the majority of patients will go on to experience mood relapses despite pharmacological treatment. Digital technologies present promising results to augment early detection of symptoms and enhance BD treatment. In this editorial, we will discuss current findings on the use of digital technologies in the field of BD, while debating the challenges associated with their implementation in clinical practice and the future directions.
Collapse
Affiliation(s)
- Taiane de Azevedo Cardoso
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- JMIR Publications, Toronto, ON, Canada
| | | | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emma Morton
- School of Psychological Sciences, Monash University, Clayton, Australia
| |
Collapse
|
43
|
Griffith F, Ash G, Augustine M, Latimer L, Verne N, Redeker N, O'Malley S, DeMartini K, Fucito L. Leveraging Natural Language Processing to Evaluate Young Adults' User Experiences with a Digital Sleep Intervention for Alcohol Use. RESEARCH SQUARE 2024:rs.3.rs-3977182. [PMID: 38585984 PMCID: PMC10996819 DOI: 10.21203/rs.3.rs-3977182/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Evaluating user experiences with digital interventions is critical to increase uptake and adherence, but traditional methods have limitations. We incorporated natural language processing (NLP) with convergent mixed methods to evaluate a personalized feedback and coaching digital sleep intervention for alcohol risk reduction: 'Call it a Night' (CIAN; N = 120). In this randomized clinical trial with young adults with heavy drinking, control conditions were A + SM: web-based advice + active and passive monitoring; and A: advice + passive monitoring. Findings converged to show that the CIAN treatment condition group found feedback and coaching most helpful, whereas participants across conditions generally found advice helpful. Further, most participants across groups were interested in varied whole-health sleep-related factors besides alcohol use (e.g., physical activity), and many appreciated increased awareness through monitoring with digital tools. All groups had high adherence, satisfaction, and reported feasibility, but participants in CIAN and A + SM reported significantly higher effectiveness than those in A. NLP corroborated positive sentiments across groups and added critical insight that sleep, not alcohol use, was a main participant motivator. Digital sleep interventions are an acceptable, novel alcohol treatment strategy, and improving sleep and overall wellness may be important motivations for young adults. Further, NLP provides an efficient convergent method for evaluating experiences with digital interventions.
Collapse
|
44
|
Vereschagin M, Wang AY, Richardson CG, Xie H, Munthali RJ, Hudec KL, Leung C, Wojcik KD, Munro L, Halli P, Kessler RC, Vigo DV. Effectiveness of the Minder Mobile Mental Health and Substance Use Intervention for University Students: Randomized Controlled Trial. J Med Internet Res 2024; 26:e54287. [PMID: 38536225 PMCID: PMC11007604 DOI: 10.2196/54287] [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: 11/05/2023] [Revised: 12/05/2023] [Accepted: 02/17/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND University attendance represents a transition period for students that often coincides with the emergence of mental health and substance use challenges. Digital interventions have been identified as a promising means of supporting students due to their scalability, adaptability, and acceptability. Minder is a mental health and substance use mobile app that was codeveloped with university students. OBJECTIVE This study aims to examine the effectiveness of the Minder mobile app in improving mental health and substance use outcomes in a general population of university students. METHODS A 2-arm, parallel-assignment, single-blinded, 30-day randomized controlled trial was used to evaluate Minder using intention-to-treat analysis. In total, 1489 participants were recruited and randomly assigned to the intervention (n=743, 49.9%) or waitlist control (n=746, 50.1%) condition. The Minder app delivers evidence-based content through an automated chatbot and connects participants with services and university social groups. Participants are also assigned a trained peer coach to support them. The primary outcomes were measured through in-app self-assessments and included changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured using the 7-item General Anxiety Disorder scale, 9-item Patient Health Questionnaire, and US Alcohol Use Disorders Identification Test-Consumption Scale, respectively, from baseline to 30-day follow-up. Secondary outcomes included measures related to changes in the frequency of substance use (cannabis, alcohol, opioids, and nonmedical stimulants) and mental well-being. Generalized linear mixed-effects models were used to examine each outcome. RESULTS In total, 79.3% (589/743) of participants in the intervention group and 83% (619/746) of participants in the control group completed the follow-up survey. The intervention group had significantly greater average reductions in anxiety symptoms measured using the 7-item General Anxiety Disorder scale (adjusted group mean difference=-0.85, 95% CI -1.27 to -0.42; P<.001; Cohen d=-0.17) and depressive symptoms measured using the 9-item Patient Health Questionnaire (adjusted group mean difference=-0.63, 95% CI -1.08 to -0.17; P=.007; Cohen d=-0.11). A reduction in the US Alcohol Use Disorders Identification Test-Consumption Scale score among intervention participants was also observed, but it was not significant (P=.23). Statistically significant differences in favor of the intervention group were found for mental well-being and reductions in the frequency of cannabis use and typical number of drinks consumed. A total of 77.1% (573/743) of participants in the intervention group accessed at least 1 app component during the study period. CONCLUSIONS In a general population sample of university students, the Minder app was effective in reducing symptoms of anxiety and depression, with provisional support for increasing mental well-being and reducing the frequency of cannabis and alcohol use. These findings highlight the potential ability of e-tools focused on prevention and early intervention to be integrated into existing university systems to support students' needs. TRIAL REGISTRATION ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/49364.
