Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany

Service Attributes and Acceptability of Digital and Nondigital Depression Management Methods Among Individuals With Depressive Symptoms: Survey Study

BACKGROUND

Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings.

OBJECTIVE

This study aims to analyze service characteristics that service users value and compare the extent to which various digital and nondigital mental health treatments and management methods fulfill users' expectations.

METHODS

A total of 114 people with at least moderate levels of depressive symptoms (as measured by Patient Health Questionnaire-9 score ≥10) completed a web-based questionnaire measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time, and more. They were also assessed on their expectations toward seven common mental health treatments and management methods, including (1) face-to-face psychological intervention, (2) medication, (3) guided internet-based psychological intervention, (4) face-to-face counseling service, (5) self-guided mental health apps for depression, (6) self-help bibliotherapy, and (7) psychological intervention via videoconferencing.

RESULTS

A Friedman test with a Dunn posttest showed the average importance rank of "effectiveness" was significantly higher than all other measured attributes. "Privacy," "credibility," and "cost" were ranked as equally important. Participants rated face-to-face psychological intervention the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychological intervention, medication, and counseling were considered less satisfactory due to their higher costs and longer waiting times when compared to digital services. Repeated measures ANOVA showed some forms of management method were more likely to be adopted, including guided internet-based psychological intervention, psychological intervention via videoconferencing, face-to-face psychological intervention, and face-to-face counseling services provided by a counselor as compared to self-guided mobile apps, self-help bibliotherapy, and medication.

CONCLUSIONS

The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to nondigital services, digital services were identified as having specific strengths as perceived by users. Future dissemination and promotion efforts may focus on debunking myths of guided internet-based psychological intervention as a less effective option and promoting the particular service strengths of digital services.

Investigating non-inferiority of internet-delivered versus face-to-face cognitive behavioural therapy for insomnia (CBT-I): a randomised controlled trial (iSleep well)

BACKGROUND

Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined.

METHODS

This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment).

DISCUSSION

The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I.

TRIAL REGISTRATION

Trial registration number in the German Clinical Trials Register: DRKS00028153 ( https://drks.de/search/de/trial/DRKS00028153 ). Registered on 16th May 2023.

Understanding university students' attitudes and preferences for internet-based mental health interventions

Internet-based interventions are recognised as a practical approach to address mental health issues. The acceptance and utilisation of such interventions are closely linked to user attitudes and preferences. This study aims to examine the predictors of university students' attitudes towards internet-based interventions. Additionally, it seeks to elucidate students' preferences regarding crucial features of these interventions, such as the format, delivery mode, content type, and structural components, to understand better what makes these interventions appealing and practical for university students. A total of 273 university students (comprising 68 % females and 32 % males) participated in the study. The data collection instruments employed were the Personal Information Form, Internet-Based Intervention Preference Survey, E-therapy Attitude Measure (ETAM), Digital Literacy Scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 (GAD-7). The data were analysed utilising descriptive statistics, Pearson correlation analysis, and multiple linear regression analysis. The multiple regression analysis revealed digital literacy as a predictive factor for attitudes towards internet-based interventions. Demographic variables, such as age and gender, and psychological variables, such as depression and anxiety levels, were found not to be associated with attitudes towards these interventions. While students are actively seeking mental health information online, a significant majority remain unaware of internet-based interventions. They show a preference for interventions offering greater human interaction, including face-to-face guidance and video content featuring people. Participants favour completing one or two sessions of the intervention weekly. Desired features of internet-based interventions include self-assessment scales, relatable characters, voice relaxation exercises, practical daily life activity tasks, and weekly reminders throughout the process. In conclusion, initiatives aimed at enhancing digital literacy levels could foster more positive attitudes towards internet-based interventions among students. Developers creating Internet-Based Interventions (IBI) for university students should consider these preferences.

Digital intervention for public health: searching for implementing characteristics, concepts and recommendations: scoping review

Studying the impact of digital interventions on public health can help ensure that the offered services produce the desired results. In order to address these factors, the subsequent study uses a scope review to evaluate the state of the field while concentrating on ideas and suggestions that represent factors that have been crucial in the management of digital intervention for public health. To shed light on the traits, ideas and suggestions related to public health digital intervention, a scoping review was carried out. Five electronic databases were used to locate pertinent research that were published before February 2022. All texts were examined, and study abstracts were scrutinized to determine their eligibility. The last analysis of this study included fifteen publications; five reviews, four qualitative studies, two quantitative studies, one viewpoint study, one mixed-method study, one perspective study, and one interventional study. The key ideas for digital interventions in population management and health studies are presented in this overview. Many concepts, implementation characteristics and recommendations have been raised which highlight the future role of these interventions to enhance public engagement and health equity.

Immediate Effects of Mobile Phone App for Depressed Mood in Young Adults with Subthreshold Depression: A Pilot Randomized Controlled Trial

Background

Preventive interventions for subthreshold depression (StD) are essential to reduce the incidence of major depressive disorder. Our smartphone application presenting positive word stimulation in video (ie, Subliminal Priming with Supraliminal Reward Stimulation, SPSRS) was suggested to improve depressive symptoms in people with StD, although it is unclear whether it can immediately improve depressed mood. This pilot randomized controlled trial (RCT) aimed to investigate the preliminary efficacy of SPSRS application intervention on depressive mood in people with StD.

Methods

Thirty-two participants with StD were randomly assigned to the experimental (n = 16) or control group (n = 16). The experimental group received SPSRS application intervention (10-minute video with positive word stimulation) and the control group received YouTube application intervention (10-minute video without positive word stimulation). Both groups used identical iPhones managed by the research team. The primary outcome was the change from baseline in depression-dejection on the Profile of Mood States 2nd Edition-Adult Short (POMS 2-A Short) after the intervention.

Results

No participants dropped out of the study. The experimental group showed a small improvement in depression-dejection on the POMS 2-A Short score (adjusted Hedges's g = -0.32) compared to the control group. Post-hoc power analyses estimated a sample size of 56 per group (112 total) to evaluate depression-dejection on the POMS 2-A Short in a future full-scale RCT.

Conclusion

SPSRS application intervention may be effective in immediately improving depressive mood in people with StD. A future full-scale RCT based on a formally calculated sample size should be conducted to replicate these findings.

Breast Cancer Survivors' Attitudes toward eMental Health: A Cross-Sectional Study

BACKGROUND

Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables.

METHODS

A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ2, and multiple regression analyses were computed to explore associations between attitudes and collected variables.

RESULTS

BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH.

CONCLUSIONS

eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.

Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis

BACKGROUND

Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment.

OBJECTIVE

This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample.

METHODS

Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit.

RESULTS

The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models.

CONCLUSIONS

The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored.

