Digital Mental Health Interventions for Young People in Rural South Africa: Prospects and Challenges for Implementation

Digital Health Interventions for Adolescents with Long-Term Health Conditions in South Africa: A Scoping Review

Adolescents with long-term health conditions may benefit from digital health interventions (DHIs) to support self-management. The study aimed to map the current research on DHIs for adolescents with long-term conditions in South Africa, focusing on the types of interventions, targeted chronic conditions, and reported outcomes. The scoping review was conducted following the Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Searches were conducted in electronic databases such as EBSCOHost (CINAHL, MEDLINE, Academic Search Ultimate, and APA PSycArticles), Wiley Online Library, and PubMed for articles published between 2014 and 2024. Studies that (1) involved adolescents with a long-term health condition (aged 15-24) residing in South Africa, (2) reported on the use of digital health technology, and (3) provided empirical evidence were included. Nine studies were included in the analysis, focusing primarily on HIV, depression/anxiety, and diabetes. Most interventions utilized WhatsApp, SMS, or social media to provide peer or healthcare worker support. Process outcomes like acceptability and feasibility dominated, with limited data on effectiveness. DHIs show potential for supporting adolescent health but cover a limited number of long-term health conditions and face barriers to effective implementation. Affordable, context-specific solutions co-designed with adolescents are crucial to enhance engagement and ensure scalability in the South African context. Registration: The protocol was registered on Open Science Framework.

Computational Psychotherapy System for Mental Health Prediction and Behavior Change with a Conversational Agent

Background

The importance of computational psychotherapy is increasing due to the record high prevalence of mental health issues worldwide. Despite advancements, current computational psychotherapy systems lack advanced prediction and behavior change mechanisms using conversational agents.

Purpose

This work presents a computational psychotherapy system for mental health prediction and behavior change using a conversational agent. It makes two major contributions. First, we introduce a novel, golden standard dataset, comprising panel data with 1495 instances of quantitative stress, anxiety, and depression (SAD) symptom scores from diagnostic-level questionnaires and qualitative daily diary entries. Second, we present the computational psychotherapy system itself.

Hypothesis

We hypothesize that simulating a theory of mind - the human cognitive ability to understand others - in a conversational agent enhances its effectiveness in relieving mental health issues.

Methods

The system simulates theory of mind with a cognitive architecture comprising an ensemble of computational models, using cognitive modelling and machine learning models trained on the novel dataset, and novel ontologies. The system was evaluated through a computational experiment on mental health phenomena prediction from text, and an empirical interventional study on relieving mental health issues in 42 participants.

Results

The system outperformed state-of-the-art systems in terms of the number of detected categories and detection accuracy (highest accuracy: 91.41% using k-nearest neighbors (kNN); highest accuracy of other systems: 84% using long-short term memory network (LSTM)). The highest accuracy for 7-day forecasting was 87.68%, whereas the other systems were not able to forecast trends. In the study, the system outperformed Woebot, the current state-of-the-art, in reducing stress (p = 0.004) and anxiety (p = 0.008) levels.

Conclusion

The confirmation of our hypothesis indicates that incorporating theory of mind simulation in conversational agents significantly enhances their efficacy in computational psychotherapy, offering a promising advancement for mental health interventions and support compared to current state-of-the-art systems.

A pilot randomised control study to investigate the effect of the South African Adolescence Group Sleep Intervention (SAASI) on adolescent sleep and PTSD

