%0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25235 %T Feasibility and Acceptability of a Digital Intervention to Support Shared Decision-making in Children’s and Young People’s Mental Health: Mixed Methods Pilot Randomized Controlled Trial %A Liverpool,Shaun %A Edbrooke-Childs,Julian %+ Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, 4-8 Rodney Street, The Kantor Centre of Excellence, London, N1 9JH, United Kingdom, 44 7539468630, shaun.liverpool.14@ucl.ac.uk %K mental health %K pilot projects %K child %K adolescent %K parents %K shared decision making %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Interventions to involve parents in decisions regarding children’s and young people’s mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness. Objective: This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children’s and young people’s mental health. Methods: A mixed method study design was adopted. In stage 1, health care professionals and parents provided feedback on acceptability, usefulness, and suggestions for further development. Stage 2 was a multicenter, 3-arm, individual, and cluster randomized controlled pilot feasibility trial with parents accessing services related to children’s and young people’s mental health. Outcome measures collected data on demographics, participation rates, SDM, satisfaction, and parents’ anxiety. Qualitative data were analyzed using thematic analysis. Google Analytics estimates were used to report engagement with the prototype. Outcomes from both stages were tested against a published set of criteria for proceeding to a randomized controlled trial. Results: Despite evidence suggesting the acceptability of Power Up for Parents, the findings suggest that recruitment modifications are needed to enhance the feasibility of collecting follow-up data before scaling up to a fully powered randomized controlled trial. On the basis of the Go or No-Go criteria, only 50% (6/12) of the sites successfully recruited participants, and only 38% (16/42) of parents completed follow-up measures. Nonetheless, health care practitioners and parents generally accessed and used the intervention. Themes describing appearance and functionality, perceived need and general helpfulness, accessibility and appropriateness, and a wish list for improvement emerged, providing valuable information to inform future development and refinement of the intervention. Conclusions: Owing to the high attrition observed in the trial, proceeding directly to a full randomized controlled trial may not be feasible with this recruitment strategy. Nonetheless, with some minor adjustments and upgrades to the intervention, this pilot study provides a platform for future evaluations of Power Up for Parents. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 39238984; http://www.isrctn.com/ISRCTN39238984. International Registered Report Identifier (IRRID): RR2-10.2196/14571 %M 33650973 %R 10.2196/25235 %U https://formative.jmir.org/2021/3/e25235 %U https://doi.org/10.2196/25235 %U http://www.ncbi.nlm.nih.gov/pubmed/33650973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22393 %T Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China %A Yu,Yanqiu %A Li,Ji-Bin %A Lau,Joseph T F %+ Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince Whales Hospital, Sha Tin, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K gaming disorder %K ICD-11 %K high-risk subgroups %K disease awareness %K medicalization %K internet gaming %K awareness %K impact %K adolescent %K young adult %K China %K game %K disorder %K ICD %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The Eleventh Revision of International Classification of Diseases (ICD-11) newly listed gaming disorder, including internet gaming disorder (IGD), as a disease. The level of awareness and potential positive and negative impacts of this medicalization among adolescents were unknown. Objective: This study investigated the levels, associated factors, and potential positive and negative impacts of awareness of the medicalization of IGD among adolescents in China. Methods: In a cross-sectional survey, 1343 middle school students in Guangzhou, China, self-administered an anonymous questionnaire in classrooms (October to December 2019). Three risk subgroups were identified: those who scored ≥5 items in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition checklist (IGD-S), those who self-perceived having IGD currently (IGD-PC), and those who self-perceived having IGD within 12 months (IGD-P12M). Results: Of the internet gamers, 48.3% (460/952) were aware of the medicalization of IGD; they were more likely to belong to the IGD-P12M/IGD-S risk subgroups. Within the IGD-PC/IGD-P12M (but not IGD-S) risk subgroups, IGD medicalization awareness was positively associated with favorable outcomes (reduced internet gaming time in the past 12 months, seeking help from professionals if having IGD, and fewer maladaptive cognitions). After being briefed about the ICD-11 inclusion of IGD, 54.2% (516/952) and 32.8% (312/952) expressed that it would lead to the reduction of gaming time and help-seeking behaviors, respectively; however, 17.9% (170/952), 21.5% (205/952), 15.9% (151/952), and 14.5% (138/952) perceived self-doubt for being diseased, stronger pressure from family members, negative emotional responses, and labeling effect, respectively. With a few exceptions, such perceived positive or negative impacts were stronger among the IGD-S, IGD-PC, and IGD-P12M risk subgroups. Conclusions: The exploratory study shows that the medicalization of IGD may have benefits that need maximization and potentially harmful effects that need minimization. Future studies should test the efficacies of health promotion that increases IGD medicalization awareness. %M 33625362 %R 10.2196/22393 %U https://www.jmir.org/2021/2/e22393 %U https://doi.org/10.2196/22393 %U http://www.ncbi.nlm.nih.gov/pubmed/33625362 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25870 %T The Building Educators’ Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial %A Parker,Belinda L %A Chakouch,Cassandra %A Subotic-Kerry,Mirjana %A Batterham,Philip J %A Mackinnon,Andrew %A Newby,Jill M %A Whitton,Alexis E %A McGoldrick,Janey %A Cockayne,Nicole %A O'Dea,Bridianne %+ Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, 2031, Australia, 61 290659057, belinda.parker@blackdog.org.au %K mental health training %K schools %K teachers %K educators %K mental health %K student mental health %K secondary school %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators’ Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed. Objective: The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators’ confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators’ frequency of providing help to students and improving their mental health knowledge and reducing educators’ psychological distress and stigma toward students with mental health issues. Methods: The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment. Results: Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021. Conclusions: This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students’ mental health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208 International Registered Report Identifier (IRRID): DERR1-10.2196/25870 %M 33625374 %R 10.2196/25870 %U https://www.researchprotocols.org/2021/2/e25870 %U https://doi.org/10.2196/25870 %U http://www.ncbi.nlm.nih.gov/pubmed/33625374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21432 %T Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Sturlugata 1, Reykjavik, 101, Iceland, 354 6184805, erlendu@hi.is %K mHealth %K intervention %K adolescent %K attrition %K self-efficacy %K mental health %K physical activity %K young adult %K behavior %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention’s usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects. Results: The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group. Conclusions: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants’ self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. %M 33481750 %R 10.2196/21432 %U http://formative.jmir.org/2021/2/e21432/ %U https://doi.org/10.2196/21432 %U http://www.ncbi.nlm.nih.gov/pubmed/33481750 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23960 %T Developmental Assets of Adolescents and Young Adults With Chronic Illness and Comorbid Depression: Qualitative Study Using YouTube %A Zheng,Katherine %A George,Maureen %A Roehlkepartain,Eugene %A Santelli,John %A Bruzzese,Jean-Marie %A Smaldone,Arlene %+ The Feinberg School of Medicine, Center for Education in Health Sciences, Northwestern University, 633 N Saint Clair St, 20th Floor, Chicago, IL, 60605, United States, 1 6032036736, katzheng1@gmail.com %K adolescent development %K chronic disease %K depression %K developmental assets %K positive youth development %K YouTube %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Developmental assets provide a framework for optimizing development among adolescents but have not been studied in adolescents with chronic illness and comorbid depression, which is a group at risk for poor health outcomes. YouTube postings provide valuable insights to understand this understudied population. Objective: This study aims to explore asset development from the perspectives of adolescents and young adults (AYAs) with chronic illness and comorbid depression. Methods: YouTube was searched using 12 chronic illnesses (eg, diabetes) coupled with “depression” as keywords. Videos were included if they were uploaded by AYAs aged between 11 and 29 years and discussed living with chronic illness and depression during adolescence. Video transcripts were coded deductively for 40 internal and external assets that constitute the Developmental Assets Framework. Categories not captured by deductive coding were identified using conventional content analysis. Categories and their respective assets were labeled as being discussed either negatively or positively. Results: In total, 31 videos from 16 AYAs met the inclusion criteria. A total of 7 asset categories, support, constructive use of time, boundaries and expectations (external assets), identity, commitment to learning, positive values, and social competence (internal assets), reflecting 25 (13 internal; 12 external) assets, were discussed. Internal assets, particularly relating to identity, were commonly discussed by AYAs either in a negative way or fluctuated between positive and negative perspectives. Conclusions: In this sample of AYAs with chronic illness and comorbid depression, internal assets were commonly discussed in a negative way. Future research is needed to better understand how assets develop and if the Developmental Assets Framework adequately represents the experiences of this population. %M 33591288 %R 10.2196/23960 %U http://mental.jmir.org/2021/2/e23960/ %U https://doi.org/10.2196/23960 %U http://www.ncbi.nlm.nih.gov/pubmed/33591288 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23917 %T The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study %A Liu,Guihua %A Wang,Shuo %A Liao,Jinhua %A Ou,Ping %A Huang,Longsheng %A Xie,Namei %A He,Yingshuang %A Lin,Jinling %A He,Hong-Gu %A Hu,Rongfang %+ The School of Nursing, Fujian Medical University, 1 Xuefu Road, Shangjie Zhen, Minhou County, Fuzhou, 350000, China, 86 13509366729, hulu2886@sina.com %K coronavirus disease 2019 %K autism spectrum disorder %K parenting training %K psychological well-being %K social media %K WeChat %K COVID-19 %K autism %K parenting %K mental health %K well-being %K anxiety %K depression %K stress %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 %M 33481751 %R 10.2196/23917 %U https://mental.jmir.org/2021/2/e23917 %U https://doi.org/10.2196/23917 %U http://www.ncbi.nlm.nih.gov/pubmed/33481751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23502 %T Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis %A Cheng,Vanessa Wan Sze %A Piper,Sarah E %A Ottavio,Antonia %A Davenport,Tracey A %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 93510774, vanessa.cheng@sydney.edu.au %K mental health %K health information technologies %K self-determination theory %K eHealth %K internet %K digital health %K adolescent %K mental health services %K young adult %K LGBTQ persons %K mobile phone %K rural health %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Culturally diverse populations (including Aboriginal and Torres Strait Islander people, people of diverse genders and sexualities, and culturally and linguistically diverse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers. Objective: This study aims to identify how best to improve a mental health and well-being HIT for culturally diverse Australians in nonurban areas. Methods: We conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally diverse groups. Results: We identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to design an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to use an HIT. Conclusions: Although culturally diverse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete examples of design features recommended by participants. %M 33565985 %R 10.2196/23502 %U https://www.jmir.org/2021/2/e23502 %U https://doi.org/10.2196/23502 %U http://www.ncbi.nlm.nih.gov/pubmed/33565985 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e21872 %T An Online Platform to Provide Work and Study Support for Young People With Mental Health Challenges: Observational and Survey Study %A Rickwood,Debra %A Kennedy,Vanessa %A Miyazaki,Koki %A Telford,Nic %A Carbone,Stephen %A Hewitt,Ella %A Watts,Carolyn %+ Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, Canberra, 2617, Australia, 61 407661157, debra.rickwood@canberra.edu.au %K youth %K mental health %K unemployment %K work %K study %K online support %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people, aged 15-25 years, are at a critical stage of life when they need to navigate vocational pathways and achieve work and study outcomes. Those with mental health problems are particularly at risk of disengagement with work and study and need effective support. The headspace Work and Study (hWS) service is an innovative online platform implemented in Australia to support young people aged 15-25 years with mental health problems to achieve work and study goals. Objective: This study aims to determine whether the hWS service has been implemented as planned, provides appropriate support for young people, and achieves its main goals. Methods: Data were collected via 2 methodologies: (1) the hWS Minimum Data Set, which includes data on all clients in the service (n=1139), services delivered, and service impact; and (2) a survey of hWS clients who volunteered to participate in an evaluation of the hWS service (n=137). Results: The service was accessed by its defined target group, young people aged 15-25 years with mental health and work and study difficulties. Young people found the online platform to be acceptable, and the assistance provided and clinical integration useful; many young people achieved positive work and study outcomes, particularly those who engaged more times with the service. More assistance was sought for work than study goals, suggesting that the transition to work may be particularly challenging for young people. One-third (298/881, 33.8%) of the sample for the service impact analyses achieved at least 1 primary work or study outcome, and this increased to 44.5% (225/506) for those who engaged with 5 or more sessions, demonstrating that greater engagement with the service produced better outcomes. Conclusions: Critical work and study support can be effectively delivered via an online modality to young people with common mental health problems. Digital services are scaleable to reach many young people and are of particular value for those with difficulty accessing in-person services. %M 33560238 %R 10.2196/21872 %U https://mental.jmir.org/2021/2/e21872 %U https://doi.org/10.2196/21872 %U http://www.ncbi.nlm.nih.gov/pubmed/33560238 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e21338 %T Online Mental Health Animations for Young People: Qualitative Empirical Thematic Analysis and Knowledge Transfer %A Coughlan,Helen %A Quin,David %A O'Brien,Kevin %A Healy,Colm %A Deacon,Jack %A Kavanagh,Naoise %A Humphries,Niamh %A Clarke,Mary C %A Cannon,Mary %+ Royal College of Surgeons in Ireland, Department of Psychiatry, RCSI Education & Research Centre, Dublin 9, D09 YD60, Ireland, 353 1 8093855, helencoughlan@rcsi.ie %K mental health %K public health %K mental health literacy %K social media %K youth %K qualitative %K knowledge translation %K anxiety %K bullying %K depression %K loneliness %K internet %D 2021 %7 9.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental ill-health is one of the most significant health and social issues affecting young people globally. To address the mental health crisis, a number of cross-sectoral research and action priorities have been identified. These include improving mental health literacy, translating research findings into accessible public health outputs, and the use of digital technologies. There are, however, few examples of public health–oriented knowledge transfer activities involving collaborations between researchers, the Arts, and online platforms in the field of youth mental health. Objective: The primary aim of this project was to translate qualitative research findings into a series of online public mental health animations targeting young people between the ages of 16 and 25 years. A further aim was to track online social media engagement and viewing data for the animations for a period of 12 months. Methods: Qualitative data were collected from a sample of 17 youth in Ireland, aged 18-21 years, as part of the longitudinal population-based Adolescent Brain Development study. Interviews explored the life histories and the emotional and mental health of participants. The narrative analysis revealed 5 thematic findings relating to young people’s emotional and mental health. Through a collaboration between research, the Arts, and the online sector, the empirical thematic findings were translated into 5 public health animations. The animations were hosted and promoted on 3 social media platforms of the Irish youth health website called SpunOut. Viewing data, collected over a 12-month period, were analyzed to determine the reach of the animations. Results: Narrative thematic analysis identified anxiety, depression, feeling different, loneliness, and being bullied as common experiences for young people. These thematic findings formed the basis of the animations. During the 12 months following the launch of the animations, they were viewed 15,848 times. A majority of views occurred during the period of the social media ad campaign at a cost of €0.035 (approximately US $0.042) per view. Animations on feeling different and being bullied accounted for the majority of views. Conclusions: This project demonstrates that online animations provide an accessible means of translating empirical research findings into meaningful public health outputs. They offer a cost-effective way to provide targeted online information about mental health, coping, and help-seeking to young people. Cross-sectoral collaboration is required to leverage the knowledge and expertise required to maximize the quality and potential reach of any knowledge transfer activities. A high level of engagement is possible by targeting non–help-seeking young people on their native social media platforms. Paid promotion is, therefore, an important consideration when budgeting for online knowledge translation and dissemination activities in health research. %M 33560231 %R 10.2196/21338 %U http://www.jmir.org/2021/2/e21338/ %U https://doi.org/10.2196/21338 %U http://www.ncbi.nlm.nih.gov/pubmed/33560231 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26567 %T Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study %A Kuriyan,Aparajita %A Kinkler,Grace %A Cidav,Zuleyha %A Kang-Yi,Christina %A Eiraldi,Ricardo %A Salas,Eduardo %A Wolk,Courtney Benjamin %+ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Philadelphia, PA, 19104, United States, 1 215 746 6099, cbenja@upenn.edu %K teams %K Team Strategies and Tools to Enhance Performance and Patient Safety %K school mental health %K school health %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. Objective: The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. Methods: Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. Results: Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. Conclusions: This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. Trial Registration: ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228 International Registered Report Identifier (IRRID): DERR1-10.2196/26567 %M 33555258 %R 10.2196/26567 %U https://www.researchprotocols.org/2021/2/e26567 %U https://doi.org/10.2196/26567 %U http://www.ncbi.nlm.nih.gov/pubmed/33555258 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e16490 %T Smartphone-Based Interventions and Internalizing Disorders in Youth: Systematic Review and Meta-analysis %A Buttazzoni,Adrian %A Brar,Keshbir %A Minaker,Leia %+ School of Planning, University of Waterloo, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 46564, anbuttazzoni@uwaterloo.ca %K mental health %K meta-analysis %K mobile phone %K smartphone %K systematic review %K youth %D 2021 %7 11.1.2021 %9 Review %J J Med Internet Res %G English %X Background: Mental health disorders in youth are a global issue that have important implications for the future quality of life and morbidity of affected individuals. In the context of public health initiatives, smartphone-based interventions have been suggested to hold the potential to be an effective strategy to reduce the symptoms of mental health disorders in youth; however, further evaluation is needed to confirm their effectiveness. This systematic review and meta-analysis documents and synthesizes existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Objective: This study aims to synthesize existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Methods: PubMed and SCOPUS were searched in 2019, and 4334 potentially relevant articles were found. A total of 12 studies were included in the final synthesis. We used the Hedges g meta-analysis approach and a random effects model for analysis. Results: The results of this review note that depression and anxiety are the most commonly targeted symptoms, and unlike other similar topics, most studies reviewed were linked to a proven treatment. The overall pooled effect from the meta-analysis showed small but significant effects (κ=12; N=1370; Hedges g=0.20; 95% CI 0.02-0.38) for interventions in reducing the symptoms of internalizing disorders. In total, 4 subgroup analyses examining specific symptoms and intervention styles found varied small significant and nonsignificant effects. Conclusions: Future research should focus on developing robust evaluative frameworks and examining interventions among more diverse populations and settings. More robust research is needed before smartphone-based interventions are scaled up and used at the population level to address youth internalizing disorders. %M 33427682 %R 10.2196/16490 %U http://www.jmir.org/2021/1/e16490/ %U https://doi.org/10.2196/16490 %U http://www.ncbi.nlm.nih.gov/pubmed/33427682 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e16508 %T Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review %A MacDougall,Sarah %A Jerrott,Susan %A Clark,Sharon %A Campbell,Leslie Anne %A Murphy,Andrea %A Wozney,Lori %+ Mental Health and Addictions, Policy and Planning, Nova Scotia Health, 200 Pleasant Street, Dartmouth, NS, B2Y 3S3, Canada, 1 (902) 471 5463, lori.wozney@nshealth.ca %K adolescent %K mental health %K eHealth %K text messaging %K SMS %K information science %K cell phone %K implementation %K review %D 2021 %7 8.1.2021 %9 Review %J JMIR Ment Health %G English %X Background: The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective: The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents. Methods: A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications. Results: We screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported. Conclusions: The use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone–based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required. %M 33416504 %R 10.2196/16508 %U https://mental.jmir.org/2021/1/e16508 %U https://doi.org/10.2196/16508 %U http://www.ncbi.nlm.nih.gov/pubmed/33416504 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25860 %T Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial %A Agley,Jon %A Jun,Mikyoung %A Eldridge,Lori %A Agley,Daniel L %A Xiao,Yunyu %A Sussman,Steve %A Golzarri-Arroyo,Lilian %A Dickinson,Stephanie L %A Jayawardene,Wasantha %A Gassman,Ruth %+ Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, 501 N Morton St, Suite 110, Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K cyberbullying %K bullying %K social-emotional learning %K SEL %K social-emotional competence %K RCT %K randomized controlled trial %K outcome %K emotion %K bully %K prevention %K school %K intervention %K assessment %K effectiveness %K implementation %K fidelity %K reception %K children %K young adults %K adolescents %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students’ receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants’ social-emotional competence. The intervention’s impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. Trial Registration: Clinicaltrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID): RR2-10.2196/17900 %M 33338986 %R 10.2196/25860 %U http://mental.jmir.org/2021/1/e25860/ %U https://doi.org/10.2196/25860 %U http://www.ncbi.nlm.nih.gov/pubmed/33338986 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e25087 %T Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study %A MacIsaac,Angela %A Mushquash,Aislin R %A Mohammed,Shakira %A Grassia,Elizabeth %A Smith,Savanah %A Wekerle,Christine %+ Lakehead University, 955 Oliver Road, Thunder Bay, ON, , Canada, 1 8073438771, aislin.mushquash@lakeheadu.ca %K adverse childhood experiences %K resilience %K emotion regulation %K smartphone %K app %K childhood %K emotion %K mental health %K transition %K innovation %K intervention %D 2021 %7 4.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The effects of adverse childhood experiences (ACEs) on mental health, self-regulatory capacities, and overall resilience are well-known. Given such effects, ACEs may play a role in how individuals adjust to challenges later in life. Of interest in this study is the transition to university, a time of heightened stress when adapting to circumstances is required and when those with ACEs may need additional in-the-moment support to exercise resilience. A smartphone app may provide a worthwhile and readily accessible medium for a resilience intervention, provided behavioral outcomes are adequately evaluated. Objective: This study evaluates the impact of an innovative, smartphone app–based resilience intervention. The JoyPop app was designed to promote resilience through the use of self-regulatory skills such as emotion regulation and executive functioning. Among a sample of first-year undergraduate students, we explored whether use of the app would be associated with positive changes in resilience and related outcomes, and whether these benefits were influenced by level of childhood adversity. Methods: Participants (N=156) were requested to use the JoyPop app for 4 weeks, at least twice daily. Changes in resilience, emotion regulation, executive functioning, and depression were assessed after 2 and 4 weeks of app usage using multilevel modeling. Results: The sample of 156 participants included 123 females and 33 males, with a mean age of 19.02 years (SD 2.90). On average participants used the app on 20.43 of the possible 28 days (SD 7.14). App usage was associated with improvements in emotion regulation (χ21=44.46; P<.001), such that it improved by 0.25 points on the 18-point scale for each additional day of app usage, and symptoms of depression (χ21=25.12; P<.001), such that depression symptoms were reduced by .08 points on the 9-point scale with each additional day of app usage. An interaction between ACEs and days of app usage existed for emotion regulation, such that participants with more adversity evidenced a faster rate of change in emotion regulation (P=.02). Conclusions: Results highlight that daily incorporation of an app-based resilience intervention can help youth who have experienced adversity to improve emotion regulation skills and experience reductions in depression. The JoyPop app represents an important step forward in the integration of resilience intervention research with a technology-based medium that provides in-the-moment support. %M 33393908 %R 10.2196/25087 %U http://mhealth.jmir.org/2021/1/e25087/ %U https://doi.org/10.2196/25087 %U http://www.ncbi.nlm.nih.gov/pubmed/33393908 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24578 %T Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond %A Davenport,Tracey A %A Cheng,Vanessa Wan Sze %A Iorfino,Frank %A Hamilton,Blake %A Castaldi,Eva %A Burton,Amy %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 404 83 9897, tracey.davenport@sydney.edu.au %K health information technologies %K clinical staging %K youth %K mental health %K transdiagnostic %K eHealth %K routine outcome monitoring %K adolescent %K mental health services %K health services %K telemedicine %K monitoring %K outcome %K young adult %K COVID-19 %D 2020 %7 15.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of “right care, first time.” We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By “flipping” the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future. %M 33206051 %R 10.2196/24578 %U http://mental.jmir.org/2020/12/e24578/ %U https://doi.org/10.2196/24578 %U http://www.ncbi.nlm.nih.gov/pubmed/33206051 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e18439 %T A Mobile Phone–Based App for Use During Cognitive Behavioral Therapy for Adolescents With Anxiety (MindClimb): User-Centered Design and Usability Study %A Newton,Amanda %A Bagnell,Alexa %A Rosychuk,Rhonda %A Duguay,Janelle %A Wozney,Lori %A Huguet,Anna %A Henderson,Joanna %A Curran,Janet %+ Department of Psychiatry, Dalhousie University, PO Box 9700, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 902 470 8087, Alexa.Bagnell@iwk.nshealth.ca %K anxiety disorders %K mobile apps %K adolescents %K usability testing %K development %K design %K anxiety %D 2020 %7 8.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective: This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods: This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen’s usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. Results: Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. Conclusions: The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes. %M 33289671 %R 10.2196/18439 %U https://mhealth.jmir.org/2020/12/e18439 %U https://doi.org/10.2196/18439 %U http://www.ncbi.nlm.nih.gov/pubmed/33289671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20158 %T Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review %A Gilbey,Dylan %A Morgan,Helen %A Lin,Ashleigh %A Perry,Yael %+ Telethon Kids Institute, 15 Hospital Avenue, Perth , Australia, 61 63191195, Dylan.Gilbey@telethonkids.org.au %K systematic review %K mental health %K physical health %K sexual health %K youth %K sexuality %K gender %K mobile phones %D 2020 %7 3.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. Objective: This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. Methods: A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. Results: The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health–related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. Conclusions: There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender–attracted women, trans and gender-diverse people, and people with intersex variations. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164 %M 33270039 %R 10.2196/20158 %U https://www.jmir.org/2020/12/e20158 %U https://doi.org/10.2196/20158 %U http://www.ncbi.nlm.nih.gov/pubmed/33270039 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e15149 %T Health Personnel’s Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study %A Størksen,Hege Therese %A Haga,Silje Marie %A Slinning,Kari %A Drozd,Filip %+ Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, Oslo, 0484, Norway, 47 95972822, hege.storksen@r-bup.no %K internet %K parent support %K children %K mental health %K acceptability %K health care services %D 2020 %7 18.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Approximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel’s attitudes to perceived usefulness of internet-based interventions. Objective: The purpose of this study was to examine health professionals’ perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. Methods: Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: “How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?” The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). Results: The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). Conclusions: Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support. %M 33206058 %R 10.2196/15149 %U http://mental.jmir.org/2020/11/e15149/ %U https://doi.org/10.2196/15149 %U http://www.ncbi.nlm.nih.gov/pubmed/33206058 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e24536 %T Parents’ Perceptions of Their Children’s Engagement in a Consumer-Based Meditation Mobile App: Cross-Sectional Survey Study %A Puzia,Megan %A Laird,Breanne %A Green,Jeni %A Huberty,Jennifer %+ Behavioral Research and Analytics LLC, 154 S Street, Salt Lake City, UT, 84103, United States, 1 7046043782, meganpuzia@gmail.com %K mindfulness %K meditation %K children %K mental health %K sleep %K mHealth %D 2020 %7 13.11.2020 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: In the United States, nearly half (48%) of school-aged children experience sleep disturbance that results in less than the recommended sleep duration, which may negatively impact mental health and behavior. Mindfulness interventions may improve sleep and mental health in youth. However, there are gaps in the literature regarding how children (2-12 years) and adolescents (13-17 years) practice mindfulness and the extent to which they benefit from these practices. Objective: The purpose of this study was to determine parents’ perceptions of their children’s engagement with a consumer-based mindfulness meditation app and the extent to which they believe their children have benefitted from using the app, particularly with regard to sleep. Methods: This study is a secondary analysis of a cross-sectional survey in adult subscribers (N=11,108) to the mindfulness meditation mobile app Calm. Participants who indicated that they had a child or children younger than 18 years (2944/11,108) who used the Calm app were asked additional questions related to their perceptions of their children’s engagement with Calm. Descriptive statistics were used to assess children’s app engagement, and chi-square tests and binary logistic regression models were used to assess differences in children’s usage based on gender and age. Results: Among the survey respondents, approximately half of the parents (1537/2944, 52.21%) reported that their children used Calm. Children used Calm mostly for (1) sleep (1168/1537, 75.99%), (2) stress (491/1537, 31.95%), (3) depression or anxiety (430/1537, 27.98%), and (4) improvement of overall health (215/1537,13.99%). Older children were more likely to begin using Calm to reduce stress, depression, or anxiety, whereas younger children were more likely begin using Calm to improve sleep. Most children used Calm when lying down to go to bed (1113/1529, 72.79%). Children were most likely to use sleep stories at night (1144/1207, 94.78%), followed by music and soundscapes (749/1114, 67.24%), meditations (736/1120, 65.71%), and breathing exercises (610/1092, 55.86%). Nearly all parents believed that using sleep stories was helpful for their children’s sleep (1090/1128, 96.63%), and the majority of parents felt that the other components were also helpful for their children’s sleep (music and soundscapes [570/728, 78.30%], meditations [445/696, 63.94%], and breathing exercises [610/1092, 55.86%]). Conclusions: To our knowledge, this is the first study to explore parents’ perceptions of how their children or adolescents use a popular consumer-based mindfulness mobile app (ie, Calm). As the majority of children use the app for sleep, mindfulness meditation mobile apps should consider incorporating age-appropriate sleep content to meet the needs of this audience. More research is needed to confirm the feasibility and effectiveness of mindfulness meditation apps for improving sleep and mental health in children and adolescents. %M 33185564 %R 10.2196/24536 %U http://pediatrics.jmir.org/2020/2/e24536/ %U https://doi.org/10.2196/24536 %U http://www.ncbi.nlm.nih.gov/pubmed/33185564 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e21145 %T Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis %A Michel,Toni %A Tachtler,Franziska %A Slovak,Petr %A Fitzpatrick,Geraldine %+ Technical University Vienna, Wien, Argentinierstraße 8, Vienna, , Austria, 49 1773075023, toni.michel@tuwien.ac.at %K adolescent %K mental health %K health resources %D 2020 %7 9.11.