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Wang N. The role of psychotherapy apps during teaching solo vocals: The specifics of students' psychological preparation for performing in front of an audience. Acta Psychol (Amst) 2024; 249:104417. [PMID: 39121613 DOI: 10.1016/j.actpsy.2024.104417] [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: 01/10/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
This study aimed to determine the effectiveness of a self-help application to reduce performance-related excitement in students of solo vocals in higher education institutions. The study participants (n = 219) used the mobile application during 6 weeks. Statistically significant effect of the intervention was achieved by Negative cognitions, Psychological vulnerability, and Anxiety perception constructs. The study also examines the influence of sociodemographic and personal characteristics on anxiety. Gender, graduate status, and self-efficacy were statistically significant variables when using the psychological self-help application. The investigation failed to disclose any significant impact of performance experience. Psychological self-help applications can be used in vocal/music education as a low-threshold intervention to reduce anxiety symptoms. The findings of the study introduce new data into approaches to the treatment of anxiety and expand the understanding of the characteristic features of singer training.
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Affiliation(s)
- Ning Wang
- College of Music and Dance, Henan Normal University, No. 46, Jianshe East Road, Xinxiang 453007, Henan Province, China.
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Chan SCY, Huang QL. The mediating role of self-esteem in the relationship between hope and life satisfaction among university students during a global health crisis. Health Sci Rep 2024; 7:e2311. [PMID: 39135702 PMCID: PMC11318025 DOI: 10.1002/hsr2.2311] [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: 04/17/2024] [Revised: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
Background and Aims The worldwide health emergency sparked by the COVID-19 pandemic has deeply shaken educational environments, posing unprecedented challenges to university students' well-being. While individual links between self-esteem, hope, and well-being are established, their combined impacts during crises remain underexplored. Our study addresses this gap by investigating the interplay among hope, self-esteem, and life satisfaction within the context of university students navigating the challenges posed by the pandemic. Methods Conducting an online cross-sectional self-administered survey during Hong Kong's third pandemic wave, we measured hope, self-esteem, and life satisfaction using validated scales. Three hundred and fifteen university students (211 females; mean age = 22.08; SD = 2.74) participated. Results Through multiple regression and mediation analyses, our findings indicate that university students with elevated hope and self-esteem scored higher on life satisfaction measures. Specifically, our analysis revealed that self-esteem may serve as a partial mediator in the relationship between hope and life satisfaction, highlighting how heightened hope indirectly enhances life satisfaction by strengthening self-esteem. Conclusion This study reveals intricate relationships among hope, self-esteem, and life satisfaction in university students, particularly during external adversities like the COVID-19 pandemic. The implications extend to mental health interventions, emphasizing the potential benefits of cultivating hope and self-esteem to enhance life satisfaction among university students confronting formidable challenges.
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Affiliation(s)
- Stephen Cheong Yu Chan
- Felizberta Lo Padilla Tong School of Social SciencesSaint Francis UniversityTseung Kwan OHong Kong
| | - Qi Lu Huang
- Department of Social and Behavioural SciencesCity University of Hong KongKowloonHong Kong
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Rolvien L, Buddeberg L, Gehlenborg J, Borsutzky S, Moritz S. A Self-Guided Internet-Based Intervention for the Reduction of Gambling Symptoms: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417282. [PMID: 38904962 PMCID: PMC11193125 DOI: 10.1001/jamanetworkopen.2024.17282] [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: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 06/22/2024] Open
Abstract
Importance Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments. Objective To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators. Design, Setting, and Participants This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments. Intervention The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing. Main Outcome and Measures The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction. Results A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group. Conclusions and Relevance In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling. Trial Registration bfarm.de Identifier: DRKS00024840.
