TY - JOUR AU - Tse, Chloe Trinity AU - Weiner, S. Lauren AU - Funkhouser, J. Carter AU - DeLuise, Danielle AU - Cullen, Colleen AU - Blumkin, Zachary AU - O'Brien, Casey AU - Auerbach, P. Randy AU - Allen, B. Nicholas PY - 2025/5/2 TI - Acceptability and Usability of a Digital Behavioral Health Platform for Youth at Risk of Suicide: User-Centered Design Study With Patients, Practitioners, and Business Gatekeepers JO - JMIR Form Res SP - e65418 VL - 9 KW - user-centered design KW - mobile sensing KW - behavior change KW - suicide prevention KW - digital health KW - mental health N2 - Background: Youth suicide rates are climbing, underscoring the need to improve clinical care. Personal smartphones can provide an understanding of proximal risk factors associated with suicide and facilitate consistent contact between patients and practitioners to improve treatment engagement and effectiveness. The Vira digital behavior change platform (Vira) consists of a patient smartphone app and a web-based practitioner portal (Vira Pro) that integrates objective mobile sensing data with Health Insurance Portability and Accountability Act (HIPAA)?compliant communication tools. Through Vira, practitioners can continuously assess patients? real-world behavior and provide clinical tools to enhance treatment via just-in-time behavior change support. Objective: This study aimed to explore the acceptability and usability of the minimal viable product version of Vira through a user-centered design (UCD) approach and to identify barriers to implementing Vira in the context of an adolescent intensive outpatient program. Methods: Over 2 iterative phases, feedback was gathered from adolescent patients (n=16), mental health practitioners (n=11), and business gatekeepers (n=5). The mixed methods UCD approach included individual semistructured interviews (eg, perspectives on treatment and attitudes toward digital tools), surveys (eg, usability), and unmoderated user testing sessions (eg, user experience). Results: Overall, participants expressed optimism regarding Vira, particularly among adolescents, who showed high satisfaction with the app?s interface and design. However, clinicians reported more mixed views, agreeing that it would be useful in treatment but also expressing concerns about the volume and displays of patient data in Vira Pro, workload management, and boundaries. Gatekeepers identified usability issues and implementation barriers related to electronic health records but also recognized Vira?s potential to enhance treatment outcomes. Feedback from stakeholders informed several crucial changes to the platform, including adjustments to data-sharing protocols, user interface enhancements, and modifications to training methods. Conclusions: Vira has a high potential to improve patient engagement and improve clinical outcomes among high-risk youth. Iterative UCD and ongoing stakeholder engagement are essential for developing technology-based interventions that effectively meet the needs of diverse end users and align with clinical workflows. UR - https://formative.jmir.org/2025/1/e65418 UR - http://dx.doi.org/10.2196/65418 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65418 ER - TY - JOUR AU - Jiang, Yuxuan AU - Xiao, Chuman AU - Wang, Xiang AU - Yuan, Dongling AU - Liu, Qian AU - Han, Yan AU - Fan, Jie AU - Zhu, Xiongzhao PY - 2025/5/2 TI - The Longitudinal Effect of Psychological Distress on Internet Addiction Symptoms Among Chinese College Students: Cross-Lagged Panel Network Analysis JO - J Med Internet Res SP - e70680 VL - 27 KW - internet addiction KW - depression KW - anxiety KW - stress KW - cross-lagged panel network analysis KW - network analysis KW - college students KW - psychological distress N2 - Background: There is a growing amount of evidence suggesting high rates of co-occurring internet addiction (IA) symptoms and psychological distress in youth. However, the extent to which IA symptoms develop over time, how they interact with psychological distress symptoms dynamically, and how they predict one another remain unclear. Additionally, what specific types of distress, including depression, anxiety, and stress, are more closely associated with IA symptoms remains inconclusive. Objective: This longitudinal study aimed to explore the development of and changes in IA symptoms over time and the directional relationship between IA and various psychological distress symptoms. Methods: This study followed a sample of 2497 Chinese college students (mean age 19.14, SD 0.72 years) across 3 waves of a data collection span of 2 years. Their IA and psychological distress symptoms were assessed at baseline (T1), 12-month follow-up (T2), and 24-month follow-up (T3). We used network analysis to examine the network structure of IA symptoms at each wave and cross-lagged panel network (CLPN) analysis to investigate longitudinal associations between IA symptoms and psychological distress, including depressive, anxiety, and stress symptoms. Results: The cross-sectional networks of IA symptoms at 3 time points showed high similarity in terms of structure, existence of edges, and centrality indices. Nodes A2 (excessive use), A1 (salience), and A5 (lack of control) emerged as nodes with the highest expected influence (EI) centrality in the IA symptom networks across time (A2: EI=1.13 at T1, 1.15 at T2, 1.17 at T3; A1: EI=1.10 at T1, 1.13 at T2, 1.15 at T3; A5: EI=0.86 at T1, 0.88 at T2, 0.92 at T3). CLPN analysis revealed that psychological distress predicts IA symptoms but not the other way around. Depressive symptoms played a key role in predicting various IA-related problems (T1 to T2, edge weight=0.11; T2 to T3, edge weight=0.28; T1 to T3, edge weight=0.22) and served as bridge symptoms connecting IA and psychological distress (T1 to T2: bridge?expected influence [BEI]=0.15; T2 to T3: BEI=0.14; T1 to T3: BEI=0.19). Conclusions: Findings revealed a relatively stable network structure of IA symptoms among college students and suggested that psychological distress, especially depressive symptoms, may play a central role in activating IA symptoms over time. These results provide evidence for understanding the directional relationship between the central characteristics of distress symptoms and IA. The study also underscores the importance of depressive symptoms in their co-occurrence with IA, indicating that the key and bridge symptoms identified in this study can be prioritized as targets for preventing and treating IA in Chinese youth. Through identification and early intervention of depressive symptoms, we may avoid the progression of co-occurring issues, leading to more effective treatment outcomes. UR - https://www.jmir.org/2025/1/e70680 UR - http://dx.doi.org/10.2196/70680 UR - http://www.ncbi.nlm.nih.gov/pubmed/40315013 ID - info:doi/10.2196/70680 ER - TY - JOUR AU - Lincke, Lena AU - Martin-Döring, Tim AU - Daunke, Andrea AU - Sadkowiak, Antonia AU - Nolkemper, Alexandra Daria AU - Sproeber-Kolb, Nina AU - Bienioschek, Stefanie AU - Reis, Olaf AU - Kölch, Michael PY - 2025/5/1 TI - Integration of a Mental Health App (e-MICHI) Into a Blended Treatment of Depression in Adolescents: Single-Group, Naturalistic Feasibility Trial JO - JMIR Form Res SP - e58427 VL - 9 KW - adolescents KW - major depressive disorder (MDD) KW - cognitive behavioral therapy (CBT) KW - digital health interventions (DHIs) KW - feasibility KW - adherence KW - outpatient setting KW - mobile application KW - accessibility KW - availability KW - efficacy KW - mobile phone N2 - Background: Major depressive disorder is a common diagnosis among adolescents. Cognitive behavioral therapy is recommended as the first line of treatment. Digital health interventions, such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face-to-face therapy, and the ability to intensify therapy by incorporating it into the patients? everyday lives. Challenges such as low adherence rates are common in digital health interventions. Therefore, they need to undergo rigorous testing for feasibility and effectiveness. Objective: An evaluated, cognitive behavioral therapy?based face-to-face therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in outpatient settings. Methods: Adolescents aged 12 to 18 years with major depressive disorder receiving outpatient care were recruited from 2 university hospitals (n=36 included in analysis). The e-MICHI intervention combined daily app engagement over 6 weeks with 3 face-to-face sessions with a therapist. Feasibility was measured using various variables, including an adherence score (0=no or little patient engagement to 3=excellent engagement) and engagement rates (number of modules completed, number of messages sent by participants via the in-app messenger), satisfaction ratings from both participants and therapists, as well as participants? ratings of the usefulness of the antidepressant strategies covered in the app and the transfer of these strategies to everyday practice. Trends of efficacy were evaluated from multiple perspectives (participant self-rating, independent rater, or therapist), using the Beck Depression Inventory-II, the Children?s Depression Rating Scale-Revised, and the Clinical Global Impressions-Severity Scale. Feasibility metrics were assessed by analyzing their central tendency and dispersion, efficacy data were analyzed using a repeated measures ANOVA. Results: e-MICHI was positively evaluated by both participants and therapists (participants: mean 7.3, SD 1.2 and therapists: mean 7.3, SD 1.1, on a scale from 0=bad to 10=excellent). Participants demonstrated high adherence rates (nearly 80%, n=25, received a ?good? or ?excellent? adherence score) and showed overall good engagement (app modules completed [maximum 6]: mean 5.03, SD 1.27 and messages sent via messenger: mean 23, SD 22.1). Participants rated the psychoeducational content of the app as particularly useful and reported consistent practice of the e-MICHI strategies in everyday life. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs 3-month follow-up, Beck Depression Inventory-II: mean ?6.76, SD 11.49, P=.01; Children?s Depression Rating Scale-Revised: mean ?16.45, SD 16.76, P<.001; Clinical Global Impressions-Severity Scale: mean ?1.1, SD 1.24, P<.001). Conclusions: While acknowledging its limitations, such as the small number of participants and the limited validity concerning efficacy, this study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings. Trial Registration: German Clinical Trial Register DRKS00022420; https://drks.de/search/en/trial/DRKS00022420/details UR - https://formative.jmir.org/2025/1/e58427 UR - http://dx.doi.org/10.2196/58427 ID - info:doi/10.2196/58427 ER - TY - JOUR AU - Westerveld, M. Myrna AU - van der Mheen, Malindi AU - Knipschild, Rik AU - Maijer, Kim AU - de Keizer-Altink, E. Marieke AU - Albisser, Nina AU - Hoekstra, E. Marielle J. AU - Timmermans-Jansen, Anne AU - Zijp, Rosa AU - Krabbendam, A. Anne AU - van Steensel, A (Bonny) Francisca J. AU - Kan, Kees-Jan AU - Huyser, Chaim AU - Staal, G. Wouter AU - Utens, J. Elisabeth M. W. AU - Lindauer, L. Ramón J. PY - 2025/4/30 TI - Short- and Long-Term Effectiveness of Brief Intensive Trauma Treatment for Adolescents With Posttraumatic Stress Disorder and Their Caregivers: Protocol for a Multicenter Randomized Controlled Trial JO - JMIR Res Protoc SP - e66115 VL - 14 KW - brief intensive trauma treatment KW - adolescents KW - stress disorder KW - post-traumatic KW - adverse childhood experiences KW - eye movement desensitization reprocessing KW - trauma-focused cognitive behavioral therapy KW - Caribbean KW - randomized controlled trials KW - multicenter studies N2 - Background: Childhood trauma is pervasive, with approximately 50% of adolescents experiencing at least one potentially traumatic event before adulthood. Eight percent to 33% of potentially traumatic event?exposed adolescents develop posttraumatic stress disorder (PTSD), which can cause extreme suffering and coincides with numerous comorbid illnesses and high-risk behaviors. PTSD can be effectively treated in adolescents through weekly sessions of eye movement desensitization and reprocessing or trauma-focused cognitive behavioral therapy. Despite the availability of these treatments, numerous severely traumatized adolescents do not receive available treatment options due to high treatment avoidance. In adolescents who receive care, a large group of youth does not experience a sufficient symptom decrease after regular treatment. In addition, dropout rates during prolonged treatment are substantial, varying between 10% and 30%. This underscores the need for innovative and brief trauma treatment. Pilot studies indicate that Brief Intensive Trauma Treatment (BITT) can be a safe and effective treatment for adolescents with PTSD. However, randomized controlled trials on its effectiveness are crucial and urgently needed. Objective: This is the first study to test the effectiveness of a 1-week BITT in adolescents with PTSD and comorbid symptoms and their caregivers. Methods: This multicenter, single-blinded randomized controlled trial will be conducted in 4 youth care centers in the European and Caribbean Netherlands: Levvel, Karakter, Fornhese-GGz Centraal, and Mental Health Caribbean (Bonaire). We will randomize adolescents (12-18 years old) with PTSD to a BITT (n=50) or waitlist control group (WLCG; n=50). BITT comprises 1-week (ie, 5 consecutive workdays) intensive trauma treatment, encompassing daily 90-minute manualized sessions of trauma-focused cognitive behavioral therapy and eye movement desensitization and reprocessing. The day begins and ends with psychomotor therapy. Caregivers receive daily parental counseling sessions consisting of