Collapse
Affiliation(s)
- Melissa Vereschagin
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Angel Y Wang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris G Richardson
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hui Xie
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Richard J Munthali
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristen L Hudec
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Calista Leung
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katharine D Wojcik
- Menninger Department of Psychiatry & Behavioural Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Lonna Munro
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Priyanka Halli
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Daniel V Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
45
|
Macrynikola N, Mir Z, Gopal T, Rodriguez E, Li S, Cox M, Yeh G, Torous J. The impact of mindfulness apps on psychological processes of change: a systematic review. NPJ MENTAL HEALTH RESEARCH 2024; 3:14. [PMID: 38609511 PMCID: PMC10955957 DOI: 10.1038/s44184-023-00048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/08/2023] [Indexed: 04/14/2024]
Abstract
Mindfulness-based interventions (MBIs) have demonstrated therapeutic efficacy for various psychological conditions, and smartphone apps that facilitate mindfulness practice can enhance the reach and impact of MBIs. The goal of this review was to summarize the published evidence on the impact of mindfulness apps on the psychological processes known to mediate transdiagnostic symptom reduction after mindfulness practice. A literature search from January 1, 1993, to August 7, 2023 was conducted on three databases, and 28 randomized controlled trials involving 5963 adults were included. Across these 28 studies, 67 outcome comparisons were made between a mindfulness app group and a control group. Between-group effects tended to favor the mindfulness app group over the control group in three psychological process domains: repetitive negative thinking, attention regulation, and decentering/defusion. Findings were mixed in other domains (i.e., awareness, nonreactivity, non-judgment, positive affect, and acceptance). The range of populations examined, methodological concerns across studies, and problems with sustained app engagement likely contributed to mixed findings. However, effect sizes tended to be moderate to large when effects were found, and gains tended to persist at follow-up assessments two to six months later. More research is needed to better understand the impact of these apps on psychological processes of change. Clinicians interested in integrating apps into care should consider app-related factors beyond evidence of a clinical foundation and use app databases to identify suitable apps for their patients, as highlighted at the end of this review.
Collapse
Affiliation(s)
- Natalia Macrynikola
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
| | - Zareen Mir
- Teacher's College, Columbia University, New York, NY, USA
| | | | | | - Sunnie Li
- Northeastern University, Boston, MA, USA
| | - Milann Cox
- Penn State College of Medicine, Hershey, PA, USA
| | - Gloria Yeh
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
46
|
Bell IH, Eisner E, Allan S, Cartner S, Torous J, Bucci S, Thomas N. Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis. Schizophr Bull 2024; 50:238-265. [PMID: 37606276 PMCID: PMC10919779 DOI: 10.1093/schbul/sbad127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, this systematic review aimed to summarize the methodological approaches used for positive symptoms in psychosis populations and evaluate feasibility with a focus on completion rates. METHODS A systematic review of PubMed, PsycINFO, MEDLINE, Web of Science, EBSCOhost, and Embase databases using search terms related to EMA and psychosis was conducted. Excluding duplicate samples, a meta-analysis was conducted of EMA survey completion rates and meta-regression to examine predictors of completion. RESULTS Sixty-eight studies were included in the review. Characteristics and reporting of EMA methodologies were variable across studies. The meta-mean EMA survey completion computed from the 39 unique studies that reported a mean completion rate was 67.15% (95% CI = 62.3, 71.9), with an average of 86.25% of the sample meeting a one-third EMA completion criterion. No significant predictors of completion were found in the meta-regression. A variety of EMA items were used to measure psychotic experiences, of which few were validated. CONCLUSIONS EMA methods have been widely applied in psychosis studies using a range of protocols. Completion rates are high, providing clear evidence of feasibility in psychosis populations. Recommendations for reporting in future studies are provided.
