A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb

Cultivating participatory processes in self-harm app development: A case-study and working methodology

Background

Self-harm and suicide related behaviours are increasing in young people, and clinical support is not adequately meeting needs. Improved approaches to assessment and the clinical management of self-harm will result from codesign processes and include greater shared decision-making between young people and practitioners. The CaTS-App (an adapted digital version of the existing Card-Sort Task for Self-harm research tool) aims to facilitate a collaborative understanding of adolescent self-harm and support decision-making within clinical settings. The codevelopment of a digital, clinical tool which meets the needs of multiple stakeholders requires careful consideration.

Methods

We present a case-study describing the participatory aspects of the development of the CaTS-App, which included comprehensive patient involvement, research activities and coproduction with diverse young people aged 17-24 with lived experience of self-harm. We share our processes and activities to deliver safe, engaging, sustainable, ethical and responsible participatory practice and co-created knowledge, in the codevelopment of the CaTS-App.

Results

Activities spanned a 48-month period in both face-to-face and online settings. Example processes and activities are provided in narrative, tabular and diagrammatic form, alongside discussion of the rationale for choices made. A summary methodology is also shared to stimulate continued discussion and development of participatory approaches in digital mental health.

Conclusions

The paper contributes important insight and practical detail for the delivery of genuine participatory processes in digital mental health development when working with a population who may be considered vulnerable.

A Systematic Review Protocol for the Effectiveness of Psycho-Educational Intervention Programmes in Addressing the Psychological Risk Factors Associated with Non-Communicable Diseases among Adolescents

The psychological health concerns and risk factors associated with non-communicable disease among adolescents have been prioritized on the agenda of international health institutions globally. The aims of this systematic review are to determine the various types of psycho-educational intervention programmes developed to address the psychological risk factors associated with non-communicable diseases among adolescents, and to assess the effectiveness of the psycho-educational intervention programmes. The systematic review will include case-control and randomized controlled studies. The review will be conducted using the following electronic databases, PubMed, CINAHL, Science Direct, Cochrane Library, SCOPUS, and ERIC, as well as the grey literature for the thesis repository from 2012 to 2022. The key search terms will include intervention programme, adolescents (aged 10-19 years), psychological risk factors and non-communicable diseases. The studies identified by the search strategy will be downloaded into Mendeley and exported to Covidence software for screening, quality assessment and data extraction. The quality assessment tool that will be utilized is the Joanna Briggs Institute critical appraisal checklists to ensure relevance and quality of the articles. This systematic review will use two types of data analysis: narrative synthesis of qualitative studies and meta-analysis of quantitative studies. The findings from this systematic review will provide evidence-based tools for the management of psychological risk factors associated with non-communicable diseases, as well as present key insights for future intervention programmes on the management of psychological risk factors associated with NCDs among adolescents.

Identifying adolescents' gaming preferences for a tobacco prevention social game: A qualitative study

INTRODUCTION

Considering the dangers of adolescent tobacco use, the successful design of behavioral programs is crucial for tobacco prevention. According to preliminary research, social game interventions can improve adolescent tobacco outcomes. The current qualitative study aims to (1) uncover the gaming elements that adolescents deem important for a positive learning experience, and (2) confirm these gaming elements with adolescents who are presented with a tobacco prevention game concept that applies these elements.

METHODS

Findings from this study are drawn from two phases. Phase 1 involved in-person focus group discussions (n = 15) and Phase 2 included three online focus groups and a paired interview with another set of adolescents (n = 15). The study was conducted under a project that aimed to design and test a social game-based tobacco prevention program for adolescents (Storm-Heroes). With open coding and thematic analysis, two research team members identified repeated topics and relevant quotes to organize them into themes. The themes evolved as new content was identified during the process. This process was repeated until thematic saturation was reached.

RESULTS

Thematic analysis across Phase 1 and Phase 2 revealed four major themes: 1) Balance during gaming challenges, 2) Healthy social interaction, 3) Performance and creative freedom, and 4) Fictional world and game mechanics for tobacco prevention.

CONCLUSION

This study identified specific intervention features that best fit the needs of adolescents in the context of a social game for tobacco prevention. For future research, we will use a participatory approach to allow adolescents to take part in the design process, improve Storm-Heroes, and develop health promotional messages that can be incorporated into the program. Ultimately, a board game for tobacco prevention is expected to bring adolescents together to create lasting memories that nudge them away from tobacco use and the harm it can cause.

Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach

BACKGROUND

Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions.

OBJECTIVE

This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy-a smartphone app that helps young people manage suicidal thoughts.

METHODS

Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings-from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population-with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops.

RESULTS

Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components.

CONCLUSIONS

This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health.

Further development and feasibility randomised controlled trial of a digital programme for adolescent depression, MoodHwb: study protocol

INTRODUCTION

A digital programme, MoodHwb, was codesigned with young people experiencing or at high risk of depression, parents/carers and professionals, to provide support for young people with their mood and well-being. A preliminary evaluation study provided support for the programme theory and found that MoodHwb was acceptable to use. This study aims to refine the programme based on user feedback, and to assess the acceptability and feasibility of the updated version and study methods.

METHODS AND ANALYSIS

Initially, this study will refine MoodHwb with the involvement of young people, including in a pretrial acceptability phase. This will be followed by a multicentre feasibility randomised controlled trial comparing MoodHwb plus usual care with a digital information pack plus usual care. Up to 120 young people aged 13-19 years with symptoms of depression and their parents/carers will be recruited through schools, mental health services, youth services, charities and voluntary self-referral in Wales and Scotland. The primary outcomes are the feasibility and acceptability of the MoodHwb programme (including usage, design and content) and of trial methods (including recruitment and retention rates), assessed 2 months postrandomisation. Secondary outcomes include potential impact on domains including depression knowledge and stigma, help-seeking, well-being and depression and anxiety symptoms measured at 2 months postrandomisation.

ETHICS AND DISSEMINATION

The pretrial acceptability phase was approved by the Cardiff University School of Medicine Research Ethics Committee (REC) and the University of Glasgow College of Medicine, Veterinary and Life Sciences REC. The trial was approved by Wales NHS REC 3 (21/WA/0205), the Health Research Authority(HRA), Health and Care Research Wales (HCRW), university health board Research and Development (R&D) departments in Wales, and schools in Wales and Scotland. Findings will be disseminated in peer-reviewed open-access journals, at conferences and meetings, and online to academic, clinical, and educational audiences and the wider public.

TRIAL REGISTRATION NUMBER

ISRCTN12437531.

Perceived Support from Best Friends and Depressive Symptoms During Adolescence: Disentangling Personal from Dyadic Level Effects

Support from best friends is an important interpersonal factor in adolescent depression development but is often studied from an individual perspective in which dyadic effects are overlooked. This study aims to a) test whether differences in support vary at the individual level and are related to individual differences in the development of depressive symptoms, whether these differences vary at the dyadic level and are related to dyadic depression symptom development, or both, b) explore whether these associations are moderated by initial levels of depressive symptoms on the individual and/or dyadic level. Data from 452 adolescents (Mage = 13.03), nested in 226 same-gender friendship dyads (60.6% boy-dyads) who participated in the RADAR-Y project were included. Best friends self-reported annually (2006-2008; 3 waves) on their own depressive symptoms and perceived support from their friend. Multilevel models showed no direct association between support and depression development on the individual or dyadic level. However, the initial level of dyads' depressive symptoms moderated the association between dyadic support and dyads' subsequent depression symptom development. When dyads experienced relatively more initial depressive symptoms, higher levels of dyadic support were associated with relative increasing dyadic depressive symptoms. When dyads experienced relatively few initial depressive symptoms, higher levels of dyadic support were associated with relative decreasing dyadic depressive symptoms. Findings suggest that support from best friends can either protect against or exacerbate the development of depressive symptoms for friends, depending on the initial level of depressive symptoms of the dyad.

Analyzing User-Generated Web-Based Posts of Adolescents' Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis

BACKGROUND

Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking.

OBJECTIVE

This study aimed to fill this knowledge gap through a new understanding of adolescents' cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice.

METHODS

The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression.

RESULTS

Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts.

CONCLUSIONS

These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action.