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. Objective: The aim of this study is to explore young people’s attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. Methods: We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. Results: Some interventions were conflicting with young people’s values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. Conclusions: Values, context, strengths, and other personal factors are entangled with young people’s attitudes toward digital instantiations of PPI principles. %M 33164908 %R 10.2196/21145 %U http://humanfactors.jmir.org/2020/4/e21145/ %U https://doi.org/10.2196/21145 %U http://www.ncbi.nlm.nih.gov/pubmed/33164908 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e17453 %T Smartphone-Based Self-Monitoring, Treatment, and Automatically Generated Data in Children, Adolescents, and Young Adults With Psychiatric Disorders: Systematic Review %A Melbye,Sigurd %A Kessing,Lars Vedel %A Bardram,Jakob Eyvind %A Faurholt-Jepsen,Maria %+ The Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Rigshospitalet, Blegdamsvej 9, København Ø, 2200, Denmark, 45 28966634, sigurd.arne.melbye@regionh.dk %K mHealth %K child and adolescent psychiatry %K eHealth %K systematic review %K psychiatry %K mobile phone %D 2020 %7 29.10.2020 %9 Review %J JMIR Ment Health %G English %X Background: Psychiatric disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning smartphone-based monitoring and treatment in this population has been published. Objective: This systematic review aims at describing the following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies. Methods: We conducted a systematic literature search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically assessed. Results: A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants’ adherence to self-monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials, the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas. Conclusions: Smartphones hold great potential as a modern, widely available technology platform to help diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses. %M 33118950 %R 10.2196/17453 %U http://mental.jmir.org/2020/10/e17453/ %U https://doi.org/10.2196/17453 %U http://www.ncbi.nlm.nih.gov/pubmed/33118950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e16802 %T 24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial %A Van Voorhees,Benjamin %A Gladstone,Tracy R G %A Sobowale,Kunmi %A Brown,C Hendricks %A Aaby,David A %A Terrizzi,Daniela A %A Canel,Jason %A Ching,Eumene %A Berry,Anita D %A Cantorna,James %A Eder,Milton %A Beardslee,William %A Fitzgibbon,Marian %A Marko-Holguin,Monika %A Schiffer,Linda %A Lee,Miae %A de Forest,Sarah A %A Sykes,Emily E %A Suor,Jennifer H %A Crawford,Theodore J %A Burkhouse,Katie L %A Goodwin,Brady C %A Bell,Carl %+ Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, 840 South Wood Street (MC 856), Chicago, IL, United States, 1 312 996 8352, bvanvoor@uic.edu %K adolescent %K depression %K prevention %K scalable %K eHealth %D 2020 %7 28.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes. Objective: This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings. Methods: A 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale. Results: In intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat). Conclusions: A technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit. Trial Registration: ClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749. %M 33112254 %R 10.2196/16802 %U https://www.jmir.org/2020/10/e16802 %U https://doi.org/10.2196/16802 %U http://www.ncbi.nlm.nih.gov/pubmed/33112254 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20976 %T Repeated Psychosocial Screening of High School Students Using YouthCHAT: Cohort Study %A Thabrew,Hiran %A Kumar,Harshali %A Goldfinch,Mary %A Cavadino,Alana %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, The University of Auckland, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K mental health %K school health services %K eHealth %D 2020 %7 26.10.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Psychosocial problems are common during adolescence and can have long-lasting effects on health and on academic and social functioning. YouthCHAT, an electronic HEEADSSS (home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality and safety)-aligned instrument, has recently been demonstrated to be an acceptable and effective school-based psychosocial screener for 13-year-old (Year 9) high school students. Objective: This study aims to compare acceptability and detection rates with repeated YouthCHAT screenings of high school students when they are 13 years old (Year 9) and 14 years old (Year 10). Methods: We invited all Year-10 students to complete a YouthCHAT screening in 2018. Rates of positively identified issues were compared between the subset of students screened in both 2017 and 2018. Student acceptability toward YouthCHAT was investigated through focus group sessions. Onward clinical referral rates in 2018 were also investigated to explore the potential referral burden following screening. Data analysis for rates of positively identified issues were conducted with the McNemar test. Chi-square, Fisher exact test, and Kruskal-Wallis test were used to analyze the focus group data. Results: Of 141 eligible Year-10 students, 114 (81%) completed a YouthCHAT screening during 2018, and 97 (85%) of them completed it for a second time. Apart from depression, which increased (P=.002), and perceived life stress, which decreased (P=.04), rates of identified issues were broadly similar between 13 and 14 years of age. Repeated screenings via YouthCHAT was acceptable to students and time-efficient (mean, 6 minutes and 32 seconds) but did not reduce the overall number of individuals with identified issues. Onward clinical referrals from positive screens were mostly managed by school-based health services without the need for external referrals. Conclusions: Although further evaluation is needed, our results support the value of YouthCHAT as an acceptable and effective instrument with which to achieve routine identification of psychosocial issues and early intervention within a high school environment. %M 33104007 %R 10.2196/20976 %U http://pediatrics.jmir.org/2020/2/e20976/ %U https://doi.org/10.2196/20976 %U http://www.ncbi.nlm.nih.gov/pubmed/33104007 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e19600 %T Therapist-Supported Online Interventions for Children and Young People With Tic Disorders: Lessons Learned From a Randomized Controlled Trial and Considerations for Future Practice %A Chamberlain,Liam R %A Hall,Charlotte L %A Andrén,Per %A Davies,E Bethan %A Kilgariff,Joseph %A Kouzoupi,Natalia %A Murphy,Tara %A Hollis,Chris %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 8230258, Chris.Hollis@nottingham.ac.uk %K Tourette syndrome %K tic disorders %K internet-based cognitive behavioral therapy (iCBT) %K remote therapy %K therapist support %D 2020 %7 23.10.2020 %9 Viewpoint %J JMIR Ment Health %G English %X In recent years, research into internet-based cognitive behavioral therapy (iCBT) has suggested that therapist-guided digital interventions have greater engagement, adherence, and effectiveness than self-directed digital therapies. While research has focused on the effectiveness of, and adherence to, these interventions, less attention has been paid to their implementation in practice and what aspects of the therapist role support success. An understanding of the key factors related to the therapist role and intervention delivery is required if these iCBTs are to be applied in routine clinical care and outcomes optimized. In light of the coronavirus disease 2019 (COVID-19) pandemic, there is greater emphasis on allowing patients access to remote therapies. We report the experiences and reflections of 4 therapists and their 2 supervisors in delivering an online, therapist-supported intervention in a randomized controlled trial for children and young people with tic disorders (the Online Remote Behavioural Intervention for Tics [ORBIT] trial). Themes discussed include the importance of training, supervision, creating support documents/manuals, and record keeping. Alongside this are communication strategies used by therapists to encourage patient adherence and treatment effectiveness. These include rapport building, treatment personalization, and suggestions for overcoming non-engagement. These reflections offer important considerations for the delivery of iCBTs as well as implications associated with the implementation of these interventions in existing services and future research studies. We share thoughts on where iCBTs may sit in a stepped care model, how services may deal with comorbid conditions, and the potential role of iCBTs in collecting clinical data. %M 33095180 %R 10.2196/19600 %U http://mental.jmir.org/2020/10/e19600/ %U https://doi.org/10.2196/19600 %U http://www.ncbi.nlm.nih.gov/pubmed/33095180 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21280 %T Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study %A Kahl,Bianca Lorraine %A Miller,Hilary May %A Cairns,Kathryn %A Giniunas,Hayley %A Nicholas,Mariesa %+ ReachOut Australia, Suite 2.04, Building B, 35 Saunders Street, Pyrmont, 2009, Australia, 61 02 8029 7734, bianca.kahl@reachout.com %K digital mental health %K digital intervention %K youth %K internet-based intervention %K depression %K anxiety %K stress %K suicide %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people experience a disproportionate burden associated with mental illness that Australia’s mental health care system is ill-equipped to handle. Despite improvements in the provision of mental health services, the rates of service utilization among young people remain suboptimal, and there are still considerable barriers to seeking help. Digital mental health services can overcome a number of barriers and connect young people requiring support; however, the evidence base of digital interventions is limited. Objective: The aim of this study is to examine the effectiveness of a brief, self-directed, unstructured digital intervention, ReachOut.com (hereafter ReachOut), in reducing depression, anxiety, stress, and risk of suicide. Methods: A cohort of 1982 ReachOut users participated in a 12-week longitudinal study, with a retention rate of 81.18% (1609/1982) across the duration of the study. Participants completed web-based surveys, with outcome measures of mental health status and suicide risk assessed at 3 time points across the study period. Results: The results demonstrated that over the 12-week study period, young people using ReachOut experienced modest yet significant reductions in symptoms of depression, anxiety, and stress. Significant, albeit modest, reductions in the proportion of participants at high risk of suicide were also observed. Conclusions: The findings of this research provide preliminary evidence of the promise of an unstructured digital mental health intervention, ReachOut, in alleviating symptoms of mental ill-health and promoting well-being in young people. These findings are particularly important given that digital services are not only acceptable and accessible but also have the potential to cater to the diverse mental health needs of young people at scale, in a way that other services cannot. %M 33055066 %R 10.2196/21280 %U http://mental.jmir.org/2020/10/e21280/ %U https://doi.org/10.2196/21280 %U http://www.ncbi.nlm.nih.gov/pubmed/33055066 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e23057 %T Psychosocial Challenges and Opportunities for Youth With Chronic Health Conditions During the COVID-19 Pandemic %A Serlachius,Anna %A Badawy,Sherif M %A Thabrew,Hiran %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, 1142, New Zealand, 64 9 923 3073, a.serlachius@auckland.ac.nz %K COVID-19 %K coronavirus %K pandemic %K chronic illness %K youth %K adolescents %K children %K psychosocial %K anxiety %D 2020 %7 12.10.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X School closures, altered access to health services, and economic stress during the COVID-19 pandemic have likely had an impact on the mental and physical well-being of youth worldwide, particularly among those with chronic health conditions (CHCs). A number of challenges and opportunities have emerged during the COVID-19 pandemic for youth with CHCs. Challenges include heightened anxiety, disrupted routines, academic and social stresses associated with school closure, increased risk of domestic violence and abuse, and reduced access to physical and psychosocial support. On the other hand, opportunities include reduced academic and social stress, increased time with families, reduced access to substances, easier access to health care using technology, and opportunities to build resilience. This viewpoint paper highlights both challenges and opportunities for youth with CHCs during the pandemic and offers recommendations for further research and clinical care. %M 33001834 %R 10.2196/23057 %U http://pediatrics.jmir.org/2020/2/e23057/ %U https://doi.org/10.2196/23057 %U http://www.ncbi.nlm.nih.gov/pubmed/33001834 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18140 %T User Perspectives of Mood-Monitoring Apps Available to Young People: Qualitative Content Analysis %A Widnall,Emily %A Grant,Claire Ellen %A Wang,Tao %A Cross,Lauren %A Velupillai,Sumithra %A Roberts,Angus %A Stewart,Robert %A Simonoff,Emily %A Downs,Johnny %+ Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, United Kingdom, 44 7730683269, emily.widnall@kcl.ac.uk %K mood monitoring %K engagement %K mobile applications %K mHealth %K mental health %K smartphone %K qualitative research %K mobile phone %D 2020 %7 10.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps are increasingly available and used in a clinical context to monitor young people’s mood and mental health. Despite the benefits of accessibility and cost-effectiveness, consumer engagement remains a hurdle for uptake and continued use. Hundreds of mood-monitoring apps are publicly available to young people on app stores; however, few studies have examined consumer perspectives. App store reviews held on Google and Apple platforms provide a large, rich source of naturally generated, publicly available user reviews. Although commercial developers use these data to modify and improve their apps, to date, there has been very little in-depth evaluation of app store user reviews within scientific research, and our current understanding of what makes apps engaging and valuable to young people is limited. Objective: This study aims to gain a better understanding of what app users consider useful to encourage frequent and prolonged use of mood-monitoring apps appropriate for young people. Methods: A systematic approach was applied to the selection of apps and reviews. We identified mood-monitoring apps (n=53) by a combination of automated application programming interface (API) methods. We only included apps appropriate for young people based on app store age categories (apps available to those younger than 18 years). We subsequently downloaded all available user reviews via API data scraping methods and selected a representative subsample of reviews (n=1803) for manual qualitative content analysis. Results: The qualitative content analysis revealed 8 main themes: accessibility (34%), flexibility (21%), recording and representation of mood (18%), user requests (17%), reflecting on mood (16%), technical features (16%), design (13%), and health promotion (11%). A total of 6 minor themes were also identified: notification and reminders; recommendation; privacy, security, and transparency; developer; adverts; and social/community. Conclusions: Users value mood-monitoring apps that can be personalized to their needs, have a simple and intuitive design, and allow accurate representation and review of complex and fluctuating moods. App store reviews are a valuable repository of user engagement feedback and provide a wealth of information about what users value in an app and what user needs are not being met. Users perceive mood-monitoring apps positively, but over 20% of reviews identified the need for improvement. %M 33037875 %R 10.2196/18140 %U http://mhealth.jmir.org/2020/10/e18140/ %U https://doi.org/10.2196/18140 %U http://www.ncbi.nlm.nih.gov/pubmed/33037875 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e23463 %T Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? %A Stull,Samuel W %A McKnight,Erin R %A Bonny,Andrea E %+ Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA, 16802, United States, 1 6145518640, sws6084@psu.edu %K adolescent %K opioid use disorder %K treatment %K telehealth %K drug %K perspective %K opioid %K COVID-19 %K young adult %D 2020 %7 9.10.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term. %M 33016885 %R 10.2196/23463 %U http://pediatrics.jmir.org/2020/2/e23463/ %U https://doi.org/10.2196/23463 %U http://www.ncbi.nlm.nih.gov/pubmed/33016885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18672 %T The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review %A Szlyk,Hannah %A Tan,Jia %+ School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, New Brunswick, NJ, 08901, United States, 1 9178364225, hannah.szlyk@rutgers.edu %K youth %K suicide prevention %K technology %K continuum of care %D 2020 %7 9.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Youth suicide is a global public health issue, and using technology is one strategy to increase participation in preventive interventions. However, there is minimal knowledge on how technology-enhanced interventions for youth correspond to the stages of care, from illness or risk recognition to treatment follow-up. Objective: This systematic review aims to examine the efficacy of technology-enhanced youth suicide prevention and interventions across the continuum of care. Methods: Four electronic databases were searched up to spring 2019 for youth suicide preventive interventions that used technology. The review was not restricted by study design and eligible studies could report outcomes on suicidality or related behaviors, such as formal treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality. Results: A total of 26 studies were identified. The findings support the emerging efficacy of technology-enhanced interventions, including a decline in suicidality and an increase in proactive behaviors. However, evidence suggests that there are gaps in the continuum of care and recent study samples do not represent the diverse identities of vulnerable youth. Conclusions: The majority of identified studies were conducted in school settings and were universal interventions that aligned with the illness and risk recognition and help-seeking stages of the continuum of care. This field could be strengthened by having future studies target the stages of assessment and treatment initiation, include diverse youth demographics, and examine the varying roles of providers and technological components in emerging interventions. %M 33034568 %R 10.2196/18672 %U http://www.jmir.org/2020/10/e18672/ %U https://doi.org/10.2196/18672 %U http://www.ncbi.nlm.nih.gov/pubmed/33034568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18514 %T Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study %A Stunden,Chelsea %A Zasada,Julie %A VanHeerwaarden,Nicole %A Hollenberg,Elisa %A Abi-Jaoudé,Alexxa %A Chaim,Gloria %A Cleverley,Kristin %A Henderson,Joanna %A Johnson,Andrew %A Levinson,Andrea %A Lo,Brian %A Robb,Janine %A Shi,Jenny %A Voineskos,Aristotle %A Wiljer,David %+ Education, Technology & Innovation, University Health Network, R. Fraser Elliot Building RFE 3E-411, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.Wiljer@uhn.ca %K mental health %K students %K adolescent %K substance abuse %K eHealth %K mHealth %K mobile apps %K help-seeking behavior %K social stigma %K social support %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help. Objective: The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada. Methods: A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes. Results: Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help. Conclusions: Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth. %M 33016882 %R 10.2196/18514 %U https://www.jmir.org/2020/10/e18514 %U https://doi.org/10.2196/18514 %U http://www.ncbi.nlm.nih.gov/pubmed/33016882 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17831 %T Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Adolescents and Young Adults: Systematic Review and Meta-Analysis %A Christ,Carolien %A Schouten,Maria JE %A Blankers,Matthijs %A van Schaik,Digna JF %A Beekman,Aartjan TF %A Wisman,Marike A %A Stikkelbroek,Yvonne AJ %A Dekker,Jack JM %+ Department of Psychiatry, GGZ inGeest, Amsterdam UMC, Vrije Universiteit Amsterdam, Oldenaller 1, Amsterdam, 1081 HJ, Netherlands, 31 20 590 1339, c.christ@ggzingeest.nl %K cognitive behavior therapy %K internet %K anxiety %K depression %K youth %K meta-analysis %D 2020 %7 25.9.2020 %9 Review %J J Med Internet Res %G English %X Background: Anxiety and depressive disorders are prevalent in adolescents and young adults. However, most young people with mental health problems do not receive treatment. Computerized cognitive behavior therapy (cCBT) may provide an accessible alternative to face-to-face treatment, but the evidence base in young people is limited. Objective: The objective was to perform an up-to-date comprehensive systematic review and meta-analysis of the effectiveness of cCBT in treating anxiety and depression in adolescents and young adults compared with active treatment and passive controls. We aimed to examine posttreatment and follow-up effects and explore the moderators of treatment effects. Methods: We conducted systematic searches in the following six electronic databases: PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing cCBT with any control group in adolescents or young adults (age 12-25 years) with anxiety or depressive symptoms. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. Overall quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Posttreatment means and SDs were compared between intervention and control groups, and pooled effect sizes (Hedges g) were calculated. Random-effects meta-analyses were conducted using Comprehensive Meta-Analysis software. Subgroup analyses and meta-regression analyses were conducted to explore whether age, guidance level, and adherence rate were associated with treatment outcome. Results: The search identified 7670 papers, of which 24 studies met the inclusion criteria. Most included studies (22/24) had a high risk of bias owing to self-report measures and/or inappropriate handling of missing data. Compared with passive controls, cCBT yielded small to medium posttreatment pooled effect sizes regarding depressive symptoms (g=0.51, 95% CI 0.30-0.72, number needed to treat [NNT]=3.55) and anxiety symptoms (g=0.44, 95% CI 0.23-0.65, NNT=4.10). cCBT yielded effects similar to those of active treatment controls regarding anxiety symptoms (g=0.04, 95% CI −0.23 to 0.31). For depressive symptoms, the nonsignificant pooled effect size favored active treatment controls (g=−0.70, 95% CI −1.51 to 0.11, P=.09), but heterogeneity was very high (I2=90.63%). No moderators of treatment effects were identified. At long-term follow-up, cCBT yielded a small pooled effect size regarding depressive symptoms compared with passive controls (g=0.27, 95% CI 0.09-0.45, NNT=6.58). No other follow-up effects were found; however, power was limited owing to the small number of studies. Conclusions: cCBT is beneficial for reducing posttreatment anxiety and depressive symptoms in adolescents and young adults compared with passive controls. Compared with active treatment controls, cCBT yielded similar effects regarding anxiety symptoms. Regarding depressive symptoms, however, the results remain unclear. More high-quality research involving active controls and long-term follow-up assessments is needed in this population. Trial Registration: PROSPERO CRD42019119725; https://tinyurl.com/y5acfgd9. %M 32673212 %R 10.2196/17831 %U https://www.jmir.org/2020/9/e17831 %U https://doi.org/10.2196/17831 %U http://www.ncbi.nlm.nih.gov/pubmed/32673212 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e21155 %T Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health %A Katapally,Tarun Reddy %+ Johnson Shoyama Graduate School of Public Policy, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 3065854544, tarun.katapally@uregina.ca %K Indigenous youth %K mental health %K school policies %K health policy %K digital health interventions %K mHealth %K systems integration %K land-based learning %K physical activity %D 2020 %7 25.9.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Indigenous youth mental health is an urgent public health issue, which cannot be addressed with a one-size-fits-all approach. The success of health policies in Indigenous communities is dependent on bottom-up, culturally appropriate, and strengths-based prevention strategies. In order to maximize the effectiveness of these strategies, they need to be embedded in replicable and contextually relevant mechanisms such as school curricula across multiple communities. Moreover, to engage youth in the twenty-first century, especially in rural and remote areas, it is imperative to leverage ubiquitous mobile tools that empower Indigenous youth and facilitate novel Two-Eyed Seeing solutions. Smart Indigenous Youth is a 5-year community trial, which aims to improve Indigenous youth mental health by embedding a culturally appropriate digital health initiative into school curricula in rural and remote Indigenous communities in Canada. This policy analysis explores the benefits of such upstream initiatives. More importantly, this article describes evidence-based strategies to overcome barriers to implementation through the integration of citizen science and community-based participatory research action. %M 32975527 %R 10.2196/21155 %U http://pediatrics.jmir.org/2020/2/e21155/ %U https://doi.org/10.2196/21155 %U http://www.ncbi.nlm.nih.gov/pubmed/32975527 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e19881 %T Game-Based Meditation Therapy to Improve Posttraumatic Stress and Neurobiological Stress Systems in Traumatized Adolescents: Protocol for a Randomized Controlled Trial %A Schuurmans,Angela A T %A Nijhof,Karin S %A Scholte,Ron %A Popma,Arne %A Otten,Roy %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 24 361 61 61, angela.anna.schuurmans@gmail.com %K Adolescents %K Autonomic nervous system %K Cortisol %K Meditation %K Neurofeedback %K Posttraumatic stress %K Randomized controlled trial %K Trauma %D 2020 %7 23.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. Objective: This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. Methods: This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters. Results: The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021. Conclusions: Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents. Trial Registration: Netherlands Trial Register NL6689 (NTR6859); https://www.trialregister.nl/trial/6689 International Registered Report Identifier (IRRID): DERR1-10.2196/19881 %M 32965226 %R 10.2196/19881 %U http://www.researchprotocols.org/2020/9/e19881/ %U https://doi.org/10.2196/19881 %U http://www.ncbi.nlm.nih.gov/pubmed/32965226 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e18271 %T The Use of Mumsnet by Parents of Young People With Mental Health Needs: Qualitative Investigation %A Croucher,Lauren %A Mertan,Elif %A Shafran,Roz %A Bennett,Sophie D %+ University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 20 7242 9789, lauren.croucher.18@alumni.ucl.ac.uk %K mental health %K parenting %K internet %K evidence-based medicine %D 2020 %7 3.9.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: There are high rates of mental health needs in children in the United Kingdom, and parents are increasingly seeking help for their children's needs. However, there is not enough access to child and adolescent mental health services and parents are seeking alternative forms of support and information, often from web-based sources. Mumsnet is the largest web-based parenting forum in the United Kingdom, which includes user-created discussions regarding child mental health. Objective: This qualitative investigation aimed to explore the emergent themes within the narratives of posts regarding child mental health on Mumsnet and to extrapolate these themes to understand the purpose of Mumsnet for parents of children and young people with mental health needs. Methods: A total of 50 threads from Mumsnet Talk Child Mental Health were extracted. Following the application of inclusion and exclusion criteria, 41 threads were analyzed thematically using the framework approach, a form of qualitative thematic analysis. Results: In total, 28 themes were extracted and organized into 3 domains. These domains were emotional support, emotional expression, and advice and information. The results suggested that parents of children with mental health needs predominantly use Mumsnet to offer and receive emotional support and to suggest general advice, techniques, and resources that could be applied outside of help from professional services. Conclusions: This paper discusses the future of health information seeking. Future research is required to establish initiatives in which web-based peer-to-peer support and information can supplement professional services to provide optimum support for parents of children with mental health needs. %M 32880583 %R 10.2196/18271 %U https://mental.jmir.org/2020/9/e18271 %U https://doi.org/10.2196/18271 %U http://www.ncbi.nlm.nih.gov/pubmed/32880583 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19269 %T Harnessing Phones to Target Pediatric Populations with Socially Complex Needs: Systematic Review %A Stiles-Shields,Colleen %A Potthoff,Lauren M %A Bounds,Dawn T %A Burns,Maureen T S %A Draxler,Janel M %A Otwell,Caitlin H %A Wolodiger,Emily D %A Westrick,Jennifer %A Karnik,Niranjan S %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Chicago, IL, 60612-3227, United States, 1 3129429998, colleen_stiles-shields@rush.edu %K underserved youth %K digital mental health %K mHealth %K telehealth %K health disparities %D 2020 %7 26.8.2020 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mobile and smartphones are owned and accessed by many, making them a potentially optimal delivery mechanism to reach pediatric patients with socially complex needs (ie, pediatric populations who face overlapping adversities). Objective: To address the specialized needs of youth from such groups, this review synthesized the literature exploring the use of phone-based delivery to access pediatric populations with socially complex needs, targeting mental and behavioral health outcomes. The purpose of this synthesis was to provide recommendations for future research developing phone-based interventions for youth with socially complex needs. Methods: A trained medical librarian conducted the search strategy in the following databases: PubMed, Scopus, CINAHL, PsycINFO, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Studies targeting youth with socially complex needs were defined by recruiting samples that were primarily from traditionally underserved populations (ie, sex/gender minorities, racial/ethnic background, low socioeconomic status, rural/remote location, and sexual orientation). A systematic narrative framework was utilized and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed (registration number CRD42020141212). Results: A total of 14 studies met the inclusion criteria, with 3 depicting the use of phones to complete assessment and tracking goals and 11 to intervene on mental and behavioral health targets. Conclusions: The literature indicates important directions for future research, including (1) involving diverse and representative teens (ie, the likely users of the interventions), stakeholders, and clinical/research staff; (2) integrating evidence-based therapies with minority-focused theories; (3) harnessing mobile device capabilities; and (4) considering and assessing for potential costs in phones as delivery mechanisms. Trial Registration: PROSPERO CRD42020141212; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141212 %M 32845244 %R 10.2196/19269 %U http://pediatrics.jmir.org/2020/2/e19269/ %U https://doi.org/10.2196/19269 %U http://www.ncbi.nlm.nih.gov/pubmed/32845244 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e19779 %T Transdiagnostic Risk and Protective Factors for Psychopathology in Young People: Systematic Review Protocol %A Lynch,Samantha Jane %A Sunderland,Matthew %A Newton,Nicola Claire %A Chapman,Cath %+ The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, 2000, Australia, 61 2 9351 2222, samantha.lynch@sydney.edu.au %K psychopathology %K mental health %K adolescent %K young people %K transdiagnostic %K risk factors %K protective factors %K systematic review %K protocol %D 2020 %7 20.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental and substance use disorders are among the leading causes of burden of disease worldwide, with risk of onset peaking between the ages of 13 and 24 years. Comorbidity is also common among young people and complicates research, diagnosis and assessment, and clinical decision making. There is increasing support for empirically derived models of psychopathology that overcome issues of comorbidity and provide a transdiagnostic framework for investigating the specificity and generality of risk and protective factors for psychopathology. Objective: This systematic review aims to identify transdiagnostic risk and protective factors for psychopathology in young people by synthesizing and evaluating findings from research investigating empirically based models of psychopathology. Methods: Searches will be conducted in Medline, EMBASE, and PsycINFO databases. Reference lists of selected articles will also be hand searched for other relevant publications. All studies will be screened against eligibility criteria designed to identify studies that examined empirical models of psychopathology in relation to risk and/or protective factors in young people with a mean age between 10 and 24 years. Study quality will be assessed using the Joanna Briggs Institute Critical Appraisal Checklists for Cohort Studies and Analytical Cross-Sectional Studies. Findings will be summarized in a narrative synthesis, and a meta-analysis will be conducted if sufficient data are available. Results: This review is ongoing. At the time of submission, full-text screening was completed, and hand searching of selected articles was underway. Results are expected to be completed by the end of 2020. Conclusions: This protocol is for a systematic review of evidence for transdiagnostic risk and protective factors associated with empirically based models of psychopathology in young people. To our knowledge, the critical synthesis of this evidence will be the first to date and will provide a better understanding of the factors that contribute to the onset and maintenance of psychopathology in young people. Insights drawn from the review will provide critical new knowledge to improve the targeting of interventions to prevent or reduce mental health problems. Trial Registration: This systematic review is registered with PROSPERO (CRD42020161368) and is available via Open Science Framework. International Registered Report Identifier (IRRID): DERR1-10.2196/19779 %M 32815821 %R 10.2196/19779 %U http://www.researchprotocols.org/2020/8/e19779/ %U https://doi.org/10.2196/19779 %U http://www.ncbi.nlm.nih.gov/pubmed/32815821 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e13179 %T Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review %A Jansen,Ronelle %A Reid,Marianne %+ School of Nursing, Faculty of Health Science, University of the Free State, 205 Nelson Mandela Drive, Bloemfontein, 9301, South Africa, 27 825544731, jansenro@ufs.ac.za %K caregiver %K communication technology %K adolescent %K mental health issues %K systematic review %K self-efficacy, knowledge %K parental skills %K IMBP %D 2020 %7 19.8.