psychoeducation and social support skill training. We will conduct measurements at similar intervals for both groups: at baseline; directly after BITT or WLCG; and at 3, 6, and 9 months? follow-up. The WLCG will receive BITT after the 3-month follow-up assessment. We will assess all study parameters using digital or face-to-face questionnaires and semistructured interviews. We will assess the primary outcome PTSD symptoms using the Child and Adolescent Trauma Screen 2 (CATS-2) and the Clinician-Administered PTSD Scale for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition])-Child/Adolescent Version (CAPS-CA-5). Results: As of September 2022, we enrolled 104 participants. Data will be collected until December 2025. Results are expected to be published in the summer of 2026. Conclusions: This first, innovative study on BITT?s effectiveness may enhance treatment outcomes for PTSD by preventing dropout, reducing avoidance, shortening therapy duration, and empowering therapists by working together intensively. This research will provide valuable insights across cultures for treating severely traumatized adolescents who do not benefit sufficiently from regular treatment. Trial Registration: ClinicalTrials.gov NCT06143982, http://clinicaltrials.gov/ct2/show/NCT06143982 International Registered Report Identifier (IRRID): DERR1-10.2196/66115 UR - https://www.researchprotocols.org/2025/1/e66115 UR - http://dx.doi.org/10.2196/66115 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66115 ER - TY - JOUR AU - Yang, Chia-chen AU - Hunhoff, Paul AU - Lee, Yen AU - Abrell, Jonah PY - 2025/4/28 TI - Social Media Activities With Different Content Characteristics and Adolescent Mental Health: Cross-Sectional Survey Study JO - J Med Internet Res SP - e73098 VL - 27 KW - social media KW - depression KW - anxiety KW - social support KW - approval anxiety KW - social comparison KW - adolescence N2 - Background: Adolescent mental health concerns are rising in the United States, with social media often cited as a contributing factor, although research findings remain mixed. A key limitation is the simplistic view of social media use, which fails to consistently predict well-being. Scholars call for a more nuanced framework and a better understanding of how social media use influences adolescent mental health through various psychosocial mechanisms. Objective: Using the Multidimensional Model of Social Media Use, we explored how 4 activities with various content characteristics (intimate directed communication, intimate broadcasting, positive broadcasting, and positive content consumption) are associated with depression and anxiety through 3 psychosocial mediators: social support, approval anxiety, and social comparison. Methods: Cross-sectional survey data were collected through Qualtrics? panel service from a sample of adolescents whose gender and racial or ethnic distributions were nationally representative (N=2105; mean age 15.39, SD 1.82 years). Participants passed attention checks to ensure data validity. Measures included 9 validated scales (Cronbach ?=0.83-0.91): 4 social media activities (intimate directed communication, intimate broadcasting, positive broadcasting, and positive content consumption), 3 mediators (social support, approval anxiety, and social comparison), and 2 mental health outcomes (depression and anxiety). Using Mplus, we performed 2-step structural equation modeling. Confirmatory factor analysis established scale validity, and path analysis tested the hypothesized and exploratory associations between social media activities, mediators, and mental health, controlling for demographic covariates and the amount of phone use. Model fit criteria (comparative fit index and Tucker-Lewis index were close to or greater than 0.95; root mean square error of approximation was less than 0.08) were met. Significance was determined using a false discovery rate control, with the familywise type 1 error rate set at 0.05. Results: Our findings showed that positive broadcasting was associated with lower depression (?=?.14; P<.001) and anxiety (?=?.06; P=.03), mainly through the direct paths. The other 3 activities were related to more mental health problems. Specifically, intimate directed communication was associated with greater depression (?=.06; P=.03) and anxiety (?=.06; P=.04); intimate broadcasting was associated with greater anxiety (?=.07; P=.02); and positive content consumption was related to higher depression (?=.13; P<.001). Approval anxiety or social comparison played a salient role in these total effects. Conclusions: The findings highlight the importance of distinguishing social media activities when assessing risks and benefits. Intimate directed communication, intimate broadcasting, and positive content consumption became risk factors for increased anxiety and depression through approval anxiety, social comparison, or both. Positive broadcasting was related to better mental health because of its direct associations with lower depression and anxiety. UR - https://www.jmir.org/2025/1/e73098 UR - http://dx.doi.org/10.2196/73098 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/73098 ER - TY - JOUR AU - Kendall, D. Ashley AU - Pela, Emily AU - Amonica, Danielle AU - Jaworski, Erin AU - Floyd, Brenikki AU - PY - 2025/4/24 TI - Feasibility Testing a Meditation App for Professionals Working With Youth in the Legal System: Protocol for a Hybrid Type 2 Effectiveness-Implementation Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e71867 VL - 14 KW - mobile app KW - mHealth KW - digital mental health KW - meditation KW - mindfulness KW - juvenile legal system KW - officers KW - workplace KW - ecological momentary assessment (EMA) KW - emotion regulation N2 - Background: Probation officers and other professionals who work with youth in the legal system often experience high chronic workplace stress, which can contribute over time to elevations in anxiety, depression, and workplace burnout. Emotion dysregulation appears to function as a common mechanism underlying these elevations, and growing evidence suggests it can be improved with mindfulness meditation. Implemented successfully, app-based meditation programs could provide professionals with real-time tools for mitigating the effects of chronic workplace stress. Objective: This paper describes the protocol for a hybrid type 2 effectiveness-implementation pilot randomized controlled trial (RCT) of Bodhi AIM+, a meditation app adapted with and for professionals who work with youth in the legal system. The adaptation process and implementation plan, as well as the pilot RCT design, were guided by theoretically driven implementation science frameworks. The primary outcome of the pilot RCT is app adherence (ie, ongoing app usage per objective analytics data). Methods: The RCT will be fully remote. Officers and other professionals