Sustaining and Expanding Internet-Delivered Cognitive Behavioral Therapy (ICBT) for Public Safety Personnel across Canada: A Survey of Stakeholder Perspectives

Public safety personnel (PSP) experience an elevated risk of mental health problems and face barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) has been tailored to PSP to improve access to mental health care. In this study, we sought to investigate perceptions of ICBT, particularly among those with and without prior knowledge of ICBT and between PSP leaders and non-leaders. A survey was administered to 524 PSP from across Canada to identify (a) how PSP perceive ICBT, (b) the extent of organizational support for tailored ICBT in PSP organizations, particularly leadership's support, and (c) perceived facilitators and barriers to funding tailored ICBT. The results indicated that PSP perceive ICBT to have more advantages than disadvantages. PSP who had previously heard of tailored ICBT had more positive perceptions. PSP indicated that there is a need for ICBT, and PSP leaders indicated their support for the implementation of tailored ICBT. The study identified that there is a need for increasing awareness of the effectiveness of and need for ICBT in order to facilitate funding of services. Overall, the current study indicates that PSP support ICBT as a valued form of therapy and that policy makers and service providers seeking to provide ICBT to PSP may increase support for ICBT services through more education and awareness.

Telemedicine during the COVID-19 pandemic in Germany: Results from three nationally representative surveys on use, attitudes and barriers among adults affected by depression

Introduction

The COVID-19 pandemic has necessitated a reduction in face-to-face consultations, resulting in significant limitations in healthcare for individuals with depression. To ensure safe and adequate care, e-health services, such as telemedicine, gained a more prominent role. Governments have eased restrictions on the use of telemedicine, enabling healthcare professionals to increasingly offer video and telephone consultations.

Objective

This study examines, 1) possible changes over the course of the pandemic in reported use of video and telephone consultations and intended future use of video consultations with healthcare professionals among adults with diagnosed depression; 2) their attitudes towards video and telephone consultations and perceived barriers towards using e-health after prolonged time of the pandemic; and 3) differences in results between subgroups based on sociodemographic and clinical characteristics.

Methods

Three population-representative online surveys were conducted in Germany at different timepoints (t) during the COVID-19 pandemic. Respondents aged 18-69 years with a professionally diagnosed depression were included in the present analyses (t1: June/July 2020 with n = 1094; t2: February 2021 with n = 1038; t3: September 2021 with n = 1255).

Results

The overall proportion of adults with depression who used video or telephone consultations did not change significantly in the time surveyed (t1: 16.51 %, n = 179; t2: 20.23 %, n = 210; t3: 18.47 %, n = 230). However, among users, reported use of video consultations with a psychotherapist increased significantly from t1 (34.83 %, n = 62) to t3 (44.98 %, n = 102, p = .023). Intended future use of VC for healthcare varied depending on the purpose of the consultation. Significant differences over time were only found for the purpose of using VC to discuss clinical findings, laboratory results and diagnostic analyses with a doctor, with higher intentions reported at t2 during lockdown in Germany. At t3, the majority of adults with depression felt that video and telephone consultations were too impersonal and considered them more as a helpful support rather than an alternative to face-to-face psychotherapy. Key barriers to using e-health were found within the societal context and the lacking support from significant others for using e-health, while knowledge and skills represented facilitators for using e-health.

Conclusion

Despite ambivalent attitudes towards video and telephone consultations among adults with depression, reported use of video consultations with a psychotherapist increased during the COVID-19 pandemic.

User experiences of an online therapist-guided psychotherapy platform, OPTT: A cross-sectional study

Introduction

In the last few years, online psychotherapy programs have burgeoned since they are a more accessible and scalable treatment option compared to in-person therapies. While these online programs are promising, understanding the user experience and perceptions of care is essential for program optimization.

Methods

This study investigated the experiences of end-users who had previously received online psychotherapy through a web-based platform. A 35-item multiple-choice survey was developed by the research team and distributed to past users to capture their perceptions of the program.

Results

The survey yielded 163 responses, with a 90 % completion rate. Participants were predominantly white and female, with an average age of 42 years. While most participants preferred in-person therapy, they also reported the benefits of the online psychotherapy program. Participants had positive perceptions of the platform, the quality and interaction of their therapist, and the homework assignments and skills covered. Lack of motivation to complete weekly homework assignments was cited as a common struggle.

Discussion

The findings support online psychotherapy as a beneficial digital mental health tool and highlight some areas for improvement. Scalability and accessibility are key benefits of the platform. At the same time, improvements in participant engagement, including those from equity-seeking and equity-deserving groups, may enhance the efficacy of the programs offered.

Connected Mental Health Solutions: Global Attitudes, Preferences, and Concerns

Background: Connected mental health (CMH) presents several technology-based solutions, which can help overcome many mental care delivery barriers. However, attitudes toward the use of CMH are diverse and differ from a cohort to another. Objective: The purpose of this study is to investigate the global attitudes toward CMH use and assess the use of technology for mental care. Methods: This study presents a synthesis of literature available in Scopus, Science Direct, and PubMed digital libraries, investigating attitudes toward CMH in different cohorts from different countries, based on a systematic review of relevant publications. This study also analyzes technology use patterns of the cohorts investigated, the reported preferred criteria that should be considered in CMH, and issues and concerns regarding CMH use. Results: One hundred and one publications were selected and analyzed. These publications were originated from different countries, with the majority (n = 23) being conducted in Australia. These studies reported positive attitudes of investigated cohorts toward CMH use and high technology use and ownership. Several preferred criteria were reported, mainly revolving around providing blended care functionalities, educational content, and mental health professionals (MHPs) support. Whereas concerns and issues related to CMH use addressed technical problems related to access to technology and to CMH solutions, the digital divide, lack of knowledge and use of CMH, and general reservations to use CMH. Concerns related to institutional and work barriers were also identified. Conclusions: Attitudes toward CMH show promising results from users and MHP views. However, factors such as providing blended care options and considering technical concerns should be taken into consideration for the successful adoption of CMH.

Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic

BACKGROUND

Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms.

METHOD

The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic.

RESULTS

More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship.

CONCLUSION

Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Evaluation of Psychometric Properties of the Acceptability of ICT Use for Mental Health Care Questionnaire

The adoption of e-mental health strategies is determined by the acceptability of Information and Communication Technologies (ICT) to professionals, an issue barely explored in Mexico. The objective was to evaluate the psychometric properties of the Acceptability of ICT Use for Mental Health Care Questionnaire. A convenience sample of 492 Mexican mental health professionals answered the questionnaire on ICT use for mental health care. Internal consistency analyses, exploratory, and confirmatory factor analyses were performed. Around 73.4% of the sample are women, aged between 21 and 30 (32.1%), around 50% has completed graduate studies, and 88.3% is practicing psychologists. The questionnaire comprised 11 items grouped into three factors: perceived usefulness, risk perception, and subjective norm. The CFA indicated a good fit χ2 SB/gl = 443.38/206 = 2.15; CFI = 0.930; RMSEA = 0.068 (95% CI [0.059-0.077]). The instrument has adequate psychometric properties for evaluating the acceptability of ICT use for mental health care.