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. Objective: The study aimed to answer the question: “What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.” Methods: A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. Results: The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. Conclusions: The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers’ needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed. %M 32663143 %R 10.2196/13179 %U http://mhealth.jmir.org/2020/8/e13179/ %U https://doi.org/10.2196/13179 %U http://www.ncbi.nlm.nih.gov/pubmed/32663143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17155 %T A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service %A Alvarez-Jimenez,Mario %A Rice,Simon %A D'Alfonso,Simon %A Leicester,Steven %A Bendall,Sarah %A Pryor,Ingrid %A Russon,Penni %A McEnery,Carla %A Santesteban-Echarri,Olga %A Da Costa,Gustavo %A Gilbertson,Tamsyn %A Valentine,Lee %A Solves,Laia %A Ratheesh,Aswin %A McGorry,Patrick D %A Gleeson,John %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 9966 9383, mario.alvarez@orygen.org.au %K mHealth %K youth %K social media %K social networking %K mobile phone %K internet-based intervention %D 2020 %7 13.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. Objective: The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. Methods: Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. Results: Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P<.001), perceived stress (d=−0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=−0.29; P<.001), loneliness (d=−0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. Conclusions: MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services. %M 32788151 %R 10.2196/17155 %U https://www.jmir.org/2020/8/e17155 %U https://doi.org/10.2196/17155 %U http://www.ncbi.nlm.nih.gov/pubmed/32788151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16924 %T Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review %A Brigden,Amberly %A Anderson,Emma %A Linney,Catherine %A Morris,Richard %A Parslow,Roxanne %A Serafimova,Teona %A Smith,Lucie %A Briggs,Emily %A Loades,Maria %A Crawley,Esther %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 42 83080, amberly.brigden@bristol.ac.uk %K mobile phone %K mHealth %K mobile health %K eHealth %K electronic health %K digital health %K behavior %K pediatrics %K chronic illness %K systematic review %D 2020 %7 31.7.2020 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. %M 32735227 %R 10.2196/16924 %U http://www.jmir.org/2020/7/e16924/ %U https://doi.org/10.2196/16924 %U http://www.ncbi.nlm.nih.gov/pubmed/32735227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17481 %T A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) %A O'Grady,Conor %A Melia,Ruth %A Bogue,John %A O'Sullivan,Mary %A Young,Karen %A Duggan,Jim %+ School of Computer Science, National University of Ireland Galway, University Road, Galway, H91 TK33, Ireland, 353 91493336, james.duggan@nuigalway.ie %K mobile apps %K suicide %K mHealth %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users’ access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app’s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. %M 32729845 %R 10.2196/17481 %U http://www.jmir.org/2020/7/e17481/ %U https://doi.org/10.2196/17481 %U http://www.ncbi.nlm.nih.gov/pubmed/32729845 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e18990 %T Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study %A Valentine,Lee %A McEnery,Carla %A Bell,Imogen %A O'Sullivan,Shaunagh %A Pryor,Ingrid %A Gleeson,John %A Bendall,Sarah %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Melbourne, 3052, Australia, 61 17398175, lee.valentine@orygen.org.au %K Blended Treatment %K Psychotic Disorders %K Digital Intervention %K Adolescent %K Young Adults %K mHealth %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: A small number of studies have found that digital mental health interventions can be feasible and acceptable for young people experiencing first-episode psychosis; however, little research has examined how they might be blended with face-to-face approaches in order to enhance care. Blended treatment refers to the integration of digital and face-to-face mental health care. It has the potential to capitalize on the evidence-based features of both individual modalities, while also exceeding the sum of its parts. This integration could bridge the online–offline treatment divide and better reflect the interconnected, and often complementary, ways young people navigate their everyday digital and physical lives. Objective: This study aimed to gain young people’s perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment. Methods: This qualitative study was underpinned by an end-user development framework and was based on semistructured interviews with 10 participants aged 19 to 28 (mean 23.4, SD 2.62). A thematic analysis was used to analyze the data. Results: Three superordinate themes emerged relating to young people’s perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment: (1) blended features, (2) cautions, and (3) therapeutic alliance. Conclusions: We found that young people were very enthusiastic about the prospect of blended models of mental health care, in so far as it was used to enhance their experience of traditional face-to-face treatment but not to replace it overall. Aspects of blended treatment that could enhance clinical care were readily identified by young people as increasing accessibility, continuity, and consolidation; accessing posttherapy support; strengthening the relationship between young person and clinician; and tracking personal data that could be used to better inform clinical decision making. Future research is needed to investigate the efficacy of blended models of care by evaluating its impact on the therapeutic alliance, clinical and social outcomes, cost-effectiveness, and engagement. %M 32720904 %R 10.2196/18990 %U http://mental.jmir.org/2020/7/e18990/ %U https://doi.org/10.2196/18990 %U http://www.ncbi.nlm.nih.gov/pubmed/32720904 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19867 %T Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19 %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, , United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K pediatrics %K mental health %K stay-at-home orders %K health technology %K digital interventions %K social distancing %K COVID-19 %D 2020 %7 28.7.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X The coronavirus disease (COVID-19) pandemic has spread rapidly throughout the world and has had a long-term impact. The pandemic has caused great harm to society and caused serious psychological trauma to many people. Children are a vulnerable group in this global public health emergency, as their nervous systems, endocrine systems, and hypothalamic-pituitary-adrenal axes are not well developed. Psychological crises often cause children to produce feelings of abandonment, despair, incapacity, and exhaustion, and even raise the risk of suicide. Children with mental illnesses are especially vulnerable during the quarantine and social distancing period. The inclusion of psychosocial support for children and their families are part of the health responses to disaster and disaster recovery. Based on the biopsychosocial model, some children may have catastrophic thoughts and be prone to experience despair, numbness, flashbacks, and other serious emotional and behavioral reactions. In severe cases, there may be symptoms of psychosis or posttraumatic stress disorder. Timely and appropriate protections are needed to prevent the occurrence of psychological and behavioral problems. The emerging digital applications and health services such as telehealth, social media, mobile health, and remote interactive online education are able to bridge the social distance and support mental and behavioral health for children. Based on the psychological development characteristics of children, this study also illustrates interventions on the psychological impact from the COVID-19 pandemic. Even though the world has been struggling to curb the influences of the pandemic, the quarantine and social distancing policies will have long-term impacts on children. Innovative digital solutions and informatics tools are needed more than ever to mitigate the negative consequences on children. Health care delivery and services should envision and implement innovative paradigms to meet broad well-being needs and child health as the quarantine and social distancing over a longer term becomes a new reality. Future research on children's mental and behavioral health should pay more attention to novel solutions that incorporate cutting edge interactive technologies and digital approaches, leveraging considerable advances in pervasive and ubiquitous computing, human-computer interaction, and health informatics among many others. Digital approaches, health technologies, and informatics are supposed to be designed and implemented to support public health surveillance and critical responses to children’s growth and development. For instance, human-computer interactions, augmented reality, and virtual reality could be incorporated to remote psychological supporting service for children’s health; mobile technologies could be used to monitor children’s mental and behavioral health while protecting their individual privacy; big data and artificial intelligence could be used to support decision making on whether children should go out for physical activities and whether schools should be reopened. Implications to clinical practices, psychological therapeutic practices, and future research directions to address current effort gaps are highlighted in this study. %M 32634105 %R 10.2196/19867 %U http://pediatrics.jmir.org/2020/2/e19867/ %U https://doi.org/10.2196/19867 %U http://www.ncbi.nlm.nih.gov/pubmed/32634105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14223 %T An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial %A Edridge,Chloe %A Wolpert,Miranda %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 020 7443 2218, Chloe.edridge@annafreud.org %K cluster trial %K behavioral difficulties %K schools %K mHealth %K digital %K mental health %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. Objective: The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. Methods: The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. Results: There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. Conclusions: It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7019 %M 32716299 %R 10.2196/14223 %U http://www.jmir.org/2020/7/e14223/ %U https://doi.org/10.2196/14223 %U http://www.ncbi.nlm.nih.gov/pubmed/32716299 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e13356 %T An Internet-Based Cognitive Behavioral Program for Adolescents With Anxiety: Pilot Randomized Controlled Trial %A O'Connor,Kathleen %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Radomski,Ashley %A Rosychuk,Rhonda J %A Curtis,Sarah %A Jabbour,Mona %A Fitzpatrick,Eleanor %A Johnson,David W %A Ohinmaa,Arto %A Joyce,Anthony %A Newton,Amanda %+ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7802485581, mandi.newton@ualberta.ca %K internet %K cognitive behavioral therapy %K adolescents %K anxiety %K randomized controlled trial %K pilot %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (ICBT) is a treatment approach recently developed and studied to provide frontline treatment to adolescents with anxiety disorders. Objective: This study aimed to pilot procedures and obtain data on methodological processes and intervention satisfaction to determine the feasibility of a definitive randomized controlled trial (RCT) to test the effectiveness of a self-managed ICBT program, Breathe (Being Real, Easing Anxiety: Tools Helping Electronically), for adolescents with anxiety concerns. Methods: This study employed a two-arm, multisite, pilot RCT. Adolescents aged 13 to 17 years with a self-identified anxiety concern were recruited online from health care settings and school-based mental health care services across Canada between April 2014 and May 2016. We compared 8 weeks of ICBT with ad hoc telephone and email support (Breathe experimental group) to access to a static webpage listing anxiety resources (control group). The primary outcome was the change in self-reported anxiety from baseline to 8 weeks (posttreatment), which was used to determine the sample size for a definitive RCT. Secondary outcomes were recruitment and retention rates, a minimal clinically important difference (MCID) for the primary outcome, intervention acceptability and satisfaction, use of cointerventions, and health care resource use, including a cost-consequence analysis. Results: Of the 588 adolescents screened, 94 were eligible and enrolled in the study (49 adolescents were allocated to Breathe and 45 were allocated to the control group). Analysis was based on 74% (70/94) of adolescents who completed baseline measures and progressed through the study. Enrolled adolescents were, on average, 15.3 years old (SD 1.2) and female (63/70, 90%). Retention rates at 8 weeks were 28% (13/46; Breathe group) and 58% (24/43; control group). Overall, 39% (14/36) of adolescents provided feedback on completion of the Breathe program. Adolescents’ scores on a satisfaction survey indicated a moderate level of satisfaction. All but one adolescent indicated that Breathe was easy to use and they understood all the material presented. The most frequent barrier identified for program completion was difficulty in completing exposure activities. The power analysis indicated that 177 adolescents per group would be needed to detect a medium effect size (d=0.3) between groups in a definitive trial. Data for calculating an MCID or conducting a cost-consequence analysis were insufficient due to a low response rate at 8 weeks. Conclusions: Adolescents were moderately satisfied with Breathe. However, program adjustments will be needed to address attrition and reduce perceived barriers to completing key aspects of the program. A definitive RCT to evaluate the effectiveness of the program is feasible if protocol adjustments are made to improve recruitment and retention to ensure timely study completion and increase the completeness of the data at each outcome measurement time point. Trial Registration: ClinicalTrials.gov NCT02059226; http://clinicaltrials.gov/ct2/show/NCT02059226. %M 32706720 %R 10.2196/13356 %U https://mental.jmir.org/2020/7/e13356 %U https://doi.org/10.2196/13356 %U http://www.ncbi.nlm.nih.gov/pubmed/32706720 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e14536 %T A Digital Intervention for Adolescent Depression (MoodHwb): Mixed Methods Feasibility Evaluation %A Bevan Jones,Rhys %A Thapar,Anita %A Rice,Frances %A Mars,Becky %A Agha,Sharifah Shameem %A Smith,Daniel %A Merry,Sally %A Stallard,Paul %A Thapar,Ajay K %A Jones,Ian %A Simpson,Sharon A %+ Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, Wales, CF24 4HQ, United Kingdom, 44 02920688451, bevanjonesr1@cardiff.ac.uk %K adolescent %K depression %K internet %K education %K early medical intervention %K feasibility study %D 2020 %7 17.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32384053 %R 10.2196/14536 %U https://mental.jmir.org/2020/7/e14536 %U https://doi.org/10.2196/14536 %U http://www.ncbi.nlm.nih.gov/pubmed/32384053 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e17044 %T High School Students’ Preferences and Design Recommendations for a Mobile Phone–Based Intervention to Improve Psychological Well-Being: Mixed Methods Study %A Müssener,Ulrika %A Thomas,Kristin %A Bendtsen,Preben %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan 1, Linköping, 58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K mental health %K stress %K high school students %K intervention %K mHealth %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Young adults’ mental health is characterized by relatively high rates of stress and anxiety and low levels of help-seeking behavior. Mobile health (mHealth) interventions could offer a cost-effective and readily available avenue to provide personalized support to young adults. More research needs to be directed at the development of mHealth interventions targeting youths specifically, as well as at determining how to reach young people and how to effectively intervene to improve psychological well-being. Objective: The objective was to gather perceptions from high school students to inform the development of a prototype mHealth intervention aiming to promote psychological well-being. Methods: A mixed methods design was used to (1) investigate high school students’ perceptions about stress and its consequences in daily life, as well as their ability to cope with stress, and (2) explore their preferences and design recommendations for an mHealth intervention to improve psychological well-being. Students from two high schools in the southeast of Sweden were invited to take part in the study. Recruitment of high school students was completed over a 6-week period, between October 25 and December 7, 2018. Recruitment entailed inviting students to complete a stress test (ie, screening and feedback) on their mobile phones. After completing the stress test, all participants were invited to complete a follow-up questionnaire and take part in telephone interviews. Results: A total of 149 high school students completed the stress test, of which 68 completed the questionnaire. There were 67 free-text comments distributed across the items. The majority of participants (55/68, 81%) stated that they coped with stress better or in the same way after engaging in the stress test, due to time management, dialogue with others, and self-refection. A total of 4 out of 68 participants (6%)—3 female students (75%) and 1 male student (25%)—took part in telephone interviews. Three main themes were identified from the interview data: perceptions about stress, design features, and intervention features. Conclusions: Stress was described by the students as a condition caused by high demands set by oneself and the social environment that impacted their physical health, personal relationships, school performance, and emotional well-being. Participants claimed that mHealth interventions need to be clearly tailored to a young age group, be evidence based, and offer varied types of support, such as information about stress, exercises to help organize tasks, self-assessment, coping tools, and recommendations of other useful websites, literature, blogs, self-help books, or role models. Mobile phones seemed to be a feasible and acceptable platform for the delivery of an intervention. %M 32673268 %R 10.2196/17044 %U https://pediatrics.jmir.org/2020/2/e17044 %U https://doi.org/10.2196/17044 %U http://www.ncbi.nlm.nih.gov/pubmed/32673268 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e20513 %T Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health %A Schleider,Jessica Lee %A Dobias,Mallory %A Sung,Jenna %A Mumper,Emma %A Mullarkey,Michael C %+ Department of Psychology, Stony Brook University, Psychology-B 340, Stony Brook, NY, 11794-2500, United States, 1 9174391872, jessica.schleider@stonybrook.edu %K internet intervention %K online interventions %K youth %K mental health %K adolescent %K depression %K single-session intervention %K intervention %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood. Objective: We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment & Support), an open-access platform offering three online SSIs for youth internalizing distress. Methods: After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES. Results: From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers). Conclusions: Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress. Trial Registration: Open Science Framework; osf.io/e52p3 %M 32602846 %R 10.2196/20513 %U http://mental.jmir.org/2020/6/e20513/ %U https://doi.org/10.2196/20513 %U http://www.ncbi.nlm.nih.gov/pubmed/32602846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17570 %T Young People’s Experience of a Long-Term Social Media–Based Intervention for First-Episode Psychosis: Qualitative Analysis %A Valentine,Lee %A McEnery,Carla %A O’Sullivan,Shaunagh %A Gleeson,John %A Bendall,Sarah %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 0417398175, lee.valentine@orygen.org.au %K social media %K social networking %K youth %K young adult %K psychotic disorders %K mHealth %K qualitative research %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health interventions present a unique opportunity to address the lack of social connection and loneliness experienced by young people with first-episode psychosis (FEP). The first generation of digital interventions, however, is associated with high attrition rates. Social media presents an opportunity to target this issue. A new generation of digital intervention has harnessed the popularity of social media to both promote engagement and foster social connectedness in youth mental health interventions. Despite their potential, little is known about how young people engage with, and experience, social media–based interventions as well as the optimal design, implementation, and management needed to ensure young people with psychosis receive benefit. Objective: This study aimed to explore how young people engage with, and experience, a long-term social media–based mental health intervention designed to address social functioning in individuals with FEP. Methods: This qualitative study was based on 12 interviews with young people who used Horyzons, a long-term social media–based mental health intervention, as part of a previous randomized controlled trial. A semistructured phenomenological interview guide with open-ended questions was used to explore young people’s subjective experience of the intervention. All interviews were recorded and transcribed verbatim. Data were analyzed using interpretative phenomenological analysis. Results: A total of 4 superordinate themes emerged during the analysis including (1) shared experience as the catalyst for a cocreated social space, (2) the power of peer support, (3) an upbeat environment, and (4) experiences that interrupt being in Horyzons. Conclusions: We found that Horyzon’s therapeutic social network fostered a connection and an understanding among young people. It also aided in the creation of an embodied experience that afforded young people with FEP a sense of self-recognition and belonging over the long term. However, although we found that most young people had strong positive experiences of a social connection on Horyzons, we also found that they experienced significant barriers that could substantively interrupt their ability to use the platform. We found that social anxiety, paranoia, internalized stigma, lack of autonomy, and social protocol confusion interfered with young people’s usage of the platform. From a design perspective, digital interventions are flexible and thus equipped to begin addressing these implications by providing customizable and personalized treatment options that account for varying levels of social connection and psychological need that could otherwise interrupt young people’s usage of social media–based interventions. %M 32384056 %R 10.2196/17570 %U https://www.jmir.org/2020/6/e17570 %U https://doi.org/10.2196/17570 %U http://www.ncbi.nlm.nih.gov/pubmed/32384056 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15942 %T Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review %A Lo,Brian %A Shi,Jenny %A Hollenberg,Elisa %A Abi-Jaoudé,Alexxa %A Johnson,Andrew %A Wiljer,David %+ Education, Technology and Innovation, University Health Network, 3-RFE-441, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 4163404800 ext 6322, David.Wiljer@uhn.ca %K user engagement %K mobile apps %K mHealth %K telemedicine %K mental health %K adolescent %K data analytics %D 2020 %7 25.6.2020 %9 Review %J JMIR Ment Health %G English %X Background: Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. Objective: This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). Methods: A scoping review was conducted using the Arksey and O’Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. Results: Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. Conclusions: This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority. %M 32348261 %R 10.2196/15942 %U https://mental.jmir.org/2020/6/e15942 %U https://doi.org/10.2196/15942 %U http://www.ncbi.nlm.nih.gov/pubmed/32348261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16317 %T Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers %A Liverpool,Shaun %A Mota,Catarina Pinheiro %A Sales,Célia M D %A Čuš,Anja %A Carletto,Sara %A Hancheva,Camellia %A Sousa,Sónia %A Cerón,Sonia Conejo %A Moreno-Peral,Patricia %A Pietrabissa,Giada %A Moltrecht,Bettina %A Ulberg,Randi %A Ferreira,Nuno %A Edbrooke-Childs,Julian %+ Evidence-Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 020 3108 9888, shaun.liverpool.14@ucl.ac.uk %K mHealth %K eHealth %K technology %K smartphone %K children %K adolescent mental health %K mobile phone %D 2020 %7 23.6.2020 %9 Review %J J Med Internet Res %G English %X Background: There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. Objective: This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. Methods: A literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts “child and adolescent mental health,” “digital intervention,” and “engagement.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively. Results: This study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs. Conclusions: The development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs. %M 32442160 %R 10.2196/16317 %U http://www.jmir.org/2020/6/e16317/ %U https://doi.org/10.2196/16317 %U http://www.ncbi.nlm.nih.gov/pubmed/32442160 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16963 %T Developing a Text Messaging Intervention to Reduce Deliberate Self-Harm in Chinese Adolescents: Qualitative Study %A Duan,Suqian %A Wang,Haoran %A Wilson,Amanda %A Qiu,Jiexi %A Chen,Guanmei %A He,Yuqiong %A Wang,Yuanyuan %A Ou,Jianjun %A Chen,Runsen %+ Department of Psychiatry, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Rd, Yuan Jia Ling Shang Quan, Furong District, Changsha, China, 86 731 85292158, Runsen.chen@psych.ox.ac.uk %K text messaging %K deliberate self-harm %K adolescents %K qualitative research %K mental health %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Deliberate self-harm is common during adolescence and can have detrimental consequences for the well-being of adolescents. Although it is sometimes difficult to engage adolescents in traditional psychotherapies for deliberate self-harm, SMS text messaging has been shown to be promising for cost-effective and low-intensity interventions. Objective: This study aimed to investigate the views of Chinese adolescents with deliberate self-harm about SMS text messaging interventions in order to develop an acceptable and culturally competent intervention for adolescents with deliberate self-harm. Methods: Semistructured interviews were conducted with 23 adolescents who had experience with deliberate self-harm. The transcripts of the interviews were analyzed using thematic analysis. Results: Four themes were identified: beneficial perception of receiving messages, short frequency and duration of messages, caring content in messages, and specific times for sending messages. Most of the participants perceived SMS text messaging interventions to be beneficial. The key factors that emerged for the content of the intervention included encouragement and company, feeling like a virtual friend, providing coping strategies, and individualized messages. In addition, the preferred frequency and duration of the SMS text messaging intervention were identified. Conclusions: Our study will help in the development of a culturally appropriate SMS text messaging intervention for adolescents with deliberate self-harm. It has the potential to decrease deliberate self-harm instances by providing acceptable support for adolescents with deliberate self-harm who may be reluctant to seek face-to-face psychotherapies. %M 32392173 %R 10.2196/16963 %U https://mhealth.jmir.org/2020/6/e16963 %U https://doi.org/10.2196/16963 %U http://www.ncbi.nlm.nih.gov/pubmed/32392173 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15973 %T Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study %A Khasawneh,Amro %A Chalil Madathil,Kapil %A Dixon,Emma %A Wiśniewski,Pamela %A Zinzow,Heidi %A Roth,Rebecca %+ Department of Anesthesiology and Critical Care, Johns Hopkins University, 750 E Pratt St, 15th Fl, Baltimore, MD, 21202, United States, 1 410 637 4365, akhasaw1@jhmi.edu %K suicide %K suicidal ideation %K self-mutilation %K mental health %K self-injurious behavior %K behavioral symptoms %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Research suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. In this challenge, adolescents and young adults are encouraged to engage in self-harm and eventually kill themselves. Objective: This paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations. Methods: We first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video. Results: The thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50% of the SPRC safe and effective messaging guidelines. Conclusions: These posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects. %M 32515741 %R 10.2196/15973 %U https://mental.jmir.org/2020/6/e15973 %U https://doi.org/10.2196/15973 %U http://www.ncbi.nlm.nih.gov/pubmed/32515741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17224 %T Mental Health–Related Behaviors and Discussions Among Young Adults: Analysis and Classification %A Rivas,Ryan %A Shahbazi,Moloud %A Garett,Renee %A Hristidis,Vagelis %A Young,Sean %+ Department of Computer Science and Engineering, University of California, Riverside, 363 Winston Chung Hall, 900 University Ave, Riverside, CA, United States, 1 9518272838, rriva002@ucr.edu %K social media %K data analysis %K supervised machine learning %K universities %K students %D 2020 %7 29.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. Objective: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. Methods: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. Results: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. Conclusions: Our results show that messages containing data about students’ mental health–related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support. %M 32469317 %R 10.2196/17224 %U http://www.jmir.org/2020/5/e17224/ %U https://doi.org/10.2196/17224 %U http://www.ncbi.nlm.nih.gov/pubmed/32469317 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e17345 %T Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study %A Czyz,Ewa K %A Arango,Alejandra %A Healy,Nathaniel %A King,Cheryl A %A Walton,Maureen %+ Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 7346476727, ewac@umich.edu %K adolescents %K suicide %K text messaging %K safety planning %D 2020 %7 25.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents’ transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. Objective: In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization. Methods: Adolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview. Results: Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents’ perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents’ affect. Specifically, higher within-person (relative to adolescents’ own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). Conclusions: Text-based support appears to be an acceptable continuity of care strategy to support adolescents’ transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes. %M 32160150 %R 10.2196/17345 %U http://mental.jmir.org/2020/5/e17345/ %U https://doi.org/10.2196/17345 %U http://www.ncbi.nlm.nih.gov/pubmed/32160150 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e17520 %T Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach %A Thorn,Pinar %A Hill,Nicole TM %A Lamblin,Michelle %A Teh,Zoe %A Battersby-Coulter,Rikki %A Rice,Simon %A Bendall,Sarah %A Gibson,Kerry L %A Finlay,Summer May %A Blandon,Ryan %A de Souza,Libby %A West,Ashlee %A Cooksey,Anita %A Sciglitano,Joe %A Goodrich,Simon %A Robinson,Jo %+ Orygen, 35 Poplar Road, Parkville, VIC, Australia, 61 412 999 140, jo.robinson@orygen.org.au %K suicide %K social media %K health promotion %K co-design %K adolescent %K young adult %K #chatsafe %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions. Objective: This study aimed to document key elements of the co-design process; to evaluate young people’s experiences of the co-design process; and to capture young people’s recommendations for the #chatsafe suicide prevention social media campaign. Methods: In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people’s experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators. Results: The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services. Conclusions: This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web. %M 32391800 %R 10.2196/17520 %U https://mental.jmir.org/2020/5/e17520 %U https://doi.org/10.2196/17520 %U http://www.ncbi.nlm.nih.gov/pubmed/32391800 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e16066 %T Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study %A Bossenbroek,Rineke %A Wols,Aniek %A Weerdmeester,Joanneke %A Lichtwarck-Aschoff,Anna %A Granic,Isabela %A van Rooij,Marieke M J W %+ Behavioural Science Institute, Radboud University, PO Box 9104, Nijmegen, 6500 HE, Netherlands, 31 243612638, r.bossenbroek@pwo.ru.nl %K anxiety %K disruptive behavior %K single-case study %K applied game %K serious games %K special education %K attention-deficit/hyperactivity disorder (ADHD) %K autism spectrum disorder (ASD) %K adolescents %D 2020 %7 24.3.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual’s inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed. Objective: This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP. Methods: A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases. Results: From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=–0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=−0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average. Conclusions: This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population. %M 32207697 %R 10.2196/16066 %U http://mental.jmir.org/2020/3/e16066/ %U https://doi.org/10.2196/16066 %U http://www.ncbi.nlm.nih.gov/pubmed/32207697 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e16945 %T Youth Experiences With Referrals to Mental Health Services in Canada: Protocol for a Web-Based Cross-Sectional Survey Study %A Lal,Shalini %A Starcevic,Danielle Joanna %A Fuhrer,Rebecca %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, CP 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 514 890 8000 ext 31676, shalini.lal@umontreal.ca %K mental disorders %K health care quality, access, and evaluation %K mental health %K psychology %K telemedicine %K young adult %K health services accessibility %K technology %K referral and consultation %D 2020 %7 24.3.