Managing Minds at Work: Development of a Digital Line Manager Training Program

Mental ill-health is the leading cause of sickness absence, creating a high economic burden. Workplace interventions aimed at supporting employers in the prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work is a digital intervention aimed at supporting line managers in promoting better mental health at work through a preventative approach. This intervention was developed as part of the Mental Health and Productivity Pilot, a wider initiative aimed at supporting employers across the Midlands region of the United Kingdom to improve the future of workplace mental health and wellbeing. The aim of the study is to describe the design and development of the Managing Minds at Work digital training program, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). An agile methodology was used to co-create intervention content with a stakeholder virtual community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. It was considered by stakeholders to be appropriate for any type of organization, irrespective of their size or resources. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that the program was perceived to be useful, relevant, and easy to use by managers across sectors, organization types, and sizes. We identified positive impacts on manager attitudes and behavioral intentions related to preventing mental ill-health and promoting good mental wellbeing at work. The next step is to explore the feasibility and acceptability of Managing Minds at Work with line managers in diverse employment settings.

Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review

BACKGROUND

Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development.

OBJECTIVE

The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research.

METHODS

An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies.

RESULTS

A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41%), codesign (6/27, 22%), user-centered design (5/27, 19%), or a specific design method (5/27, 19%). Just over half (15/27, 56%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27% (8/30) of all the included studies explicitly mentioned the presence of designers on their team.

CONCLUSIONS

Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research.

A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe

Adolescence is associated with heightened vulnerability to symptoms of depression and anxiety. In-person and computerised cognitive behavioural therapy (CBT) are effective treatment options, yet uptake and engagement remain low. Smartphone delivery of CBT offers an alternative, highly accessible method of delivering CBT. However, there is no freely available CBT smartphone application (app) specifically designed to reduce depression and anxiety symptoms in adolescents. The aim of this study was to design a new CBT smartphone app (ClearlyMe) that targets depressive and anxiety symptoms in adolescents. We engaged in a rigorous co-design process with adolescents (n=36), parents (n=15), and mental health professionals (n=32). Co-design involved: (1) discovery of users’ needs, views and preferences by conducting focus groups, (2) defining app features through ideation workshops and user consultations, (3) designing therapeutic CBT content and visual features, and (4) testing prototypes. Users were involved at every step and the process was iterative, with findings carried forward to ensure continued refinement of concepts and features. We found a preference for vibrant, cheerful colours and illustrations and non-endorsement of gamification and chatbots, which contrasted with findings from other studies. Preferences were largely consistent between the three user groups. However, adolescents preferred an app that could be used autonomously without professional support, whereas mental health professionals desired a product for use as a therapy adjunct to support CBT skill development. The importance of co-design, and particularly the inclusion of all stakeholders throughout the entire co-design process, is discussed in relation to the design of ClearlyMe.

Key learning aims

(1)

Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores

Background

Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use.

Objective

The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both.

Methods

A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores—Google Play Store and Apple App Store—to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information.

Results

The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially.

Conclusions

A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality—utility, safety, and effectiveness—of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms.

Interventions to reduce post-traumatic stress disorder symptoms in health care professionals from 2011 to 2021: a scoping review

OBJECTIVES

This scoping review aimed to describe available interventions for decreasing (post-traumatic stress disorder) PTSD symptoms among healthcare professionals in hospital care.

METHOD

A scoping review was conducted following Arksey and O'Malley's framework. PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest were searched for original research published in English from 2011 to 2021, on 8 July 2021. We included studies that described interventions that focused on reducing the PTSD symptoms of healthcare professionals. A narrative synthesis was adopted to synthesise the data.

RESULTS

A total of eight studies out of 2558 articles were identified. Six used a quantitative study design and two adopted qualitative methods. cognitive behavioural therapy and mindfulness-based interventions were the most commonly adopted. Most studies used a combination of different intervention strategies. Trauma-related knowledge, emotion regulation and relaxation skill training, and psychological support from peers and psychologists were three core intervention components. The duration ranged from 2 weeks to 6 months. Healthcare professionals who participated in training programmes reported both positive experiences and suggestions for the improvement of PTSD-reducing interventions in their qualitative feedback.

CONCLUSIONS

The scoping review provides a practical summary of the intervention characteristics for reducing the PTSD symptoms of healthcare professionals. Hospitals and managers could use the overview of interventions to assist healthcare professionals with PTSD symptoms. More research investigating the effects of PTSD symptom-reducing interventions for healthcare professionals with appropriate follow-up assessments is needed in the future.