who work with youth in the legal system (N=50) will be individually randomized to use the meditation app or an active control app matched for time and structure. All participants will be asked to follow a 30-day path of brief audio- or video-guided content and invited to use additional app features as desired. In-app analytics will capture the objective usage of each feature. An adaptive engagement design will be employed to engage nonusers of both apps, whereby analytics data indicating nonuse will trigger additional support (eg, text messages promoting engagement). Mental health outcomes and potential moderators and covariates will be self-reported at baseline, posttest, and 6 months. Participants will also complete 1-week bursts of ecological momentary assessment (EMA) at baseline and over the last week of the intervention to capture the mechanistic target (ie, emotion regulation) in real time. All participants will be invited to complete qualitative posttest interviews. Descriptive statistics will be calculated for quantitative data. Qualitative data will be analyzed using a combined deductive-inductive approach. The quantitative and qualitative data will be incorporated into a mixed methods triangulation design, allowing for the evaluation of app adherence and other implementation outcomes as well as related barriers and facilitators to implementation. Results: Enrollment into the trial started in December 2024 and is currently underway. Study results are anticipated to be available in 2026. Conclusions: Completion of this pilot trial will inform a future, fully powered RCT to formally evaluate the effectiveness and implementation of Bodhi AIM+. Its use of implementation science methods, coupled with digital technology, positions the present study not only to help make meditation tools available to an important workforce at scale but also to inform broader efforts at implementing and evaluating health apps within workplace settings. Trial Registration: ClincialTrials.gov NCT06555172; https://clinicaltrials.gov/study/NCT06555172 International Registered Report Identifier (IRRID): DERR1-10.2196/71867 UR - https://www.researchprotocols.org/2025/1/e71867 UR - http://dx.doi.org/10.2196/71867 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/71867 ER - TY - JOUR AU - Butorac, Isobel AU - McNaney, Roisin AU - Seguin, Paolo Joshua AU - Olivier, Patrick AU - Northam, C. Jaimie AU - Tully, A. Lucy AU - Carl, Talia AU - Carter, Adrian PY - 2025/4/22 TI - Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study JO - JMIR Pediatr Parent SP - e65163 VL - 8 KW - digital mental health KW - young people KW - cultural diversity KW - web-based and mobile health interventions KW - qualitative methods KW - user-centered design KW - human-computer interaction N2 - Background: Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. Objective: The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based ?check-in? tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. Methods: We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Results: Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. Conclusions: The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study?s findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations. UR - https://pediatrics.jmir.org/2025/1/e65163 UR - http://dx.doi.org/10.2196/65163 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65163 ER - TY - JOUR AU - Zhu, Shimin AU - Hu, Yuxi AU - Qi, Di AU - Tse, Samson AU - Chan, Ling Ko AU - Sun, Jessica AU - Lee, Paul PY - 2025/4/18 TI - Effects of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Four-Armed Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e63500 VL - 8 KW - belief-in-change KW - growth mindset KW - mental health KW - secondary school students KW - brief intervention KW - randomized controlled trial N2 - Background: Anxiety disorders are the most common mental health conditions worldwide, yet 65% of those affected do not access services. The high prevalence of anxiety and the low rate of intervention uptake highlight the urgent need to develop timely, scalable, and effective interventions suitable for adolescents. This study adapted existing single-session interventions (SSIs) to further develop an SSI focused on a growth mindset regarding negative emotions for adolescent mental health. Objective: The study aims to compare the effectiveness of 4 SSIs, SSI of a growth mindset for anxiety (SIGMA), SIGMA with boosters (SIGMA-Booster), SSI of a growth mindset of personality (SSIGP), and an active control group (support therapy [ST]), in reducing adolescent anxiety. Methods: Classes from each secondary school were randomized to 1 of 4 intervention conditions: SIGMA, SIGMA-Booster, SSIGP, or ST. Each intervention took approximately 45 minutes online. Participants reported on anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-harming thoughts, perceived control, hopelessness, attitude toward help-seeking, and psychological well-being (secondary outcomes) at preintervention, 2-week follow-up, and 8-week follow-up. Participants also completed a feedback scale postintervention. Generalized estimating equations were used to examine the effectiveness of the SSIs. Results: A total of 731 adolescents from 7 secondary schools were randomized. The intent-to-treat analysis found a significant decrease in anxiety symptoms. The mean and 95% CI at baseline were 6.8 (6.0-7.6) for SIGMA-Booster, 6.5 (5.8-7.3) for SIGMA, 7.0 (6.2-7.7) for SSIGP, and 6.9 (6.1-7.7) for ST. At the 2-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.7 (4.9-6.5) for SIGMA, 5.4 (4.6-6.2) for SSIGP, and 5.7 (4.9-6.4) for ST. At the 8-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.3 (4.5-6.0) for SIGMA, 5.6 (4.8-6.4) for SSIGP, and 5.8 (5.1-6.6) for ST. These reductions were observed across all 4 groups. Moderation analysis found that participants with higher motivation for change, higher baseline anxiety scores, and fixed mindsets showed greater improvements in anxiety symptoms. Most participants (459/731, 62.8%) viewed the feasibility and acceptability of the SSIs positively. Conclusions: The SSI for all 4 groups was effective in reducing anxiety and depression among adolescents over 8 weeks. Our data suggest the potential benefits of brief web-based interventions for adolescents, which could serve as scalable, destigmatized, and cost-effective alternatives to school-based programs. The intervention effects may have been underestimated, as this study did not exclude adolescents with minimal or no anxiety symptoms. Future studies should focus on the specific effects of interventions for adolescents with varying levels of anxiety symptoms. Trial Registration: ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880 UR - https://pediatrics.jmir.org/2025/1/e63500 UR - http://dx.doi.org/10.2196/63500 UR - http://www.ncbi.nlm.nih.gov/pubmed/40249649 ID - info:doi/10.2196/63500 ER - TY - JOUR AU - Cao, Yuan AU - Shi, Yuanxin AU - Low, Wing Debbie Chi AU - Shek, L. Daniel T. AU - Shum, K. David H. AU - Tanksale, Radhika AU - Dingle, Genevieve PY - 2025/4/16 TI - Using Music to Promote Hong Kong Young People?s Emotion Regulation and Reduce Their Mood Symptoms and Loneliness: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e67764 VL - 14 KW - youth KW - adolescents KW - adolescence KW - teens KW - teenagers KW - music KW - moods KW - mood symptoms KW - loneliness KW - emotion regulation KW - emotions KW - Hong Kong KW - mental health KW - mental illnesses KW - mental disorders KW - randomized controlled trial KW - RCTs KW - protocol N2 - Background: Mental health needs in the community surged during the pandemic, with concerning reports of increased negative mood symptoms among youth. At the same time, preventive psychoeducational interventions were insufficient within frontline youth mental health services in Hong Kong, and research specifically addressing youth loneliness remained limited on an international scale. Given the association between loneliness and other mental health symptoms, psychoeducational programs that empower adolescents to cope with emotions may help address both the research gap and local demand. As such, Tuned In, a previously validated intervention program originally developed in Australia, was introduced to the local context. Cultural adaptations and an added focus on loneliness were incorporated into the project to enhance its acceptability and test its effectiveness. Objective: This study aims to evaluate an adapted version of the Tuned In music-based psychoeducation program, designed to reduce loneliness, depression, and anxiety symptoms among young people in Hong Kong by enhancing their emotion regulation skills. Methods: Participants aged 16-19 years will be randomly assigned to either the experimental or control group. The experimental group will receive an online, group-based psychoeducation program focused on emotion recognition and management, delivered weekly over 4 consecutive weeks. The intervention is grounded in Russell?s emotion circumplex model and music psychology, and program content included: The 2D model and characteristics of emotions from different quadrants (session 1); happiness and loneliness (session 2); high-arousal and negative-valence emotions, for example, stress and anxiety (sessions 3); and anxiety, perfectionism, and a celebration of achievement (session 4). Both therapist- and participant-selected music will be used in the intervention to provide a rich repertoire for group discussion, psychoeducation, reflection, and the practice of social skills. The main outcome measures will be assessed using the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale, the Depression Anxiety Stress Scale, and the De Jong Gierveld Loneliness Scale. Feedback on the project arrangement will be gathered through qualitative input. A mixed methods analysis will be conducted following data collection. Results: The project was successfully funded in February 2023 by the Health and Medical Research Fund in Hong Kong and commenced in August 2023. As of September 16, 2024, a total of 316 completed questionnaires had been received through Qualtrics for screening purposes, with 89 participants deemed eligible for the program. The project is scheduled to conclude in August 2025, with results to be published thereafter. Conclusions: Participants are expected to show improvements in emotion regulation, along with reductions in mood symptoms and loneliness, following the intervention. Trial Registration: ClinicalTrials.gov NCT06147297; https://clinicaltrials.gov/study/NCT06147297 International Registered Report Identifier (IRRID): DERR1-10.2196/67764 UR - https://www.researchprotocols.org/2025/1/e67764 UR - http://dx.doi.org/10.2196/67764 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67764 ER - TY - JOUR AU - Ibrahim, Hussein Radhwan AU - Yaas, Hussein Marghoob AU - Hamarash, Qadir Mariwan AU - Al-Mukhtar, Hazim Salwa AU - Abdulghani, Faris Mohammed AU - Al Mushhadany, Osama PY - 2025/4/11 TI - Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes JO - JMIR Pediatr Parent SP - e67137 VL - 8 KW - cognitive behavioral therapy KW - CBT KW - psychotherapy KW - mHealth KW - app KW - adolescents KW - teenager KW - mental health KW - usability KW - engagement KW - anxiety KW - depression KW - user experience KW - UX KW - focus group KW - interview KW - digital health N2 - Background: Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited. Objective: This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes. Methods: A qualitative study was conducted with 40 adolescents aged 13?19 years (mean age 15.8, SD 1.9 years; 18/40, 45% male; 22/40, 55% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50%), depression (15/40, 38%), and both (5/40, 13%). Of these, 10 (25%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests. Results: The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16?19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13?15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95% CI 1.6?5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95% CI 1.7?5.6; P=.001). Usability challenges included complex navigation (20/40, 50%), interface design issues (12/40, 30%), and content overload (8/40, 20%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50%) and gamification features (10/40, 25%), while lack of personalization (14/40, 35%) and external distractions (18/40, 45%) were significant barriers. Mood improvement (15/40, 38%) and learning new coping skills (12/40, 30%) were the most reported outcomes. Conclusions: The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement. UR - https://pediatrics.jmir.org/2025/1/e67137 UR - http://dx.doi.org/10.2196/67137 ID - info:doi/10.2196/67137 ER - TY - JOUR AU - Coren, A. Morgan AU - Lindhiem, Oliver AU - Angus, R. Abby AU - Toevs, K. Emma AU - Radovic, Ana PY - 2025/4/10 TI - Provider Perspectives on Implementing an Enhanced Digital Screening for Adolescent Depression and Suicidality: Qualitative Study JO - JMIR Form Res SP - e67624 VL - 9 KW - depression KW - suicidality KW - adolescent mental health screening KW - primary care KW - digital tools N2 - Background: With a growing adolescent mental health crisis, pediatric societies are increasingly recommending that primary care providers (PCPs) engage in mental health screening. While symptom-level screens identify symptoms, novel technology interventions can assist PCPs with providing additional point-of-care guidance to increase uptake for behavioral health services. Objective: In this study, we sought community PCP feedback on a web-based, digitally enhanced mental health screening tool for adolescents in primary care previously only