Collapse
Affiliation(s)
- Imogen H Bell
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, Zochonis Building, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | | | - Sharla Cartner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, Zochonis Building, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| |
Collapse
|
47
|
Lukka L, Karhulahti VM, Bergman VR, Palva JM. Measuring digital intervention user experience with a novel ecological momentary assessment (EMA) method, CORTO. Internet Interv 2024; 35:100706. [PMID: 38274123 PMCID: PMC10808917 DOI: 10.1016/j.invent.2023.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Digital interventions often suffer from low usage, which may reflect insufficient attention to user experience. Moreover, the existing evaluation methods have limited applicability in the remote study of user experience of complex interventions that have expansive content and that are used over an extensive period of time. To alleviate these challenges, we describe here a novel qualitative Ecological Momentary Assessment (EMA) method: the CORTO method (Contextual, One-item, Repeated, Timely, Open-ended). We used it to gather digital intervention user experience data from Finnish adults (n = 184) who lived with interview-confirmed major depressive disorder (MDD) and took part in a randomized controlled trial (RCT) that studied the efficacy of a novel 12-week game-based digital intervention for depression. A second dataset on user experience was gathered with retrospective interviews (n = 22). We inductively coded the CORTO method and retrospective interview data, which led to four user experience categories: (1) contextual use, (2) interaction-elicited emotional experience, (3) usability, and (4) technical issues. Then, we used the created user experience categories and Template Analysis to analyze both datasets together, and reported the results qualitatively. Finally, we compared the two datasets with each other. We found that the data generated with the CORTO method offered more insights into usability and technical categories than the interview data that particularly illustrated the contextual use. The emotional valence of the interview data was more positive compared with the CORTO data. Both the CORTO and interview data detected 55 % of the micro-level categories; 20 % of micro-level categories were only detected by the CORTO data and 25 % only by the interview data. We found that the during-intervention user experience measurement with the CORTO method can provide intervention-specific insights, and thereby further the iterative user-centered intervention development. Overall, these findings highlight the impact of evaluation methods on the categories and qualities of insights acquired in intervention research.
Collapse
Affiliation(s)
- Lauri Lukka
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | | | - Vilma-Reetta Bergman
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | - J. Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Finland
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom
| |
Collapse
|
48
|
Moggia D, Lutz W, Kazantzis N, Schwartz B, Bakker D. Symptom Reduction and Engagement in a Cognitive-Behavioral Mobile Phone App: A Study of User Profiling to Determine Prognostic Indicators. Behav Ther 2024; 55:217-232. [PMID: 38418036 DOI: 10.1016/j.beth.2023.05.014] [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: 10/18/2022] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE We investigated the presence of latent transition profiles in a sample of users of a cognitive-behavioral mental health app for the general population. Users' baseline characteristics were used as predictors of the profiles. The role of engagement with the app in the transition profiles was examined. METHOD A total of 541 users completed the Patient Health Questionnaire-9 and the General Anxiety Disorder-7 when started using the app and 30 days after. Random-Intercept Latent Transition Analysis was implemented to identify users' profiles and transition patterns as classes. The age of the users and the Emotional Self-Awareness Scale-Revised (ESAS-R) were used as predictors of class membership at baseline. The Homework Rating Scale-Mobile Application (HRS-MA; as a measure of engagement) was used as a predictor of class membership at 30 days of app use. RESULTS A 3-class solution was obtained according to the severity of symptoms (from mild to moderately severe). Age and ESAS-R predicted class membership initially; the higher the age and ESAS-R, the higher the probability of starting using the app with lower distress levels. The HRS-MA predicted class membership at 30 days of app use; the higher the engagement for more symptomatic and younger users, the higher the probability of improvement. However, older users tended to engage less. CONCLUSION Our findings underpin the relevance of easily accessible digital interventions for young adults with mild to moderate mental health problems. Further studies and developments are required to enhance these apps for older cohorts.
Collapse
Affiliation(s)
| | | | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit; Beck Institute for Cognitive Behavior Therapy
| | | | - David Bakker
- Monash University; University of Tasmania; Cognitive Behavior Therapy Research Unit
| |
Collapse
|
49
|
Lo B, Shin HD, Kemp J, Munnery M, Chen S, Ma C, Jankowicz D, Mehta R, Harris A, Sakal M, Pundit R, Chung K, Kuziemsky C, Rossetti S, Strudwick G. Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:217-227. [PMID: 37644885 PMCID: PMC10874602 DOI: 10.1177/07067437231197060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aims to understand whether higher use of a patient portal can have an impact on mental health functioning and recovery. METHOD A mixed methods approach was used for this study. In 2019-2021, patients with mental health diagnoses at outpatient clinics in an academic centre were invited to complete World Health Organization Disability Assessment Scale 12 (WHODAS-12) and Mental Health Recovery Measure surveys at baseline, 3 months, and 6 months after signing up for the portal. At the 3-month time point, patients were invited to a semistructured interview with a member of the team to contextualize the findings obtained from the surveys. Analytics data was also collected from the platform to understand usage patterns on the portal. RESULTS Overall, 113 participants were included in the analysis. There was no significant change in mental health functioning and recovery scores over the 6-month period. However, suboptimal usage was observed as 46% of participants did not complete any tasks within the portal. Thirty-five participants had low use of the portal (1-9 interactions) and 18 participants had high usage (10+ interactions). There were also no differences in mental health functioning and recovery scores between low and high users of the portal. Qualitative interviews highlighted many opportunities where the portal can support overall functioning and mental health recovery. CONCLUSIONS Collectively, this study suggests that higher use of a portal had no impact, either positive or negative, on mental health outcomes. While it may offer convenience and improved patient satisfaction, adequate support is needed to fully enable these opportunities for patient care. As the type of interaction with the portal was not specifically addressed, future work should focus on looking at ways to support patient engagement and portal usage throughout their care journey.