Finding Relevant Psychoeducation Content for Adolescents Experiencing Symptoms of Depression: Content Analysis of User-Generated Online Texts

Background

Symptoms of depression are frequent in youth and may develop into more severe mood disorders, suggesting interventions should take place during adolescence. However, young people tend not to share mental problems with friends, family, caregivers, or professionals. Many receive misleading information when searching the internet. Among several attempts to create mental health services for adolescents, technological information platforms based on psychoeducation show promising results. Such development rests on established theories and therapeutic models. To fulfill the therapeutic potential of psychoeducation in health technologies, we lack data-driven research on young peoples’ demand for information about depression.

Objective

Our objective is to gain knowledge about what information is relevant to adolescents with symptoms of depression. From this knowledge, we can develop a population-specific psychoeducation for use in different technology platforms.

Methods

We conducted a qualitative, constructivist-oriented content analysis of questions submitted by adolescents aged 16-20 years to an online public information service. A sample of 100 posts containing questions on depression were randomly selected from a total of 870. For analysis, we developed an a priori codebook from the main information topics of existing psychoeducational programs on youth depression. The distribution of topic prevalence in the total volume of posts containing questions on depression was calculated.

Results

With a 95% confidence level and a ±9.2% margin of error, the distribution analysis revealed the following categories to be the most prevalent among adolescents seeking advice about depression: self-management (33%, 61/180), etiology (20%, 36/180), and therapy (20%, 36/180). Self-management concerned subcategories on coping in general and how to open to friends, family, and caregivers. The therapy topic concerned therapy options, prognosis, where to seek help, and how to open up to a professional. We also found young people dichotomizing therapy and self-management as opposite entities. The etiology topic concerned stressors and risk factors. The diagnosis category was less frequently referred to (9%, 17/180).

Conclusions

Self-management, etiology, and therapy are the most prevalent categories among adolescents seeking advice about depression. Young people also dichotomize therapy and self-management as opposite entities. Future research should focus on measures to promote self-management, measures to stimulate expectations of self-efficacy, information about etiology, and information about diagnosis to improve self-monitoring skills, enhancing relapse prevention.

Effectiveness of nonpharmacological interventions for reducing postpartum fatigue: a meta-analysis

BACKGROUND

Postpartum fatigue is the most common issue among postnatal women and it could not only seriously affect the health of mothers but also bring about adverse impacts on their offspring. This meta-analysis aims to synthesize nonpharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperae.

METHODS

The Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases were searched for papers published from inception until June 2021. Grey literature was searched using OpenGrey. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating nonpharmacological interventions conducted during 0 ~ 78 weeks postpartum for fatigue reduction were eligible for inclusion. The methodological quality of the included studies was independently assessed by two reviewers using the Cochrane risk-of-bias tool and the risk of bias in nonrandomized studies of interventions. Cohen's kappa coefficient was used to measure inter-rater agreement. The meta-analysis was conducted using Review Manager 5.3.

RESULTS

Seventeen published clinical trials matched the eligibility criteria and ten studies involving 1194 participants were included in this meta-analysis. The intervention start time varied from immediately postpartum care to 1 year after delivery, and duration ranged from 1 day to 3 months. The results revealed that exercise (SMD = - 1.74, 95% CI = -2.61 to - 0.88) and drinking tea (MD = - 3.12, 95% CI = -5.44 to - 0.80) resulted in significant improvements in women's postpartum fatigue at postintervention. Drinking tea may have beneficial effects on depression (MD = - 2.89, 95% CI = -4.30 to - 1.49). Positive effects of psychoeducational interventions on postpartum fatigue or depression were not observed. Physical therapies including mother-infant skin-to-skin contact, taking warm showers and breathing lavender oil aroma were used for reducing postpartum fatigue. No significant risk of publication bias was found. Small number of included studies and sample sizes, not time-matched conditions of control groups, high heterogeneity and the risk of bias within the included studies were the main limitations of our review.

CONCLUSIONS

This review provides evidence that exercise and drinking tea may be effective nonpharmacological interventions for relieving postpartum fatigue. More effective and targeted exercise programs need to be further studied. Rigorous RCTs of drinking tea are needed. Caution is required when interpreting the findings due to the limitations of our study. Further studies are still needed to validate our findings and increase confidence in the results.

Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial

Background

Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers.

Objective

This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis.

Methods

Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later.

Results

The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled.

Conclusions

Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving.