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Affiliation(s)
- Lara Rolvien
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Buddeberg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Swantje Borsutzky
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Moritz S, Grudzień DP, Gawęda Ł, Aleksandrowicz A, Balzan R, Shaffy A, Bruhns A, Borsutzky SM, Rolvien L. A randomized controlled trial on COGITO, a free self-help smartphone app to enhance mental well-being. J Psychiatr Res 2024; 174:254-257. [PMID: 38670060 DOI: 10.1016/j.jpsychires.2024.04.021] [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: 02/10/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Smartphone apps may help to prevent the transition from minor to severe mental health problems. We compared a free self-help smartphone app (COGITO; www.uke.de/cogito_app) against a wait-list condition for the improvement of self-esteem and depression. METHODS The Rosenberg Self-Esteem Scale represented the primary outcome in this controlled trial. The final sample (n = 213) was randomly assigned to either the app or to the control condition. RESULTS The app condition significantly improved the primary outcome relative to controls for all analyses. Satisfaction of completers was high. The present results warrant independent replication; the retention rate needs to be increased to allow solid inferences about acceptance. CONCLUSIONS The present study demonstrates that the COGITO app may represent an effective self-help tool for psychological problems.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Dominik Paweł Grudzień
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Adrianna Aleksandrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Ryan Balzan
- College of Education, Psychology & Social Work, Flinders University, Australia
| | - Athif Shaffy
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Bruhns
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Swantje Marie Borsutzky
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Rolvien
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sriati A, Kurniawan K, Senjaya S, Khoirunnisa K, Muslim RNI, Putri AM, Aghnia N. The Effectiveness of Digital-Based Psychotherapy in Overcoming Psychological Problems in College Students During the COVID-19 Pandemic: A Scoping Review. J Holist Nurs 2024; 42:S26-S39. [PMID: 37097892 PMCID: PMC10130939 DOI: 10.1177/08980101231162990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Purpose: This review aims to determine the effectiveness of the application of digital-based psychotherapy in overcoming the psychological problems of college students during the COVID-19 pandemic. Methods: Several databases consisting of EBSCO-Host CINAHL, PubMed, Scopus, Sage Journal, and Taylor and Francis were used in the search process and resulted in experimental studies focusing on the effectiveness of the application of digital-based psychotherapy during the COVID-19 pandemic timeline (2019-2022). Descriptive and exploratory analyses were performed based on the data set from the study. Results: A total of 12 articles were included in the review. The digital psychotherapy interventions found are diverse including websites, smartphone applications, and video conferencing with the types of therapies provided in the form of, Cognitive Therapy, Cognitive-Behavioral Therapy, Psychodynamic Therapy, and Mindfulness Therapy. Each intervention has a diverse duration and frequency adjusting to the type of therapy given. Digital psychotherapeutic interventions are effective in reducing mental health problems among college students during the COVID-19 pandemic. Conclusions: The use of digital psychotherapy can be used as a prevention and support service for students who experience psychological problems during the COVID-19 pandemic. The combination of the use of digital media with video conferencing can be considered to increase the effectiveness of this service. Nurses need to understand how the procedure for implementing digital-based psychotherapy is to improve the quality of mental care services as an effort to prevent and support students. More research is needed to find out the effectiveness of the use of digital psychotherapy services and how they impact the psychological well-being of students holistically.
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Bosbach K, Martin A, Stricker J, Schoenenberg K. Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training. Behav Cogn Psychother 2024; 52:226-242. [PMID: 38407138 DOI: 10.1017/s1352465824000110] [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: 02/27/2024]
Abstract
BACKGROUND Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD). AIMS For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms. METHOD The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training. RESULTS In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high. CONCLUSIONS Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.