evaluated in research studies to inform implementation in community settings. Methods: A total of 10 adolescent providers were recruited to trial the new screening tool and participate in structured interviews based on the Consolidated Framework for Implementation Research domains. Interviews were audio recorded, transcribed, and coded according to a prespecified codebook using a template analysis approach. Results: Providers identified improving mental health screening and treatment in pediatric primary care as a priority and agreed that a web-based digitally enhanced screening tool could help facilitate identification of and management of adolescent depression. Salient barriers identified were lack of electronic health record integration, time to administer screening, implications on clinic workflow, accessibility, and lack of transparency within health care organizations about the process of approving new technologies for clinical use. Providers made multiple suggestions to enhance implementation in community settings, such as incorporating customization options. Conclusions: Technology interventions can help address the need for improved behavioral health support in primary care settings. However, numerous barriers exist, complicating implementation of new technologies in real-world settings. UR - https://formative.jmir.org/2025/1/e67624 UR - http://dx.doi.org/10.2196/67624 ID - info:doi/10.2196/67624 ER - TY - JOUR AU - Cho, Minseo AU - Park, Doeun AU - Choo, Myounglee AU - Han, Hyun Doug AU - Kim, Jinwoo PY - 2025/4/9 TI - Adolescent Self-Reflection Process Through Self-Recording on Multiple Health Metrics: Qualitative Study JO - J Med Internet Res SP - e62962 VL - 27 KW - self-recording KW - self-tracking KW - self-regulation KW - personal informatics KW - digital health KW - qualitative study KW - grounded theory KW - adolescents KW - teenagers KW - adolescent health KW - self-reflection KW - health metrics KW - behavior change KW - self-awareness KW - decision-making KW - mental health KW - behavioral health KW - health management KW - semi-structured interview N2 - Background: Self-recording is an effective behavior change technology that has long been used in diverse health contexts. Recent technological advancements have broadened its applications. While previous studies have explored its role and benefits in enhancing self-awareness and informed decision-making, relatively little attention has been given to its potential to address the multidimensional nature of health with various health metrics. Objective: This study investigates the process of self-recording in adolescent health, recognizing the connections between lifestyle behaviors and mental health. Specifically, we aim to incorporate both behavioral and emotional health metrics into the self-recording process. Grounded in self-regulation theory, we explore how adolescents record lifestyle behaviors and emotions, and how they inform and implement health management strategies. Methods: We conducted a qualitative study using the grounded theory methodology. Data were collected through individual semistructured interviews with 17 adolescents, who recorded their emotions and behaviors over 4 weeks using a prototype application. Analysis followed iterative phases of coding, constant comparison, and theme saturation. This process revealed how adolescents engage in self-recording for behaviors and emotions, as well as their failures and potential system support strategies. We further examined the relevance of the identified themes to theoretical constructs in self-regulation theory. Results: Under self-regulation theory, we gained insights into how adolescents manage their health through self-recording. The findings suggested variability in the self-recording process, in relation to specific health metrics of lifestyle behaviors and emotions. Adolescents focused on evaluating behaviors for management purposes while exploring the causes underlying emotional experiences. Throughout the health management, which involved modifying behavior or distancing from triggering factors, they monitored progress and outcomes, demonstrating a self-experimental approach. Uncertainty emerged as a barrier throughout the self-regulation process, suggesting that self-recording systems for adolescents should prioritize strategies to address these uncertainties. In addition, the self-recording system demonstrated interventional effects in aiding future planning and fostering a sense of relatedness among users. Conclusions: This study offers a theoretical framework for adolescents? self-recording process on diverse health metrics. By integrating self-regulation theory, we suggest a stepwise process from recording lifestyle behaviors and emotions to health management behaviors. Through exploring potential features and health-supportive effects, our findings contribute to the development of digital self-recording systems that address various health metrics in adolescent health. UR - https://www.jmir.org/2025/1/e62962 UR - http://dx.doi.org/10.2196/62962 UR - http://www.ncbi.nlm.nih.gov/pubmed/40202781 ID - info:doi/10.2196/62962 ER - TY - JOUR AU - Sørensen, Marie Nikita AU - Skaarnes, Helene AU - Mathiasen, Kim AU - Thastum, Mikael AU - Lomholt, Jeppesen Johanne PY - 2025/4/8 TI - Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention JO - JMIR Form Res SP - e66966 VL - 9 KW - user-centered design KW - digital treatment KW - digital mental health KW - internet-based KW - cognitive behavioral therapy KW - anxiety KW - adolescents N2 - Background: Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation. Objective: This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework. Methods: The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback. Results: In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled ?humans? received more votes as adolescents could better ?identify? themselves with them. Communication should preferably be ?supportive? and feel ?like a friend? talking to them. Statements including praise?such as ?You?re well on your way. How are you today???received the most votes (12 votes), whereas directive statements such as ?Tell us how your day has been?? and ?How is practicing your steps going?? received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks. Conclusions: Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice. UR - https://formative.jmir.org/2025/1/e66966 UR - http://dx.doi.org/10.2196/66966 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66966 ER - TY - JOUR AU - Wüllner, Sarah AU - Hermenau, Katharin AU - Hecker, Tobias AU - Siniatchkin, Michael PY - 2025/4/8 TI - The Use of Mobile Apps in Adolescent Psychotherapy: Assessment of Psychotherapists? Perspectives JO - JMIR Form Res SP - e65788 VL - 9 KW - mental health app KW - psychotherapy KW - adolescent KW - mHealth KW - youth KW - feasibility