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Youth mental health is an important public health concern affecting low-, middle-, and high-income countries, and many young people in need of mental health services do not receive the care they need when they need it. An early step in accessing mental health care is the referral process, yet most of the research done on pathways to care has focused on clinical populations (eg, first-episode psychosis) recruited from mental health care settings. There has been limited research attention on the experiences of referral to mental health services from the perspectives of youth recruited from the general population who may or may not have received the services they need. Objective: This study aims to investigate the experiences that youth between the ages of 17 and 30 years have with referrals to mental health services and to better understand their perspectives on the use of technology to facilitate referrals. Methods: This study will use a cross-sectional, Web-based survey design. A convenience sample of 400 participants from 3 Canadian provinces (Quebec, Ontario, and British Columbia), between the ages of 17 and 30 years, will be recruited via Facebook and will be invited to complete a Web-based survey anonymously. A questionnaire including a series of quantitative and qualitative questions will ask participants about their sociodemographic characteristics, past experiences with referral and access to mental health services, and opinions about using technology to facilitate the referral process. Results: Participant recruitment is planned to be initiated by early January 2020 and is estimated to be completed by May 2020. Data will be analyzed using descriptive statistics and logistic regression or chi-square tests for quantitative data, and descriptive content analysis will be used for the qualitative data. Conclusions: The results of this study can help inform the improvement of referral policies and procedures in youth mental health service delivery. A better understanding of young people’s perspectives on referral processes and their opinions on how these processes can be improved are essential to providing appropriate and timely access to mental health care. International Registered Report Identifier (IRRID): PRR1-10.2196/16945 %M 32207698 %R 10.2196/16945 %U http://www.researchprotocols.org/2020/3/e16945/ %U https://doi.org/10.2196/16945 %U http://www.ncbi.nlm.nih.gov/pubmed/32207698 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e14842 %T Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial %A Cliffe,Bethany %A Croker,Abigail %A Denne,Megan %A Smith,Jacqueline %A Stallard,Paul %+ Department of Health, University of Bath, 1 West, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01225 388388, p.stallard@bath.ac.uk %K insomnia %K internet-based intervention %K cognitive therapy %K mental health %D 2020 %7 3.3.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Insomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated, and the effects of digital cognitive behavioral therapy (CBT) for insomnia (CBTi) on the mental health of adolescents with significant mental health problems are unknown. Objective: This open study aimed to assess the feasibility of adding supported Web-based CBT for insomnia to the usual care of young people aged 14 to 17 years attending specialist child and adolescent mental health services (CAMHS). Methods: A total of 39 adolescents with insomnia aged 14 to 17 years attending specialist CAMHS were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence-based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator [SCI], Insomnia Severity Scale, and Web- or app-based sleep diaries), anxiety (Revised Child Anxiety and Depression Scale [RCADS]), and depression (Mood and Feelings Questionnaire [MFQ]) were completed at baseline and post intervention. Postuse interviews assessed satisfaction with digital CBTi. Results: Average baseline sleep efficiency was very poor (53%), with participants spending an average of 9.6 hours in bed but only 5.1 hours asleep. All participants scored less than 17 on the SCI, with 92% (36/39) participants scoring 15 or greater on the Insomnia Severity Scale, suggesting clinical insomnia. Of the 39 participants, 36 (92%) scored 27 or greater on the MFQ for major depression and 20 (51%) had clinically elevated symptoms of anxiety. The majority of participants (38/49, 78%) were not having any treatment for their insomnia, with the remaining 25% (12/49) receiving medication. Sleepio was acceptable, with 77% (30/39) of the participants activating their account and 54% (21/39) completing the program. Satisfaction was high, with 84% (16/19) of the participants finding Sleepio helpful, 95% (18/19) indicating that they would recommend it to a friend, and 37% (7/19) expressing a definite preference for a digital intervention. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (P=.005) and sleep quality (P=.001) and on measures of sleep (SCI: P=.001 and Insomnia Severity Index: P=.001), low mood (MFQ: P=.03), and anxiety (RCADS: P=.005). Conclusions: Our study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and no follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health. International Registered Report Identifier (IRRID): RR2-10.2196/11324 %M 32134720 %R 10.2196/14842 %U https://mental.jmir.org/2020/3/e14842 %U https://doi.org/10.2196/14842 %U http://www.ncbi.nlm.nih.gov/pubmed/32134720 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e16762 %T A Chatbot-Based Coaching Intervention for Adolescents to Promote Life Skills: Pilot Study %A Gabrielli,Silvia %A Rizzi,Silvia %A Carbone,Sara %A Donisi,Valeria %+ eHealth Unit, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312477, sgabrielli@fbk.eu %K life skills %K chatbots %K conversational agents %K mental health %K participatory design %K adolescence %K bullying %K cyberbullying %K well-being intervention %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Adolescence is a challenging period, where youth face rapid changes as well as increasing socioemotional demands and threats, such as bullying and cyberbullying. Adolescent mental health and well-being can be best supported by providing effective coaching on life skills, such as coping strategies and protective factors. Interventions that take advantage of online coaching by means of chatbots, deployed on Web or mobile technology, may be a novel and more appealing way to support positive mental health for adolescents. Objective: In this pilot study, we co-designed and conducted a formative evaluation of an online, life skills coaching, chatbot intervention, inspired by the positive technology approach, to promote mental well-being in adolescence. Methods: We co-designed the first life skills coaching session of the CRI (for girls) and CRIS (for boys) chatbot with 20 secondary school students in a participatory design workshop. We then conducted a formative evaluation of the entire intervention—eight sessions—with a convenience sample of 21 adolescents of both genders (mean age 14.52 years). Participants engaged with the chatbot sessions over 4 weeks and filled in an anonymous user experience questionnaire at the end of each session; responses were based on a 5-point Likert scale. Results: A majority of the adolescents found the intervention useful (16/21, 76%), easy to use (19/21, 90%), and innovative (17/21, 81%). Most of the participants (15/21, 71%) liked, in particular, the video cartoons provided by the chatbot in the coaching sessions. They also thought that a session should last only 5-10 minutes (14/21, 66%) and said they would recommend the intervention to a friend (20/21, 95%). Conclusions: We have presented a novel and scalable self-help intervention to deliver life skills coaching to adolescents online that is appealing to this population. This intervention can support the promotion of coping skills and mental well-being among youth. %M 32130128 %R 10.2196/16762 %U http://humanfactors.jmir.org/2020/1/e16762/ %U https://doi.org/10.2196/16762 %U http://www.ncbi.nlm.nih.gov/pubmed/32130128 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 2 %P e15914 %T Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies %A Ospina-Pinillos,Laura %A Davenport,Tracey A %A Navarro-Mancilla,Alvaro Andres %A Cheng,Vanessa Wan Sze %A Cardozo Alarcón,Andrés Camilo %A Rangel,Andres M %A Rueda-Jaimes,German Eduardo %A Gomez-Restrepo,Carlos %A Hickie,Ian B %+ Brain and Mind Centre, Sydney, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 2 9351 0652, laura.ospinapinillos@sydney.edu.au %K Colombia %K telemedicine %K medical informatics %K eHealth %K mental health %K cultural characteristics %K cultural competency %K ethnic groups %K quality of health care %K community-based participatory research %K primary health care %K patient participation %K patient preference %K patient satisfaction %K consumer health information %K methods %K research design %D 2020 %7 6.2.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. Objective: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. Results: A total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. Conclusions: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time. %R 10.2196/15914 %U https://mental.jmir.org/2020/2/e15914 %U https://doi.org/10.2196/15914 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 2 %P e15795 %T Examining the Usage, User Experience, and Perceived Impact of an Internet-Based Cognitive Behavioral Therapy Program for Adolescents With Anxiety: Randomized Controlled Trial %A Radomski,Ashley D %A Bagnell,Alexa %A Curtis,Sarah %A Hartling,Lisa %A Newton,Amanda S %+ Department of Pediatrics, University of Alberta, 3-077 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7802485581, mandi.newton@ualberta.ca %K internet %K cognitive behavioral therapy %K computer-assisted therapy %K anxiety %K adolescents %K clinical effectiveness %K satisfaction %K minimal clinically important difference %K treatment adherence %D 2020 %7 5.2.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) increases treatment access for adolescents with anxiety; however, completion rates of iCBT programs are typically low. Understanding adolescents’ experiences with iCBT, what program features and changes in anxiety (minimal clinically important difference [MCID]) are important to them, may help explain and improve iCBT program use and impact. Objective: Within a randomized controlled trial comparing a six-session iCBT program for adolescent anxiety, Being Real, Easing Anxiety: Tools Helping Electronically (Breathe), with anxiety-based resource webpages, we aimed to (1) describe intervention use among adolescents allocated to Breathe or webpages and those who completed postintervention assessments (Breathe or webpage respondents); (2) describe and compare user experiences between groups; and (3) calculate an MCID for anxiety and explore relationships between iCBT use, experiences, and treatment response among Breathe respondents. Methods: Enrolled adolescents with self-reported anxiety, aged 13 to 19 years, were randomly allocated to Breathe or webpages. Self-reported demographics and anxiety symptoms (Multidimensional Anxiety Scale for Children—2nd edition [MASC-2]) were collected preintervention. Automatically-captured Breathe or webpage use and self-reported symptoms and experiences (User Experience Questionnaire for Internet-based Interventions) were collected postintervention. Breathe respondents also reported their perceived change in anxiety (Global Rating of Change Scale [GRCS]) following program use. Descriptive statistics summarized usage and experience outcomes, and independent samples t tests and correlations examined relationships between them. The MCID was calculated using the mean MASC-2 change score among Breathe respondents reporting somewhat better anxiety on the GRCS. Results: Adolescents were mostly female (382/536, 71.3%), aged 16.6 years (SD 1.7), with very elevated anxiety (mean 92.2, SD 18.1). Intervention use was low for adolescents allocated to Breathe (mean 2.2 sessions, SD 2.3; n=258) or webpages (mean 2.1 visits, SD 2.7; n=278), but was higher for Breathe (median 6.0, range 1-6; 81/258) and webpage respondents (median 2.0, range 1-9; 148/278). Total user experience was significantly more positive for Breathe than webpage respondents (P<.001). Breathe respondents reported program design and delivery factors that may have challenged (eg, time constraints and program support) or facilitated (eg, demonstration videos, self-management activities) program use. The MCID was a mean MASC-2 change score of 13.8 (SD 18.1). Using the MCID, a positive treatment response was generated for 43% (35/81) of Breathe respondents. Treatment response was not correlated with respondents’ experiences or use of Breathe (P=.32 to P=.88). Conclusions: Respondents reported positive experiences and changes in their anxiety with Breathe; however, their reports were not correlated with program use. Breathe respondents identified program design and delivery factors that help explain their experiences and use of iCBT and inform program improvements. Future studies can apply our measures to compare user experiences between internet-based interventions, interpret treatment outcomes and improve treatment decision making for adolescents with anxiety. Trial Registration: ClinicalTrials.gov NCT02970734; https://clinicaltrials.gov/ct2/show/NCT02970734 %R 10.2196/15795 %U https://mental.jmir.org/2020/2/e15795 %U https://doi.org/10.2196/15795 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e15564 %T Exploring Mental Health Professionals’ Perspectives of Text-Based Online Counseling Effectiveness With Young People: Mixed Methods Pilot Study %A Navarro,Pablo %A Sheffield,Jeanie %A Edirippulige,Sisira %A Bambling,Matthew %+ Kids Helpline, yourtown, yourtown Business Centre, 5 Cordova Street, Milton, Brisbane, 4064, Australia, 61 1800555079, pablo.fernandez@uqconnect.edu.au %K mental health %K child health %K adolescent health %K distance counseling %K mHealth %K applied psychology %K psychological processes %D 2020 %7 29.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Population-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups. Objective: This pilot study aimed to explore and confirm e-mental health professional’s perspectives about various domains and themes related to young service users’ (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities. Methods: Participants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness. Results: A total of 4 domains and various subthemes were confirmed and identified to be related to YSUs’ characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors). Conclusions: Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor’s interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation. %M 32012097 %R 10.2196/15564 %U https://mental.jmir.org/2020/1/e15564 %U https://doi.org/10.2196/15564 %U http://www.ncbi.nlm.nih.gov/pubmed/32012097 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e14045 %T Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study %A Cao,Jian %A Truong,Anh Lan %A Banu,Sophia %A Shah,Asim A %A Sabharwal,Ashutosh %A Moukaddam,Nidal %+ Menninger Department of Psychiatry, Baylor College of Medicine, 1504 Taub Loop, NPC Bldg, Houston, TX, 77030, United States, 1 7138735270, nidalm@bcm.edu %K SOLVD-Teen and SOLVD-Parent App %K adolescent depression %K smartphone monitoring %K self-evaluation %K parental input %K sensory data %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression carries significant financial, medical, and emotional burden on modern society. Various proof-of-concept studies have highlighted how apps can link dynamic mental health status changes to fluctuations in smartphone usage in adult patients with major depressive disorder (MDD). However, the use of such apps to monitor adolescents remains a challenge. Objective: This study aimed to investigate whether smartphone apps are useful in evaluating and monitoring depression symptoms in a clinically depressed adolescent population compared with the following gold-standard clinical psychometric instruments: Patient Health Questionnaire (PHQ-9), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A). Methods: We recruited 13 families with adolescent patients diagnosed with MDD with or without comorbid anxiety disorder. Over an 8-week period, daily self-reported moods and smartphone sensor data were collected by using the Smartphone- and OnLine usage–based eValuation for Depression (SOLVD) app. The evaluations from teens’ parents were also collected. Baseline depression and anxiety symptoms were measured biweekly using PHQ-9, HAM-D, and HAM-A. Results: We observed a significant correlation between the self-evaluated mood averaged over a 2-week period and the biweekly psychometric scores from PHQ-9, HAM-D, and HAM-A (0.45≤|r|≤0.63; P=.009, P=.01, and P=.003, respectively). The daily steps taken, SMS frequency, and average call duration were also highly correlated with clinical scores (0.44≤|r|≤0.72; all P<.05). By combining self-evaluations and smartphone sensor data of the teens, we could predict the PHQ-9 score with an accuracy of 88% (23.77/27). When adding the evaluations from the teens’ parents, the prediction accuracy was further increased to 90% (24.35/27). Conclusions: Smartphone apps such as SOLVD represent a useful way to monitor depressive symptoms in clinically depressed adolescents, and these apps correlate well with current gold-standard psychometric instruments. This is a first study of its kind that was conducted on the adolescent population, and it included inputs from both teens and their parents as observers. The results are preliminary because of the small sample size, and we plan to expand the study to a larger population. %M 32012072 %R 10.2196/14045 %U http://mental.jmir.org/2020/1/e14045/ %U https://doi.org/10.2196/14045 %U http://www.ncbi.nlm.nih.gov/pubmed/32012072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e16176 %T A Customized Social Network Platform (Kids Helpline Circles) for Delivering Group Counseling to Young People Experiencing Family Discord That Impacts Their Well-Being: Exploratory Study %A Campbell,Andrew %A Ridout,Brad %A Amon,Krestina %A Navarro,Pablo %A Collyer,Brian %A Dalgleish,John %+ Cyberpsychology Research Group, Faculty of Medicine & Health, The University of Sydney, Level 2, Charles Perkins Centre, Camperdown, 2006, Australia, 61 415280495, andrew.campbell@sydney.edu.au %K social media %K social networking %K online counseling %K family discord %K well-being %D 2019 %7 20.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being. Objective: In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment. Methods: The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures. Results: Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement. Conclusions: Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381 %M 31859671 %R 10.2196/16176 %U http://www.jmir.org/2019/12/e16176/ %U https://doi.org/10.2196/16176 %U http://www.ncbi.nlm.nih.gov/pubmed/31859671 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 12 %P e14866 %T Moderated Online Social Therapy: Viewpoint on the Ethics and Design Principles of a Web-Based Therapy System %A D'Alfonso,Simon %A Phillips,Jessica %A Valentine,Lee %A Gleeson,John %A Alvarez-Jimenez,Mario %+ School of Computing and Information Systems, University of Melbourne, Grattan Street, Parkville, 3010, Australia, 61 399669387, dalfonso@unimelb.edu.au %K Web-based intervention %K social network %K well-being %K eudaimonia %K persuasive technology %K ethical design %D 2019 %7 4.12.2019 %9 Viewpoint %J JMIR Ment Health %G English %X The modern omnipresence of social media and social networking sites (SNSs) brings with it a range of important research questions. One of these concerns the impact of SNS use on mental health and well-being, a question that has been pursued in depth by scholars in the psychological sciences and the field of human-computer interaction. Despite this attention, the design choices made in the development of SNSs and the notion of well-being employed to evaluate such systems require further scrutiny. In this viewpoint paper, we examine the strategic design choices made in our development of an enclosed SNS for young people experiencing mental ill-health in terms of ethical and persuasive design and in terms of how it fosters well-being. In doing so, we critique the understanding of well-being that is used in much of the existing literature to make claims about the impact of a given technology on well-being. We also demonstrate how the holistic concept of eudaimonic well-being and ethical design of SNSs can complement one another. %M 31799937 %R 10.2196/14866 %U https://mental.jmir.org/2019/12/e14866 %U https://doi.org/10.2196/14866 %U http://www.ncbi.nlm.nih.gov/pubmed/31799937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13911 %T Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial %A Thabrew,Hiran %A D'Silva,Simona %A Darragh,Margot %A Goldfinch,Mary %A Meads,Jake %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Department of Psychological Medicine, University of Auckland, Level 12, Support Block, Auckland Hospital, 2 Park Road, Grafton, Auckland, 1142, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K adolescents %K anxiety %K depression %K substance-related disorders %K primary health care %K school health services %K eHealth %D 2019 %7 3.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS Objective: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Trial Registration: Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422. %M 31793890 %R 10.2196/13911 %U https://www.jmir.org/2019/12/e13911 %U https://doi.org/10.2196/13911 %U http://www.ncbi.nlm.nih.gov/pubmed/31793890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13873 %T Young People’s Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review %A Pretorius,Claudette %A Chambers,Derek %A Coyle,David %+ School of Computer Science, University College Dublin, Belfield, Dublin, Ireland, 353 017162818, claudette.pretorius@ucdconnect.ie %K internet %K help-seeking behavior %K youth %K mental health %K online behavior %K self-determination theory %K systematic review %D 2019 %7 19.11.2019 %9 Review %J J Med Internet Res %G English %X Background: Young people frequently make use of the internet as part of their day-to-day activities, and this has extended to their help-seeking behavior. Offline help-seeking is known to be impeded by a number of barriers including stigma and a preference for self-reliance. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties without being encumbered by these same barriers. Objective: The objective of this systematic literature review was to examine young peoples’ online help-seeking behaviors for mental health concerns. It aimed to summarize young peoples’ experiences and identify benefits and limitations of online help-seeking for this age group. It also examined the theoretical perspectives that have been applied to understand online help-seeking. Methods: A systematic review of peer-reviewed research papers from the following major electronic databases was conducted: PsycINFO, Cumulative Index of Nursing and Allied Health Literature, PubMed, Cochrane Library, Association for Computing Machinery Digital Library, and Institute of Electrical and Electronics Engineers Xplore. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search was conducted in August 2017. The narrative synthesis approach to reviews was used to analyze the existing evidence to answer the review questions. Results: Overall, 28 studies were included. The most common method of data collection was through the use of surveys. Study quality was moderate to strong. Text-based query via an internet search engine was the most commonly identified help-seeking approach. Social media, government or charity websites, live chat, instant messaging, and online communities were also used. Key benefits included anonymity and privacy, immediacy, ease of access, inclusivity, the ability to connect with others and share experiences, and a greater sense of control over the help-seeking journey. Online help-seeking has the potential to meet the needs of those with a preference for self-reliance or act as a gateway to further help-seeking. Barriers to help-seeking included a lack of mental health literacy, concerns about privacy and confidentiality, and uncertainty about the trustworthiness of online resources. Until now, there has been limited development and use of theoretical models to guide research on online help-seeking. Conclusions: Approaches to improving help-seeking by young people should consider the role of the internet and online resources as an adjunct to offline help-seeking. This review identifies opportunities and challenges in this space. It highlights the limited use of theoretical frameworks to help conceptualize online help-seeking. Self-determination theory and the help-seeking model provide promising starting points for the development of online help-seeking theories. This review discusses the use of these theories to conceptualize online help-seeking and identify key motivations and tensions that may arise when young people seek help online. %M 31742562 %R 10.2196/13873 %U http://www.jmir.org/2019/11/e13873/ %U https://doi.org/10.2196/13873 %U http://www.ncbi.nlm.nih.gov/pubmed/31742562 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e12427 %T Electronic Health Interventions for Preventing and Treating Negative Psychological Sequelae Resulting From Pediatric Medical Conditions: Systematic Review %A McGar,Ashley Brook %A Kindler,Christine %A Marsac,Meghan %+ Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States, 1 (859) 323 3850, meghan.marsac@uky.edu %K telemedicine %K children %K caregivers %K injury %K chronic disease %K wounds and injuries %K depression %K anxiety %D 2019 %7 11.11.2019 %9 Review %J JMIR Pediatr Parent %G English %X Background: Pediatric medical conditions have the potential to result in challenging psychological symptoms (eg, anxiety, depression, and posttraumatic stress symptoms [PTSS]) and impaired health-related quality of life in youth. Thus, effective and accessible interventions are needed to prevent and treat psychological sequelae associated with pediatric medical conditions. Electronic health (eHealth) interventions may help to meet this need, with the capacity to reach more children and families than in-person interventions. Many of these interventions are in their infancy, and we do not yet know what key components contribute to successful eHealth interventions. Objective: The primary objective of this study was to conduct a systematic review to summarize current evidence on the efficacy of eHealth interventions designed to prevent or treat psychological sequelae in youth with medical conditions. Methods: MEDLINE (PubMed) and PsycINFO databases were searched for studies published between January 1, 1998, and March 1, 2019, using predefined search terms. A total of 2 authors independently reviewed titles and abstracts of search results to determine which studies were eligible for full-text review. Reference lists of studies meeting eligibility criteria were reviewed. If the title of a reference suggested that it might be relevant for this review, the full manuscript was reviewed for inclusion. Inclusion criteria required that eligible studies (1) had conducted empirical research on the efficacy of a Web-based intervention for youth with a medical condition, (2) had included a randomized trial as part of the study method, (3) had assessed the outcomes of psychological sequelae (ie, PTSS, anxiety, depression, internalizing symptoms, or quality of life) in youth (aged 0-18 years), their caregivers, or both, (4) had included assessments at 2 or more time points, and (5) were available in English language. Results: A total of 1512 studies were reviewed for inclusion based on their title and abstracts; 39 articles qualified for full-text review. Moreover, 22 studies met inclusion criteria for the systematic review. Of the 22 included studies, 13 reported results indicating that eHealth interventions significantly improved at least one component of psychological sequelae in participants. Common characteristics among interventions that showed an effect included content on problem solving, education, communication, and behavior management. Studies most commonly reported on child and caregiver depression, followed by child PTSS and caregiver anxiety. Conclusions: Previous research is mixed but suggests that eHealth interventions may be helpful in alleviating or preventing problematic psychological sequelae in youth with medical conditions and their caregivers. Additional research is needed to advance understanding of the most powerful intervention components and to determine when and how to best disseminate eHealth interventions, with the goal of extending the current reach of psychological interventions. %M 31710299 %R 10.2196/12427 %U http://pediatrics.jmir.org/2019/2/e12427/ %U https://doi.org/10.2196/12427 %U http://www.ncbi.nlm.nih.gov/pubmed/31710299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13393 %T Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial %A Topooco,Naira %A Byléhn,Sandra %A Dahlström Nysäter,Ellen %A Holmlund,Jenny %A Lindegaard,Johanna %A Johansson,Sanna %A Åberg,Linnea %A Bergman Nordgren,Lise %A Zetterqvist,Maria %A Andersson,Gerhard %+ Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, Linköping, SE-581 83, Sweden, 46 13281000, naira.topooco@liu.se %K adolescent %K depression %K cognitive behavioral therapy %K randomized controlled trial %K internet %K digital health %K technology %K mental health %K text messaging %K instant messaging %D 2019 %7 1.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective: The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods: In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results: Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (P<.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions: The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants’ age and baseline depression severity are of interest in relation to used study methods. Trial Registration: ClinicalTrials.gov NCT02363205; https://clinicaltrials.gov/ct2/show/NCT02363205 %M 31682572 %R 10.2196/13393 %U https://www.jmir.org/2019/11/e13393 %U https://doi.org/10.2196/13393 %U http://www.ncbi.nlm.nih.gov/pubmed/31682572 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e13807 %T Potential Reduction of Symptoms With the Use of Persuasive Systems Design Features in Internet-Based Cognitive Behavioral Therapy Programs for Children and Adolescents With Anxiety: A Realist Synthesis %A Radomski,Ashley D %A Wozney,Lori %A McGrath,Patrick %A Huguet,Anna %A Hartling,Lisa %A Dyson,Michele P %A Bennett,Kathryn J %A Newton,Amanda S %+ Department of Pediatrics, University of Alberta, 11405 - 87 Avenue, 3-526 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada, 1 7802485581, mandi.newton@ualberta.ca %K internet %K cognitive behavioral therapy %K computer-assisted therapy %K persuasive communication %K anxiety %K children %K adolescents %K review %K treatment effectiveness %K clinical effectiveness %K treatment efficacy %K clinical %D 2019 %7 23.10.2019 %9 Review %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy—therapeutic content, technological features, and interactions between the user and program—intended to reduce users’ anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. Objective: The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. Methods: A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our prespecified inclusion criteria were appraised for relevance and methodological rigor. Data extraction was guided by the persuasive systems design (PSD) model. The model describes 28 technological design features, organized into 4 categories that help users meet their health goals: primary task support, dialogue support, system credibility support, and social support. We generated initial hypotheses for how PSD (mechanisms) and program delivery (context of use) features were linked to symptom changes (outcomes) across iCBT programs using realist and meta-ethnographic techniques. These hypothesized context-mechanism-outcome configurations were refined during analysis using evidence from the literature to improve their explanatory value. Results: A total of 63 documents detailing 15 iCBT programs were included. A total of six iCBT programs were rated high for relevance, and most studies were of moderate-to-high methodological rigor. A total of 11 context-mechanism-outcome configurations (final hypotheses) were generated. Configurations primarily comprised PSD features from the primary task and dialogue support categories. Several key PSD features (eg, self-monitoring, simulation, social role, similarity, social learning, and rehearsal) were consistently reported in programs shown to reduce anxiety; many features were employed simultaneously, suggesting synergy when grouped. We also hypothesized the function of PSD features in generating iCBT impacts. Adjunct support was identified as an important aspect of context that may have complemented certain PSD features in reducing users’ anxiety. Conclusions: This synthesis generated context-mechanism-outcome configurations (hypotheses) about the potential function, combination, and impact of iCBT program components thought to support desired program effects. We suggest that, when delivered with adjunct support, PSD features may contribute to reduced anxiety for child and adolescent users. Formal testing of the 11 configurations is required to confirm their impact on anxiety-based outcomes. From this we encourage a systematic and deliberate approach to iCBT design and evaluation to increase the pool of evidence-based interventions available to prevent and treat children and adolescents with anxiety. %M 31647474 %R 10.2196/13807 %U https://mental.jmir.org/2019/10/e13807 %U https://doi.org/10.2196/13807 %U http://www.ncbi.nlm.nih.gov/pubmed/31647474 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e13189 %T Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial %A Sanci,Lena %A Kauer,Sylvia %A Thuraisingam,Sharmala %A Davidson,Sandra %A Duncan,Ann-Maree %A Chondros,Patty %A Mihalopoulos,Cathrine %A Buhagiar,Kerrie %+ Department of General Practice, University of Melbourne, 780 Elizabeth St, Parkville, 3052, Australia, 61 3 8344 6152, l.sanci@unimelb.edu.au %K adolescent %K young adult %K internet %K web archives as topic %K mental health %K mental disorders %K help-seeking behavior %K mental health services %K affect %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. Objective: The study aimed to investigate the effect of Link on young people’s positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. Methods: Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). Results: In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. Conclusions: The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731 %M 31625945 %R 10.2196/13189 %U https://mental.jmir.org/2019/10/e13189 %U https://doi.org/10.2196/13189 %U http://www.ncbi.nlm.nih.gov/pubmed/31625945 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e13434 %T Effectiveness and Cost-Effectiveness of Blended Cognitive Behavioral Therapy in Clinically Depressed Adolescents: Protocol for a Pragmatic Quasi-Experimental Controlled Trial %A Rasing,Sanne P A %A Stikkelbroek,Yvonne A J %A Riper,Heleen %A Dekovic,Maja %A Nauta,Maaike H %A Dirksen,Carmen D %A Creemers,Daan H M %A Bodden,Denise H M %+ Child and Adolescent Studies, Utrecht University, PO Box 80140, Utrecht, 3508 TC, Netherlands, 31 30 253 47 00, s.p.a.rasing1@uu.nl %K depression %K major depressive disorder %K cognitive behavioral therapy %K blended %K eHealth %K online %K adolescents %K effectiveness %K cost-effectiveness %D 2019 %7 7.