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Affiliation(s)
- Katharina Bosbach
- University of Wuppertal, School of Human and Social Sciences, Department of Clinical Psychology and Psychotherapy, Wuppertal, Germany
| | - Alexandra Martin
- University of Wuppertal, School of Human and Social Sciences, Department of Clinical Psychology and Psychotherapy, Wuppertal, Germany
| | - Johannes Stricker
- University of Wuppertal, School of Human and Social Sciences, Department of Clinical Psychology and Psychotherapy, Wuppertal, Germany
| | - Katrin Schoenenberg
- University of Wuppertal, School of Human and Social Sciences, Department of Clinical Psychology and Psychotherapy, Wuppertal, Germany
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Haaf R, Vock P, Wächtershäuser N, Correll CU, Köhler S, Klein JP. [Efficacy of internet-based interventions for depression available in Germany-A systematic review and meta-analysis]. DER NERVENARZT 2024; 95:206-215. [PMID: 38260995 PMCID: PMC10914865 DOI: 10.1007/s00115-023-01587-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Internet-based interventions (IBIs) for the treatment of depression have been found to have positive effects in international meta-analyses; however, it is unclear whether these effects also extend to IBIs specifically available in Germany. The aim of this meta-analysis was to estimate the immediate effects and the long-term effects of IBIs available in Germany free of charge or available on prescription and covered by the public health insurances as so-called digital health applications (DiGAs) and to compare the efficacy of DiGAs and freely available IBIs. METHOD A systematic literature search and random-effects meta-analysis were performed (preregistration: INPLASY202250070). Randomized controlled trials (RCTs) of IBIs freely available in Germany or as DiGA in adults with elevated depressive symptoms were compared with active and inactive controls available at the time of the survey in May 2022. RESULTS A total of six interventions were identified: COGITO, deprexis, iFightDepression, moodgym, Novego, and Selfapy. The pooled effect size of a total of 28 studies with 13,413 participants corresponded to an effect of Cohen's d = 0.42, (95% confidence interval, CI: 0.31-0.54, I2 = 81%). The analysis of long-term effects showed a smaller effect size of d = 0.29, (95% CI: 0.21-0.37, I2 = 22%, N = 10). Subgroup analyses indicated a possible superiority of the three interventions listed in the DiGA directory (d = 0.56, 95% CI: 0.38-0.74, I2 = 83%, N = 15) compared to the three freely available IBIs (d = 0.24, 95% CI: 0.14-0.33, I2 = 44%, N = 13, p = 0.002). CONCLUSION The IBIs for depressive disorders available in Germany are effective and can therefore be used in the treatment of people with a depressive disorder; however, it is possible that not all interventions are equally effective.
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Affiliation(s)
- Raoul Haaf
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Deutschland.
| | - Pia Vock
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universität zu Lübeck, Lübeck, Deutschland
| | - Nikolaj Wächtershäuser
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universität zu Lübeck, Lübeck, Deutschland
| | - Christoph U Correll
- Klinik für Kinder- und Jugendpsychiatrie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Stephan Köhler
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Deutschland
| | - Jan Philipp Klein
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universität zu Lübeck, Lübeck, Deutschland
- Center for Brain, Behavior and Metabolism, Universität zu Lübeck, Lübeck, Deutschland
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Baumeister A, Schmotz S, Weidinger S, Moritz S. Is Self-Help Dangerous? Examination of Adverse Effects of a Psychological Internet-Based Self-Help Intervention for Body-Focused Repetitive Behavior (Free From BFRB). Behav Ther 2024; 55:136-149. [PMID: 38216227 DOI: 10.1016/j.beth.2023.05.013] [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: 10/10/2022] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 01/14/2024]
Abstract
Despite the proven effectiveness of psychotherapy for psychiatric disorders, adverse events or unwanted effects may occur. Unwanted effects, however, are rarely assessed. In self-help interventions, which usually are not supported by a therapist, such effects have received even less attention even though special caution is needed regarding unwanted effects such as those related to misapplication. For the present study, we present the newly developed Positive and Negative Effects of Psychotherapy Scale for Internet-Based Intervention (PANEPS-I) and examine possible unwanted effects of an internet-based self-help intervention in individuals with body-focused repetitive behaviors (BFRBs), aggregating three different techniques: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is). Some HRT users have expressed concern that the suppression of the problematic behavior could lead to rebound effects, but this has not been examined rigorously. Following baseline assessment, 141 participants with at least one BFRB were randomly assigned to two intervention groups that differed only with respect to the delivery mode (video, manual); the content was the same. After 6 weeks, a post-assessment was conducted. Unwanted effects were assessed using the PANEPS-I. A total of 70% of the participants (both treatment groups combined) reported at least one positive effect of the intervention. Negative effects were reported by 14-92% of participants, depending on the effect. The highest agreement rates were found for "no positive goal orientation" (52.5%), "did not address personal problems" (48.8%), "time/performance pressure" (20.9%), shame (16.3%), and concerns about data privacy (14.3%). Participants in the manual intervention group reported unethical procedures (e.g., data privacy concerns) more often (Cohen's d = .44) than those in the video intervention group. Responders reported more positive effects and nonresponders more malpractice (|d| = .80, .54, respectively). HRT users (self-report) showed no significant differences compared to nonusers regarding negative effects. Stepwise hierarchical regression analyses indicated a dose-response relationship for reported positive effects and malpractice. Side effects may occur in any kind of intervention. Usage of HRT did not lead to more reported negative effects compared to nonusage. To improve the quality and effectiveness and ensure the safety of the user, especially those using digital self-help interventions, it is important to regularly assess unintended effects since there is no supervision of the patient in unguided self-help interventions.