Trial Registration

ClinicalTrials.gov NCT04662008; http://clinicaltrials.gov/ct2/show/NCT04662008

International Registered Report Identifier (IRRID)

DERR1-10.2196/30617

Perceptions of mental health nurses about psychosocial management of depression in adolescents, North West province, South Africa

Background

Depression in adolescents is a multifactorial global public health concern, with devastating consequences on the sufferer. The prevalence of depression amongst this age group is on the rise, and thus there is the need for greater attention.

Aim

To explore and describe the perceptions of mental health nurses regarding the psychosocial management of depression in adolescents in North West province, South Africa.

Setting

The study was conducted in two mental healthcare institutions and two mental healthcare units within two general hospitals in North West province, South Africa.

Method

A qualitative, explorative, descriptive and contextual research design was used in conducting this study. Data were collected through focus group discussions from four groups of mental health nurses from each of the mental healthcare institutions and mental healthcare units with 18 mental health nurses. Data were analysed using Tesch’s open coding method.

Results

Two themes emerged from the study: comprehensive psychosocial management and involvement of different stakeholders.

Conclusion

The findings revealed clear psychosocial management for depression in adolescents. Adopting the findings of this study could improve depressive symptoms and curtail the prevalence of depression amongst adolescents in the North West province, South Africa.

Investigating the Use of Electronic Well-being Diaries Completed Within a Psychoeducation Program for University Students: Longitudinal Text Analysis Study

Background

Psychoeducation has the potential to support students experiencing distress and help meet the demand for support; however, there is a need to understand how these programs are experienced. Web-based diaries are a useful activity for psychoeducation because of their therapeutic benefits, ability to capture naturalistic data relevant to well-being, and appropriateness for text analysis methods.

Objective

This study aims to examine how university students use electronic diaries within a psychoeducation program designed to enhance mental well-being.

Methods

The Science of Happiness course was administered to 154 undergraduate students in a university setting (the United Kingdom). Diaries were collected from the students for 9 weeks. Baseline well-being data were collected using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). The percentage of negative and positive emotion words used in diaries (emotional tone) and use of words from five life domains (social, work, money, health, and leisure) were calculated using the Linguistic Inquiry and Word Count 2015 software. Random effects (generalized least squares) regression models were estimated to examine whether time, diary characteristics, demographics, and baseline well-being predict the emotional tone of diaries.

Results

A total of 149 students participated in the diary study, producing 1124 individual diary entries. Compliance with the diary task peaked in week 1 (n=1041, 92.62%) and was at its lowest in week 3 (n=807, 71.81%). Compared with week 1, diaries were significantly more positive in their emotional tone during week 5 (mean difference 23.90, 95% CI 16.89-30.90) and week 6 (mean difference 26.62, 95% CI 19.35-33.88) when students were tasked with writing about gratitude and their strengths. Across weeks, moderate and high baseline SWEMWBS scores were associated with a higher percentage of positive emotion words used in diaries (increases compared with students scoring low in SWEMWBS were 5.03, 95% CI 0.08-9.98 and 7.48, 95% CI 1.84-13.12, respectively). At week 1, the diaries of students with the highest levels of baseline well-being (82.92, 95% CI 73.08-92.76) were more emotionally positive on average than the diaries of students with the lowest levels of baseline well-being (59.38, 95% CI 51.02-67.73). Diaries largely focused on the use of social words. The emotional tone of diary entries was positively related to the use of leisure (3.56, 95% CI 2.28-4.85) and social words (0.74, 95% CI 0.21-1.27), and inversely related to the use of health words (−1.96, 95% CI −3.70 to −0.22).

Conclusions

We found evidence for short-term task-specific spikes in the emotional positivity of web-based diary entries and recommend future studies examine the possibility of long-term impacts on the writing and well-being of students. With student well-being strategies in mind, universities should value and encourage leisure and social activities.

Using Mixed Methods to Identify the Primary Mental Health Problems and Needs of Children, Adolescents, and Their Caregivers during the Coronavirus (COVID-19) Pandemic

Our understanding of child, adolescent, and caregiver mental health (MH) problems during the coronavirus pandemic, and which interventions are needed, may be advanced by consumer input. 133 general population caregivers reported top MH problems and needs for themselves and their children (M_age = 8.21; SD = 4.94), using standardized and idiographic measures. We applied linear regression models to quantitative data and thematic analysis to qualitative data. Caregivers' COVID-era depression and anxiety symptom means fell within the clinical range, as did their children's MH symptoms. Caregiver-reported child and adolescent symptoms were positively associated with number of children in the home. Caregiver and caregiver-reported child and adolescent symptoms were more pronounced in regions with more lenient COVID-19 restrictions. Among the kinds of help most urgently needed, MH services were ranked #1 for caregivers and adolescents, #2 for 6-12 year-olds, and #3 for 1-5 year-olds. Top problems identified for each age group highlight pressing pandemic-related intervention targets.