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk. Objective: In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents. Methods: A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups. Results: The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT. Conclusions: This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed. Trial Registration: Dutch Trial Register (NTR6759); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6759 International Registered Report Identifier (IRRID): DERR1-10.2196/13434 RR1-10.2196/12654 %M 31593538 %R 10.2196/13434 %U https://www.researchprotocols.org/2019/10/e13434 %U https://doi.org/10.2196/13434 %U http://www.ncbi.nlm.nih.gov/pubmed/31593538 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12407 %T Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study %A Ryan-Pettes,Stacy R %A Lange,Lindsay L %A Magnuson,Katherine I %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798-7334, United States, 1 2547102544, stacy_ryan@baylor.edu %K mobile phones %K text messaging %K substance use treatment %K mhealth %K parenting %K aftercare %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Improvements in parenting practices can positively mediate the outcomes of treatment for adolescent substance use disorder. Given the high rates of release among adolescents (ie, 60% within three months and 85% within one year), there is a critical need for interventions focused on helping parents achieve and maintain effective parenting practices posttreatment. Yet, research suggests that engaging parents in aftercare services is difficult, partly due to systemic-structural and personal barriers. One way to increase parent use of aftercare services may be to offer mobile health interventions, given the potential for wide availability and on-demand access. However, it remains unclear whether mobile phone–based aftercare support for caregivers of substance-using teens is feasible or desired. Therefore, formative work in this area is needed. Objective: This study aims to determine the feasibility and acceptability of mobile phone–based aftercare support in a population of caregivers with teens in treatment for substance use. Methods: Upon enrollment in a treatment program, 103 caregivers completed a mobile phone use survey, providing information about mobile phone ownership, access, and use. Caregivers also provided a response to items assessing desire for aftercare services, in general; desire for mobile phone–based aftercare services specifically; and desire for parenting specific content as part of aftercare services. Research assistants also monitored clinic calls made to caregivers’ mobile phones to provide an objective measure of the reliability of phone service. Results: Most participants were mothers (76.7%) and self-identified as Hispanic (73.8%). The average age was 42.60 (SD 9.28) years. A total of 94% of caregivers owned a mobile phone. Most had pay-as-you-go phone service (67%), and objective data suggest this did not impede accessibility. Older caregivers more frequently had a yearly mobile contract. Further, older caregivers and caregivers of adolescent girls had fewer disconnections. Bilingual caregivers used text messaging less often; however, caregivers of adolescent girls used text messaging more often. Although 72% of caregivers reported that aftercare was needed, 91% of caregivers endorsed a desire for mobile phone–based aftercare support in parenting areas that are targets of evidence-based treatments. Conclusions: The results suggest that mobile phones are feasible and desired to deliver treatments that provide support to caregivers of teens discharged from substance use treatment. Consideration should be given to the age of caregivers when designing these programs. Additional research is needed to better understand mobile phone use patterns based on a child’s gender and among bilingual caregivers. %M 31573920 %R 10.2196/12407 %U https://mhealth.jmir.org/2019/9/e12407 %U https://doi.org/10.2196/12407 %U http://www.ncbi.nlm.nih.gov/pubmed/31573920 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 0 %N 0 %P e0 %T Using Wearable Physiological Monitors With Suicidal Adolescent Inpatients: Feasibility and Acceptability Study %A Kleiman,Evan %A Millner,Alexander J %A Joyce,Victoria W %A Nash,Carol C %A Buonopane,Ralph J %A Nock,Matthew K %+ Rutgers, The State University of New Jersey, Department of Psychology, 53 Avenue E, Room 627, Piscataway, NJ, 08854, United States, 1 8484452345, evan.kleiman@rutgers.edu %K feasibility studies %K wearable electronic devices %K adolescent, hospitalized %K self-injurious behavior %K qualitative research %D 2019 %7 24.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable physiological monitoring devices enable the continuous measurement of human behavior and psychophysiology in the real world. Although such monitors are promising, their availability does not guarantee that participants will continuously wear and interact with them, especially during times of psychological distress. Objective: This study aimed to evaluate the feasibility and acceptability of using a wearable behavioral and physiological monitor, the Empatica E4, to continuously assess a group of suicidal adolescent inpatients. Methods: Participants (n=50 adolescent inpatients) were asked to wear an Empatica E4 on their wrist for the duration of their inpatient stay. In addition to assessing behavioral metadata (eg, hours worn per day), we also used qualitative interviews and self-report measures to assess participants’ experience of wearing the monitor. Results: Results supported the feasibility and acceptability of this approach. Participants wore the monitor for an average of 18 hours a day and reported that despite sometimes finding the monitor uncomfortable, they did not mind wearing it. Many of the participants noted that the part of the study they enjoyed most was contributing to scientific understanding, especially if it could help people similar to them in the future. Conclusions: These findings provide promising support for using wearable monitors in clinical samples in future studies, especially if participants are invested in being part of a research study. %M 31586364 %R 10.2196/13725 %U http://mhealth.jmir.org/2019/0/e0/ %U https://doi.org/10.2196/13725 %U http://www.ncbi.nlm.nih.gov/pubmed/31586364 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 8 %P e13524 %T Young People Seeking Help Online for Mental Health: Cross-Sectional Survey Study %A Pretorius,Claudette %A Chambers,Derek %A Cowan,Benjamin %A Coyle,David %+ School of Computer Science, University College Dublin, Belfield, Dublin, D04 V1W8, Ireland, 353 017162818, claudette.pretorius@ucdconnect.ie %K mental health %K eHealth %K mHealth %K Internet %K help-seeking behavior %K health literacy %K young adults %K survey and questionnaires %D 2019 %7 26.08.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people are particularly vulnerable to experiencing mental health difficulties, but very few seek treatment or help during this time. Online help-seeking may offer an additional domain where young people can seek aid for mental health difficulties, yet our current understanding of how young people seek help online is limited. Objective: This was an exploratory study which aimed to investigate the online help-seeking behaviors and preferences of young people. Methods: This study made use of an anonymous online survey. Young people aged 18-25, living in Ireland, were recruited through social media ads on Twitter and Facebook and participated in the survey. Results: A total of 1308 respondents completed the survey. Many of the respondents (80.66%; 1055/1308) indicated that they would use their mobile phone to look online for help for a personal or emotional concern. When looking for help online, 82.57% (1080/1308) of participants made use of an Internet search, while 57.03% (746/1308) made use of a health website. When asked about their satisfaction with these resources, 36.94% (399/1080) indicated that they were satisfied or very satisfied with an Internet search while 49.33% (368/746) indicated that they were satisfied or very satisfied with a health website. When asked about credibility, health websites were found to be the most trustworthy, with 39.45% (516/1308) indicating that they found them to be trustworthy or very trustworthy. Most of the respondents (82.95%; 1085/1308) indicated that a health service logo was an important indicator of credibility, as was an endorsement by schools and colleges (54.97%; 719/1308). Important facilitators of online help-seeking included the anonymity and confidentiality offered by the Internet, with 80% (1046/1308) of the sample indicating that it influenced their decision a lot or quite a lot. A noted barrier was being uncertain whether information on an online resource was reliable, with 55.96% (732/1308) of the respondents indicating that this influenced their decision a lot or quite a lot. Conclusions: Findings from this survey suggest that young people are engaging with web-based mental health resources to assist them with their mental health concerns. However, levels of satisfaction with the available resources vary. Young people are engaging in strategies to assign credibility to web-based resources, however, uncertainty around their reliability is a significant barrier to online help-seeking. %M 31452519 %R 10.2196/13524 %U http://mental.jmir.org/2019/8/e13524/ %U https://doi.org/10.2196/13524 %U http://www.ncbi.nlm.nih.gov/pubmed/31452519 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13628 %T Medium-Term Effects of a Tailored Web-Based Parenting Intervention to Reduce Adolescent Risk of Depression and Anxiety: 12-Month Findings From a Randomized Controlled Trial %A Yap,Marie Bee Hui %A Cardamone-Breen,Mairead C %A Rapee,Ronald M %A Lawrence,Katherine A %A Mackinnon,Andrew J %A Mahtani,Shireen %A Jorm,Anthony F %+ School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Wellington Road, Clayton, Melbourne, 3168, Australia, 61 0399051250, marie.yap@monash.edu %K family %K parenting %K mental health %K depression %K anxiety %K adolescent %K internet %K randomized controlled trial %K preventive health services %D 2019 %7 15.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevention of depression and anxiety disorders early in life is a global health priority. Evidence on risk and protective factors for youth internalizing disorders indicates that the family represents a strategic setting to target preventive efforts. Despite this evidence base, there is a lack of accessible, cost-effective preventive programs for parents of adolescents. To address this gap, we recently developed the Partners in Parenting (PiP) program—an individually tailored Web-based parenting program targeting evidence-based parenting risk and protective factors for adolescent depression and anxiety disorders. We previously reported the postintervention outcomes of a single-blinded parallel-group superiority randomized controlled trial (RCT) in which PiP was found to significantly improve self-reported parenting compared with an active-control condition (educational factsheets). Objective: This study aimed to evaluate the effects of the PiP program on parenting risk and protective factors and symptoms of adolescent depression and anxiety using data from the final assessment time point (12-month follow-up) of this RCT. Methods: Parents (n=359) and adolescents (n=332) were recruited primarily from secondary schools and completed Web-based assessments of parenting and adolescent depression and anxiety symptoms at baseline, postintervention (3 months later), and 12-month follow-up (317 parents, 287 adolescents). Parents in the PiP intervention condition received personalized feedback about their parenting and were recommended a series of up to 9 interactive modules. Control group parents received access to 5 educational factsheets about adolescent development and mental health. Both groups received a weekly 5-min phone call to encourage progress through their program. Results: Intervention group parents completed an average of 73.7% of their intended program. For the primary outcome of parent-reported parenting, the intervention group showed significantly greater improvement from baseline to 12-month follow-up compared with controls, with a medium effect size (Cohen d=0.51; 95% CI 0.30 to 0.72). When transformed data were used, greater reduction in parent-reported adolescent depressive symptoms was observed in the intervention group (Cohen d=−0.21; 95% CI −0.42 to −0.01). Mediation analyses revealed that these effects were mediated by improvements in parenting (indirect effect b=−0.08; 95% CI −0.16 to −0.01). No other significant intervention effects were found for adolescent-reported parenting or adolescent depression or anxiety symptoms. Both groups showed significant reductions in anxiety (both reporters) and depressive (parent reported) symptoms. Conclusions: PiP improved self-reported parenting for up to 9 months postintervention, but its effects on adolescent symptoms were less conclusive, and parent-reported changes were not perceived by adolescents. Nonetheless, given its scalability, PiP may be a useful low-cost, sustainable program to empower parents of adolescents. Trial Registration: Australian Clinical Trials Registration Number (ACTRN): 12615000328572; http://www.anzctr.org.au/ACTRN12615000328572.aspx (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj). %M 31418422 %R 10.2196/13628 %U http://www.jmir.org/2019/8/e13628/ %U https://doi.org/10.2196/13628 %U http://www.ncbi.nlm.nih.gov/pubmed/31418422 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 8 %P e14029 %T A Smart Toy Intervention to Promote Emotion Regulation in Middle Childhood: Feasibility Study %A Theofanopoulou,Nikki %A Isbister,Katherine %A Edbrooke-Childs,Julian %A Slovák,Petr %+ Department of Informatics, King's College London, Bush House, 30 Aldwych, London, WC2B 4BG, United Kingdom, 44 2078481988, petr.slovak@kcl.ac.uk %K mental health %K children %K families %K stress, psychological %K emotional adjustment %D 2019 %7 05.08.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: A common challenge with existing psycho-social prevention interventions for children is the lack of effective, engaging, and scalable delivery mechanisms, especially beyond in-person therapeutic or school-based contexts. Although digital technology has the potential to address these issues, existing research on technology-enabled interventions for families remains limited. This paper focuses on emotion regulation (ER) as an example of a core protective factor that is commonly targeted by prevention interventions. Objective: The aim of this pilot study was to provide an initial validation of the logic model and feasibility of in situ deployment for a new technology-enabled intervention, designed to support children’s in-the-moment ER efforts. The novelty of the proposed approach relies on delivering the intervention through an interactive object (a smart toy) sent home with the child, without any prior training necessary for either the child or their carer. This study examined (1) engagement and acceptability of the toy in the homes during 1-week deployments, and (2) qualitative indicators of ER effects, as reported by parents and children. In total, 10 families (altogether 11 children aged 6-10 years) were recruited from 3 predominantly underprivileged communities in the United Kingdom, as low SES populations have been shown to be particularly at risk for less developed ER competencies. Children were given the prototype, a discovery book, and a simple digital camera to keep at home for 7 to 8 days. Data were gathered through a number of channels: (1) semistructured interviews with parents and children prior to and right after the deployment, (2) photos children took during the deployment, and (3) touch interactions automatically logged by the prototype throughout the deployment. Results: Across all families, parents and children reported that the smart toy was incorporated into the children’s ER practices and engaged with naturally in moments the children wanted to relax or calm down. Data suggested that the children interacted with the toy throughout the deployment, found the experience enjoyable, and all requested to keep the toy longer. Children’s emotional connection to the toy appears to have driven this strong engagement. Parents reported satisfaction with and acceptability of the toy. Conclusions: This is the first known study on the use of technology-enabled intervention delivery to support ER in situ. The strong engagement, incorporation into children’s ER practices, and qualitative indications of effects are promising. Further efficacy research is needed to extend these indicative data by examining the psychological efficacy of the proposed intervention. More broadly, our findings argue for the potential of a technology-enabled shift in how future prevention interventions are designed and delivered: empowering children and parents through child-led, situated interventions, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent skills application. %M 31381502 %R 10.2196/14029 %U https://mental.jmir.org/2019/8/e14029/ %U https://doi.org/10.2196/14029 %U http://www.ncbi.nlm.nih.gov/pubmed/31381502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14127 %T Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study %A Ospina-Pinillos,Laura %A Davenport,Tracey %A Mendoza Diaz,Antonio %A Navarro-Mancilla,Alvaro %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, Shops 1-3, 66-70 Parramatta Road, Sydney, NSW, 2051, Australia, 61 028 627 6946, laura.ospinapinillos@sydney.edu.au %K telemedicine %K medical informatics %K eHealth %K mental health %K cultural characteristics %K cultural competency %K ethnic groups %K transients and migrants %K quality of health care %K international students %K Hispanics %K Latinos %K community-based participatory research %K primary health care %K patient participation %K patient preference %K patient satisfaction %K consumer health information %D 2019 %7 02.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries. %M 31376271 %R 10.2196/14127 %U https://www.jmir.org/2019/8/e14127/ %U https://doi.org/10.2196/14127 %U http://www.ncbi.nlm.nih.gov/pubmed/31376271 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e11591 %T An Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth Diagnosed With Major Depressive Disorders: Protocol for a Randomized Controlled Trial %A Ritvo,Paul %A Daskalakis,Zafiris J %A Tomlinson,George %A Ravindran,Arun %A Linklater,Renee %A Kirk Chang,Megan %A Knyahnytska,Yuliya %A Lee,Jonathan %A Alavi,Nazanin %A Bai,Shari %A Harber,Lillian %A Jain,Tania %A Katz,Joel %+ School of Kinesiology and Health Science, York University, Bethune Building, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 4165808021, pritvo@yorku.ca %K intervention study %K telemedicine %K mobile phone %K mhealth %K fitbit %K depression %K cognitive behavioral therapy %D 2019 %7 29.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: About 70% of all mental health disorders appear before the age of 25 years. When untreated, these disorders can become long-standing and impair multiple life domains. When compared with all Canadian youth (of different ages), individuals aged between 15 and 25 years are significantly more likely to experience mental health disorders, substance dependencies, and risks for suicidal ideation and death by suicide. Progress in the treatment of youth, capitalizing on their online responsivity, can strategically address depressive disorders. Objective: We will conduct a randomized controlled trial to compare online mindfulness-oriented cognitive behavioral therapy (CBT-M) combined with standard psychiatric care versus psychiatric care alone in youth diagnosed with major depressive disorder. We will enroll 168 subjects in the age range of 18 to 30 years; 50% of subjects will be from First Nations (FN) backgrounds, whereas the other 50% will be from all other ethnic backgrounds. There will be equal stratification into 2 intervention groups (INT1 and INT2) and 2 wait-list control groups (CTL1 and CTL2) with 42 subjects per group, resulting in an equal number of INT1 and CTL1 of FN background and INT2 and CTL2 of non-FN background. Methods: The inclusion criteria are: (1) age 18 to 30 years, FN background or other ethnicity; (2) Beck Depression Inventory (BDI)-II of at least mild severity (BDI-II score ≥14) and no upper limit; (3) Mini-International Neuropsychiatric Interview (MINI)–confirmed psychiatric diagnosis of major depressive disorder; and (4) fluent in English. All patients are diagnosed by a Centre for Addiction and Mental Health psychiatrist, with diagnoses confirmed using the MINI interview. The exclusion criteria are: (1) individuals receiving weekly structured psychotherapy; (2) individuals who meet the Diagnostic and Statistical Manual of Mental Disorders criteria for severe alcohol/substance use disorder in the past 3 months, or who demonstrate clinically significant suicidal ideation defined as imminent intent, or who have attempted suicide in the past 6 months; and (3) individuals with comorbid diagnoses of borderline personality, schizophrenia, bipolar disorder, and/or obsessive compulsive disorder. All subjects are provided standard psychiatric care defined as 1 monthly session that focuses on appropriate medication, with session durations of 15 to 30 min. Experimental subjects receive an additional intervention consisting of the CBT-M online software program (in collaboration with Nex J Health, Inc). Exposure to and interaction with the online workbooks are combined with navigation-coaching delivered by phone and secure text message interactions. Results: The outcomes selected, combined with measurement blinding, are key features in assessing whether significant benefits regarding depression and anxiety symptoms occur. Conclusions: If results confirm the hypothesis that youth can be effectively treated with online CBT-M, effective services may be widely delivered with less geographic restriction. International Registered Report Identifier (IRRID): PRR1-10.2196/11591 %M 31359869 %R 10.2196/11591 %U http://www.researchprotocols.org/2019/7/e11591/ %U https://doi.org/10.2196/11591 %U http://www.ncbi.nlm.nih.gov/pubmed/31359869 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13065 %T The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial %A Le,Long Khanh-Dao %A Sanci,Lena %A Chatterton,Mary Lou %A Kauer,Sylvia %A Buhagiar,Kerrie %A Mihalopoulos,Cathrine %+ Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 392468383, long.le@deakin.edu.au %K economic evaluation %K cost effectiveness %K mental health %K help-seeking %K internet intervention %D 2019 %7 22.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. Objective: The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. Methods: A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life–4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. Results: Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus −$81 (Aus −$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. Conclusions: Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731 %M 31333199 %R 10.2196/13065 %U http://www.jmir.org/2019/7/e13065/ %U https://doi.org/10.2196/13065 %U http://www.ncbi.nlm.nih.gov/pubmed/31333199 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13798 %T Audience Response Systems and Missingness Trends: Using Interactive Polling Systems to Gather Sensitive Health Information From Youth %A Toscos,Tammy %A Drouin,Michelle %A Flanagan,Mindy %A Carpenter,Maria %A Kerrigan,Connie %A Carpenter,Colleen %A Mere,Cameron %A Haaff,Marcia %+ Parkview Research Center, 10622 Parkview Plaza Dr, Fort Wayne, IN, 46845, United States, 1 260 266 5586, Tammy.Toscos@parkview.com %K mental health %K youth %K surveys and questionnaires %K health care %K software %D 2019 %7 16.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The widespread availability and cost-effectiveness of new-wave software-based audience response systems (ARSs) have expanded the possibilities of collecting health data from hard-to-reach populations, including youth. However, with all survey methods, biases in the data may exist because of participant nonresponse. Objective: The aims of this study were to (1) examine the extent to which an ARS could be used to gather health information from youths within a large-group school setting and (2) examine individual- and survey-level response biases stemming from this Web-based data collection method. Methods: We used an ARS to deliver a mental health survey to 3418 youths in 4 high schools in the Midwestern United States. The survey contained demographic questions, depression, anxiety, and suicidality screeners, and questions about their use of offline resources (eg, parents, peers, and counselors) and Web-based resources (ie, telemental health technologies) when they faced stressful life situations. We then examined the response rates for each survey item, focusing on the individual- and survey-level characteristics that related to nonresponse. Results: Overall, 25.39% (868/3418) of youths answered all 38 survey questions; however, missingness analyses showed that there were some survey structure factors that led to higher rates of nonresponse (eg, questions at the end of survey, sensitive questions, and questions for which precise answers were difficult to provide). There were also some personal characteristics that were associated with nonresponse (eg, not identifying as either male or female, nonwhite ethnicity, and higher levels of depression). Specifically, a multivariate model showed that male students and students who reported their gender as other had significantly higher numbers of missed items compared with female students (B=.30 and B=.47, respectively, P<.001). Similarly, nonwhite race (B=.39, P<.001) and higher depression scores (B=.39, P<.001) were positively related to the number of missing survey responses. Conclusions: Although our methodology-focused study showed that it is possible to gather sensitive mental health data from youths in large groups using ARSs, we also suggest that these nonresponse patterns need to be considered and controlled for when using ARSs for gathering population health data. %M 31313658 %R 10.2196/13798 %U https://formative.jmir.org/2019/3/e13798/ %U https://doi.org/10.2196/13798 %U http://www.ncbi.nlm.nih.gov/pubmed/31313658 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e13368 %T Virtual Reality and Web-Based Growth Mindset Interventions for Adolescent Depression: Protocol for a Three-Arm Randomized Trial %A Schleider,Jessica Lee %A Mullarkey,Michael C %A Weisz,John R %+ Department of Psychology, Stony Brook University, Psychology B 340, Stony Brook, NY,, United States, 1 631 632 4131, jessica.schleider@stonybrook.edu %K mental health %K depression %K virtual reality %K adolescence %K ehealth %D 2019 %7 09.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression is the leading cause of disability in youth, with a global economic burden of US >$210 billion annually. However, up to 70% of youth with depression do not receive services. Even among those who do access treatment, 30% to 65% fail to respond and many dropout prematurely, demonstrating a need for more potent, accessible interventions. In a previous trial, a single-session Web-based growth mindset (GM) intervention significantly reduced depressive symptoms in high-symptom adolescents; however, this intervention did not benefit adolescents uniformly. For instance, the intervention reduced depression in adolescents who reported post intervention increases in perceived control, but it did not lead to significant depression reductions in adolescents who reported no significant post intervention increases in perceived control. Objective: The goal of this project is to test the acceptability and efficacy of a novel, single-session, virtual reality (VR) depression intervention—the VR Personality Project—teaching GM, the belief that personal attributes are malleable rather than fixed. The VR Personality Project was designed to systematically target and increase adolescents’ perceived control by offering a more immersive, engaging, user-directed intervention experience than the Web-based intervention can provide. By targeting an identified predictor of intervention response, the VR Personality Project may lead to larger reductions in depressive symptoms than existing Web-based mindset interventions. Methods: Adolescents with elevated depressive symptoms or a recent history of depression (N=159; ages 12 to 16 years) will be randomized to one of 3 intervention conditions: the VR Personality Project; the Web-based GM intervention tested previously; or an active, Web-based control. Adolescents and their parents will report on the adolescents’ depression symptoms, perceived control, and related domains of functioning at preintervention, postintervention, and at 3- and 9-month follow-up assessments. Results: We predict that the VR and Web-based mindset interventions will both lead to larger reductions in adolescent symptoms than the control intervention. Additionally, we predict that the VR-based single session intervention will lead to larger reductions in depression than the online mindset intervention and that these symptom reductions will be mediated by increases in adolescents’ perceived control from pre- to postintervention. Conclusions: The results may suggest an efficient strategy for reducing adolescent depressive symptoms: One that is mechanism-targeted, relatively affordable (less than US $200 for a commercially available VR headset, a fraction of the cost of long-term psychotherapy) and potentially engaging to adolescents experiencing mood-related distress. Trial Registration: ClinicalTrials.gov NCT0385881; https://clinicaltrials.gov/ct2/show/NCT03858881 (Archived by WebCite at http://www.webcitation.org/78C3roDgA). International Registered Report Identifier (IRRID): DERR1-10.2196/13368 %M 31290406 %R 10.2196/13368 %U https://www.researchprotocols.org/2019/7/e13368/ %U https://doi.org/10.2196/13368 %U http://www.ncbi.nlm.nih.gov/pubmed/31290406 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 7 %P e13152 %T Exploring Young People’s Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study %A Navarro,Pablo %A Bambling,Matthew %A Sheffield,Jeanie %A Edirippulige,Sisira %+ Kids Helpline, Yourtown, 5 Cordova St, Milton, Brisbane, 4064, Australia, 61 800 555 079, pablo.fernandez@uqconnect.edu.au %K mental health %K child health %K adolescent health %K distance counseling %K mhealth %K applied psychology %K psychological processes %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people aged 10-24 years are at the highest risk for mental health problems and are the least likely to seek professional treatment. Owing to this population’s high consumption of internet content, electronic mental (e-mental) health services have increased globally, with an aim to address barriers to treatment. Many of these services use text-based online counseling (TBOC), which shows promising results in supporting young people but also greater variance in outcomes compared with adult comparators. Objective: This pilot study qualitatively explored the characteristics of users aged 15-25 years accessing TBOC services, their motivations for access, and their perceptions about factors believed to influence the effectiveness of these modalities. Methods: E-surveys were administered naturalistically to 100 young service users aged 15-25 years who accessed webchat and email counseling services via an Australian e-mental health service. Thematic analysis of qualitative themes and quantitative descriptive and proportional data presented in electronic surveys were examined across the areas of user characteristics, motivations for selecting TBOC modalities, and their perceptions of TBOC effectiveness. Results: Participants were predominately female high school students of Caucasian or European descent from middle socioeconomic status, living with their parents in major cities. Four domains and various themes and subthemes were related to participants’ reasons for accessing TBOC and perceptions of its effectiveness: user characteristics (ie, physical and mental health syndrome and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), factors perceived to increase effectiveness (ie, general therapeutic benefits, positive modality and service factors, and persisting with counseling to increase benefit), and factors perceived to decrease effectiveness (ie, negative modality and service factors, and persisting with counseling despite benefit). Conclusions: Participants were motivated to use TBOC to increase their sense of safety in response to negative perceptions of their social skills and the response of the online counsellor to their presenting problem. By using TBOC services, they also sought to improve their access to mental health services that better met their expectations. Factors that increased effectiveness of TBOC were the counsellor’s interpersonal skills, use of text-based communication, and persisting with beneficial counseling sessions. Factors that reduced TBOC effectiveness were poor timeliness in response to service requests, experiencing no change in their presenting problem, not knowing what postcounseling action to take, and persisting with ineffective counseling sessions. %M 31271149 %R 10.2196/13152 %U https://mental.jmir.org/2019/7/e13152/ %U https://doi.org/10.2196/13152 %U http://www.ncbi.nlm.nih.gov/pubmed/31271149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12347 %T A Mobile Phone–Based Intervention to Improve Mental Health Among Homeless Young Adults: Pilot Feasibility Trial %A Schueller,Stephen M %A Glover,Angela C %A Rufa,Anne K %A Dowdle,Claire L %A Gross,Gregory D %A Karnik,Niranjan S %A Zalta,Alyson K %+ Department of Psychological Science, University of California Irvine, 4201 Social & Behavioral Sciences Gateway, University of California, Irvine, Irvine, CA, 92697, United States, 1 9498243850, s.schueller@uci.edu %K mental health %K homelessness %K telemedicine %K treatment %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care. Objective: This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network. Methods: A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses. Results: Most participants (20/35, 57%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100% (23/23) of such participants indicating that they would recommend participation to someone else and 52% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression (d=0.27), post-traumatic stress disorder (d=0.17), and emotion regulation (d=0.10). Conclusions: This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform. Trial Registration: ClinicalTrials.gov NCT03620682; https://clinicaltrials.gov/ct2/show/NCT03620682 %M 31267980 %R 10.2196/12347 %U https://mhealth.jmir.org/2019/7/e12347/ %U https://doi.org/10.2196/12347 %U http://www.ncbi.nlm.nih.gov/pubmed/31267980 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11310 %T Evaluation of the Effectiveness of a Musical Cognitive Restructuring App for Black Inner-City Girls: Survey, Usage, and Focus Group Evaluation %A Neal-Barnett,Angela %A Stadulis,Robert %A Ellzey,Delilah %A Jean,Elizabeth %A Rowell,Tiffany %A Somerville,Keaton %A Petitti,Kallie %A Siglow,Benjamin %A Ruttan,Arden %A Hogue,Mary %+ Kent State University, Department of Psychological Sciences, Program for Research on Anxiety Disorders among African Americans, 600 Hilltop Dr, Kent, OH, 44242-0001, United States, 1 330 672 2166, aneal@kent.edu %K black girls %K musical cognitive restructuring %K mHealth %K negative thinking %D 2019 %7 27.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research on mobile health (mHealth) app use during adolescence is growing; however, little attention has been paid to black adolescents, particularly black girls, who are generally underresearched and underserved in psychological intervention research. Cognitive restructuring is an important tool in anxiety and fear management and involves two parts: (1) recognizing and deconstructing erroneous thoughts and (2) replacing negative anxiety and stress-provoking thoughts with positive thoughts. In our work with black adolescent females, we found that cognitive restructuring is a difficult skill to practice on one’s own. Thus, drawing upon the importance of music in the black community, we developed the Build Your Own Theme Song (BYOTS) app to deliver a musical form of the technique to middle-school black girls. Objective: Our aim in this mixed methods study is to evaluate the effectiveness of the BYOTS app. We hypothesize that participants will expect the app to be effective in reducing negative thoughts and that the app will meet their expectations and data generated from the app will demonstrate a reduction in negative thinking and anxiety. Methods: A total of 72 black or biracial seventh- and eighth-grade adolescent females were enrolled in Sisters United Now (SUN), an eight-session culturally infused and app-augmented stress and anxiety sister circle intervention. Before using the BYOTS app, girls completed the Multidimensional Anxiety Scale for Children 2 and the App Expectations Survey. Usage data collected from the app included an assessment of negative thinking before and after listening to their song. After completion of the intervention, focus groups were held to gather qualitative data on participants’ app experience. Results: Results using paired sample t tests indicated negative thinking was significantly lower at day 7 than day 1 (t31=1.69, P=.05). Anxiety from preuse to postuse of the app was also reduced (t38=2.82, P=.004). Four effectiveness themes emerged from the focus groups: difference in behavior and temperament, promoted calmness, helpfulness in stressful home situations, and focused thinking via the SUN theme song. Conclusions: The BYOTS app is a useful tool for delivering musical cognitive restructuring to reduce negative thinking and anxiety in an underserved urban population. Changes were supported both quantitatively and qualitatively. Participants, their peers, and their family noted the difference. Findings support expanding the research to black girls of various socioeconomic statuses and geographic diversity. Currently, the app augments SUN, a culturally relevant intervention. Future research will explore BYOTS as a stand-alone app. %M 31188130 %R 10.2196/11310 %U http://mhealth.jmir.org/2019/6/e11310/ %U https://doi.org/10.2196/11310 %U http://www.ncbi.nlm.nih.gov/pubmed/31188130 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13230 %T Teens Using Screens for Help: Impact of Suicidal Ideation, Anxiety, and Depression Levels on Youth Preferences for Telemental Health Resources %A Toscos,Tammy %A Coupe,Amanda %A Flanagan,Mindy %A Drouin,Michelle %A Carpenter,Maria %A Reining,Lauren %A Roebuck,Amelia %A Mirro,Michael J %+ Parkview Research Center, Parkview Health, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, United States, 1 260 266 5586, tammy.toscos@parkview.com %K adolescent %K students %K telemedicine %K mental health %K suicidal ideation %K depression %K anxiety %K health resources %K online social networking %K mental health services %K help-seeking behavior %D 2019 %7 21.6.