Background: Trauma exposure prevalence and consequent post-traumatic stress disorder among South African adolescents are significant. Sleep disturbances are among the most frequently reported difficulties faced by those dealing with PTSD. The current study examined the feasibility and preliminary efficacy of the South African Adolescence Group Sleep Intervention on PTSD symptom severity and sleep disturbance.Method: Sixty-one adolescents with PTSD diagnoses and sleep disturbance were randomly assigned (1:1) to one individual and four group sessions of a sleep intervention (SAASI) or a control group. Participants completed the Child PTSD symptom scale for DSM5 (CPSS-5) and the Pittsburgh Sleep Quality Index (PSQI) among other sleep and psychiatric measures. The trial was registered on the Pan African Trial Registry (PACTR202208559723690).Results: There was a significant but similar decrease in PSQI scores in both groups over time indicating no overall intervention effect (Wald test = -2.18, p = .029), mean slope = -0.2 (95% CI: -0.37 to -0.02) (p = .583). On the CPSS-5, interaction between groups was also not significant (p = .291). Despite this overall finding, the mean difference in CPSS-SR-5 scores increased over time, with the difference between groups post-treatment -9.10 (95%CI: -18.00 to -0.21), p = .045 and the 1-month follow-up contrast - 11.22 (95%CI: -22.43 to -0.03), p = .049 suggesting that PTSD symptom severity decreased more in the intervention group than the control group. The dropout rate was higher than expected for both the intervention (n = 10; 32%) and control (n = 8; 26.7%) groups. Dropout were mostly school commitments or travel related.Conclusions: Early findings suggest a trend towards dual improvement in sleep quality and PTSD symptom severity in adolescents with a sleep disturbance and PTSD receiving a group sleep intervention (SAASI). Further investigation in a properly powered RCT with detailed retention planning is indicated.

Digital Methods for the Spiritual and Mental Health of Generation Z: Scoping Review

BACKGROUND

Generation Z (Gen Z) includes individuals born between 1995 and 2012. These individuals experience high rates of anxiety and depression. Most Gen Z individuals identify with being spiritual, and aspects from religion and spirituality can be integrated into mental health treatment and care as both are related to lower levels of depression. However, research on the spiritual and mental health of Gen Z is sparse. To date, there are no systematic or scoping reviews on digital methods to address the spiritual and mental health of Gen Z.

OBJECTIVE

This scoping review aimed to describe the current state of digital methods to address spiritual and mental health among Gen Z, identify the knowledge gaps, and make suggestions for how to leverage digital spiritual and mental health interventions for Gen Z.

METHODS

A comprehensive literature search was conducted in PubMed, Scopus, PsycInfo, CINAHL, Education Full Text, Google Scholar, SocIndex, and Sociological Abstracts. The inclusion criteria were as follows: (1) study population born between 1995 and 2012 (ie, Gen Z); (2) reporting on spiritual health or well-being, spirituality or religion, and mental health or well-being; (3) reporting on using digital methods; (4) publication in 1996 or beyond; (5) human subject research; (6) full text availability in English; (7) primary research study design; and (8) peer-reviewed article. Two authors screened articles and subsequently extracted data from the included articles to describe the available evidence.

RESULTS

A total of 413 articles were screened at the title and abstract levels, of which 27 were further assessed with full text for eligibility. Five studies met the inclusion criteria, and data were extracted to summarize study characteristics and findings. The studies were performed across 4 different countries. There were 2 mixed-methods studies (South Africa and Canada), 2 cross-sectional studies (China and United States), and 1 randomized controlled trial (United States). Of these studies, only 2 discussed digital interventions (a text messaging-based intervention to improve spiritual and mental health, and a feasibility study for a mental health app). Other studies had a digital component with minor or unclear spiritual and mental health measures. Overall, there was a lack of consistency in how spiritual and mental health were measured.

CONCLUSIONS

Few studies have focused on assessing the spiritual and mental health of Gen Z in the digital context, and no research to date has examined a digital spiritual and mental health application among Gen Z. Research is needed to inform the development and evaluation of approaches to address the spiritual and mental health of Gen Z via digital means (eg, mobile apps).

Implementation of digital health in rural populations with chronic musculoskeletal conditions: A scoping review protocol

Musculoskeletal conditions are a major source of disability worldwide, and its burden have been rising in the last decades. Rural areas, in particular, are associated with higher prevalence of these conditions as well as higher levels of disability, which is likely related to other determinants that affect these communities. Although digital health has been identified as a potential solution to mitigate the impact of these determinants, it is also known that these populations may face barriers that limit the implementation of these interventions. Therefore, the aim of this scoping review is to comprehensively map the evidence regarding the implementation of digital health interventions in rural populations with chronic musculoskeletal conditions. We will include studies published from the year 2000; that report the use of digital interventions that promote prevention, treatment or monitoring of any chronic musculoskeletal condition or chronic pain from musculoskeletal origin, in patients that live in rural areas. This protocol follows the methodological framework for scoping reviews proposed by Arksey and O'Malley, as well as the Joana Briggs Institute (JBI) approach. We will conduct the search on Medline (PubMed), EMBASE, Web of Science and Scopus, as well as grey literature databases. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess the eligibility of the articles. Data extracted will include the identification of the digital interventions used, barriers and enablers identified by the patients or healthcare providers, the patient-level outcomes measured, and the implementation strategies and outcomes reported. By mapping the evidence on the implementation of digital health interventions in rural communities with musculoskeletal conditions, this scoping review will enhance our understanding of their applicability in real-world settings.