Assessing Patients' Attitudes towards Telepsychotherapy: The Development of the Unified Theory of Acceptance and Use of Technology -Patient Version

This study presents the development of a self-report measure of patients' attitudes towards telepsychotherapy. The measure is based on a well-researched model of attitudes towards using technology, the Unified Theory of Acceptance and Use of Technology (UTAUT) framework (Venkatesh et al., 2003). We examined the psychometric properties of the UTAUT adapted for psychotherapy patients (UTAUT-P) in a sample of 107 psychotherapy patients who received telepsychotherapy via videoconferencing during the COVID-19 pandemic. Exploratory factor analysis resulted in a 14-item UTAUT-P version, with four factors; 1) Therapy Quality Expectancy, 2) Convenience, 3) Ease of Use, and 4) Pressure from Others, and was further corroborated by the results of the confirmatory factor analysis. Our results indicated the four-factor model's adequate fit to the data and demonstrated adequate construct validity and reliability of the UTAUT-P factors. All factors, except for Ease of Use, were significantly and positively associated with intention to use telepsychotherapy technology in the future. This study complements the research on therapists' attitudes towards telepsychotherapy, based on the therapist version of the UTAUT. The developed 14-item UTAUT-P might be a helpful, brief self-report tool in clinical practice, which might give the patient a voice around the potential use of telepsychotherapy technology in their care. This initial application of the UTAUT-P patients during the COVID-19 pandemic offers a building block for future research on patients' attitudes towards telepsychotherapy, outside the context of a forced transition.

A quantitative study exploring the acceptance of the eHealth model for mental wellness among digital workers

Background: eHealth makes use of information and communication technologies (ICT) to improve health. In the digital age, the use of eHealth applications and other health-related applications has gained popularity, particularly during the COVID-19 pandemic. As a result of the pandemic, many uncertainties have arisen, causing stress and affecting the mental health of many skilled workers in the digital industry, particularly in the ICT, computing, and creative media industries. eHealth applications have the potential to benefit people's health. As a prerequisite for effective implementation of eHealth for mental wellness (EHMW), this paper examines the acceptance of EHMW among digital workers in Malaysia.  The objectives of this research are two-fold: 1) To explore the acceptance of EHMW among digital workers in a local Premier Digital Tech Institution (PDTI), and 2) To explore how these talents' demographic profiles, mental health literacy and workplace wellness influence their acceptance of EHMW.   Methods: This research surveyed 41 digital workers who played vital roles in providing digital skills at a tertiary education level.    Results: Most respondents agreed that eHealth was appropriate for managing mental wellness. Among the three eHealth domains for managing mental wellness, the acceptance level is the highest for the application domain of "interacting for health", with male respondents more likely to accept the use of EHMW.  Conclusions: This small-scale survey could not fully examine the acceptance of eHealth and its usage patterns for mental wellness among digital workers in Malaysia. Future research will target more digital workers in Malaysia. This research addresses the research gap on the eHealth perspectives of digital workers on their acceptance, and the potential influence of demographic profiles, mental health literacy, and workplace wellness on EHMW's acceptance of digital health tools/platforms to promote their mental wellness.

Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression

The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88-0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.

Shifting to tele-creative arts therapies during the COVID-19 pandemic: An international study on helpful and challenging factors

The COVID-19 pandemic has led to an unprecedented shift to online treatment. For the creative arts therapies (CATs) - a healthcare profession that involves the intentional use of the visual art, drama, music, dance, and poetry within a therapeutic relationship - this shift has been highly consequential for practice. This study examined (a) how the COVID-19 pandemic has impacted clinical practice in the CATs, and (b) the features characterizing online practice in an international sample of 1206 creative arts therapists aged 22-86 (92% female). It aimed to identify changes in the use of the arts in therapy, resources that contributed to the delivery of therapy, and the role of therapists' creative self-efficacy in adapting to these changes. Respondents completed close and open-ended questions providing examples of what does and does not work in online practice. The results indicate that creative self-efficacy plays a meaningful role in buffering the impact of therapists' computer comfort on their perceived difference in online clinical practice; confidence in one's abilities positively contributed to their adaptation to online practice. The qualitative analysis yielded four main categories: the challenges of tele-CATs, continuing the therapeutic process through tele-CATs, adaptations for tele-CATs, and future directions. Overall, the results present a timely report on the inevitable transition of the CATs to online practice.

The development of a self-report scale to assess therapists' acceptance of telepsychotherapy

OBJECTIVE

We aimed to develop a self-report measure of therapist acceptance of telepsychotherapy based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework.

METHODS

Using a cross-sectional survey design, 1265 therapists completed the UTAUT-T, as well as additional questions.

RESULTS

Confirmatory analysis indicated that the original UTAUT model did not fit the therapist context well. Exploratory factor analysis specified a better-fitting five-factor model, which showed good internal validity fit (χ²  = 17,753.36, RMSEA = 0.063, TLI = 0.886, SRMSR = 0.04). The five UTAUT-T subscales showed high internal consistency (Cronbach's α = 0.86) and together predicted the intention to use online therapy in the future (R²  = 0.42, F(5, 1259) = 181.9, p < 0.001).

CONCLUSION

The 21-item UTAUT-T offers a promising self-report measure of therapist acceptance of telepsychotherapy and intention towards using it in the future. Future studies on the convergent and predictive validity of the UTAUT-T are warranted.

Sociodemographic Characteristics Associated with an eHealth System Designed to Reduce Depressive Symptoms among Patients with Breast or Prostate Cancer: Prospective Study (Preprint)

Background

eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions.

Objective

This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer.

Methods

The study included a total of 129 patients diagnosed with breast (n=80, 62%) or prostate (n=49, 38%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period.

Results

The analysis was based on 108 patients (n=68, 63%, patients with breast cancer and n=40, 37%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men (β=.16; P=.03, 95% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use (β=–0.13; P=.04, 95% CI −0.25 to −0.01), after adjusting for other covariates.

Conclusions

The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability.

Trial Registration

German Clinical Trials Register RKS00013391; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013391

How Does It Feel to Be Online? Psychotherapists' Self-Perceptions in Telepsychotherapy Sessions During the COVID-19 Pandemic in Italy

Aims: The COVID-19 pandemic and consequent extreme restrictions imposed by governments across the world forced psychotherapists to abruptly change their working modality. The first aim of the current study was to assess psychotherapists’ self-perceptions (i.e., affective and cognitive perceptions about their self and their self in relation to clients) when providing telepsychotherapy during the first peak of the COVID-19 pandemic in Italy. The second aim was to explore the associations between psychotherapists’ self-perceptions, characteristics, and clinical practices.

Method: An online survey was administered to 281 Italian licensed psychotherapists (M_age=45.15; SD=10.2; 83.6% female) between April 5 and May 10, 2020. The survey comprised ad-hoc questions that were designed to collect sociodemographic details and information related to working practices. Moreover, a semantic differential (SD) scale was developed to assess psychotherapists’ self-perceptions, and a factor analysis was performed from the SD items.