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: High rates of mental illness, stress, and suicidality among teens constitute a major public health concern in the United States. However, treatment rates remain low, partially because of barriers that could be mitigated with tech-based telemental health (TMH) resources, separate from or in addition to traditional care. Objective: This study aimed to analyze TMH resource usage by high school students to establish current user characteristics and provide a framework for future development. Methods: A total of 2789 students were surveyed regarding demographics, recent anxiety and depression symptoms, suicidality, and stress; people with whom they could openly and honestly discuss stress or problems, and prior TMH use. Logistic regression models and a general linear model were used to test relationships between variables. Results: Overall, 30.58% (853/2789) and 22.91% (639/2789) of students reported moderate to severe anxiety and depression symptoms, respectively, in the past 2 weeks; 16.24% (414/2550) had seriously considered suicide in the past year, consistent with national averages. Meanwhile, 16.03% (447/2789) of students had previously used at least 1 of 4 types of TMH resources (ie, self-help, anonymous chat, online counselor, or crisis text line). Teens reporting depression symptoms, higher stress, or suicidality were less likely to talk to a parent about stress or problems and more likely to tell no one. Suicidality was related to the use of all 4 types of TMH resources. Depression symptoms were related to the use of anonymous chat and crisis text line, and those with higher stress were more likely to have used an online counselor. Those reporting anxiety symptoms were less likely to have no one to talk to and more likely to have used a self-help resource. Conclusions: Youth struggling with mental health symptoms, some of whom lack real-life confidants, are using existing TMH support, with resource preferences related to symptoms. Future research should consider these preferences and assist in the creation of specialized, evidence-based TMH resources. %M 31228179 %R 10.2196/13230 %U http://mental.jmir.org/2019/6/e13230/ %U https://doi.org/10.2196/13230 %U http://www.ncbi.nlm.nih.gov/pubmed/31228179 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13462 %T An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study %A Craig,Shelley L %A McInroy,Lauren B %A Eaton,Andrew David %A Iacono,Gio %A Leung,Vivian WY %A Austin,Ashley %A Dobinson,Cheryl %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada, 1 4169788847, shelley.craig@utoronto.ca %K sexual and gender minorities %K youth %K coping behavior %K pragmatic clinical trial %K cognitive behavioral therapy %K implementation science %D 2019 %7 06.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. Conclusions: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. International Registered Report Identifier (IRRID): DERR1-10.2196/13462 %M 31172957 %R 10.2196/13462 %U https://www.researchprotocols.org/2019/6/e13462/ %U https://doi.org/10.2196/13462 %U http://www.ncbi.nlm.nih.gov/pubmed/31172957 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11677 %T A Feasibility Trial of Power Up: Smartphone App to Support Patient Activation and Shared Decision Making for Mental Health in Young People %A Edbrooke-Childs,Julian %A Edridge,Chloe %A Averill,Phoebe %A Delane,Louise %A Hollis,Chris %A Craven,Michael P %A Martin,Kate %A Feltham,Amy %A Jeremy,Grace %A Deighton,Jessica %A Wolpert,Miranda %+ Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT, United Kingdom, 44 (0) 20 7794 2313, julian.edbrooke-childs@annafreud.org %K telemedicine %K patient participation %K mental health %K adolescent %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and, therefore, develop evidence-based recommendations for practice. Objective: This study aimed to determine the feasibility of undertaking a cluster randomized controlled trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. Methods: Overall, 270 young people were screened for participation and 52.5% (142/270) were recruited and completed baseline measures across 8 specialist child mental health services (n=62, mean age 14.66 (SD 1.99) year; 52% [32/62] female) and 2 mainstream secondary schools (n=80; mean age 16.88 [SD 0.68] years; 46% [37/80] female). Young people received Power Up in addition to management as usual or received management as usual only. Posttrial interviews were conducted with 11 young people from the intervention arms (specialist services n=6; schools n=5). Results: Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported (1) their motivation for use of Power Up, (2) the impact of use, and (3) barriers to use. Out of the 142 recruited participants, 45.0% (64/142) completed follow-up measures, and the approaches to increase retention agreed by the steering group are discussed. Conclusions: The findings of this study indicate that the app is acceptable, and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT02552797; https://clinicaltrials.gov/ct2/show/NCT02552797 (Archived by WebCite at http://www.webcitation.org/6td6MINP0) %M 31165709 %R 10.2196/11677 %U https://mhealth.jmir.org/2019/6/e11677/ %U https://doi.org/10.2196/11677 %U http://www.ncbi.nlm.nih.gov/pubmed/31165709 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e13498 %T Adverse Childhood Experiences Ontology for Mental Health Surveillance, Research, and Evaluation: Advanced Knowledge Representation and Semantic Web Techniques %A Brenas,Jon Hael %A Shin,Eun Kyong %A Shaban-Nejad,Arash %+ Department of Pediatrics, Oak Ridge National Laboratory Center for Biomedical Informatics, University of Tennessee Health Science Center, 50 N Dunlap Street, R492, Memphis, TN, 38103, United States, 1 901 287 5836, ashabann@uthsc.edu %K ontologies %K mental health surveillance %K adverse childhood experiences %K semantics %K computational psychiatry %D 2019 %7 21.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adverse Childhood Experiences (ACEs), a set of negative events and processes that a person might encounter during childhood and adolescence, have been proven to be linked to increased risks of a multitude of negative health outcomes and conditions when children reach adulthood and beyond. Objective: To better understand the relationship between ACEs and their relevant risk factors with associated health outcomes and to eventually design and implement preventive interventions, access to an integrated coherent dataset is needed. Therefore, we implemented a formal ontology as a resource to allow the mental health community to facilitate data integration and knowledge modeling and to improve ACEs’ surveillance and research. Methods: We use advanced knowledge representation and semantic Web tools and techniques to implement the ontology. The current implementation of the ontology is expressed in the description logic ALCRIQ(D), a sublogic of Web Ontology Language (OWL 2). Results: The ACEs Ontology has been implemented and made available to the mental health community and the public via the BioPortal repository. Moreover, multiple use-case scenarios have been introduced to showcase and evaluate the usability of the ontology in action. The ontology was created to be used by major actors in the ACEs community with different applications, from the diagnosis of individuals and predicting potential negative outcomes that they might encounter to the prevention of ACEs in a population and designing interventions and policies. Conclusions: The ACEs Ontology provides a uniform and reusable semantic network and an integrated knowledge structure for mental health practitioners and researchers to improve ACEs’ surveillance and evaluation. %M 31115344 %R 10.2196/13498 %U http://mental.jmir.org/2019/5/e13498/ %U https://doi.org/10.2196/13498 %U http://www.ncbi.nlm.nih.gov/pubmed/31115344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13882 %T Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study %A Smelror,Runar Elle %A Bless,Josef Johann %A Hugdahl,Kenneth %A Agartz,Ingrid %+ Department of Psychiatric Research, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo, 0319, Norway, 47 95744029, runar.smelror@medisin.uio.no %K experience sampling method %K ecological momentary assessment %K schizophrenia %K mHealth %K health care technology %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Auditory verbal hallucinations (AVH) are the most frequent symptom in early-onset psychosis (EOP) and a risk factor for increased suicide attempts in adolescents. Increased knowledge of AVH characteristics can lead to better prediction of risk and precision of diagnosis and help identify individuals with AVH who need care. As 98% of Norwegian adolescents aged 12 to 16 years own a mobile phone, the use of mobile phone apps in symptom assessment and patient communication is a promising new tool. However, when introducing new technology to patients, their subjective experiences are crucial in identifying risks, further development, and potential integration into clinical care. Objective: The objective was to explore the feasibility and acceptability of a newly developed mobile phone app in adolescents with EOP by examining compliance with the app and user experiences. Indication of validity was explored by examining associations between AVH dimensions, which were correlated and analyzed. Methods: Three adolescents with EOP and active AVH were enrolled. Real-time AVH were logged on an iPod touch using the experience sampling method (ESM), for seven or more consecutive days. The app included five dimensions of AVH characteristics and was programmed with five daily notifications. Feasibility and acceptability were examined using the mean response rate of data sampling and by interviewing the participants. Validity was assessed by examining associations between the AVH dimensions using nonparametric correlation analysis and by visual inspection of temporal fluctuations of the AVH dimensions. Results: One participant was excluded from the statistical analyses but completed the interview and was included in the examination of acceptability. The sampling period of the two participants was mean 12 (SD 6) days with overall completed sampling rate of 74% (SD 30%), indicating adequate to high compliance with the procedure. The user experiences from the interviews clustered into four categories: (1) increased awareness, (2) personal privacy, (3) design and procedure, and (4) usefulness and clinical care. One participant experienced more commenting voices during the sampling period, and all three participants had concerns regarding personal privacy when using electronic devices in symptom assessment. The AVH dimensions of content, control, and influence showed moderate to strong significant correlations with all dimensions (P<.001). Days of data sampling showed weak to moderate correlations with localization (P<.001) and influence (P=.03). Visual inspection indicated that the app was able to capture fluctuations within and across days for all AVH dimensions. Conclusions: This study demonstrates the value of including patients’ experiences in the development and pilot-testing of new technology. Based on the small sample size, the use of mobile phones with ESM seems feasible for patients with EOP, but the acceptability of using apps should be considered. Further investigation with larger samples is warranted before definitive conclusions are made. %M 31094321 %R 10.2196/13882 %U http://formative.jmir.org/2019/2/e13882/ %U https://doi.org/10.2196/13882 %U http://www.ncbi.nlm.nih.gov/pubmed/31094321 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e12656 %T The Importance of User Segmentation for Designing Digital Therapy for Adolescent Mental Health: Findings From Scoping Processes %A Fleming,Theresa %A Merry,Sally %A Stasiak,Karolina %A Hopkins,Sarah %A Patolo,Tony %A Ruru,Stacey %A Latu,Manusiu %A Shepherd,Matthew %A Christie,Grant %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 9 923 5025, t.fleming@auckland.ac.nz %K gamification %K computerized therapy %K mental health %K adolescent %K mobile apps %K internet %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: New Zealand youth, especially those of Māori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement. Objective: We aimed to carry out preliminary scoping to understand adolescents’ current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers. Methods: Interactive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach. Results: Participants (N=58) engaged in 2 whānau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face. Conclusions: Defining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health–need groups. This study demonstrates the importance of scoping possible user needs to inform design processes. %M 31066705 %R 10.2196/12656 %U https://mental.jmir.org/2019/5/e12656/ %U https://doi.org/10.2196/12656 %U http://www.ncbi.nlm.nih.gov/pubmed/31066705 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e13242 %T An Interactive Mobile App Game to Address Aggression (RegnaTales): Pilot Quantitative Study %A Ong,Jeffrey G %A Lim-Ashworth,Nikki S %A Ooi,Yoon P %A Boon,Jillian S %A Ang,Rebecca P %A Goh,Dion H %A Ong,Say H %A Fung,Daniel S %+ Department of Developmental Psychiatry, Institute of Mental Health, Health Promotion Board Building, 3 Second Hospital Avenue #03-01, Singapore, 168937, Singapore, 65 64353251, jeffrey_gx_ong@imh.com.sg %K video games %K mental health %K anger management %K mobile app %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: The rapid advancement in media technology has radically changed the way we learn and interact with one another. Games, with their engaging and interactive approach, hold promise in the delivery of knowledge and building of skills. This has potential in child and adolescent mental health work, where the lack of insight and motivation for therapy are major barriers to treatment. However, research on the use of serious games in mental health interventions for children and adolescents is still in its infancy. Objective: This study adds to the research on serious games in mental health interventions through the development and evaluation of RegnaTales, a series of 6 mobile apps designed to help children and adolescents manage anger. We examined the usability and playability of RegnaTales, as well as children’s aggression levels before and after the game play. Methods: A total of 72 children aged between 6 and 12 years were recruited for the study. Thirty-five participants had a clinical diagnosis of disruptive behavior disorders (DBD), whereas 37 were typically developing (TD) children. Each child played 1 of the 6 RegnaTales apps for approximately 50 min before completing the Playability and Usability Questionnaire. The Reactive-Proactive Aggression Questionnaire was completed before and after the game play. Results: The overall results showed high levels of enjoyment and playability. TD children and children with DBD had similar experienced fun and perceived playability scores on all 6 mobile apps. All 6 mobile apps garnered comparable experienced fun and perceived playability scores. Furthermore, 42% (5/12) to 67% (8/12) of the children indicated that they would like to play the games again. Importantly, children felt that they acquired skills in anger management, were motivated to use them in their daily lives, and felt confident that the skills would help them better manage their anger. Children reported significantly lower reactive aggression after playing the mobile apps Rage Raver (P=.001), Abaddon (P=.008), and RegnaTools (P=.03). These apps focused on the psychoeducation of the link between thoughts and emotions, as well as equipping the participants with various emotion regulation strategies such as relaxation and cognitive restructuring. Conclusions: This study presents evidence to support RegnaTales as a feasible serious game. The preliminary findings associated with reduction in reactive aggression, coupled with future research to further establish its efficacy, could warrant RegnaTales as a potential intervention for anger issues among clinical and community populations. %M 31066682 %R 10.2196/13242 %U http://games.jmir.org/2019/2/e13242/ %U https://doi.org/10.2196/13242 %U http://www.ncbi.nlm.nih.gov/pubmed/31066682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11958 %T The Implementation of an mHealth Intervention (ReZone) for the Self-Management of Overwhelming Feelings Among Young People %A Edridge,Chloe %A Deighton,Jessica %A Wolpert,Miranda %A Edbrooke-Childs,Julian %+ Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU, United Kingdom, 44 020 7433 6191, chloe.edridge@annafreud.org %K cluster trial %K behavioural difficulties %K schools %K mHealth, digital %K mental health %K mobile phone %D 2019 %7 02.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. Objective: The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools. Methods: Preliminary data for 79 students collected as part of a larger trial were analyzed. We additionally conducted postimplementation consultations with teachers. Results: ReZone was used 1043 times by 36 students in the intervention arm during the study period. Postimplementation teacher consultations provided data on implementation strategies, barriers, and facilitators. Conclusions: Implementation strategies, barriers, and facilitators for digital interventions need to be considered to limit nonadoption and inadequate implementation in larger trials. Important considerations involve tailoring the characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organization in which it is implemented. Trial Registration: International Standard Randomised Controlled Trial Number: 13425994; http://www.isrctn.com/ISRCTN13425994 %M 31045499 %R 10.2196/11958 %U http://formative.jmir.org/2019/2/e11958/ %U https://doi.org/10.2196/11958 %U http://www.ncbi.nlm.nih.gov/pubmed/31045499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11410 %T Improving Moderator Responsiveness in Online Peer Support Through Automated Triage %A Milne,David N %A McCabe,Kathryn L %A Calvo,Rafael A %+ School of Information, Systems and Modelling, Faculty of Engineering and Information Technology, University of Technology, Sydney, PO Box 123, Sydney, NSW 2007, Australia, 61 (02) 9514 3171, david.milne@uts.edu.au %K social support %K triage %K classification %K natural language processing %D 2019 %7 26.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Online peer support forums require oversight to ensure they remain safe and therapeutic. As online communities grow, they place a greater burden on their human moderators, which increases the likelihood that people at risk may be overlooked. This study evaluated the potential for machine learning to assist online peer support by directing moderators’ attention where it is most needed. Objective: This study aimed to evaluate the accuracy of an automated triage system and the extent to which it influences moderator behavior. Methods: A machine learning classifier was trained to prioritize forum messages as green, amber, red, or crisis depending on how urgently they require attention from a moderator. This was then launched as a set of widgets injected into a popular online peer support forum hosted by ReachOut.com, an Australian Web-based youth mental health service that aims to intervene early in the onset of mental health problems in young people. The accuracy of the system was evaluated using a holdout test set of manually prioritized messages. The impact on moderator behavior was measured as response ratio and response latency, that is, the proportion of messages that receive at least one reply from a moderator and how long it took for these replies to be made. These measures were compared across 3 periods: before launch, after an informal launch, and after a formal launch accompanied by training. Results: The algorithm achieved 84% f-measure in identifying content that required a moderator response. Between prelaunch and post-training periods, response ratios increased by 0.9, 4.4, and 10.5 percentage points for messages labelled as crisis, red, and green, respectively, but decreased by 5.0 percentage points for amber messages. Logistic regression indicated that the triage system was a significant contributor to response ratios for green, amber, and red messages, but not for crisis messages. Response latency was significantly reduced (P<.001), between the same periods, by factors of 80%, 80%, 77%, and 12% for crisis, red, amber, and green messages, respectively. Regression analysis indicated that the triage system made a significant and unique contribution to reducing the time taken to respond to green, amber, and red messages, but not to crisis messages, after accounting for moderator and community activity. Conclusions: The triage system was generally accurate, and moderators were largely in agreement with how messages were prioritized. It had a modest effect on response ratios, primarily because moderators were already more likely to respond to high priority content before the introduction of triage. However, it significantly and substantially reduced the time taken for moderators to respond to prioritized content. Further evaluations are needed to assess the impact of mistakes made by the triage algorithm and how changes to moderator responsiveness impact the well-being of forum members. %M 31025945 %R 10.2196/11410 %U https://www.jmir.org/2019/4/e11410/ %U https://doi.org/10.2196/11410 %U http://www.ncbi.nlm.nih.gov/pubmed/31025945 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12358 %T A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study %A McCreary,Michael %A Arevian,Armen C %A Brady,Madeline %A Mosqueda Chichits,Ana E %A Zhang,Lily %A Tang,Lingqi %A Zima,Bonnie %+ Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, 10920 Wilshire Blvd, Los Angeles, CA,, United States, 1 310 794 2400, mmccreary@mednet.ucla.edu %K integrated health care systems %K data collection methods %K community-based participatory research %K community mental health services %D 2019 %7 23.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. Objective: The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. Methods: Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. Results: A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. Conclusions: Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. Trial Registration: ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW) %M 31012861 %R 10.2196/12358 %U http://mental.jmir.org/2019/4/e12358/ %U https://doi.org/10.2196/12358 %U http://www.ncbi.nlm.nih.gov/pubmed/31012861 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12169 %T Young People’s Satisfaction With the Online Mental Health Service eheadspace: Development and Implementation of a Service Satisfaction Measure %A Rickwood,Debra %A Wallace,Alison %A Kennedy,Vanessa %A O’Sullivan,Shaunagh %A Telford,Nic %A Leicester,Steven %+ headspace National Youth Mental Health Foundation, Level 2, South Tower, 485 LaTrobe Street, Melbourne, 3000, Australia, 61 90270154, alison.wallace@headspace.org.au %K mental health %K adolescent %K telemedicine %K counseling %K internet %K satisfaction %K feedback %K telehealth %K young people %D 2019 %7 17.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online youth mental health services are an expanding approach to meeting service need and can be used as the first step in a stepped-care approach. However, limited evidence exists regarding satisfaction with online services, and there is no standardized service satisfaction measure. Objective: This study implemented an online youth mental health service satisfaction questionnaire within eheadspace, an online youth mental health service. The aims were to test the questionnaire’s psychometric properties and identify current levels of satisfaction among service users, as well as to identify client and service contact characteristics that affect satisfaction. Methods: Data were collected from 2280 eheadspace clients via an online questionnaire advertised and accessed through the eheadspace service platform between September 2016 and February 2018. Client and service contact characteristics, potential outcomes, and session and service feedback data were collected. Results: The service satisfaction questionnaire demonstrated high internal consistency for the overall satisfaction scale (alpha=.95) and its three subscales: session satisfaction, potential outcomes, and service satisfaction. A three-factor model was the best fit to the data, although including a higher order unidimensional construct of overall satisfaction was also a reasonable fit. Overall, young people were very satisfied with eheadspace (mean 3.60, SD 0.83). Service characteristics, but not client characteristics, were significantly associated with satisfaction. Young people were more satisfied with eheadspace when they had greater engagement as evident through receiving esupport rather than briefer service provision, having a longer session and greater interaction with the clinician, and not previously attending a face-to-face headspace center. Conclusions: The online youth mental health service satisfaction questionnaire developed for and implemented in eheadspace showed good psychometric properties. The measure is brief, has good internal consistency, and has a clear factor structure. The measure could be adapted for use in other online youth mental health services. The young people using eheadspace and completing the feedback survey were highly satisfied. Greater engagement with the online service was shown to be associated with greater satisfaction. No specific client demographic groups were shown to be more or less satisfied. %M 30994470 %R 10.2196/12169 %U http://mental.jmir.org/2019/4/e12169/ %U https://doi.org/10.2196/12169 %U http://www.ncbi.nlm.nih.gov/pubmed/30994470 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10904 %T Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study %A Tolou-Shams,Marina %A Yonek,Juliet %A Galbraith,Katharine %A Bath,Eraka %+ Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA,, United States, 1 415 206 2212, marina.tolou-shams@ucsf.edu %K juvenile delinquency %K treatment adherence and compliance %K mental health %K short message service text messaging %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. Objective: This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth’s behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. Methods: CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. Results: Overall, 28 individuals participated in focus groups and interviews—8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. Conclusions: Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step. %M 30950808 %R 10.2196/10904 %U https://mhealth.jmir.org/2019/4/e10904/ %U https://doi.org/10.2196/10904 %U http://www.ncbi.nlm.nih.gov/pubmed/30950808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12003 %T A Digital Game and School-Based Intervention for Students in Hong Kong: Quasi-Experimental Design %A Shum,Angie KY %A Lai,Eliza SY %A Leung,Wing Gi %A Cheng,Mabel NS %A Wong,Ho Kit %A So,Sam WK %A Law,Yik Wa %A Yip,Paul SF %+ The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 28315232, sfpyip@hku.hk %K digital game-based learning %K school-based learning %K mental health %K schools %K students %K child welfare %K health promotion %K follow-up studies %K internet access %K public health %K non-randomized controlled trials %D 2019 %7 05.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In Hong Kong, with an increasing number of children experiencing mental health issues, there is a need to not only develop innovative interventions but also develop comprehensive prevention interventions so as to reduce their anxiety symptoms and enhance their emotional management and interpersonal relationships. Objective: The aim of this study was to determine the effectiveness of The Adventures of DoReMiFa, an integration model of the cognitive-behavioral approach and positive psychology by using digital game–based and school-based mental health enhancement intervention to magnify the social and emotional health and well-being of the school children in Hong Kong aged 9 to 11 years. Methods: A quasi-experimental design method was used to evaluate this digital game and school-based intervention. The Adventures of DoReMiFa was piloted in 4 primary schools where students were allocated to either an intervention or a control group. The participants were assessed at pre- and postintervention with a 6-month follow-up measuring their mental health knowledge, levels of anxiety symptoms, positive and negative thinking, perspective-taking, and self-esteem. Results: A total of 459 primary school students from 4 primary schools participated in the study. The response rate on the questionnaires answered on the Web was up to 85.1% (391/459). Compared with the control group, the intervention group was found to have significant association with improved mental health knowledge at the time immediately after the intervention (beta=.46; P=.01) and in the 6-month postintervention period (beta=.66; P<.001); for perspective-taking, the intervention group had exhibited a significant improvement 6 months after the completion of the universal program (beta=1.50; P=.03). The intervention, however, was found not to be effective in reducing the rates of anxiety symptoms and negative thinking among the participating students. Conclusions: The Adventures of DoReMiFa, an integration of a digital game–based and school-based mental health enhancement intervention, was shown to be effective in elevating the knowledge of mental health and promoting perspective-taking in the primary school students of Hong Kong. Although there was insufficient evidence to support a reduction in symptoms of anxiety and negative automatic thoughts, the overall results were still encouraging in that a preventive effect was found, indicating that the program has the potential to enhance the mental well-being of schoolchildren. It also suggests that knowledge enhancement may not necessarily lead to behavior change, and more focused effort may be needed to achieve the translation. The implications and limitations of this study and suggestions for future research were also discussed. %M 30950795 %R 10.2196/12003 %U https://www.jmir.org/2019/4/e12003/ %U https://doi.org/10.2196/12003 %U http://www.ncbi.nlm.nih.gov/pubmed/30950795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e11255 %T A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial %A Tuijnman,Anouk %A Kleinjan,Marloes %A Hoogendoorn,Evert %A Granic,Isabela %A Engels,Rutger CME %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 24 3612076, a.tuijnman@pwo.ru.nl %K depression %K help-seeking behavior %K helping behavior %K health literacy %K stigma %K video games %K adolescence %K secondary schools %D 2019 %7 14.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. Objective: Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. Methods: Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. Results: Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. Conclusions: If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. Trial Registration: Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855 International Registered Report Identifier (IRRID): DERR1-10.2196/11255 %M 30869652 %R 10.2196/11255 %U https://www.researchprotocols.org/2019/3/e11255/ %U https://doi.org/10.2196/11255 %U http://www.ncbi.nlm.nih.gov/pubmed/30869652 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11711 %T How Do Adolescents Use Electronic Diaries? A Mixed-Methods Study Among Adolescents With Depressive Symptoms %A Metsäranta,Kiki %A Kurki,Marjo %A Valimaki,Maritta %A Anttila,Minna %+ Department of Nursing Science, University of Turku, Hoitotieteen laitos, Joukahaisenkatu 3-5, Turun yliopisto, 20014, Finland, 358 456716156, kianme@utu.fi %K adolescent %K depression %K electronic diary %K mental health %K mobile phone %K outpatient care %D 2019 %7 20.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression in adolescence is common. Less than half of the adolescents with depression receive mental health care; furthermore, treatment tends to be suspended, and its success rates are low. There is a need for these adolescents to have a safe place to share their thoughts. Studies have shown that writing may be a useful treatment method for people with mental health problems. Objective: This study aims to describe the use of an electronic diary (e-diary) among adolescents with depressive symptoms. Methods: This paper describes a substudy of a randomized controlled trial. We used a mixed-methods approach to understand the way in which e-diaries were used by participants in the intervention under the randomized controlled trial. Data were collected during 2008-2010 at 2 university hospitals in Finland. Study participants (N=89) were 15-17-year-old adolescents who had been referred to an adolescent outpatient psychiatric clinic due to depressive symptoms. Participants were instructed to use the e-diary at least once a week to describe their thoughts, feelings, and moods. The content of the e-diary data was analyzed using descriptive statistics and inductive content analysis. Results: Overall, 53% (47/89) of the adolescents used the e-diary. Most of them (39/47, 83%) logged into the program during the first week, and about one-third (19/47, 40%) logged into the e-diary weekly as suggested. The number of words used in the e-diary per each log ranged between 8 and 1442 words. The 3 topics most often written about in the e-diary were related to mental health problems (mental disorder), social interaction (relationship), and one’s own development (identity). Conclusions: An e-diary may be a usable tool to reflect experiences and thoughts, especially among adolescents who have signs of depression. The results of this study can be used to develop user-centered electronic health applications that allow users to express their own thoughts and experiences in ways other than systematic mood monitoring. %M 30785408 %R 10.2196/11711 %U http://www.jmir.org/2019/2/e11711/ %U https://doi.org/10.2196/11711 %U http://www.ncbi.nlm.nih.gov/pubmed/30785408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11128 %T Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective %A Radomski,Ashley D %A Wozney,Lori %A McGrath,Patrick %A Huguet,Anna %A Hartling,Lisa %A Dyson,Michele P %A Bennett,Kathryn %A Newton,Amanda S %+ Department of Pediatrics, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K internet %K cognitive behavioral therapy %K computer-assisted therapy %K persuasive communication %K anxiety %K children %K adolescents %K review %K adherence %D 2019 %7 05.02.2019 %9 Review %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. Objective: The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. Methods: A search of published and gray literature was conducted up to November 2017. Prespecified inclusion criteria identified research studies, study protocols, and program websites on iCBT for child and adolescent anxiety. Literature was critically appraised for relevance and methodological rigor. The persuasive systems design (PSD) model, a comprehensive framework for designing and evaluating persuasive systems, was used to guide data extraction. iCBT program features were grouped under 4 PSD categories—Primary task support, Dialogue support, System credibility support, and Social support. iCBT design (PSD Mechanisms) and delivery features (Context of use) were linked to program use (Outcomes) using meta-ethnographic methods; these relationships were described as Context-Mechanism-Outcome configurations. For our configurations, we identified key PSD features and delivery contexts that generated moderate-to-high program use based on moderate-to-high quality evidence found across multiple iCBT programs. Results: A total of 44 documents detailing 10 iCBT programs were included. Seven iCBT programs had at least one document that scored high for relevance; most studies were of moderate-to-high methodological rigor. We developed 5 configurations that highlighted 8 PSD features (Tailoring, Personalization [Primary task supports]; Rewards, Reminders, Social role [Dialogue supports]; and Trustworthiness, Expertise, Authority [System credibility supports]) associated with moderate-to-high program use. Important features of delivery Context were adjunct support (a face-to-face, Web- or email-based communications component) and whether programs targeted the prevention or treatment of anxiety. Incorporating multiple PSD features may have additive or synergistic effects on program use. Conclusions: The Context-Mechanism-Outcome configurations we developed suggest that, when delivered with adjunct support, certain PSD features contribute to moderate-to-high use of iCBT prevention and treatment programs for children and adolescents with anxiety. Standardization of the definition and measurement of program use, formal testing of individual and combined PSD features, and use of real-world design and testing methods are important next steps to improving how we develop and deliver increasingly useful treatments to target users. %M 30720436 %R 10.2196/11128 %U https://www.jmir.org/2019/2/e11128/ %U https://doi.org/10.2196/11128 %U http://www.ncbi.nlm.nih.gov/pubmed/30720436 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 2 %P e11629 %T Identifying Positive Adaptive Pathways in Low-Income Families in Singapore: Protocol for Sequential, Longitudinal Mixed-Methods Design %A Goh,Esther Chor Leng %A Chong,Wan Har %A Mohanty,Jayashree %A Law,Evelyn Chung Ning %A Hsu,Chin-Ying Stephen %A De Mol,Jan %A Kuczynski,Leon %+ Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, AS3 Level 4, Singapore, 117570, Singapore, 65 65163811, swkegcl@nus.edu.sg %K low-income families %K family agency %K adaptive pathways %K trajectories %D 2019 %7 01.02.