Mental health implications of suicide rates in South Africa

Mental health challenges are a severe issue that could lead to suicide if not properly addressed. South Africa has a significant burden of mental health issues, which contributes to the soaring rate of suicide. Adequate mental health-care provision could reduce the high suicide rate in South Africa. Since the apartheid regime, the country has made a series of efforts to improve mental health. This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications. This study adopted a narrative review approach. Electronic databases (PubMed, Scilit, Google Scholar and Semantic Scholar) were used to identify published articles in the English language with crucial search terms that included mental health, South African mental health policy, South Africa, suicide and policy. Literature suggests that at the provincial level, there are no adequate mental health policies, and the implementation of the country's mental health policy is faced with many challenges, such as a shortage of professionals and finances. The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health. This study concludes that the mental health treatment gap still exists in South Africa, and this needs to be tackled using effective, multi-level counselling interventions and policy initiatives. Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.

Identification of mental disorders in South Africa using complex probabilistic hesitant fuzzy N-soft aggregation information

This paper aims to address the challenges faced by medical professionals in identifying mental disorders. These mental health issues are an increasing public health concern, and middle-income nations like South Africa are negatively impacted. Mental health issues pose a substantial public health concern in South Africa, putting forth extensive impacts on both individuals and society broadly. Insufficient funding for mental health remains the greatest barrier in this country. In order to meet the diverse and complex requirements of patients effective decision making in the treatment of mental disorders is crucial. For this purpose, we introduced the novel concept of the complex probabilistic hesitant fuzzy N-soft set (CPHFNSS) for modeling the unpredictability and uncertainty effectively. Our approach improves the precision with which certain traits connected to different types of mental conditions are recognized by using the competence of experts. We developed the fundamental operations (like extended and restricted intersection, extended and restricted union, weak, top, and bottom weak complements) with examples. We also developed the aggregation operators and their many features, along with their proofs and theorems, for CPHFNSS. By implementing these operators in the aggregation process, one could choose a combination of characteristics. Further, we introduced the novel score function, which is used to determine the optimal choice among them. In addition, we created an algorithm with numerical illustrations for decision making in which physicians employ CPHFNS data to diagnose a specific condition. Finally, comparative analyses confirm the practicability and efficacy of the technique that arises from the model developed in this paper.

Measuring Performance of Rural Mental Healthcare Services in Saudi Arabia

Introduction

Recently, the Saudi government has proposed several initiatives to promote mental health, including the national program named Wazen. The objective of this study was to observe the performance of mental hospitals using a balanced scorecard through this federal program.

Methods

Secondary quantitative analysis was implemented utilizing the Wazen report program data in 2022. The report adopted a balanced scorecard (BSC) concept. The study focused on 19 mental health facilities (Eraddah Hospitals) in the Ministry of Health (MOH) regions. The MOH's annual statistical report for 2018 and 2022 was reviewed to explore more about beds, staff, and the number of new mental disorder cases. Data were analyzed using Microsoft Excel 365 and the Statistical Package for Social Sciences (SPSS Version 25) software. Mental health hospitals were classified into three categories.

Results

Most rural hospitals had lower performance in the yellow threshold value that might need improvement. The data shows that the mean of all hospital performance in some domains ranged, yielding 70% staff engagement and 77% continued educational activity, indicating unsatisfactory performance across public mental health services. The means score of access to care was 97.0% and 94.7%, marking the better mental health services provided. Between 2018 and 2022, there was a significant rise in the prevalence of mental disorders, as evidenced by the number of new patients and outpatients indicated by specific mental diseases, including conditions of psychological development (F80-F98).