Results: The SD scale showed an overall trend of positive psychotherapist self-perception during telepsychotherapy, despite reports of greater fatigue and directive and talkative behavior during sessions. Four SD factors accounted for 45% of the variance: “Affective Availability,” “Attitude Predisposition,” “Well-being,” and “Interventionism.” Scores on the first three factors were indicative of psychotherapists’ Positive vs. Negative self-perception. A comparison of the Positive and Negative attitudinal profiles using the chi-squared test with Yates’s correction and a Monte Carlo simulation found that psychotherapists with a Positive profile reported greater satisfaction with the telematic modality and were more likely to perceive that their clients were able to maintain privacy during sessions.

Conclusion: The results suggest that Italian psychotherapists have been able to promptly adapt to the imposed telematic modality during the COVID-19 pandemic. However, they may have attempted to compensate for their physical distance from clients by intervening more during sessions. These findings may support psychotherapists who are currently practicing and inform future practitioners who are considering the use of telematic treatment as a routine component of psychotherapeutic care.

A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland

Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services.

Key learning aims

(1)

Assessing attitudes towards online psychoeducational interventions: Psychometric properties of a Brief Attitudes Scale

Participant attitudes are an explanatory factor for attrition in online health-related interventions. However, its assessment prior to interventions start is uncommon, partly because proper measures are missing. This study presents the psychometric properties of a new scale measuring attitudes towards online psychoeducational interventions (OPIs). Structural validity, reliability and screening performance of the Online Psychoeducational Intervention - Brief Attitudes Scale (OPI-BAS) were studied in a sample of 157 dementia caregivers. Scale cut-off scores were derived to categorise the participants into 'OPIs sympathisers' or 'non-sympathisers'. Groups were compared across sociodemographic and internet use variables. A parsimonious five-item version of OPI-BAS demonstrated good structural validity, with one factor explaining 63.3% of variance. Internal consistency of the scale was high (α = 0.85). OPI-BAS showed good screening performance in identifying individuals with either a preference to use conventional face-to-face or online psychoeducational interventions (area under the curve = 0.84). An optimal cut-off score of 20 was suggested by the receiver operating characteristic graph, providing good sensitivity (74%) and specificity (84%). No significant differences were found between groups on sociodemographic and internet use variables. Attitudes towards OPIs were overall positive, but face-to-face interventions were preferred. This study offers preliminary support to the psychometric quality of OPI-BAS. This short scale has practical applications for research and intervention.

Exploring the influence of testimonial source on attitudes towards e-mental health interventions among university students: Four-group randomized controlled trial

Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, “information only”, n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (p_s<0.01), as well as a partial mediation effect of perceived similarity in favor of testimonials targeted to students (95% CI [0.22, 0.50]). Overall, this study indicated no meaningful impact of information on attitudes and limited evidence for benefits of tailored narrative messages. Since attitudes were already positive at baseline, further research with a representative student sample mimicking real-world decision scenarios is needed to gain an in-depth understanding of acceptance-facilitating message features that may contribute to promote the adoption of evidence-based eMHSs.

Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees

Background: Web-based and mobile mental health applications for the prevention and treatment of common mental disorders (CMDs) are on the rise. Under certain circumstances they have proved to be effective for a range of conditions (e.g., depression). Objective: There is not sufficient evidence regarding the benefits and barriers especially for mobile phone apps and for programs in the field of primary prevention. Studies on the acceptance of potential users of mental health apps yielded mixed outcomes. In a large survey we investigated the attitudes of employees toward mental health apps and various traditional mental health services. Our main research question in this contribution focuses on the acceptance of apps compared to other measures and the moderating influence of individual characteristics. Methods: The standardized survey was completed by members of an online access panel with different job types. A set of 33 self-developed items, including three questions on e-health, captured the perceived relevance of prevention at the (A) occupational, (B) individual, and (C) societal level. On the basis of an exploratory factor analysis, mean scores for mapping seven (sub-)dimensions were constructed and compared using the Wilcoxon test. The influence of potential predictors was analyzed in linear regression models. Results: The data of 610 respondents were analyzed (response rate 75%). Support from mental health applications was rated significantly less important compared to all other dimensions at the levels (A) to (C). Respondents were more likely to use mental health apps if they felt literate with electronic devices, perceived a high relevance of work-related demands as causal factors for CMDs, stated they would be ashamed of having a CMD, and would be willing to begin psychotherapy if recommended. Discussion and Conclusions: The results confirm the critical attitudes of potential mental health app users found in other studies. Since users with a negative attitude toward e-health might have a higher risk for dropout and non-adherence as well as lower intervention effects, well-designed educational strategies should be carried out beforehand.

Perspectives of e-health interventions for treating and preventing eating disorders: descriptive study of perceived advantages and barriers, help-seeking intentions, and preferred functionality

PURPOSE

Digital interventions that consider end-user needs, preferences, and concerns may address suboptimal rates of e-health uptake, usage, and engagement. We explored target-user perspectives of e-health treatment and prevention programs for eating disorders (EDs), with a focus on investigating (1) perceived advantages and barriers of e-health; (2) help-seeking intentions; and (3) preferences for different digital functionality, device types, and content-delivery formats.

METHODS

Survey data were analysed from 722 community-based participants. Participants were categorized into one of four groups based on symptom presentation and severity, ranging from low risk to probable bulimia nervosa or binge-eating disorder.

RESULTS

e-health advantages that received the highest endorsement (~ 84%) were "always there in times of need" and "travel not required". e-health barriers that received the highest endorsement (~ 50%) were concerns about data privacy and the accuracy of content presented. Nearly three-quarters reported an intention to use an e-health platform for preventing or treating EDs. Preference ratings were highest for programs to be available on all digital devices (relative to restricting the program to one type of device) and for content to be presented via graphics and video tutorials (rather than audio-based). e-health functionality that received highest preference ratings (~ 80%) were added clinician support, tailored feedback, strategies to change unhelpful ED thoughts, screening scales to assess symptoms, ED psychoeducation, and just-in-time intervention prompts. Preference and intention ratings were strikingly similar across all subgroups.

CONCLUSION

Findings may inform the development and design of e-health platforms that meet the needs of people at different stages of an ED.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden

INTRODUCTION

A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support. E-mental health (e-MH) may offer a solution to reduce this treatment gap. However, research examining e-MH for AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to: (1) help-seeking behaviour and/or (2) e-MH acceptability. The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen's behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MH interventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking.

METHODS AND ANALYSIS

An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16-39 years, diagnosed with cancer when 0-18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-06271). Results will be disseminated in scientific publications and academic conference presentations.

TRIAL REGISTRATION NUMBER

ISRCTN70570236.

Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review

Background

Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions.

Objective

This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs.

Methods

A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included.

Results

A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health.

Conclusions

Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.

Preferences for e-Mental Health Interventions in Germany: A Discrete Choice Experiment

OBJECTIVES

Recent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment.

METHODS

Using a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents' demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level.

RESULTS

A total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site.

DISCUSSION

Our results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.