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: This study aims to examine the adaptive process of children and mothers from multistressed low-income families in Singapore. It aims to bridge the knowledge gap left by existing poverty studies, which are predominately risk focused. Through a sequential longitudinal mixed-methods design, we will differentiate children and mothers who demonstrate varied social, developmental, and mental health trajectories of outcomes. Through utilizing the Latent Growth Curve Model (LGCM), we aim to detect the development and changes of the positive Family Agency and adaptive capacities of these families over time. The construct of Family Agency is underpinned by the theoretical guidance from the Social Relational Theory, which examines child agency, parent agency, relational agency, and the interactions among these members. It is hypothesized that positive Family Agency within low-income families may lead to better outcomes. The key research questions include whether the extent of positive Family Agency mediates the relationship among financial stress, resource utilization, home environment, and parental stress. Objective: The study elucidates the Family Agency construct through interviews with mother-child dyads. It also aims to understand how financial stress and resources are differentially related to home environment, parent stress, and parent and child outcomes. Methods: In phase 1, 60 mother-child dyads from families receiving government financial assistance and with children aged between 7 and 12 years will be recruited. In-depth interviews will be conducted separately with mothers and children. On the basis of 120 interviews, a measurement for the construct of Family Agency will be developed and will be pilot tested. In phase 2a, a longitudinal survey will be conducted over 3 time points from 800 mother-child dyads. The 3 waves of survey results will be analyzed by LGCM to identify the trajectories of adaptation pathways of these low-income families. In addition, 10 focus groups with up to 15 participants in each will be conducted to validate the LGCM results. Results: This project is funded by the Social Science Research Thematic Grant (Singapore). The recruitment of 60 mother-child dyads has been achieved. Data collection will commence once the amendment to the protocol has been approved by the Institutional Review Board. Analysis of phase 1 data will be completed by the end of the first quarter of 2019, and the first set of results is expected to be submitted for publication by the second quarter of 2019. Phase 2 implementation will commence in the second quarter of 2019, and the project end date is in May 2021. Conclusions: Findings from this study can potentially inform social policy and programs as it refines the understanding of low-income families by distinguishing trajectories of adaptive capacities so that policies and interventions can be targeted in enhancing the adaptive pathways of low-income families with children. International Registered Report Identifier (IRRID): PRR1-10.2196/11629 %M 30707101 %R 10.2196/11629 %U http://www.researchprotocols.org/2019/2/e11629/ %U https://doi.org/10.2196/11629 %U http://www.ncbi.nlm.nih.gov/pubmed/30707101 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e10106 %T Designing Online Interventions in Consideration of Young People’s Concepts of Well-Being: Exploratory Qualitative Study %A Winsall,Megan %A Orlowski,Simone %A Vogl,Gillian %A Blake,Victoria %A Nicholas,Mariesa %A Antezana,Gaston %A Schrader,Geoffrey %A Bidargaddi,Niranjan %+ Personal Health Informatics, Flinders University, 1284 South Road, Clovelly Park, SA 5024, Australia, 61 872218842, niranjan.bidargaddi@flinders.edu.au %K well-being %K youth %K online intervention %K participatory design %K technology %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A key challenge in developing online well-being interventions for young people is to ensure that they are based on theory and reflect adolescent concepts of well-being. Objective: This exploratory qualitative study aimed to understand young people’s concepts of well-being in Australia. Methods: Data were collected via workshops at five sites across rural and metropolitan sites with 37 young people from 15 to 21 years of age, inclusive. Inductive, data-driven coding was then used to analyze transcripts and artifacts (ie, written or image data). Results: Young adults’ conceptions of well-being were diverse, personally contextualized, and shaped by ongoing individual experiences related to physical and mental health, along with ecological accounts acknowledging the role of family, community, and social factors. Key emerging themes were (1) positive emotions and enjoyable activities, (2) physical wellness, (3) relationships and social connectedness, (4) autonomy and control, (5) goals and purpose, (6) being engaged and challenged, and (7) self-esteem and confidence. Participants had no difficulty describing actions that led to positive well-being; however, they only considered their own well-being at times of stress. Conclusions: In this study, young people appeared to think mostly about their well-being at times of stress. The challenge for online interventions is to encourage young people to monitor well-being prior to it becoming compromised. A more proactive focus that links the overall concept of well-being to everyday, concrete actions and activities young people engage in, and that encourages the creation of routine good habits, may lead to better outcomes from online well-being interventions. %M 30698537 %R 10.2196/10106 %U http://humanfactors.jmir.org/2019/1/e10106/ %U https://doi.org/10.2196/10106 %U http://www.ncbi.nlm.nih.gov/pubmed/30698537 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11528 %T Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint %A Scholten,Hanneke %A Granic,Isabela %+ Behavioural Science Institute, Radboud University, PO Box 9104, Nijmegen, 6500 HE, Netherlands, 31 24 3612527, h.scholten@bsi.ru.nl %K anxiety %K depression %K design thinking %K e-mental health %K youth %D 2019 %7 14.01.2019 %9 Viewpoint %J J Med Internet Res %G English %X Numerous reviews and meta-analyses have indicated the enormous potential of technology to improve the appeal, effectiveness, cost, and reach of mental health interventions. However, the promise of digital mental health interventions for youth has not yet been realized. Significant challenges have been repeatedly identified, including engagement, fidelity, and the lack of personalization. We introduce the main tenets of design thinking and explain how they can specifically address these challenges, with an entirely new toolbox of mindsets and practices. In addition, we provide examples of a new wave of digital interventions to demonstrate the applicability of design thinking to a wide range of intervention goals. In the future, it will be critical for scientists and clinicians to implement their scientific standards, methods, and review outlets to evaluate the contribution of design thinking to the next iteration of digital mental health interventions for youth. %M 31344671 %R 10.2196/11528 %U https://www.jmir.org/2019/1/e11528/ %U https://doi.org/10.2196/11528 %U http://www.ncbi.nlm.nih.gov/pubmed/31344671 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e11249 %T How LGBT+ Young People Use the Internet in Relation to Their Mental Health and Envisage the Use of e-Therapy: Exploratory Study %A Lucassen,Mathijs %A Samra,Rajvinder %A Iacovides,Ioanna %A Fleming,Theresa %A Shepherd,Matthew %A Stasiak,Karolina %A Wallace,Louise %+ School of Health, Wellbeing and Social Care, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908652987, mathijs.lucassen@open.ac.uk %K sexuality %K LGBT %K transgender %K depression %K adolescent %K psychotherapy %K mental health %K computer games %K computerized CBT %K e-therapy %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Lesbian, gay, bisexual, and transgender (LGBT) youth and other young people diverse in terms of their sexuality and gender (LGBT+) are at an elevated risk of mental health problems such as depression. Factors such as isolation and stigma mean that accessing mental health services can be particularly challenging for LGBT+ young people, and previous studies have highlighted that many prefer to access psychological support on the Web. Research from New Zealand has demonstrated promising effectiveness and acceptability for an LGBT+ focused, serious game–based, computerized cognitive behavioral therapy program, Rainbow Smart, Positive, Active, Realistic, X-factor thoughts (SPARX). However, there has been limited research conducted in the area of electronic therapy (e-therapy) for LGBT+ people. Objective: This study aimed to explore how and why LGBT+ young people use the internet to support their mental health. This study also sought to explore LGBT+ young people’s and professionals’ views about e-therapies, drawing on the example of Rainbow SPARX. Methods: A total of 3 focus groups and 5 semistructured interviews were conducted with 21 LGBT+ young people (aged 15-22 years) and 6 professionals (4 health and social care practitioners and 2 National Health Service commissioners) in England and Wales. A general inductive approach was used to analyze data. Results: LGBT+ youth participants considered that the use of the internet was ubiquitous, and it was valuable for support and information. However, they also thought that internet use could be problematic, and they highlighted certain internet safety and personal security considerations. They drew on a range of gaming experiences and expectations to inform their feedback about Rainbow SPARX. Their responses focused on the need for this e-therapy program to be updated and refined. LGBT+ young people experienced challenges related to stigma and mistreatment, and they suggested that strategies addressing their common challenges should be included in e-therapy content. Professional study participants also emphasized the need to update and refine Rainbow SPARX. Moreover, professionals highlighted some of the issues associated with e-therapies needing to demonstrate effectiveness and challenges associated with health service commissioning processes. Conclusions: LGBT+ young people use the internet to obtain support and access information, including information related to their mental health. They are interested in LGBT-specific e-therapies; however, these must be in a contemporary format, engaging, and adequately acknowledge the experiences of LGBT+ young people. %M 30578194 %R 10.2196/11249 %U http://games.jmir.org/2018/4/e11249/ %U https://doi.org/10.2196/11249 %U http://www.ncbi.nlm.nih.gov/pubmed/30578194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e12244 %T The Use of Social Networking Sites in Mental Health Interventions for Young People: Systematic Review %A Ridout,Brad %A Campbell,Andrew %+ Cyberpsychology Research Group, Faculty of Health Sciences, The University of Sydney, City Road, Sydney, 2006, Australia, 61 2 9351 7089, brad.ridout@sydney.edu.au %K social media %K social networking %K mental health %K social support %K support groups %D 2018 %7 18.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of mental health problems peaks between adolescence and young adulthood; however, young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health via the Web, especially via social networking sites (SNSs), and hence, there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people; however, none of the reviews have covered the breadth of SNS–based youth mental health interventions available across all mental health issues. Objective: This review aimed to systematically identify available evidence regarding the use of SNS–based interventions to support the mental health of young people aged up to 25 years, to evaluate their effectiveness, suitability, and safety, and identify gaps and opportunities for future research. Methods: The PubMed and PsycINFO databases were searched using Medical Subject Headings terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, 9 articles met the review inclusion criteria. Given the small number of studies, and the variety of outcome measures used, a quantitative meta-analysis was not possible. Results: The 9 articles (quantitative studies, qualitative studies, and descriptions of the iterative design process) covered 5 separate interventions. Of the 5 interventions, 2 interventions used purpose-built platforms based on the moderated online social therapy (MOST) model, 2 used Facebook, and 1 evaluated a purpose-built mobile app. The 2 MOST interventions targeted specific mental health issues (depression and psychosis), whereas the others focused on improving mental health literacy, social support, and general well-being. Only 3 quantitative studies were identified, and all used a pre-post design (without a control group) to establish proof of concept. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms were generally high, as were perceptions of usefulness and safety. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over Web-based interfaces. Conclusions: The evidence reviewed suggests young people find SNS–based interventions highly usable, engaging, and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given young people are already turning to SNSs to engage in knowledge seeking and peer-to-peer support, SNS–based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information. %M 30563811 %R 10.2196/12244 %U https://www.jmir.org/2018/12/e12244/ %U https://doi.org/10.2196/12244 %U http://www.ncbi.nlm.nih.gov/pubmed/30563811 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10067 %T Desired Features of a Digital Technology Tool for Self-Management of Well-Being in a Nonclinical Sample of Young People: Qualitative Study %A Babbage,Camilla %A Jackson,Georgina Margaret %A Nixon,Elena %+ Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, C21, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 823 0428, Elena.Nixon@nottingham.ac.uk %K adolescence %K young people %K well-being %K self-management %K digital technology %K E-health %K coping strategies %K mental health, help-seeking %K qualitative %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adaptive coping behaviors can improve well-being for young people experiencing life stressors, while maladaptive coping can increase vulnerability to mental health problems in youth and into adulthood. Young people could potentially benefit from the use of digital technology tools to enhance their coping skills and overcome barriers in help-seeking behaviors. However, little is known about the desired digital technology use for self-management of well-being among young people in the general population. Objective: This is a small, qualitative study aimed at exploring what young people desire from digital technology tools for the self-management of their well-being. Methods: Young people aged 12-18 years were recruited from the general community to take part in semistructured interviews. Recorded data from the interviews were transcribed and analyzed using inductive thematic analysis. Results: In total, 14 participants were recruited and completed the study, with a mean age of 14.6 years (female n=3). None of the participants reported using any digital tools specifically designed to manage well-being. However, as indicated through the emerged themes, young people used digital technology to reduce their stress levels and manage their mood, mainly through games, music, and videos. Overall, identified themes showed that young people were keen on using such tools and desired certain facets and features of an ideal tool for self-management of well-being. Themes related to these facets indicated what young people felt a tool should do to improve well-being, including being immersed in a stress-free environment, being uplifting, and that such a tool would direct them to resources based on their needs. The feature-based themes suggested that young people wanted the tool to be flexible and enable engagement with others while also being sensitive to privacy. Conclusions: The young people interviewed in this study did not report engaging with digital technology specialized to improving well-being but instead used media already accessed in their daily lives in order to self-manage their psychological states. As a result, the variety of coping strategies reported and digital tools used was limited to the resources that were already being used for recreational and social purposes. These findings contribute to the scarce research into young people’s preferred use of digital technology tools for the self-management of their well-being. However, this was a small-scale study and the current participant sample is not representative of the general youth population. Therefore, the results are only tentative and warrant further investigation. %M 30563820 %R 10.2196/10067 %U http://mental.jmir.org/2018/4/e10067/ %U https://doi.org/10.2196/10067 %U http://www.ncbi.nlm.nih.gov/pubmed/30563820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e259 %T Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study %A Ospina-Pinillos,Laura %A Davenport,Tracey %A Iorfino,Frank %A Tickell,Ashleigh %A Cross,Shane %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, Shops 1-3, 66-70 Parramatta Road, Camperdown, Sydney,, Australia, 61 028 627 6946, laura.ospinapinillos@sydney.edu.au %K staging model %K mental health %K primary health care %K telemedicine %K symptom assessment health service reform %D 2018 %7 10.09.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective: The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods: The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P<.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions: The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right time. %M 30201602 %R 10.2196/jmir.9966 %U http://www.jmir.org/2018/9/e259/ %U https://doi.org/10.2196/jmir.9966 %U http://www.ncbi.nlm.nih.gov/pubmed/30201602 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 3 %P e10655 %T Phase I of the Detecting and Evaluating Childhood Anxiety and Depression Effectively in Subspecialties (DECADES) Study: Development of an Integrated Mental Health Care Model for Pediatric Gastroenterology %A Hullmann,Stephanie E %A Keller,Stacy A %A Lynch,Dustin O %A Jenkins,Kelli %A Moore,Courtney %A Cockrum,Brandon %A Wiehe,Sarah E %A Carroll,Aaron E %A Bennett Jr,William E %+ Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, HITS Building, Indianapolis, IN, 46202, United States, 1 3172786928, webjr@iu.edu %K qualitative research %K patient-reported outcomes %K depression %K anxiety %D 2018 %7 10.09.2018 %9 Original Paper %J J Participat Med %G English %X Background: Children with gastrointestinal symptoms have a very high rate of anxiety and depression. Rapid identification of comorbid anxiety and depression is essential for effective treatment of a wide variety of functional gastrointestinal disorders. Objective: The objective of our study was to determine patient and parent attitudes toward depression, anxiety, and mental health screening during gastroenterology (GI) visits and to determine patient and parent preferences for communication of results and referral to mental health providers after a positive screen. Methods: We augmented standard qualitative group session methods with patient-centered design methods to assess patient and parent preferences. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: Overall, 11 families (11 patients and 14 parents) participated in 2 group sessions. Overall, patients and their parents found integrated mental health care to be acceptable in the subspecialty setting. Patients’ primary concerns were for the privacy and confidentiality of their screening results. Patients and their parents emphasized the importance of mental health services not interfering with the GI visit and collaboration between the GI physician, psychologist, and primary care provider. Conclusions: Patients and their families are open to integrated mental health care in the pediatric subspecialty clinic. The next phase of the DECADES study will translate patient and parent preferences into an integrated mental health care system and test its efficacy in the pediatric GI office. %R 10.2196/10655 %U http://jopm.jmir.org/2018/3/e10655/ %U https://doi.org/10.2196/10655 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e13 %T Indigenous Adolescents’ Perception of an eMental Health Program (SPARX): Exploratory Qualitative Assessment %A Shepherd,Matthew %A Merry,Sally %A Lambie,Ian %A Thompson,Andrew %+ School of Counselling, Human Services and Social Work, Faculty of Education, The University of Auckland, Gate 4, 60 Epsom Ave, Epsom, Auckland,, New Zealand, 64 9 623 8899 ext 46368, m.shepherd@auckland.ac.nz %K Māori youth %K indigenous %K depression %K computerized CBT %K consumer views %K serious games %K virtual worlds %D 2018 %7 05.07.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Depression is a major health issue for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (Māori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioral therapy. SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a computerized intervention developed in New Zealand to treat mild-to-moderate depression in young people. Users are engaged in a virtual 3D environment where they must complete missions to progress to the next level. In each level there are challenges and puzzles to completeIt was designed to appeal to all young people in New Zealand and incorporates several images and concepts that are specifically Māori. Objective: The aim was to conduct an exploratory qualitative study of Māori adolescents’ opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions were gathered to inform the design of a computerized cognitive behavior therapy program. Methods: Taitamariki were interviewed using a semistructured interview once they had completed work with the SPARX resource. Six participants agreed to complete the interview; the interviews ranged from 10 to 30 minutes. Results: Taitamariki participating in the interviews found SPARX to be helpful. The Māori designs from the SPARX game were appropriate and useful, and the ability to customize the SPARX characters with Māori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall, using SPARX led to improved mood and increased levels of hope for the participants. In some instances, SPARX was used by wider whānau (Māori word for family) members with reported beneficial effect. Conclusions: Overall, this small group of Māori adolescents reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of these young people. %M 29980495 %R 10.2196/games.8752 %U http://games.jmir.org/2018/3/e13/ %U https://doi.org/10.2196/games.8752 %U http://www.ncbi.nlm.nih.gov/pubmed/29980495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e234 %T Large-Scale Dissemination of Internet-Based Cognitive Behavioral Therapy for Youth Anxiety: Feasibility and Acceptability Study %A March,Sonja %A Spence,Susan H %A Donovan,Caroline L %A Kenardy,Justin A %+ Institute for Resilient Regions, University of Southern Queensland, Sinnathamby Blvd, Springfield, QLD, 4300, Australia, 61 34704434, sonja.march@usq.edu.au %K adolescent %K child %K anxiety disorders %K cognitive behavioral therapy %K eHealth %K public health %D 2018 %7 04.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) for child and adolescent anxiety has demonstrated efficacy in randomized controlled trials, but it has not yet been examined when disseminated as a public health intervention. If effective, iCBT programs could be a promising first-step, low-intensity intervention that can be easily accessed by young people. Objective: The objective of our study was to examine the feasibility and acceptability of a publicly available online, self-help iCBT program (BRAVE Self-Help) through exploration of program adherence, satisfaction, and changes in anxiety. Methods: This study was an open trial involving the analysis of data collected from 4425 children and adolescents aged 7-17 years who presented with elevated anxiety at registration (baseline) for the iCBT program that was delivered through an open-access portal with no professional support. We assessed the program satisfaction via a satisfaction scale and measured adherence via the number of completed sessions. In addition, anxiety severity was assessed via scores on the Children’s Anxiety Scale, 8-item (CAS-8) at four time points: baseline, Session 4, Session 7, and Session 10. Results: Participants reported moderate satisfaction with the program and 30% completed three or more sessions. Statistically significant reductions in anxiety were evident across all time points for both children and adolescents. For users who completed six or more sessions, there was an average 4-point improvement in CAS-8 scores (Cohen d=0.87, children; Cohen d=0.81, adolescents), indicating a moderate to large effect size. Among participants who completed nine sessions, 57.7% (94/163) achieved recovery into nonelevated levels of anxiety and 54.6% (89/163) achieved statistically reliable reductions in anxiety. Conclusions: Participant feedback was positive, and the program was acceptable to most young people. Furthermore, significant and meaningful reductions in anxiety symptoms were achieved by many children and adolescents participating in this completely open-access and self-directed iCBT program. Our results suggest that online self-help CBT may offer a feasible and acceptable first step for service delivery to children and adolescents with anxiety. %M 29973338 %R 10.2196/jmir.9211 %U http://www.jmir.org/2018/7/e234/ %U https://doi.org/10.2196/jmir.9211 %U http://www.ncbi.nlm.nih.gov/pubmed/29973338 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e48 %T eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes %A Wozney,Lori %A McGrath,Patrick J %A Gehring,Nicole D %A Bennett,Kathryn %A Huguet,Anna %A Hartling,Lisa %A Dyson,Michele P %A Soleimani,Amir %A Newton,Amanda S %+ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K eHealth %K mental health %K implementation science %K healthcare planning %K organizational innovation %K decision-making %K healthcare organizations %D 2018 %7 26.06.2018 %9 Review %J JMIR Ment Health %G English %X Background: Anxiety disorders and depression are frequent conditions in childhood and adolescence. eMental healthcare technologies may improve access to services, but their uptake within health systems is limited. Objective: The objective of this review was to examine and describe how the implementation of eMental healthcare technologies for anxiety disorders and depression in children and adolescents has been studied. Methods: We conducted a search of 5 electronic databases and gray literature. Eligible studies were those that assessed an eMental healthcare technology for treating or preventing anxiety or depression, included children or adolescents (<18 years), or their parents or healthcare providers and reported findings on technology implementation. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool. Outcomes of interest were based on 8 implementation outcomes: acceptability (satisfaction with a technology), adoption (technology uptake and utilization), appropriateness (“fitness for purpose”), cost (financial impact of technology implementation), feasibility (extent to which a technology was successfully used), fidelity (implementation as intended), penetration (“spread” or “reach” of the technology), and sustainability (maintenance or integration of a technology within a healthcare service). For extracted implementation outcome data, we coded favorable ratings on measurement scales as “positive results” and unfavorable ratings on measurement scales as “negative results.” Those studies that reported both positive and negative findings were coded as having “mixed results.” Results: A total of 46 studies met the inclusion criteria, the majority of which were rated as very good to excellent in methodological quality. These studies investigated eMental healthcare technologies for anxiety (n=23), depression (n=18), or both anxiety and depression (n=5). Studies of technologies for anxiety evaluated the following: (1) acceptability (78%) reported high levels of satisfaction, (2) adoption (43%) commonly reported positive results, and (3) feasibility (43%) reported mixed results. Studies of technologies for depression evaluated the following: (1) appropriateness (56%) reported moderate helpfulness and (2) acceptability (50%) described a mix of both positive and negative findings. Studies of technologies designed to aid anxiety and depression commonly reported mixed experiences with acceptability and adoption and positive findings for appropriateness of the technologies for treatment. Across all studies, cost, fidelity, and penetration and sustainability were the least measured implementation outcomes. Conclusions: Acceptability of eMental healthcare technology is high among users and is the most commonly investigated implementation outcome. Perceptions of the appropriateness and adoption of eMental healthcare technology were varied. Implementation research that identifies, evaluates, and reports on costs, sustainability, and fidelity to clinical guidelines is crucial for making high-quality eMental healthcare available to children and adolescents. %M 29945858 %R 10.2196/mental.9655 %U http://mental.jmir.org/2018/2/e48/ %U https://doi.org/10.2196/mental.9655 %U http://www.ncbi.nlm.nih.gov/pubmed/29945858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e12 %T Investigating Associations Between Changes in Mobile Phone Use and Emotions Using the Experience Sampling Method: Pilot Study %A Roggeveen,Suzanne %A van Os,Jim %A Bemelmans,Kelly %A van Poll,Mikal %A Lousberg,Richel %+ Department of Psychiatry and Psychology, Maastricht University, Vijverdalseweg 1, Maastricht,, Netherlands, 31 43 3884111, s.roggeveen@maastrichtuniversity.nl %K mobile phone %K experience sampling method %K emotions %K affect %K concentration %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The use of mobile phones has become, especially for young people, an integrated part of everyday life. Using the experience sampling method (ESM) may provide further insight on the association between mobile phone use and mental health. Objective: The objective of this study was to examine associations between mobile phone use and subtle changes in mental state. Methods: The ESM-based PsyMate app was installed on the mobile phones of 2 healthy 20-year-old participants. Over a period of 3 months, participants rated their mental states at 10 semirandom moments in the flow of daily life. Each assessment included present state emotions, environmental circumstances, and phone use. Results: Multilevel regression analyses indicated that an increase in mobile phone use was associated with a small increase in negative affect (particularly feeling bored and feeling lonely; P<.001) and small decreases in positive affect (P=.002) and concentration (P=.001). Treating the data as 2 separate N=1 studies revealed that the association with negative affect was present in both participants, whereas the associations with positive affect and concentration were evident in only 1 of the 2 participants. Conclusions: This pilot study suggests that mobile phone use may be associated with person-specific and group-level changes in emotional state. A larger study is required to study these associations, possible causality, and factors driving underlying heterogeneity in the pattern of associations. Trial registration: ClinicalTrials.gov NCT03221985; https://clinicaltrials.gov/ct2/show/NCT03221985 (archived by WebCite at http://www.webcitation.org/6zJnp61Wj) %M 30684428 %R 10.2196/formative.8499 %U http://formative.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/formative.8499 %U http://www.ncbi.nlm.nih.gov/pubmed/30684428 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10425 %T Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test %A Pisani,Anthony R %A Wyman,Peter A %A Gurditta,Kunali %A Schmeelk-Cone,Karen %A Anderson,Carolyn L %A Judd,Emily %+ Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Box PSYC, 300 Crittenden Boulevard, Rochester, NY, 14642, United States, 1 (585) 275 3644, anthony_pisani@urmc.rochester.edu %K suicide prevention %K school-based program %K text messaging %K school health services %D 2018 %7 31.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach. Objective: We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention. Methods: We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students’ own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program. Results: Of the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful—even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated. Conclusions: Text4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy. %R 10.2196/10425 %U http://mental.jmir.org/2018/2/e10425/ %U https://doi.org/10.2196/10425 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e188 %T Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies %A Ospina-Pinillos,Laura %A Davenport,Tracey A %A Ricci,Cristina S %A Milton,Alyssa C %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 0286276946, laura.ospinapinillos@sydney.edu.au %K mental health %K community-based participatory research %K eHealth %D 2018 %7 28.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available. %R 10.2196/jmir.9716 %U http://www.jmir.org/2018/5/e188/ %U https://doi.org/10.2196/jmir.9716 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e10 %T Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial %A Boendermaker,Wouter J %A Gladwin,Thomas E %A Peeters,Margot %A Prins,Pier J M %A Wiers,Reinout W %+ Department of Interdisciplinary Social Science, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands, 31 302531897, w.j.boendermaker@uu.nl %K cognitive function %K memory %K video games %K motivation %D 2018 %7 23.05.