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Morello K, Schäfer SK, Kunzler AM, Priesterroth LS, Tüscher O, Kubiak T. Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis. Front Digit Health 2023; 5:1253390. [PMID: 37927578 PMCID: PMC10623449 DOI: 10.3389/fdgth.2023.1253390] [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: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective. Objectives To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations. Methods The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators). Results Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies. Conclusions We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].
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Affiliation(s)
- Karolina Morello
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
| | - Sarah K Schäfer
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Clinical Psychology, Psychotherapy and Diagnostics, Technische Universität Braunschweig, Brunswick, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Oliver Tüscher
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
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Duarte-Díaz A, Perestelo-Pérez L, Gelabert E, Robles N, Pérez-Navarro A, Vidal-Alaball J, Solà-Morales O, Sales Masnou A, Carrion C. Efficacy, Safety, and Evaluation Criteria of mHealth Interventions for Depression: Systematic Review. JMIR Ment Health 2023; 10:e46877. [PMID: 37756042 PMCID: PMC10568392 DOI: 10.2196/46877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Depression is a significant public health issue that can lead to considerable disability and reduced quality of life. With the rise of technology, mobile health (mHealth) interventions, particularly smartphone apps, are emerging as a promising approach for addressing depression. However, the lack of standardized evaluation tools and evidence-based principles for these interventions remains a concern. OBJECTIVE In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of mHealth interventions for depression and identify the criteria and evaluation tools used for their assessment. METHODS A systematic review and meta-analysis of the literature was carried out following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies that recruited adult patients exhibiting elevated depressive symptoms or those diagnosed with depressive disorders and aimed to assess the effectiveness or safety of mHealth interventions were eligible for consideration. The primary outcome of interest was the reduction of depressive symptoms, and only randomized controlled trials (RCTs) were included in the analysis. The risk of bias in the original RCTs was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. RESULTS A total of 29 RCTs were included in the analysis after a comprehensive search of electronic databases and manual searches. The efficacy of mHealth interventions in reducing depressive symptoms was assessed using a random effects meta-analysis. In total, 20 RCTs had an unclear risk of bias and 9 were assessed as having a high risk of bias. The most common element in mHealth interventions was psychoeducation, followed by goal setting and gamification strategies. The meta-analysis revealed a significant effect for mHealth interventions in reducing depressive symptoms compared with nonactive control (Hedges g=-0.62, 95% CI -0.87 to -0.37, I2=87%). Hybrid interventions that combined mHealth with face-to-face sessions were found to be the most effective. Three studies compared mHealth interventions with active controls and reported overall positive results. Safety analyses showed that most studies did not report any study-related adverse events. CONCLUSIONS This review suggests that mHealth interventions can be effective in reducing depressive symptoms, with hybrid interventions achieving the best results. However, the high level of heterogeneity in the characteristics and components of mHealth interventions indicates the need for personalized approaches that consider individual differences, preferences, and needs. It is also important to prioritize evidence-based principles and standardized evaluation tools for mHealth interventions to ensure their efficacy and safety in the treatment of depression. Overall, the findings of this study support the use of mHealth interventions as a viable method for delivering mental health care. TRIAL REGISTRATION PROSPERO CRD42022304684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304684.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), El Rosario, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), El Rosario, Spain
| | - Estel Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellatera (Barcelona), Spain
| | - Noemí Robles
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- eHealth Center, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Antoni Pérez-Navarro
- Faculty of Computer Sciences, Multimedia and Telecommunication, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- eHealth Lab Research Group, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Oriol Solà-Morales
- Fundació HiTT, Barcelona, Spain
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Office of Health Economics (OHE), London, United Kingdom