Evaluation of the E-Mental Health Mindfulness-Based and Skills-Based "CoPE It" Intervention to Reduce Psychological Distress in Times of COVID-19: Results of a Bicentre Longitudinal Study

Background: The SARS-CoV-2 pandemic poses immense challenges for health care systems and population-wide mental health. The e-mental health intervention "CoPE It" has been developed to offer standardized and manualized support to overcome psychological distress caused by the pandemic. The aim of this study was to assess the effectiveness of "CoPE It" in terms of reducing distress (primary outcome), depression and anxiety symptoms, and improving self-efficacy, and mindfulness (secondary outcomes). Furthermore, the intervention's usability, feasibility, and participants' satisfaction with "CoPE It" was evaluated (tertiary outcome). The study protocol has been published previously. Methods: A bicentre longitudinal study was conducted from April 27th 2020 to May 3rd 2021. N = 110 participants were included in the analyses. The intervention consisted of four modules featuring different media promoting evidence-based methods of cognitive behavioral therapy and mindfulness-based stress reduction. Difference in psychological distress between baseline (T0) and post-intervention (T1) were analyzed by repeated measure analysis of covariance. Mixed linear models were applied to assess moderating effects. Depressive symptoms, generalized anxiety symptoms, self-efficacy, and mindfulness were compared between baseline (T0) and post-intervention (T1) via t-tests. Usability of the "CoPE It" intervention and participants' satisfaction was evaluated by calculation means and frequencies. Results: Primary outcome: A significant effect of time on psychological distress at post-intervention (T1) after controlling for age, gender, education, mental illness and attitudes toward online interventions was found. Depressive and anxiety symptoms, and mindfulness were a significant moderators of the relationship between time and psychological distress for consistent wording. Secondary outcomes: There was a significant decrease in depressive symptoms and generalized anxiety, and a significant increase in self-efficacy and mindfulness between baseline (T0) and post-intervention (T1). Tertiary outcomes: 95.83% of the participants thought the "CoPE It" intervention was easy to use and 87.50% were satisfied with the "CoPE It" intervention in an overall, general sense. Conclusion: The e-mental health "CoPE It" intervention seems to be an effective approach in reducing psychological distress, anxiety and depressive symptoms, and in enhancing self-efficacy and mindfulness during the COVID-19 pandemic. Participants' satisfaction and the program's feasibility, and usability were proven to be high. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: DRKS00021301.

Psychotherapy During COVID-19: How the Clinical Practice of Italian Psychotherapists Changed During the Pandemic

Aims: Italy was one of the first countries to be significantly affected by the coronavirus disease 2019 (COVID-19) pandemic, determining a unique scenario for Italian psychotherapists to consider changing the modality in which they deliver treatment. The present study aimed at studying which factors related to psychotherapists and their clinical practice had a major role in predicting two main outcomes: (1) the rate of interrupted treatments during lockdown and (2) psychotherapists' satisfaction with the telepsychotherapy modality. Methods: An online survey was administered to licensed psychotherapists (n = 306), who worked mainly as private practitioners, between April 5 and May 10, 2020 (i.e., the peak of the pandemic in Italy). Results: Psychotherapists reported that 42.1% (SD = 28.9) of their treatments had been interrupted, suggesting that Italy faced an important undersupply of psychotherapy during the lockdown. Using the Akaike information criterion (AIC) model selection, we identified three predictors of the rate of interrupted treatments: (1) psychotherapists' lack of experience with telepsychotherapy prior to the lockdown, (2) their theoretical orientation (with cognitive behavioral psychotherapists reporting a higher rate of interrupted treatments), and (3) patients' lack of privacy at home, as reported to the psychotherapists. Furthermore, we found four predictors of psychotherapists' satisfaction with the telepsychotherapy modality: (1) the rate of interrupted treatments, (2) psychotherapists' previous experience with telepsychotherapy, (3) their beliefs about the compatibility of telepsychotherapy with their theoretical orientation, and (4) their use of a video-conferencing modality, rather than telephone. Conclusion: The following recommendations can help policy makers, professional associations, and practitioners in promoting the continuity of psychotherapy treatments during the COVID-19 outbreak and in future emergencies: (i) disseminating training programs for practitioners on telepsychotherapy, (ii) supporting patients to pragmatically access a private space at home, (iii) encouraging practitioners to use video-conferencing (instead of telephone) to deliver remote therapy, and (iv) increasing the acceptance of telepsychotherapy among both clinicians and the general public.

Exploring Perceptions of Internet-Delivered Cognitive Behaviour Therapy among Public Safety Personnel: Informing Dissemination Efforts

Background Public safety personnel (PSP) experience high rates of mental health disorders but have limited access to treatment. To improve treatment access, there is a growing interest in offering internet-delivered cognitive behaviour therapy (ICBT) to PSP. As attitudes towards ICBT can both impact and inform ICBT implementation efforts, this study examines perceptions of ICBT among PSP who viewed a poster (a commonly used method of advertising ICBT) or a poster supplemented with a story of a PSP who benefitted from ICBT. Methods Participants (N = 132) from various PSP sectors were randomly assigned to view a poster or a poster and a story. Participants then completed an online survey assessing their perceptions of ICBT using both qualitative and quantitative questions. We used a mixed-methods approach to analyze the data. Results No differences in perceptions of ICBT were identified between the conditions. Ratings of credibility, treatment expectancy, anticipated treatment adherence, and acceptability suggested that PSP had positive perceptions of ICBT. Most participants (93%) reported that they would access ICBT if they needed help with mental health concerns. Participants ranked therapist-guided ICBT as their second most preferred treatment, with psychologists ranked first. Female participants found ICBT more credible than male participants. More experienced PSP reported lower acceptability and anticipated adherence to ICBT. Conclusions The findings suggest that many PSP are likely to be receptive to ICBT even when a simple poster is used as a method of informing PSP of this treatment option. Further attention to improving the perceptions of ICBT among certain groups may be warranted.

Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners' Views

BACKGROUND

Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users' perspectives and behavior.

OBJECTIVE

This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined.

METHODS

Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted.

RESULTS

GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs' referrals and their self-rated pharmacotherapeutic competence, r(73)=-0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included "little knowledge about internet-based interventions" and "patients' lack of familiarity with technology/internet/media" (number of statements, each k=22). Key facilitators were "perceived patient suitability, e.g. well-educated, young" (k=22) and "no conflict with GP's role" (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned.

CONCLUSIONS

This study provides insights into factors influencing GPs' referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.

Potential of Mobile Technology to Relieve the Urgent Mental Health Needs in China: Web-Based Survey

Background

With the rapid development of information technology and mobile devices, an increasing number of mobile medical services and platforms have emerged. However, China’s current mental health situation necessitates further discussion and research on how to provide more patient-centered services in the face of many challenges and opportunities.

Objective

This study aims to explore the attitudes and preferences of mental health service stakeholders regarding mobile mental health services and discuss the challenges and opportunities faced by mobile technology developers in China.

Methods

A web-based survey was conducted by following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist. A total of 586 valid questionnaires were collected. Respondents included 184 patients or their family members, 225 mental health professionals, and 177 people from the general population. Data analysis was completed using SPSS 24.0.