Collapse
Affiliation(s)
- Brian Lo
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Information Management & Technology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jessica Kemp
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikayla Munnery
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Damian Jankowicz
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rohan Mehta
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Harris
- Interprofessional Practice, Unity Health Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Moshe Sakal
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ryan Pundit
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Craig Kuziemsky
- Office of Research, MacEwan University, Edmonton, AB, Canada
| | - Sarah Rossetti
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
50
|
Shinn EH, Garden AS, Peterson SK, Leupi DJ, Chen M, Blau R, Becerra L, Rafeedi T, Ramirez J, Rodriquez D, VanFossen F, Zehner S, Mercier PP, Wang J, Hutcheson K, Hanna E, Lipomi DJ. Iterative Patient Testing of a Stimuli-Responsive Swallowing Activity Sensor to Promote Extended User Engagement During the First Year After Radiation: Multiphase Remote and In-Person Observational Cohort Study. JMIR Cancer 2024; 10:e47359. [PMID: 38416544 PMCID: PMC10938225 DOI: 10.2196/47359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Frequent sensor-assisted monitoring of changes in swallowing function may help improve detection of radiation-associated dysphagia before it becomes permanent. While our group has prototyped an epidermal strain/surface electromyography sensor that can detect minute changes in swallowing muscle movement, it is unknown whether patients with head and neck cancer would be willing to wear such a device at home after radiation for several months. OBJECTIVE We iteratively assessed patients' design preferences and perceived barriers to long-term use of the prototype sensor. METHODS In study 1 (questionnaire only), survivors of pharyngeal cancer who were 3-5 years post treatment and part of a larger prospective study were asked their design preferences for a hypothetical throat sensor and rated their willingness to use the sensor at home during the first year after radiation. In studies 2 and 3 (iterative user testing), patients with and survivors of head and neck cancer attending visits at MD Anderson's Head and Neck Cancer Center were recruited for two rounds of on-throat testing with prototype sensors while completing a series of swallowing tasks. Afterward, participants were asked about their willingness to use the sensor during the first year post radiation. In study 2, patients also rated the sensor's ease of use and comfort, whereas in study 3, preferences were elicited regarding haptic feedback. RESULTS The majority of respondents in study 1 (116/138, 84%) were willing to wear the sensor 9 months after radiation, and participant willingness rates were similar in studies 2 (10/14, 71.4%) and 3 (12/14, 85.7%). The most prevalent reasons for participants' unwillingness to wear the sensor were 9 months being excessive, unwanted increase in responsibility, and feeling self-conscious. Across all three studies, the sensor's ability to detect developing dysphagia increased willingness the most compared to its appearance and ability to increase adherence to preventive speech pathology exercises. Direct haptic signaling was also rated highly, especially to indicate correct sensor placement and swallowing exercise performance. CONCLUSIONS Patients and survivors were receptive to the idea of wearing a personalized risk sensor for an extended period during the first year after radiation, although this may have been limited to well-educated non-Hispanic participants. A significant minority of patients expressed concern with various aspects of the sensor's burden and its appearance. TRIAL REGISTRATION ClinicalTrials.gov NCT03010150; https://clinicaltrials.gov/study/NCT03010150.
Collapse
Affiliation(s)
- Eileen H Shinn
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K Peterson
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Dylan J Leupi
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, United States
| | - Minxing Chen
- Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Rachel Blau
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Laura Becerra
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, United States
| | - Tarek Rafeedi
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Julian Ramirez
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Daniel Rodriquez
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Finley VanFossen
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Sydney Zehner
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Patrick P Mercier
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, United States
| | - Joseph Wang
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Kate Hutcheson
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Ehab Hanna
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Darren J Lipomi
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| |
Collapse
|