Discussion

The high quality of mental healthcare is manifested by therapeutic ethos with a high degree of interaction between professional careers and service users. The former is enhanced by highly educated, competent, compassionate, self-aware, and specialized healthcare professionals in mental health. When assessing mental healthcare services, we recommend considering providers' and professionals' conditions for successful implementation in alignment with patient experience.

Development of a relationship counselling website to identify and mitigate risk of intimate partner violence in the context of women's PrEP use

Discreet, accessible interventions are urgently needed to mitigate the risk of intimate-partner violence (IPV) and other relationship barriers that women encounter to using HIV prevention methods such as pre-exposure prophylaxis (PrEP). We adapted a counsellor-administered intervention, CHARISMA, into a mobile-optimized website to enhance accessibility and reduce human resources required for HIV prevention and relationship counseling. Using human-centered design and participatory methods, CHARISMA was adapted through workshops with former CHARISMA in-person intervention participants (n = 14; ages 18-45) and web development 'sprints' combined with cognitive interviews (n = 24). 'CHARISMA mobile' was then beta-tested with 81 women naïve to the in-person intervention. In beta-testing, participants used a 'think aloud' process to provide feedback on ease of use and rated design, functionality, comprehension, confidentiality, safety, and usefulness on a scale of 1 to 5 via a survey. Data were conducted in four rounds, interspersed with rapid assessment according to go/no-go criteria, and website adaptations. The updated website was pilot tested for 'real-world' feasibility and acceptability among 159 women using their own smartphones at a location of their choice. Feedback was measured via surveys and website analytics. Workshops and cognitive interviews generated insights on technology use, contextual adaptations, and confidentiality, which were integrated into the beta version. The beta version met all 'go' criteria and was further adapted for pilot testing. In pilot testing, users found the website was useful (mean rating 4.54 out of 5), safe (4.5 out of 5), and had few concerns about confidentiality (1.75, representing low concern). On average, users rated the website more than 4 stars out of 5. Beta and pilot-testing suggested the smartphone-optimized website was well-accepted, relevant, engaging, feasible to administer, discreet and safe. Results contributed to a refined website, suitable for adaptations to other contexts and further evaluation where outcomes related to PrEP use and relationships should be assessed.

Resilience to depression: the role of benevolent childhood experiences in a South African sample

Background

Studies elsewhere show that benevolent childhood experiences (BCEs) have protective mental health value. However, this protective value has never been investigated in an African context. Given the need to better understand what might support mental health resilience among African young people, this study explores the relationship between BCEs and depressive symptoms among a South African sample of young adults living in a community dependent on the economically volatile oil and gas industry.

Methods

A sample of young adults in an oil and gas community in South Africa (N = 313, mean age 20.3 years, SD = 1.83, range from 18 to 26; majority Black African) completed self-report questionnaires to assess BCEs and depressive symptoms (Beck Depression Inventory-II). The analysis controlled for socio-demographics and experience of family adversity. Multinomial logistic regressions were used to examine the association of BCEs with depressive symptoms using STATA 17.

Results

The majority (86.4% of the sample) reported all 10 BCEs. Of the 10 BCEs, having at least one good friend was the most reported (94%) compared to 75% of the sample reporting having a predictable home routine, such as regular meals and a regular bedtime. The unadjusted multinomial logistic regression analysis indicated that having at least one good friend, comforting beliefs, and being comfortable with self were associated with lower odds of moderate depression. The adjusted results showed no association between BCEs and the depression of young adults in this sample.

Conclusion

In this South African sample, our results do not show protective associations between BCEs and depression. This could be as a result of the homogeneity in our sample. It is also possible that the BCEs explored could not counteract the effect of chronic risk factors in the lives of the young people in this study context. Further research is needed to understand this complexity.

Digital interventions empowering mental health reconstruction among students after the COVID-19 pandemic

With the gradual end of the coronavirus disease 2019 (COVID-19) pandemic, the reconstruction of students’ mental health is urgently necessary. Digital interventions offer advantages such as high accessibility, anonymity, and accurate identification, which can promote the reconstruction of students’ mental health through the provision of psychological support platforms, psychological assessment tools, and online mental health activities. However, we recognize that digital interventions must undergo many adjustments, and corresponding ethical norms require further clarification. It is crucial for different stakeholders to collaborate and work toward maximizing the effectiveness of digital interventions for the reconstruction of mental health after the COVID-19 pandemic.