Results

Among the various problems perceived regarding the current mental health medical environment, difficulty in finding appropriate psychologists and limited visit times ranked highest. Social media (n=380/586, 64.9%) was the most preferred platform among all participants, whereas professionals showed a higher preference for smartphone apps (n=169/225, 75.1%). Professional instruction, psychological consultation, and mental health education (ranked top 3) were the most commonly identified needs. Mental health professionals generally emphasized more on treatment-related mobile mental health service needs, especially medication reminders (χ²₂=70.7; P<.001), symptom monitoring (χ²₂=24.0; P<.001), and access to mental health resources (χ²₂=38.6; P<.001). However, patients and their family members focused more on convenient web-based prescriptions (χ²₂=7.7; P=.02), with the general population interested in web-based psychological consultation (χ²₂=23.1; P<.001) and mental health knowledge (χ²₂=9.1; P=.01). Almost half of the participants regarded mobile mental health services as highly acceptable or supported their use, but less than 30% of participants thought mobile mental health services might be very helpful. Concerns about mobile mental health mainly focused on information security. Service receivers also suspected the quality and professionalism of content, and mental health professionals were worried about time and energy consumption as well as medical safety.

Conclusions

In terms of service flow, mobile services could be used to expand service time and improve efficiency before and after diagnosis. More individualized mobile mental health service content in more acceptable forms should be developed to meet the various needs of different mental health stakeholders. Multidisciplinary training and communication could be incorporated to facilitate the integration and cooperation of more well-rounded service teams. A standard medical record system and data format would better promote the development of future intelligent medical care. Issues such as ensuring service quality, solving safety risks, and better integrating mobile services with regular medical workflows also need to be addressed.

Transtheoretical Model Is Better Predictor of Physiological Stress than Perceived Stress Scale and Work Ability Index among Office Workers

Physical activity impacts positively on stress and anxiety. Working conditions affect the quality of life by increasing stress levels, which can affect job performance and work absence. The Perceived Stress Scale (PSS), Work Ability Index (WAI), Transtheoretical Model (TTM), as well as heart rate variability (HRV) have been applied to monitor the state of workers in their job. The aim of this study was to analyze PSS, WAI, and TTM classifications, and to find out how are they linked to physiological stress (HRV). One hundred and thirteen office workers responded to the three questionnaires and their HRV was monitored for at least two full days. Groups were set up according to TTM (Stage 1, Stage 2, Stage 3-4, Stage 5), WAI (weak WAI, medium WAI, good WAI), and PSS (low PSS, medium PSS, high PSS). Results obtained from the test were related to stress values measured by HRV with a Bodyguard2 device. The Stage 5 group from TTM had better HVR and stress levels than the other groups for both women and men (p < 0.05). Participants in the good WAI group and low PSS group had better results than weak WAI and high PSS, but the differences with respect to medium WAI and medium PSS were less clear. Finally, TTM seemed to be the best tool to discriminate physiological stress in office workers with regard to other questionnaires.

A survey study of attitudes toward, and preferences for, e-therapy interventions for eating disorder psychopathology

OBJECTIVE

E-therapy shows promise as a solution to the barriers that stand in the way of people receiving eating disorder (ED) treatment. Despite the potential for e-therapy to reduce the well-known treatment gap, little is known about public views and perspectives on this mode of intervention delivery. This study explored attitudes toward, and preferences for, e-therapy among individuals spanning the spectrum of eating pathology.

METHOD

Survey data assessing e-therapy attitudes and preferences were analyzed from 713 participants recruited from the public. Participants were categorized into one of five subgroups based on the type of self-reported ED symptoms and severity/risk level, ranging from high risk to a probable threshold or subthreshold ED.

RESULTS

Attitudes toward e-therapies appeared to be relatively positive; participants largely supported health care insurance coverage of costs for e-therapies, and were optimistic about the wide-ranging benefits of e-therapy. Although three-quarters of participants expressed a preference for face-to-face therapy, a significant percentage of participants (∼50%) reported an intention to use an e-therapy program for current or future eating problems, with intention ratings highest (70%) among those with probable bulimia nervosa (BN). Variables associated with an e-therapy preference were not currently receiving psychotherapy, more positive e-therapy attitudes, and greater stigma associated with professional help-seeking. Variables associated with e-therapy intentions were more positive e-therapy attitudes and a probable BN classification.

CONCLUSIONS

Present findings have important implications for increasing online intervention acceptance, engagement, and help-seeking among those at different stages of illness.

How individuals change during internet-based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback

BACKGROUND

Standardized and individualized Internet-based interventions (IBI) for depression yield significant symptom improvements. However, change patterns during standardized or individualized IBI are unknown. Identifying subgroups that experience different symptom courses during IBI and their characteristics is vital for improving response.

METHODS

Mildly to moderately depressed individuals according to self-report (N = 1,089) were randomized to receive module-wise feedback that was either standardized or individualized by a counselor within an otherwise identical cognitive-behavioral IBI for depression (seven modules over six weeks). Depressive symptoms were assessed at baseline and before each module (Patient Health Questionnaire; PHQ-9). Other individual characteristics (self-report) and the presence of an affective disorder (structured clinical interview) were assessed at baseline. Growth mixture modeling was used to identify and compare subgroups with discernable change patterns and associated client variables across conditions.

RESULTS

Model comparisons suggest equal change patterns in both conditions. Across conditions, a group of immediate (62.5%) and a group of delayed improvers (37.5%) were identified. Immediate improvers decreased their PHQ-9 score by 5.5 points from pre to post, with 33% of improvement occurring before treatment commenced. Delayed improvers were characterized by stable symptom severity during the first two modules and smaller overall symptom decrease (3.4 points). Higher treatment expectations, a current major depressive disorder (interview), and lower social support were associated with delayed improvement.

CONCLUSION

Internet-based interventions for depression with individualized and with standardized feedback lead to comparable patterns of change. Expectation management and bolstering of social support are promising strategies for individuals that are at risk for delayed improvement.

Development of the eTAP: A brief measure of attitudes and process in e-interventions for mental health

BACKGROUND

Considerable evidence supports the efficacy of e-interventions for mental health treatment and support. However, client engagement and adherence to these interventions are less than optimal and remain poorly understood.

OBJECTIVE

The aim of the current study was to develop and investigate the psychometric properties of the e-Therapy Attitudes and Process questionnaire (eTAP). Based on the Theory of Planned Behaviour (TPB), the eTAP was designed to measure factors related to client engagement in e-interventions for mental health.

METHODS

Participants were 220 adults who reported current use of an e-intervention for mental health support. Participants completed the eTAP and related measures, with a subsample of 49 participants completing a one-week follow up assessment.

RESULTS

A 16-item version of the eTAP produced a clear four-factor structure, explaining 70.25% of variance. The factors were consistent with the TPB, namely, Intention, Subjective Norm, Attitudes, and Perceived Behavioural Control. Internal consistency of the total and subscales was high, and adequate to good one-week test retest reliability was found. Convergent and divergent validity of the total and subscales was supported, as was the predictive validity. Specifically, eTAP Intentions correctly predicted engagement in e-interventions with 84% accuracy and non-engagement with 74% accuracy.