| | - Ariadna Sales Masnou
- Estudis de Ciències de la Salut, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Carme Carrion
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- eHealth Lab Research Group, School of Health Sciences and eHealth Center, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- School of Medicine, Universitat de Girona (UdG), Girona, Spain
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Lin YH, Lou MF. Systematic review: Effect of mobile applications on college students with depressive symptoms. J Adv Nurs 2023; 79:3214-3224. [PMID: 37209085 DOI: 10.1111/jan.15716] [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: 11/28/2022] [Revised: 04/23/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
AIM To evaluate the effects of mobile applications (apps) on college students with depressive symptoms. DESIGN Depression among college students is a school health issue, although little is known regarding effective app-based interventions for managing depressive symptoms. This review follows the concept of (1) theoretical guidance framework on app design, (2) app-based intervention study design and (3) effect of app-based interventions. DATA SOURCES Cochrane Library, CINAHL Plus with Full Text and PubMed were searched in October 2022. METHODS English-language reports of app-based interventions for college students with depressive symptoms. Quality appraisal and data extraction of selected articles was conducted by two independent reviewers using the mixed methods appraisal tool. Data synthesis using core outcome and findings of intervention. RESULTS Five studies have shown that depressive symptoms significantly decreased after app use, specifically indicating the effects that occur in 4 weeks. Although four studies have applied the theoretical framework to the app design, the findings showed the low implementation of the intervention activities as originally designed and at the specified dosage and difficulty in understanding the processes through which the intervention resolves the depressive symptoms. CONCLUSION App-based intervention can decrease depressive symptoms; furthermore, 4 weeks was the time point at which the changes were expected to occur. However, the theory-based app design for the depression population was rarely related, and studies clearly explaining the intervention measures, intervention dosage and duration required to achieve effectiveness are needed. IMPACT This study provides the synthesis of evidence-based app interventions to manage depressive symptoms to zoom in on different views and we suggest using the applications for at least 4 weeks before changes are expected to occur. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement in this study.
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Affiliation(s)
- Yueh-Hsiu Lin
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
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12
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Muris P, Otgaar H. Self-Esteem and Self-Compassion: A Narrative Review and Meta-Analysis on Their Links to Psychological Problems and Well-Being. Psychol Res Behav Manag 2023; 16:2961-2975. [PMID: 37554304 PMCID: PMC10406111 DOI: 10.2147/prbm.s402455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
The present review addressed the relationship between two self-related concepts that are assumed to play a role in human resilience and well-being: self-esteem and self-compassion. Besides a theoretical exploration of both concepts, a meta-analysis (k = 76, N = 35,537 participants) was conducted to examine the magnitude of the relation between self-esteem and self-compassion and their links to indices of well-being and psychological problems. The average correlation between self-esteem and self-compassion was strong (r = 0.65, effect size = 0.71), suggesting that - despite some distinct features - the overlap between both self-related constructs is considerable. Self-esteem and self-compassion displayed relations of a similar magnitude to measures of well-being and psychological problems, and both concepts accounted for unique variance in these measures once controlling for their shared variance. Self-esteem and self-compassion can best be seen as complementary concepts and we invite researchers to look more at their joint protective role within a context of well-being and mental health as well as to their additive value in the treatment of people with psychological problems.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Henry Otgaar
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Institute of Criminology, Faculty of Law and Criminology, Catholic University of Leuven, Leuven, Belgium
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13