Children and young people's concerns and needs relating to their use of health technology to self-manage long-term conditions: a scoping review

BACKGROUND

The use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies.

AIMS

To identify children and young people's reported concerns or needs in relation to using health technologies to self-manage long-term conditions.

METHODS

A scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations.

RESULTS

Thirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5-18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people's main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information.

DISCUSSION

This review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.

Practitioner review: Co-design of digital mental health technologies with children and young people

BACKGROUND

There is increasing interest in digital technologies to help improve children and young people's mental health, and the evidence for the effectiveness for these approaches is rising. However, there is concern regarding levels of user engagement, uptake and adherence. Key guidance regarding digital health interventions stress the importance of early user input in the development, evaluation and implementation of technologies to help ensure they are engaging, feasible, acceptable and potentially effective. Co-design is a process of active involvement of stakeholders, requiring a change from the traditional approaches to intervention development. However, there is a lack of literature to inform the co-design of digital technologies to help child and adolescent mental health.

METHODS

We reviewed the literature and practice in the co-design of digital mental health technologies with children and young people. We searched Medline, PsycInfo and Web of Science databases, guidelines, reviews and reference lists, contacted key authors for relevant studies, and extracted key themes on aspects of co-design relevant to practice. We supplemented this with case studies and methods reported by researchers working in the field.

RESULTS

We identified 25 original articles and 30 digital mental health technologies that were designed/developed with children and young people. The themes identified were as follows: principles of co-design (including potential stakeholders and stages of involvement), methods of involving and engaging the range of users, co-designing the prototype and the challenges of co-design.

CONCLUSIONS

Co-design involves all relevant stakeholders throughout the life and research cycle of the programme. This review helps to inform practitioners and researchers interested in the development of digital health technologies for children and young people. Future work in this field will need to consider the changing face of technology, methods of engaging with the diversity in the user group, and the evaluation of the co-design process and its impact on the technology.

A Digital Intervention for Adolescent Depression (MoodHwb): Mixed Methods Feasibility Evaluation

BACKGROUND

Treatment and prevention guidelines highlight the key role of health information and evidence-based psychosocial interventions for adolescent depression. Digital health technologies and psychoeducational interventions have been recommended to help engage young people and to provide accurate health information, enhance self-management skills, and promote social support. However, few digital psychoeducational interventions for adolescent depression have been robustly developed and evaluated in line with research guidance.

OBJECTIVE

We aimed to evaluate the feasibility, acceptability, and potential impact of a theory-informed, co-designed digital intervention program, MoodHwb.

METHODS

We used a mixed methods (quantitative and qualitative) approach to evaluate the program and the assessment process. Adolescents with or at elevated risk of depression and their parents and carers were recruited from mental health services, school counselors and nurses, and participants from a previous study. They completed a range of questionnaires before and after the program (related to the feasibility and acceptability of the program and evaluation process, and changes in mood, knowledge, attitudes, and behavior), and their Web usage was monitored. A subsample was also interviewed. A focus group was conducted with professionals from health, education, social, and youth services and charities. Interview and focus group transcripts were analyzed using thematic analysis with NVivo 10 (QSR International Pty Ltd).

RESULTS

A total of 44 young people and 31 parents or carers were recruited, of which 36 (82%) young people and 21 (68%) parents or carers completed follow-up questionnaires. In all, 19 young people and 12 parents or carers were interviewed. Overall, 13 professionals from a range of disciplines participated in the focus group. The key themes from the interviews and groups related to the design features, sections and content, and integration and context of the program in the young person's life. Overall, the participants found the intervention engaging, clear, user-friendly, and comprehensive, and stated that it could be integrated into existing services. Young people found the "Self help" section and "Mood monitor" particularly helpful. The findings provided initial support for the intervention program theory, for example, depression literacy improved after using the intervention (difference in mean literacy score: 1.7, 95% CI 0.8 to 2.6; P<.001 for young people; 1.3, 95% CI 0.4 to 2.2; P=.006 for parents and carers).