CONCLUSIONS

The eTAP was developed as a measure of factors related to engagement and adherence with e-interventions for mental health. Psychometric investigation supported the validity and reliability of the eTAP. The eTAP may be a valuable tool to understand, predict, and guide interventions to increase engagement and adherence to e-interventions for mental health.

Determinant Factors of Public Acceptance of Stress Management Apps: Survey Study

BACKGROUND

Chronic stress is a major public health concern. Mobile health (mHealth) apps can help promote coping skills in daily life and prevent stress-related issues. However, little is known about the determinant factors of public acceptance of stress management in relation to preferences for psychological services.

OBJECTIVE

The aim of this survey study was to (1) assess determinant factors of public acceptance (behavioral use intention) of stress management apps based on an adapted and extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and (2) explore preferences for mHealth apps compared with other mental health services.

METHODS

Using convenience sampling, participants completed a multiscale 54-item Web-based survey. Based on significant correlations with acceptance, hierarchical stepwise regression analysis was performed within three blocks: (1) background and stress-related control variables, (2) beliefs and attitudes toward using mHealth, and (3) the core UTAUT determinants. The preference for mHealth apps in comparison with nine other mental health services (operationalized as readiness to use) was analyzed using paired t tests.

RESULTS

Of 141 participants, nearly half (69/141, 48.9%) indicated prior mHealth use. Acceptance of stress coping apps was moderate (mean 3.10, SD 1.03, range 1-5). Hierarchical stepwise regression including four of 11 variables (R²=.62; P=.01, f²=1.63) identified positive attitudes toward using mHealth for stress coping (beta=0.69, P<.001, 46% R² increase above block 1, f²=0.85), skepticism/perceived risks (beta=-0.14, P=.01, f²=0.16), and stress symptoms (beta=0.12, P=.03, f²=0.14) as significant predictors of acceptance. UTAUT determinants added no predictive contribution beyond attitudes (all P>.05, R² increase of 1%), whereas post hoc analysis showed significant R² increases of attitudes and skepticism/perceived risks beyond UTAUT determinants (all P<.001, R² increase of 13%). The readiness to use apps was equivalent to or significantly higher than most service types, but lower than information websites.

CONCLUSIONS

Attitudes may be at least as predictive for the acceptance of stress management apps as for more elaborated outcome beliefs. Efforts aimed at improving the public adoption of mHealth could put more emphasis on the pleasant aspects of app use, address misconceptions, offer stress screening tools on health websites, and increase options to try high-quality apps.

Adolescents' Attitudes and Intentions toward Help-Seeking and Computer-Based Treatment for Depression

OBJECTIVE

Many depressed adolescents do not seek professional help despite there being evidence-based treatments for depression, such as cognitive behavioral therapy or computer-based therapy. To increase professional help-seeking behavior in depressed adolescents, it is necessary to positively change help-seeking attitudes. This study aimed to explore the effect of sub-groups of help-seeking attitudes, gender, and depression level on adolescents' help-seeking intentions and their perceptions of computer-based psychotherapy.

METHODS

Participants were 246 adolescents aged 13-18 years recruited from six middle and high schools in South Korea. Measures were self-administered questionnaires, and included the Patient Health Questionnaire-9, the Attitudes Toward Seeking Professional Psychological Help Scale, the Intention to Seek Counseling Inventory, Preferences for Depression Treatment, and the Perceptions of Computerized Therapy Questionnaire.

RESULTS

Help-seeking intentions were positively related with female gender and the recognition of the need for help. A higher level of confidence in therapists was related to high preference for computer-based therapy and face-to-face therapy. Adolescents with more severe depression were more likely to prefer pharmacotherapy. The perceptions of computer-based therapy were more positive in male adolescents, and in adolescents with a higher level of confidence in therapists yet a lower level of interpersonal openness.

CONCLUSION

To promote adolescents' help-seeking behavior, improvement of the recognition of the need for help is required, especially among male adolescents. Computer-based therapy provides an alternative for male adolescents with high confidence in therapists yet low interpersonal openness. Consideration of the help-seeking attitudes and gender is needed when providing therapeutic intervention to depressed adolescents.

Internet- and App-Based Stress Intervention for Distance-Learning Students With Depressive Symptoms: Protocol of a Randomized Controlled Trial

Background: Mental disorders are highly prevalent among university students. Distance-learning students are particularly burdened and have limited access to conventional university health services. Interventions for stress are sought after in distance learners and may help increase treatment coverage. Internet-based interventions have been shown to be effective in preventing and treating depression, but it remains unclear if interventions directed at academic stress also have this potential. Aim: The trial presented here investigates the effectiveness of an Internet- and App-based stress intervention in distance-learning students with elevated levels of depression. Methods: A sample of N = 200 students of a large German distance university with elevated levels of depression [Center for Epidemiological Studies' Depression Scale (CES-D) ≥ 16] will be randomly assigned to either an Internet- and App-based stress management intervention group (IG) or a control group (CG) receiving an Internet-based psychoeducational program for academic stress. The IG consists of eight Internet-based sessions promoting stress management skills using cognitive-behavioral and problem-solving techniques. A mobile App will be employed to facilitate training transfer. Self-report data will be assessed at baseline (T0), post-treatment (T1; 7 weeks), and 3-month follow-up (T2). Potential moderators will be assessed at baseline. The primary outcome is depression (CES-D) post-treatment. Secondary outcomes include mental health outcomes, modifiable risk and protective factors, and academic outcomes. Data will be analyzed on an intention-to-treat principle along with sensitivity analyses to assess the robustness of findings. Additional health economic analyses will be conducted. Discussion: Results will provide the basis to assess the acceptance and effectiveness of Internet-delivered stress interventions in distance-learning students with symptoms of depression. Ethics and dissemination: The study has been reviewed and approved by the University of Erlangen-Nuremberg ethics committee (Erlangen, Germany; 33_17 Bc). Results of the study will be disseminated through peer-reviewed publications. Trial Registration: German Clinical Trial Registration (DRKS), identifier DRKS00011800.

Common mental disorders through the eyes of German employees: attributed relevance of work-related causes and prevention measures assessed by a standardised survey

PURPOSE

Common mental disorders (CMDs) are becoming increasingly relevant in the working world. Numbers of risk factors have been confirmed by mostly correlative cross-sectional studies. Comprehensive and effective prevention is urgently needed. There is little knowledge about employees' own perceptions on causes of CMDs and prevention measures. Therefore, a survey was conducted in 2016.

METHODS

A standardised instrument was developed for an online survey in a commercial access panel, targeted employees in different job types. We assessed two outcomes: perceived relevance of (1) work-related demands to the development of CMDs, and (2) prevention approaches in the workplace and on individual and societal levels. Possible predictive aspects were analysed exploratively by multivariate linear regression analysis.