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Seegan PL, Miller MJ, Heliste JL, Fathi L, McGuire JF. Efficacy of stand-alone digital mental health applications for anxiety and depression: A meta-analysis of randomized controlled trials. J Psychiatr Res 2023; 164:171-183. [PMID: 37352813 PMCID: PMC10527200 DOI: 10.1016/j.jpsychires.2023.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Anxiety and depressive disorders affect 20% of the population, cause functional impairment, and represent a leading cause of disability. Although evidence-based treatments exist, the shortage of trained clinicians and high demand for mental health services have resulted in limited access to evidence-based care. Digital mental health applications (DMHA) present innovative, scalable, and sustainable solutions to address disparities in mental health care. METHODS The present study used meta-analytic techniques to evaluate the therapeutic effect of DMHAs in randomized controlled trials (RCTs) for individuals experiencing anxiety and/or depressive symptoms. Search terms were selected based on concepts related to digital mental health applications, mental health/wellness, intervention type, trial design, and anxiety and/or depression symptoms/diagnosis outcomes to capture all potentially eligible results. Potential demographic, DMHA, and trial design characteristics were examined as moderators of therapeutic effects. RESULTS Random effects meta-analyses found that stand-alone DMHAs produced a modest reduction in anxiety (g = 0.31) and depressive (g = 0.35) symptom severity. Several moderators influenced the therapeutic effects of DMHAs for anxiety and/or depressive symptoms including treatment duration, participant inclusion criteria, and outcome measures. LIMITATIONS Minimal information was available on DMHA usability and participant engagement with DMHAs within RCTs. CONCLUSIONS While DMHAs have the potential to be scalable and sustainable solutions to improve access and availability of evidence-based mental healthcare, moderator analyses highlight the considerations for implementation of DMHAs in practice. Further research is needed to understand factors that influence therapeutic effects of DMHAs and investigate strategies to optimize its implementation and overcome the extant research-to-practice gap.
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Affiliation(s)
- Paige L Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Miller
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA; Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Jennifer L Heliste
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA; Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Lily Fathi
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA; Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Borsutzky S, Moritz S, Hottenrott B, Gehlenborg J. A self-guided Internet-based intervention for individuals with chronic pain and depressive symptoms: study protocol of a randomized controlled trial. Trials 2023; 24:453. [PMID: 37434163 DOI: 10.1186/s13063-023-07440-8] [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: 03/24/2022] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Despite the existence of evidence-based therapy options for the treatment of chronic pain and comorbid depressive symptoms (e.g., CBT), many individuals remain untreated. Treatment gaps result from a lack of specialists, patient fear of stigmatization, or patient immobility. Internet-based self-help interventions could serve as an anonymous and flexible alternative treatment option. In a pilot study, chronic pain patients with comorbid depressive symptoms who used a generic Internet-based depression program showed a significant reduction in depressive symptoms (but not pain symptoms) compared to a waitlist control group. Based on these findings, we developed the low-threshold, anonymous, and cost-free Internet-based self-help intervention Lenio that is tailored to the specific needs of chronic pain patients with comorbid depressive symptoms. Lenio is accompanied by the smartphone application (app) COGITO designed to increase therapeutic success. With Lenio and COGITO addressing both chronic pain and depressive symptoms, the trial aims to increase treatment effects of online interventions for chronic pain patients by reducing both depressive symptoms and pain. METHODS The effectiveness of the Internet-based self-help intervention and accompanying smartphone app will be evaluated in a randomized controlled trial (RCT). A total of 300 participants will be randomized into an intervention group (Lenio/COGITO), an active control group (depression-focused smartphone app), or a waitlist control group. Assessments will be done at baseline, after an 8-week intervention period (post), and after 16 weeks (follow-up). The primary outcome is the post-assessment reduction in "pain impairment" (mean value of impairment in daily life, free time, and work) as assessed by the DSF (German pain questionnaire). Secondary outcomes will include the reduction in depressive symptoms as well as in the severity of pain. DISCUSSION Lenio is one of the first Internet-based interventions to reduce chronic pain and depression that will be empirically evaluated. Internet-based interventions could offer a promising alternative to conventional face-to-face psychotherapy in the treatment of chronic pain patients. The primary objective of the current study is to add essential insight into the feasibility, effectiveness, and acceptance of Internet-based interventions for people with chronic pain and depressive symptoms. TRIAL REGISTRATION DRKS-ID DRKS00026722, Registered on October 6th, 2021.