CONCLUSIONS

Findings from this early stage evaluation suggest that MoodHwb and the assessment process were feasible and acceptable, and that the intervention has the potential to be helpful for young people, families and carers as an early intervention program in health, education, social, and youth services and charities. A randomized controlled trial is needed to further evaluate the digital program.

Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study

Background

Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kræftværket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience.

Objective

The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kræftværket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app.

Methods

A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kræftværket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach.

Results

The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization—female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app.

Conclusions

Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kræftværket app with the input of more AYAs.

Mental Illness and BRCA1/2 Genetic Testing Intention Among Multiethnic Women Undergoing Screening Mammography

OBJECTIVES

To examine associations between patient-reported mental illness diagnosis and symptoms and BRCA1/2 genetic testing intention among women undergoing screening mammography.

SAMPLE & SETTING

100 multiethnic women of lower socioeconomic status who were undergoing mammography screening and met family history criteria for BRCA1/2 genetic testing.

METHODS & VARIABLES

Descriptive and bivariate nonparametric statistics and multivariate logistic regression were used to examine associations between mental illness and genetic testing intention. Variables were anxiety, depression, patient-reported mental illness diagnosis and symptoms, and testing intention.

RESULTS

Prevalence rates of mental illness symptoms were 36% for clinically significant depression and 36% for anxiety. Although 76% of participants intended to undergo genetic testing, only 5% had completed testing. History of mental illness and elevated levels of anxiety and depressive symptoms were positively correlated with testing intention in the bivariate analysis. In multivariate analysis, only younger age and less education were associated with testing intention.

IMPLICATIONS FOR NURSING

Future studies should address psychosocial needs and other competing barriers at the patient, provider, and healthcare system levels to increase access to BRCA1/2 genetic testing among multiethnic women.

Review and Implementation of Self-Help and Automated Tools in Mental Health Care

Self-help and automated technologies can be useful for behavioral and mental health education and interventions. These technologies include interactive media, online courses, artificial intelligence-powered chatbots, voice assistants, and video games. Self-help media can include books, videos, audible media like podcasts, blog and print articles, and self-contained Internet sites. Social media, online courses, and mass-market mobile apps also can include such media. These technologies serve to decrease geospatial, temporal, and financial barriers. This article describes different self-help and automated technologies, how to implement such technologies in existing clinical services, and how to implement according to patient needs.

Revealing users' experience and social interaction outcomes following a web-based smoking prevention intervention for adolescents: A qualitative study

BACKGROUND

Tobacco smoking remains a public health problem among adolescents in the United States. While Web-based interventions for smoking prevention have been successful at the individual level, there is still an urgent need to understand their engagement capabilities and their effects at the social level. In the current study, we aimed to (1) learn about adolescents' subjective experience with a Web-based program called a smoking prevention interactive experience (ASPIRE), (2) obtain suggestions for improvement in ASPIRE content, (3) identify psychological outcomes of ASPIRE, and (4) explore outcomes of social interaction.

MATERIALS AND METHODS

After a randomized controlled trial with 110 adolescents, 20 adolescent users of ASPIRE, aged 11-18, were randomly selected to participate in one-on-one interviews at four after-school programs in Houston, Texas. Interviews involved questions concerning adolescents' experience with the intervention. Qualitative data were coded and analyzed using a constant comparison approach for the generation of themes.

RESULTS

Describing their experience with ASPIRE, participants expressed comfort in material that is tailored to their demographic and preferred interactive activities over entertaining videos. Presenting suggestions for improvement, participants mainly reported the need to include gaming features into ASPIRE. Presenting psychological outcomes, they expressed emotional engagement in the program, shifts in attitudes and beliefs, and unwillingness to smoke. Finally, as outcomes of social interaction, participants reported engagement with others in discussions about tobacco and their need to hold smokers accountable for their actions.

CONCLUSIONS

Adolescents' reports moved from their individual experience with ASPIRE to their active interactions with family members and friends and their attempt to persuade others to quit smoking. Future Web-based programs for adolescents may be designed with tailoring and game play in mind, in order to provide mobilization skills and foster social interactions against smoking.

An mHealth approach to extend a brief intervention for adolescent alcohol use and suicidal behavior: Qualitative analyses of adolescent and parent feedback

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the post-hospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.