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants’ motivation to train. Objective: This study aimed to evaluate whether adding game elements to the training could help improve adolescents’ motivation to train while improving cognition. Methods: A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training. Results: Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline. Conclusions: We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time. %M 29792294 %R 10.2196/games.8364 %U http://games.jmir.org/2018/2/e10/ %U https://doi.org/10.2196/games.8364 %U http://www.ncbi.nlm.nih.gov/pubmed/29792294 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e44 %T Internet Use, Depression, and Anxiety in a Healthy Adolescent Population: Prospective Cohort Study %A Thom,Robyn Pauline %A Bickham,David S %A Rich,Michael %+ Harvard Longwood Psychiatry Residency Training Program, Brigham and Women's Hospital & Beth Israel Deaconess Medical Center, 60 Fenwood Road, Department of Psychiatry, Boston, MA, 02115, United States, 1 857 307 5521, rthom@bidmc.harvard.edu %K mental health %K psychiatric disorders %K internet use %K social networking sites %D 2018 %7 22.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Psychiatric disorders, including conduct disturbances, substance abuse, and affective disorders, emerge in approximately 20% of adolescents. In parallel with the rise in internet use, the prevalence of depression among adolescents has increased. It remains unclear whether and how internet use impacts mental health in adolescents. Objective: We assess the association between patterns of internet use and two mental health outcomes (depression and anxiety) in a healthy adolescent population. Methods: A total of 126 adolescents between the ages of 12 and 15 years were recruited. Participants reported their typical computer and internet usage patterns. At baseline and one-year follow-up, they completed the Beck Depression Index for primary care (BDI-PC) and the Beck Anxiety Inventory for Primary Care (BAI-PC). Individual linear regressions were completed to determine the association between markers of internet use at baseline and mental health outcomes at one-year follow-up. All models controlled for age, gender, and ethnicity. Results: There was an inverse correlation between minutes spent on a favorite website per visit and BAI-PC score. No association was found between internet use and BDI-PC score. Conclusions: There is no relationship between internet use patterns and depression in adolescents, whereas internet use may mitigate anxiety in adolescents with higher levels of baseline anxiety. %R 10.2196/mental.8471 %U http://mental.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/mental.8471 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e5 %T eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review %A Tozzi,Federica %A Nicolaidou,Iolie %A Galani,Anastasia %A Antoniades,Athos %+ Stremble Ventures Ltd, 59 Christaki Kranou, Germasogeia, Limassol, 4042, Cyprus, 357 25004457, federica.tozzi@stremble.com %K child %K adolescent %K anxiety %K anxiety disorders %K telemedicine %K eHealth %K mobile applications %K review %D 2018 %7 10.05.2018 %9 Review %J JMIR Pediatr Parent %G English %X Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as cognitive behavioral therapy, in the treatment of psychological disorders in adults, such as depression, anxiety, obsessive-compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone, self-help) and computer-assisted (in combination with face-to-face therapy, or therapist guided) programs for youth. Objective: Our objective was to summarize and critically review the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim was to improve the understanding of what would be critical for future development of effective technology-based interventions. Methods: We conducted an exploratory review of the literature through searches in 3 scientific electronic databases (PsycINFO, ScienceDirect, and PubMed). We used keywords in various combinations: child or children, adolescent, preschool children, anxiety, intervention or treatment or program, smartphone applications or apps, online or Web-based tool, computer-based tool, internet-based tool, serious games, cognitive behavioral therapy or CBT, biofeedback, and mindfulness. For inclusion, articles had to (1) employ a technological therapeutic tool with or without the guidance of a therapist; (2) be specific for treatment or prevention of anxiety disorders in children or adolescents; (3) be published between 2000 and 2018; and (4) be published in English and in scientific peer-reviewed journals. Results: We identified and examined 197 articles deemed to be relevant. Of these, we excluded 164 because they did not satisfy 1 or more of the requirements. The final review comprised 19 programs. Published studies demonstrated promising results in reducing anxiety, especially relative to the application of cognitive behavioral therapy with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional interventions. Other approaches have been applied to technology-based interventions with inconclusive results. Most programs were developed to be used concurrently with traditional treatments and lacked long-term evaluation. Very little has been done in terms of prevention interventions. Conclusions: Future development of eHealth programs for anxiety management in children will have to address several unmet needs and overcome key challenges. Although developmental stages may limit the applicability to preschool children, prevention should start in early ages. Self-help formats and personalization are highly relevant for large-scale dissemination. Automated data collection should be built in for program evaluation and effectiveness assessment. And finally, a strategy to stimulate motivation to play and maintain high adherence should be carefully considered. %M 31518330 %R 10.2196/pediatrics.7248 %U http://pediatrics.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/pediatrics.7248 %U http://www.ncbi.nlm.nih.gov/pubmed/31518330 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e34 %T Harnessing Social Media to Explore Youth Social Withdrawal in Three Major Cities in China: Cross-Sectional Web Survey %A Liu,Lucia Lin %A Li,Tim MH %A Teo,Alan R %A Kato,Takahiro A %A Wong,Paul WC %+ Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, 5/F, The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong,, China (Hong Kong), 852 39175029, paulw@hku.hk %K adolescent %K social withdrawal %K hikikomori %K youth social issues %K Web survey %K China %D 2018 %7 10.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature. Objective: The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China. Methods: A cross-sectional open Web survey was conducted from October 2015 to May 2016 to identify and reach socially withdrawn youth in 3 metropolitan cities in China: Beijing, Shanghai, and Shenzhen. To advertise the survey, 3 social media platforms were used: Weibo, WeChat, and Wandianba, a social networking gaming website. Results: In total, 137 participants completed the survey, among whom 13 (9.5%) were identified as belonging to the withdrawal group, 7 (5.1%) to the asocial group, and 9 (6.6%) to the hikikomori group (both withdrawn and asocial for more than 3 months). The cost of recruitment via Weibo was US $7.27 per participant. Conclusions: Several social media platforms in China are viable and inexpensive tools to reach socially withdrawn youth, and internet platforms that specialize in a certain culture or type of entertainment appeared to be more effective in reaching socially withdrawn youth. %M 29748164 %R 10.2196/mental.8509 %U http://mental.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/mental.8509 %U http://www.ncbi.nlm.nih.gov/pubmed/29748164 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e9 %T Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial %A Pramana,Gede %A Parmanto,Bambang %A Lomas,James %A Lindhiem,Oliver %A Kendall,Philip C %A Silk,Jennifer %+ Department of Health Information Management, University of Pittsburgh, 6025 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 4123836649, parmanto@pitt.edu %K gamification %K mobile health %K ecological momentary intervention %K cognitive behavioral therapy %K child anxiety treatment %K SmartCAT %K childhood anxiety disorders %D 2018 %7 10.05.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). Objective: The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. Methods: We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. Results: Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). Conclusions: The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment. %M 29748165 %R 10.2196/games.8902 %U http://games.jmir.org/2018/2/e9/ %U https://doi.org/10.2196/games.8902 %U http://www.ncbi.nlm.nih.gov/pubmed/29748165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e90 %T The Interactive Child Distress Screener: Development and Preliminary Feasibility Testing %A March,Sonja %A Day,Jamin %A Zieschank,Kirsty %A Ireland,Michael %+ Institute for Resilient Regions, University of Southern Queensland, Sinnathamby Blvd, Springfield Central, 4300, Australia, 61 34704434, sonja.march@usq.edu.au %K child %K preschool %K mental health %K symptom assessment %K self-assessment (psychology) %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective. Objective: The aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years. Methods: This paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design. Results: In study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented. Conclusions: The ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children. %M 29674310 %R 10.2196/mhealth.9456 %U http://mhealth.jmir.org/2018/4/e90/ %U https://doi.org/10.2196/mhealth.9456 %U http://www.ncbi.nlm.nih.gov/pubmed/29674310 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e27 %T Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis %A Booth,Richard G %A Allen,Britney N %A Bray Jenkyn,Krista M %A Li,Lihua %A Shariff,Salimah Z %+ Arthur Labatt Family School of Nursing, Western University, 1151 Richmond Street, FNB2333, London, ON, N6A 5B9, Canada, 1 5196612111 ext 86571, rbooth5@uwo.ca %K mental health %K youth %K adolescent %K social media %K population health %K mass media %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let’s Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can $0.05 for each interaction with a campaign-specific username (@Bell_LetsTalk). Objective: The intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada. Methods: Monthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health–related physician visit. Results: The inclusion of Twitter into the 2012 Bell Let’s Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P<.001), whereas males of the same age cohort experienced a monthly increase from 9.7/1000 to 9.8/1000 (slope change of 0.052 following campaign, P<.001). Outpatient psychiatric services visit rates also increased for both male and female adolescents aged 10 to 17 years post campaign (slope change of 0.005, P=.02; slope change of 0.003, P=.005, respectively). For young adults aged 18 to 24 years, females who used primary health care experienced the most significant increases in mental health visit rates from 26.5/1000 in April 2006 to 29.2/1000 in April 2015 (slope change of 0.17 following campaign, P<.001). Conclusions: The 2012 Bell Let’s Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services. %M 29625954 %R 10.2196/mental.8808 %U http://mental.jmir.org/2018/2/e27/ %U https://doi.org/10.2196/mental.8808 %U http://www.ncbi.nlm.nih.gov/pubmed/29625954 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e12 %T General Practitioners’ Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery %A Subotic-Kerry,Mirjana %A King,Catherine %A O'Moore,Kathleen %A Achilles,Melinda %A O'Dea,Bridianne %+ Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 2 9382 8509, m.subotic-kerry@blackdog.org.au %K anxiety %K depression %K adolescent %K general practitioners %K internet %D 2018 %7 23.03.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs’ views need to be measured. Objective: This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. Methods: GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. Results: A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. Conclusions: GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured. %M 29572203 %R 10.2196/humanfactors.8913 %U http://humanfactors.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/humanfactors.8913 %U http://www.ncbi.nlm.nih.gov/pubmed/29572203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e79 %T The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research %A VanHeerwaarden,Nicole %A Ferguson,Genevieve %A Abi-Jaoude,Alexxa %A Johnson,Andrew %A Hollenberg,Elisa %A Chaim,Gloria %A Cleverley,Kristin %A Eysenbach,Gunther %A Henderson,Joanna %A Levinson,Andrea %A Robb,Janine %A Sharpe,Sarah %A Voineskos,Aristotle %A Wiljer,David %+ Education, Technology & Innovation, University Health Network, 190 Elizabeth Street, R Fraser Elliott Building RFE 3S-411, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, david.wiljer@uhn.ca %K students %K transition-aged youth %K mental health %K substance use %K eHealth %K mobile apps %K participatory action research %K help-seeking %D 2018 %7 06.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings. Objective: The aim of this study was to describe the process of engaging with postsecondary students through the PDR approaches, with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with the PDR approaches, five student-led workshops, attended by 41 individuals, were facilitated to obtain feedback regarding the platform’s usability and functionality and its potential value in a postsecondary setting. Various creative engagement activities were delivered to gather experiences and opinions, including semistructured focus groups, questionnaires, personas, journey mapping, and a world café. Innovative technological features and refinements were also brainstormed during the workshops. Results: By using PDR methods of engagement, participants knew that their ideas and recommendations would be applied. There was also an overall sense of respect and care integrated into each group, which facilitated an exchange of ideas and suggestions. Conclusions: The process of engaging with students to redesign the Thought Spot platform through PDR has been effective. Findings from these workshops will significantly inform new technological features within the app to enable positive help-seeking behaviors among students. These behaviors will be further explored in the second phase that involves a randomized controlled trial. %M 29510970 %R 10.2196/jmir.8102 %U http://www.jmir.org/2018/3/e79/ %U https://doi.org/10.2196/jmir.8102 %U http://www.ncbi.nlm.nih.gov/pubmed/29510970 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e17 %T Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study %A Radovic,Ana %A Gmelin,Theresa %A Hua,Jing %A Long,Cassandra %A Stein,Bradley D %A Miller,Elizabeth %+ Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 3420 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 412 692 7227, ana.radovic@chp.edu %K adolescent %K adolescent health services %K technology %K depression %K anxiety %D 2018 %7 26.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Supporting Our Valued Adolescents (SOVA), a social media website for adolescents, was designed to increase mental health literacy and address negative health beliefs toward depression and/or anxiety diagnosis and treatment. This stakeholder-informed site underwent iterative user testing to evolve into its current version with daily blog posts, round-the-clock site moderation, and Web-based peer interaction to create an online support community. Objective: The aim of this study was to evaluate the technological feasibility (at least 100 users on the site, logging in 12 to 18 times in the first 6 weeks) and acceptability of the SOVA site determined by the System Usability Scale (SUS). Methods: Adolescents and young adults (aged 14-26 years) with a self-reported history of depressive and/or anxiety symptoms were recruited to access the research website (sova.pitt.edu). Participants were screened out if they reported active suicidality or a prior suicide attempt. Baseline survey measures included demographics, symptomatology using the Patient Health Questionnaire-9 modified for adolescents (PHQ-9A) and Screen for Child Anxiety Related Disorders (SCARED-C), and mental health treatment history. The 6-week follow-up measures taken in addition to the symptomatology, included feasibility (total number of log-ins), usability, and acceptability of SOVA using SUS. Results: Most of the 96 participants identified as female (75% [72/96]) and white (67% [64/96]). Most participants (73% [70/96]) reported having taken prior professional psychological help. The average PHQ-9A score was 11.8 (SD 5.5), and for SCARED-C, 85% (80/94) of the participants reported a score consistent with being susceptible to a diagnosed anxiety disorder. There were 46% (41/90) of eligible users who ever logged in. Out of the total users who ever logged in, the mean of total log-ins over the entire study was 4.1 (SD 6.9). Median number of users rated the user-friendliness of the site as “good.” The average SUS score was 71.2% (SD 18.7), or a “C-grade,” which correlated to an acceptable range. The participants reported to have liked the “easy-to-understand format” and “positive, helpful atmosphere,” but they also reported a desire for greater social interaction. Iterative recruitment resulted in incremental improvements to the site. Conclusions: The SOVA site met feasibility goals of recruiting almost 100 users and establishing acceptable usability. Subsequent interventions are planned to increase site engagement and to evaluate efficacy in increasing uptake of primary care–recommended depression and/or anxiety treatment. %M 29483067 %R 10.2196/mental.9441 %U http://mental.jmir.org/2018/1/e17/ %U https://doi.org/10.2196/mental.9441 %U http://www.ncbi.nlm.nih.gov/pubmed/29483067 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e16 %T Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience %A Grist,Rebecca %A Porter,Joanna %A Stallard,Paul %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 2253850 ext 86, rg626@bath.ac.uk %K self-injurious behavior %K mobile apps %K adolescents %K telemedicine %K qualitative research %K cognitive therapy %K behavior therapy %D 2018 %7 23.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. Objective: The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). Methods: This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Results: Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track their moods and offering new strategies to manage their thoughts to self-harm. No adverse effects were reported. For those who did not find BlueIce helpful, issues around motivation to stop self-harming impeded their ability to use the app. Conclusions: BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming. Adolescents reported numerous benefits of using BlueIce, and all would recommend the app to other young people who were struggling with self-harm. These preliminary findings are encouraging and provide initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy. %M 29475823 %R 10.2196/mental.8779 %U http://mental.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/mental.8779 %U http://www.ncbi.nlm.nih.gov/pubmed/29475823 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e48 %T Implementation of the Enhanced Moderated Online Social Therapy (MOST+) Model Within a National Youth E-Mental Health Service (eheadspace): Protocol for a Single Group Pilot Study for Help-Seeking Young People %A Rice,Simon %A Gleeson,John %A Leicester,Steven %A Bendall,Sarah %A D'Alfonso,Simon %A Gilbertson,Tamsyn %A Killackey,Eoin %A Parker,Alexandra %A Lederman,Reeva %A Wadley,Greg %A Santesteban-Echarri,Olga %A Pryor,Ingrid %A Mawren,Daveena %A Ratheesh,Aswin %A Alvarez-Jimenez,Mario %+ Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, 3052, Australia, 61 03 9342 2800, simon.rice@orygen.org.au %K internet %K social networking %K young adult %K adolescent %K mental heath %D 2018 %7 22.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a substantial need for youth electronic mental health (e-mental health) services. In addressing this need, our team has developed a novel moderated online social therapy intervention called enhanced moderated online social therapy (MOST+). MOST+ integrates real-time, clinician-delivered Web chat counseling, interactive user-directed online therapy, expert and peer moderation, and private and secure peer-to-peer social networking. MOST+ has been designed to give young people immediate, 24-hour access to anonymous, evidence-based, and short-term mental health care. Objective: The primary aims of this pilot study were to determine the feasibility, acceptability, and safety of the intervention. Secondary aims were to assess prepost changes in key psychosocial outcomes and collect qualitative data for future intervention refinement. Methods: MOST+ will be embedded within eheadspace, an Australian youth e-mental health service, and will be evaluated via an uncontrolled single-group study. Approximately 250 help-seeking young people (16-25 years) will be progressively recruited to the intervention from the eheadspace home page over the first 4 weeks of an 8-week intervention period. All participants will have access to evidence-based therapeutic content and integrated Web chat counseling. Additional access to moderated peer-to-peer social networking will be granted to individuals for whom it is deemed safe and appropriate, through a three-tiered screening process. Participants will be enrolled in the MOST+ intervention for 1 week, with the option to renew their enrollment across the duration of the pilot. Participants will complete a survey at enrollment to assess psychological well-being and other mental health outcomes. Additional assessment will occur following account deactivation (ie, after participant has opted not to renew their enrollment, or at trial conclusion) and will include an online survey and telephone interview assessing psychological well-being and experience of using MOST+. Results: Recruitment for the study commenced in October 2017. We expect to have initial results in March 2018, with more detailed qualitative and quantitative analyses to follow. Conclusions: This is the first Australia-wide research trial to pilot an online social media platform merging real-time clinical support, expert and peer moderation, interactive online therapy, and peer-to-peer social networking. The importance of the project stems from the need to develop innovative new models for the efficient delivery of responsive evidence-based online support to help-seeking young people. If successful, this research stands to complement and enhance e-mental health services in Australia. %M 29472177 %R 10.2196/resprot.8813 %U http://www.researchprotocols.org/2018/2/e48/ %U https://doi.org/10.2196/resprot.8813 %U http://www.ncbi.nlm.nih.gov/pubmed/29472177 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e13 %T A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb %A Bevan Jones,Rhys %A Thapar,Anita %A Rice,Frances %A Beeching,Harriet %A Cichosz,Rachel %A Mars,Becky %A Smith,Daniel J %A Merry,Sally %A Stallard,Paul %A Jones,Ian %A Thapar,Ajay K %A Simpson,Sharon A %+ Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Hadyn Ellis Building, Maindy Rd, Cardiff, Wales, CF24 4HQ, United Kingdom, 44 02920688451, bevanjonesr1@cardiff.ac.uk %K adolescent %K depression %K internet %K education %K preventive psychiatry %K early medical intervention %D 2018 %7 15.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression is common in adolescence and leads to distress and impairment in individuals, families and carers. Treatment and prevention guidelines highlight the key role of information and evidence-based psychosocial interventions not only for individuals but also for their families and carers. Engaging young people in prevention and early intervention programs is a challenge, and early treatment and prevention of adolescent depression is a major public health concern. There has been growing interest in psychoeducational interventions to provide accurate information about health issues and to enhance and develop self-management skills. However, for adolescents with, or at high risk of depression, there is a lack of engaging Web-based psychoeducation programs that have been developed with user input and in line with research guidelines and targeted at both the individual and their family or carer. There are also few studies published on the process of development of Web-based psychoeducational interventions. Objective: The aim of this study was to describe the process underlying the design and development of MoodHwb (HwbHwyliau in Welsh): a Web-based psychoeducation multimedia program for young people with, or at high risk of, depression and their families, carers, friends, and professionals. Methods: The initial prototype was informed by (1) a systematic review of psychoeducational interventions for adolescent depression; (2) findings from semistructured interviews and focus groups conducted with adolescents (with depressive symptoms or at high risk), parents or carers, and professionals working with young people; and (3) workshops and discussions with a multimedia company and experts (in clinical, research, and multimedia work). Twelve interviews were completed (four each with young people, parents or carers, and professionals) and six focus groups (three with young people, one with parents and carers, one with professionals, and one with academics). Results: Key themes from the interviews and focus groups were: aims of the program, design and content issues, and integration and context of the program. The prototype was designed to be person-centered, multiplatform, engaging, interactive, and bilingual. It included mood-monitoring and goal-setting components and was available as a Web-based program and an app for mobile technologies. Conclusions: MoodHwb is a Web-based psychoeducational intervention developed for young people with, or at high risk of, depression and their families and carers. It was developed with user input using qualitative methods as well as user-centered design and educational and psychological theory. Further research is needed to evaluate the effectiveness of the program in a randomized controlled trial. If found to be effective, it could be implemented in health, education, youth and social services, and charities, to not only help young people but also families, carers, friends, and professionals involved in their care. %M 29449202 %R 10.2196/mental.8894 %U http://mental.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/mental.8894 %U http://www.ncbi.nlm.nih.gov/pubmed/29449202 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e38 %T Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial %A Martínez,Vania %A Rojas,Graciela %A Martínez,Pablo %A Zitko,Pedro %A Irarrázaval,Matías %A Luttges,Carolina %A Araya,Ricardo %+ Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago,, Chile, 56 229788601, graciela.rojas.castillo@gmail.com %K primary health care %K depression %K adolescents %K Internet %K telemedicine %K medically underserved area %D 2018 %7 31.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results: More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). Conclusions: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) %M 29386172 %R 10.2196/jmir.8021 %U https://www.jmir.org/2018/1/e38/ %U https://doi.org/10.2196/jmir.8021 %U http://www.ncbi.nlm.nih.gov/pubmed/29386172 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e32 %T A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial %A Stallard,Paul %A Porter,Joanna %A Grist,Rebecca %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House 6.10, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 383282, p.stallard@bath.ac.uk %K self-injury %K smartphone %K mobile apps %K BlueIce %K adolescents %K cognitive behavioral therapy %K mHealth %D 2018 %7 30.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been specifically developed for young people, and almost none have been subject to any form of evaluation. Objective: This study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. We aimed to assess the acceptability, safety, and use of BlueIce and to explore the effects on the primary outcome of self-harm and the secondary outcomes of psychological functioning. Methods: We undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarization) and again at 12 weeks (post use). A behavior-screening questionnaire (Strengths and Difficulties Questionnaire) was completed along with standardized measures of depression (Mood and Feelings Questionnaire or MFQ) and anxiety (Revised Child Anxiety and Depression Scale or RCADS), taking into account self-reports of self-harm, app helpfulness, and safety. Results: All core CAMHS professional groups referred at least 1 young person. Out of 40 young people recruited, 37 (93%) elected to use BlueIce after familiarization, with 29 out of 33 (88%) wanting to keep it at the end of the study. No young person called the emergency numbers during the 12-week trial, and no one was withdrawn by his or her clinician due to increased risk of suicide. Almost three-quarters (73%) of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a statistically significant mean difference of 4.91 (t31=2.11; P=.04; 95% CI 0.17-9.64) on postuse symptoms of depression (MFQ) and 13.53 on symptoms of anxiety (RCADS) (t30=3.76; P=.001; 95% CI 6.17-20.90), which was evident across all anxiety subscales. Ratings of app acceptability and usefulness were high. Conclusions: Our study has a number of methodological limitations, particularly the absence of a comparison group and a prospective way of assessing self-harm. Nonetheless, our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face-to-face intervention, can help young people manage their emotional distress and urges to self-harm. %M 29382632 %R 10.2196/mhealth.8917 %U http://mhealth.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/mhealth.8917 %U http://www.ncbi.nlm.nih.gov/pubmed/29382632 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e10 %T Web-Based Decision Aid to Assist Help-Seeking Choices for Young People Who Self-Harm: Outcomes From a Randomized Controlled Feasibility Trial %A Rowe,Sarah L %A Patel,Krisna %A French,Rebecca S %A Henderson,Claire %A Ougrin,Dennis %A Slade,Mike %A Moran,Paul %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, 6th Floor, London, W1T 7NF, United Kingdom, 44 07415078280, s.rowe@ucl.ac.uk %K adolescent %K self-harm %K decision aid %K intervention %K schools %K feasibility %K randomized controlled trials %K ethics %D 2018 %7 30.01.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents who self-harm are often unsure how or where to get help. We developed a Web-based personalized decision aid (DA) designed to support young people in decision making about seeking help for their self-harm. Objective: The aim of this study was to evaluate the feasibility and acceptability of the DA intervention and the randomized controlled trial (RCT) in a school setting. Methods: We conducted a two-group, single blind, randomized controlled feasibility trial in a school setting. Participants aged 12 to 18 years who reported self-harm in the past 12 months were randomized to either a Web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomization, and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision making and help-seeking behavior. Qualitative interviews were conducted with young people, parents or carers, and staff and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 17.87% (208/1164) of parents or guardians who were contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 81.7% (170/208) of young people into the study. Of those young people screened, 13.5% (23/170) had self-harmed in the past year. Ten participants were randomized to receiving the DA, and 13 were randomized to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability, but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety, and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and the intervention are needed before generalizable research about DAs can be successfully conducted in a school setting. Trial Registration: International Standard Randomized Controlled Trial registry: ISRCTN11230559; http://www.isrctn.com/ISRCTN11230559 (Archived by WebCite at http://www.webcitation.org/6wqErsYWG) %M 29382626 %R 10.2196/mental.8098 %U http://mental.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/mental.8098 %U http://www.ncbi.nlm.nih.gov/pubmed/29382626 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e204 %T Young People, Adult Worries: Randomized Controlled Trial and Feasibility Study of the Internet-Based Self-Support Method “Feel the ViBe” for Adolescents and Young Adults Exposed to Family Violence %A van Rosmalen-Nooijens,Karin %A Lo Fo Wong,Sylvie %A Prins,Judith %A Lagro-Janssen,Toine %+ Gender & Women’s Health, Department of Primary and Community Care, Radboud university medical center, Internal post 117, P.O. Box 9101, Nijmegen, 6500HB, Netherlands, 31 0 243613110, karin.vanrosmalen-nooijens@radboudumc.nl %K domestic violence %K child abuse %K exposure to violence %K adolescent %K young adult %K telemedicine %K peer group %K peer influence %K Internet %K feasibility studies %K randomized controlled trial %K delivery of health care %D 2017 %7 12.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents and young adults (AYAs) are of special interest in a group of children exposed to family violence (FV). Past-year prevalence of exposure to FV is known to be highest in AYAs and has severe consequences. Peer support is an effective approach to behavior change and the Internet is considered suitable as a mode of delivery. Objective: The study aimed to evaluate both effectiveness and feasibility of a randomized controlled trial (RCT) and feasibility study of the Internet-based self-support method “Feel the ViBe” (FtV) using mixed-methods approach to fully understand the strengths and weaknesses of a new intervention. Methods: AYAs aged 12-25 years and exposed to FV were randomized in an intervention group (access to FtV + usual care) and a control group (minimally enhanced usual care) after they self-registered themselves. From June 2012 to July 2014, participants completed the Impact of Event Scale (IES) and Depression (DEP) and Anxiety (ANX) subscales of the Symptom CheckList-90-R (SCL-90) every 6 weeks. The Web Evaluation Questionnaire was completed after 12 weeks. Quantitative usage data were collected using Google analytics and content management system (CMS) logs and data files. A univariate analysis of variance (UNIANOVA) and mixed model analysis (intention-to-treat [ITT], complete case) were used to compare groups. Pre-post t tests were used to find within-group effects. Feasibility measures structurally address the findings. The CONsolidated Standards Of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist was closely followed. Results: In total, 31 out of 46 participants in the intervention group and 26 out of 47 participants in the control group started FtV. Seventeen participants (intervention: n=8, control: n=9) completed all questionnaires. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (P=.04) and ANX (P=.049) subscales between 6 and 12 weeks after participation started. UNIANOVA showed no significant differences. Pre-post paired sample t tests showed significant improvements after 12 weeks for the SCL-90 DEP (P=.03) and ANX (P=.046) subscales. Reported mean Web-based time per week was 2.83 with a session time of 36 min. FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. Two-thirds of the intervention participants started regular health care. Conclusions: No changes on the IES were found. SCL-90 DEP and ANX showed promising results; however, the calculated sample size was not reached (n=18). FtV functions best as a first step for adolescents and young adults in an early stage of change. FtV can be easily implemented without extensive resources and fits best in the field of public health care or national governmental care. Trial Registration: Netherlands National Trial Register (NTR): NTR3692; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3692 (Archived by WebCite at http://www.webcitation.org/6qIeKyjA4) %M 28606893 %R 10.2196/jmir.6004 %U http://www.jmir.org/2017/6/e204/ %U https://doi.org/10.2196/jmir.6004 %U http://www.ncbi.nlm.nih.gov/pubmed/28606893