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Affiliation(s)
- Swantje Borsutzky
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Hornstein S, Zantvoort K, Lueken U, Funk B, Hilbert K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front Digit Health 2023; 5:1170002. [PMID: 37283721 PMCID: PMC10239832 DOI: 10.3389/fdgth.2023.1170002] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration Identifier: CRD42022357408.
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Affiliation(s)
- Silvan Hornstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review. Healthcare (Basel) 2023; 11:healthcare11020272. [PMID: 36673640 PMCID: PMC9859497 DOI: 10.3390/healthcare11020272] [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: 12/28/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND College students are one of the most susceptible age groups to mental health problems. With the growing popularity of mobile health (mHealth), there is an increasing need to investigate its implications for mental health solutions. This review evaluates mHealth interventions for addressing mental health problems among college students. METHODS An online database search was conducted. Articles were required to focus on the impact of mHealth intervention on student mental health. Fifteen of the 487 articles, initially pulled from the search query, were included in the review. RESULTS The review identified three primary aspects of mental health: depression, anxiety, and stress. Research that found statistically significant improvements following mHealth intervention involved study durations between four and eight weeks, daily app use, guided lessons using cognitive behavioral therapy, acceptance and commitment therapy, and meditation. The review's findings show that future work must address the concern of digital divide, gender and sex differences, and have larger sample sizes. CONCLUSIONS There is potential to improve depressive symptoms and other similar mental health problems among college students via mobile app interventions. However, actions must be taken to improve barriers to communication and better reach the younger generations.
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Bruhns A, Baumeister A, Demeroutis G, Jahn H, Willenborg B, Shaffy A, Moritz S, Bücker L. A mobile-based aftercare intervention to increase self-esteem in inpatients diagnosed with depression: A randomized controlled trial. Psychother Res 2023:1-20. [PMID: 36628469 DOI: 10.1080/10503307.2022.2157226] [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] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE In this randomized controlled trial, we investigated the effectiveness, side effects and user satisfaction of the self-help smartphone app "MCT & More" among inpatients with a diagnosis of depression after their discharge from a psychiatric hospital over a period of 4 weeks. METHODS A total of 159 inpatients were recruited in four German psychiatric hospitals three days before hospital discharge (intervention group: n = 79; treatment as usual: n = 80). Based on the vulnerability model (low self-esteem contributes to depression), self-esteem represented the primary outcome, quality of life and depressive symptoms the secondary outcomes. RESULTS Intention-to-treat analyzes showed no statistical significance for the primary and secondary outcome parameters, except for the subscale self-competence in favor of the intervention group (with a small effect size of d = 0.35), in the context of an exploratory approach (post hoc). The more positive the attitude toward mobile-based interventions and the more positive the treatment expectations, the more frequently the app was used (r = .35, p = .008; r = .34, p = .009). CONCLUSION Further symptom reduction could not be obtained. However, the results suggest that an effect on improvement in self-competence could be achieved by low-threshold aftercare programs. Future studies should include long-term assessments to examine the impact of mobile-based aftercare on relapse.Trial registration: DRKS00022559.
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Affiliation(s)
- Alina Bruhns
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Baumeister
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Holger Jahn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,AMEOS Klinikum Heiligenhafen, Heiligenhafen, Germany
| | | | - Athif Shaffy
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Leung T, Yang T, Xiao L, Xu C, Zhu C. Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e39128. [PMID: 36596239 PMCID: PMC9856434 DOI: 10.2196/39128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students. OBJECTIVE This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience. METHODS We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis. RESULTS A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD -0.41, 95% CI -0.59 to -0.23; P<.001) and alleviating anxiety (SMD -0.29, 95% CI -0.50 to -0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD -0.14, 95% CI -0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD -0.33, 95% CI -0.53 to -0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI -0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The "without company support" group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the "with company support" group (SMD 1.17, 95% CI -0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD -0.06, 95% CI -0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low. CONCLUSIONS MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585.
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Affiliation(s)
| | - Ting Yang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lei Xiao
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Changxia Xu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chunqin Zhu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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