RESULTS

The response rate was 75% (n = 610). Job types were categorised as "blue", "grey" and "white-collar" workers (n = 193, 169, 248). The majority of respondents rated both outcomes consistently as "quite" or "very relevant"; societal prevention strategies were more relevant for non-white-collar workers. Perceived relevance of individual predisposition to develop a CMD was the strongest predictor for both outcomes, indicating the perception that people with higher personal vulnerability might suffer a higher strain from work-related risk factors than others.

CONCLUSION

We assume that participants in our survey judged the relevance of work-related causes of CMDs independently of their own workload. The perceived relevance of prevention measures in different areas is consistent with official guidelines. A possible selection bias due to characteristics of access panel collectives and own direct or indirect experiences with CMD should be critically questioned.

Digital Interventions for Mental Disorders: Key Features, Efficacy, and Potential for Artificial Intelligence Applications

Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people's lives in the future.

Patient's experience with blended video- and internet based cognitive behavioural therapy service in routine care

INTRODUCTION

Internet-based guided self-help and face-to-face CBT have shown to be effective in the treatment of depression, but both approaches might not be an available treatment option for all patients. A treatment which blends internet-based guided self-help with video-based psychotherapy might reduce potential disadvantages of both approaches, while maintaining major advantages such as being location-independent. Additionally, it could provide a stronger focus on patient empowerment and lower resource use compared to traditional face-to-face treatment.

AIM

The aim of this study is to evaluate patient's experiences with blended internet- and video-based CBT (blended iCBT) treatment and to derive suggestions for the improvement of such services.

METHODS

Semi-structured interviews were conducted with 15 participants of the blended iCBT treatment as part of the European MasterMind trial. Participants included adults suffering from Major Depressive Disorder. The interview guide assessed patient's experiences regarding the four treatment components program, 1. face-to-face diagnostic interviews, 2. video-based synchronous therapy sessions (VTS), 3. online self-help treatment modules (OTM) as well as 4. behaviour diaries and symptom monitoring. Interviews were analyzed using the framework method and outcomes regarding connections within and between participants and categories were generated by counting the statements within relevant themes.

RESULTS

Overall, patients indicated to have been satisfied with all components of the treatment, highlighting the option to independently work from home in their own pace. While the OTMs allowed for a deeper reflection of the content, the VTS with the therapist were mentioned to provide the personal character of the service. The working alliance with the therapist was experienced as fostering the individual fit of the treatment. Patients reported a high self-perceived treatment effectiveness. Negative effects included that some patients felt overwhelmed by the service, e.g. by working with the content of the OTM as they forced them to address their problems. Within the combination of OTM and VTS, both components were rated as equally important and patients felt that the combination depicted a treatment at least equal to regular face-to-face treatment regarding the perceived effectiveness. Other identified themes included patient's individual factors, reactions in their social environment and suggestions for improvement of the service.

DISCUSSION

Predominantly, patients reported positive experiences with the blended iCBT service and rate the treatment as adequate and effective to treat their condition. The importance of the VTS is highlighted. Following this approach might be an option to make affordable and effective evidence-based CBT available independent from regional barriers.

Barriers and facilitators for the implementation of blended psychotherapy for depression: A qualitative pilot study of therapists' perspective

INTRODUCTION

Blended therapies (BT) combine face-to-face (f2f) sessions with internet- and mobile-based interventions (IMIs). However, the use of blended interventions in routine care is still rare and depends on the acceptance of key health care professionals such as the therapists. Little is yet known about the therapists' perspective on and experiences with blended approaches. The aim of this pilot study was to identify barriers and facilitators, as perceived by psychotherapists, for implementing a blended therapy for depression.

METHODS

Semi-structured expert interviews were conducted with five therapists, who were part of the German study arm of the FP7-project E-Compared (www.e-compared.eu). All patients (N = 173) were treated in the context of a registered RCT (DRKS00006866) in which the clinical and cost-effectiveness of BT for depression, consisting of ten internet- and mobile-based cognitive behavioral therapy modules and six f2f sessions, was compared to the treatment usually provided by general practitioners. To identify barriers and facilitators an interview guide based on the theoretical domains framework (TDF) was developed. The interviews were audio-recorded, transcribed verbatim and analyzed using a qualitative content analysis by two independent coders.

RESULTS

The results revealed 29 barriers and 33 facilitators, which are hindering or enabling factors on the levels of 'implementation in the health care system', 'therapy', 'therapists' and 'patients'. Key barriers stated by all therapists were 'Limited customizability and autonomy of decisions concerning blending the therapy' (number of statements, k = 44); 'Disease-related contraindications for BT' (k = 25); 'Negative affect was caused by burden through technical problems' (k = 18); 'Limited number of f2f sessions hindered the therapy process'; and 'Establishment of therapeutic alliance was burdened by technical issues' (each k = 15). Key facilitators stated by all therapists were: 'Patients' interest, willingness and motivation to participate' (k = 22); 'Patients' access to online content between f2f sessions and after therapy end' (k = 20); 'Preset structure of IMI-part guided the treatment course of BT' (k = 18); and 'Effective help with BT in a short time frame' (k = 15), as well as 'Reduction of the treatment gap' (k = 13).

DISCUSSION

Therapists supported the implementation of BT for depression. Results indicated the consideration of a wide range of determinants: among others, the possibility of individualizing the treatment; the autonomy of decision making in respect to the ratio and number of online and f2f sessions; the necessity of providing training; the need to develop a concept of embedding BT in the health care system and funding the additional effort; and the use of sophisticated technical solutions.

Improving attitudes toward e-mental health services in the general population via psychoeducational information material: A randomized controlled trial

INTRODUCTION

In recent years, effective Internet-delivered electronic (e-) mental health services have been developed to overcome the limited resources in face-to-face health care. For the successful dissemination of e-mental health services, individual predictors for their uptake and utilization need to be explored. For instance, little is known about the role of different information sources in attitudes toward Internet therapies. On the basis of technology acceptance framework, this pilot study aimed to identify differences in both attitudes and intentions to use e-mental health treatment services after providing psychoeducational information.

METHODS

439 participants (mean age 33 years, SD = 10.6 years; 72% female) were randomly assigned to one of three text-based information groups (neutral text: n = 111; expert evaluation: n = 108; user evaluation: n = 112) or a control condition (no information: n = 108). We assessed attitudes toward e-mental health treatments using a 15-item German e-therapy attitudes measure.

RESULTS

Descriptive analyses revealed overall neutral attitudes toward Internet therapies. Ambivalent perceptions were found in terms of Perceived Usefulness (positive attitude) and Relative Advantage (negative attitude). The awareness of Internet therapies was rather low. Most participants evaluated self-help books, health websites and face-to-face counselling as more useful than web-based counselling and therapies and reported higher intentions to use conventional services in case of emotional problems. As hypothesized, variance analyses demonstrated that text-based information, especially expert evaluations, were associated with significantly more positive attitudes toward e-mental health treatment services compared to the control condition.

CONCLUSIONS

Taken together, this pilot study suggested a positive connection between the provision of general facts about e-mental health treatment services and attitudes as well as behavioral intentions to future use such services. However, a limitation was the omission of baseline attitudes assessment. Thus, further research is needed to gain deeper insights into the impact of information on attitudes.