KW - implementation KW - app features KW - barriers KW - drivers N2 - Background: Therapy-accompanying mental health apps can play an important role in the psychotherapeutic treatment of adolescents. They can enhance adolescents? engagement and autonomy, provide immediate support in critical situations, and positively influence the therapeutic working alliance. Nevertheless, mental health apps are rarely used by psychotherapists. Furthermore, due to the limited or nonexistent use of apps in psychotherapy, little is known about the actual barriers and drivers affecting their integration into psychotherapists? daily routines. To better understand how mental health apps should be designed for practical use, it is essential to explore psychotherapists? perspectives on key app features and characteristics, as well as the factors influencing their integration into clinical practice. Objective: This study aims to analyze which app features and characteristics are essential for psychotherapists to use a mobile app in psychotherapy with adolescents and to identify the key drivers and barriers influencing the integration of a psychotherapeutic app from the psychotherapists? perspectives. Methods: We conducted 3 feasibility studies using Steps, a transdiagnostic, therapy-accompanying app for adolescents, across 3 different psychotherapeutic treatment contexts: inpatient treatment, treatment in psychiatric outpatient clinics, and outpatient treatment with psychotherapists in private practice. All studies followed a qualitative quasi-experimental design. Participants provided information on their age, occupation, years of work experience, media affinity, attitudes toward psychotherapeutic apps, perceived app quality and feasibility, and the implementation process of the therapy-accompanying app. Qualitative data were analyzed using deductive qualitative content analysis. A total of 40 mental health professionals participated across the 3 studies (study 1: n=18; study 2: n=13; study 3: n=9). Results: Study participation and app usage rates were low across all studies. Six core features for a transdiagnostic, therapy-accompanying app were identified: mood checks, library, reminders, goals and tasks, emergency kit, and questionnaires. Additionally, the integration of mental health apps into daily routines was influenced by various drivers and barriers. The most significant barriers included technological issues and practical constraints, such as limited time and resources. The most important driver was the perceived improvement in treatment quality. Conclusions: Overall, psychotherapists were generally open to using a therapy-accompanying mental health app. However, study participation and app usage remained low. As psychotherapists act as gatekeepers for patients? use of mental health apps, their needs should be prioritized in the development and implementation of such apps. Trial Registration: German Clinical Trials Register DRKS00031258; https://drks.de/search/en/trial/DRKS00031258/details UR - https://formative.jmir.org/2025/1/e65788 UR - http://dx.doi.org/10.2196/65788 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65788 ER - TY - JOUR AU - Bakhti, Rinad AU - Daler, Harmani AU - Ogunro, Hephzibah AU - Hope, Steven AU - Hargreaves, Dougal AU - Nicholls, Dasha PY - 2025/4/7 TI - Exploring Engagement With and Effectiveness of Digital Mental Health Interventions in Young People of Different Ethnicities: Systematic Review JO - J Med Internet Res SP - e68544 VL - 27 KW - digital mental health interventions KW - young people KW - ethnicity KW - engagement KW - effectiveness KW - artificial intelligence KW - AI N2 - Background: The prevalence of mental health difficulties among young people has risen in recent years, with 75% of mental disorders emerging before the age of 24 years. The identification and treatment of mental health issues earlier in life improves later-life outcomes. The COVID-19 pandemic spurred the growth of digital mental health interventions (DMHIs), which offer accessible support. However, young people of different ethnicities face barriers to DMHIs, such as socioeconomic disadvantage and cultural stigma. Objective: This review aimed to summarize and evaluate the engagement with and effectiveness of DMHIs among young people of different ethnicities. Methods: A systematic search was conducted in MEDLINE, Embase, and PsycINFO for studies published between January 2019 and May 2024, with an update in September 2024. The inclusion criteria were participants aged <25 years using DMHIs from various ethnic backgrounds. Three reviewers independently screened and selected the studies. Data on engagement (eg, use and uptake) and effectiveness (eg, clinical outcomes and symptom improvement) were extracted and synthesized to compare findings. Studies were assessed for quality using the Mixed Methods Appraisal Tool. Results: The final search yielded 67 studies, of which 7 (10%) met inclusion criteria. There were 1853 participants across the 7 studies, all from high-income countries. Participants were predominantly aged 12 to 25 years, with representation of diverse ethnic identities, including Black, Asian, Hispanic, mixed race, and Aboriginal individuals. Engagement outcomes varied, with culturally relatable, low-cost interventions showing higher retention and user satisfaction. Linguistic barriers and country of origin impeded the effectiveness of some interventions, while near-peer mentorship, coproduction, and tailored content improved the effectiveness of DMHIs. While initial results are promising, small sample sizes, heterogeneity in outcome assessments, and a paucity of longitudinal data impeded robust comparisons and generalizability. Conclusions: DMHIs show potential as engaging and effective mental health promotional tools for young people of different ethnicities, especially when coproduced and culturally relatable. Initial data suggest that interventions facilitating near-peer mentoring, linguistic adaptation, low cost, and cultural relatability have improved engagement and effectiveness. Future research should focus on developing a consensus definition of DMHIs, exploring DMHIs in children aged <12 years, and conducting detailed qualitative and quantitative research on use factors and treatment efficacy of DMHIs for young people of different ethnicities. Trial Registration: PROSPERO CRD42024544364; https://tinyurl.com/yk5jt8yk UR - https://www.jmir.org/2025/1/e68544 UR - http://dx.doi.org/10.2196/68544 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68544 ER - TY - JOUR AU - Labrosse, David AU - Vié, Clara AU - Harb, Mireille AU - Montagni, Ilaria PY - 2025/4/2 TI - Escape Game to Promote Students? Mental Health Outcomes in the Aftermaths of COVID-19 Pandemic: Protocol for a Mixed Methods Study Evaluating a Cocreated Intervention JO - JMIR Res Protoc SP - e64068 VL - 14 KW - Escape game KW - pilot randomized controlled trial KW - Covid-19 KW - cocreation KW - students KW - mobile phone N2 - Background: The COVID-19 pandemic and the protracted lockdowns have heavily impacted university students? mental health. Digital Escape Games represent a good means to reach students and propose them solutions for their psychological well-being. Objective: This study aimed to evaluate a cocreated digital Escape Game on students? mental health in the aftermath of the COVID-19 pandemic, called EscapeCovid Game. The evaluation of the effectiveness of this stand-alone intervention concerns mental health outcomes (mental health literacy, appraisal and change of beliefs about mental health, management of emotions, and development of coping strategies) and the appreciation and relevance of the game. Methods: A randomized controlled trial with pre- and posttest data collection (online questionnaires with validated scales) is conducted among 500 students in Bordeaux, France, to evaluate the EscapeCovid Game cocreated with students, researchers, health professionals, and web developers. A subsample of students is randomly selected for responding to a semistructured interview following a mixed methods design. Recruitment is done through mail invitations from student associations and presentations in university classes. Half of the sample of the trial plays the Escape Game, while the other half receives an email with mental health?related information. Within the game, students discuss their personal experiences. The text is further used for the qualitative analyses. The whole study is carried out online. Results: The EscapeCovid Game has been developed, tested, and finalized by the end of March 2023. As of November 4, 2024, a total of 191 students have answered the baseline questionnaire (90 intervention vs 101 control). A total of 23 students have played the game and 53 are in the control arm. Among participants, by the end of September 20, 2023, twenty were interviewed (10 intervention and 10 control) reaching sample saturation. According to preliminary results, the EscapeCovid Game has had a positive impact on all defined outcomes, while the email has been effective in increasing knowledge on resources available and on coping strategies and meditation techniques. We expect the trial to be completed by the end of June 2025. Conclusions: The mixed methods findings of this study are due to demonstrate the effectiveness of the EscapeCovid Game in improving students? mental health outcomes. Preliminary results from the qualitative substudy are promising: in the aftermath of the COVID-19 crisis, this intervention is intended to promote players? mental health through gamification, knowledge transfer, and a learning-by-doing approach. Trial Registration: ClinicalTrials.gov NCT06720792; https://clinicaltrials.gov/study/NCT06720792 International Registered Report Identifier (IRRID): DERR1-10.2196/64068 UR - https://www.researchprotocols.org/2025/1/e64068 UR - http://dx.doi.org/10.2196/64068 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64068 ER - TY - JOUR AU - Reisner, Sari AU - Liu, Yuxin AU - Tham, Regina AU - Kane, Kaiden AU - Cole, Wilson S. AU - Boskey, R. Elizabeth AU - Katz-Wise, L. Sabra AU - Keuroghlian, S. Alex AU - Xu, Rena PY - 2025/3/24 TI - Prevalence and Correlates of Clinically Elevated Depressive Symptoms in a Nationwide Sample of Transgender, Nonbinary, and Gender Diverse Young Adults in the United States: Cross-Sectional Survey Study JO - Interact J Med Res SP - e66630 VL - 14 KW - transgender KW - depression KW - preventive screening KW - young adult KW - LGBTQ+ KW - nonbinary KW - gender minority KW - gender diverse KW - mental health KW - prevalence KW - cross-sectional KW - survey KW - questionnaire KW - nationwide KW - USA KW - United States KW - North America N2 - Background: In the United States, transgender, nonbinary, and gender diverse (TGD) young adults experience a higher risk of depression compared to their cisgender peers. Understanding factors associated with increased risk of depression within the TGD young adult population is important to guide clinical care as well as inform the development of interventions to reduce mental health disparities. Objective: This exploratory study investigated the prevalence and correlates of positive screening for depressive symptoms among TGD young adults to inform the design, development, and implementation of national interventions aimed at improving mental health in this at-risk population. Methods: In August 2022, a cross-sectional, nationwide online survey was conducted among TGD young adults aged 18?25 (N=104) in the United States. Measures included sociodemographic variables, family characteristics, mental health care utilization, and the two-item Patient Health Questionnaire-2 (PHQ-2) screener for depression. Poisson regression models with robust variance estimation were fitted to estimate adjusted prevalence ratios (aPR) and 95% CI for correlates of PHQ-2 depression (score ?3). Results: The study sample had a mean age of 22 (SD 2) years; 48/104 (46%) individuals identified as Black, Indigenous, or other People of Color, and 69/104 (66%) were nonbinary. Overall, 44 (42%) individuals screened positive for depression using PHQ-2. In a multivariable model adjusted for age, race and ethnicity, US census region, and health insurance status, factors associated with increased depression prevalence using PHQ-2 included low versus high family support (aPR 1.54, 95% CI 1.05?2.27) and identifying with a nonChristian religion versus being unaffiliated (aPR 1.66, 95% CI 1.04?2.63). Factors associated with reduced depression prevalence included living in a rural versus suburban area (aPR 0.48, 95% CI 0.26?0.92) and receiving mental health therapy versus not (aPR 0.71, 95% CI 0.53?0.97). Conclusions: The high prevalence of depressive symptoms among TGD young adults in this study sample highlights the need for comprehensive mental health evaluation and support in this population. Depression risk is increased among certain subgroups, such as those with low family support. These findings are valuable in informing the development of interventions that aim to improve mental health outcomes among TGD young people. UR - https://www.i-jmr.org/2025/1/e66630 UR - http://dx.doi.org/10.2196/66630 ID - info:doi/10.2196/66630 ER - TY - JOUR AU - Zhu, Shimin AU - Wang, Yongyi AU - Hu, Yuxi PY - 2025/3/24 TI - Facilitators and Barriers to Digital Mental Health Interventions for Depression, Anxiety, and Stress in Adolescents and Young Adults: Scoping Review JO - J Med Internet Res SP - e62870 VL - 27 KW - digital mental health interventions KW - adolescents KW - young adults KW - common mental disorders KW - thematic analysis KW - relative frequency of occurrence N2 - Background: Digital mental health interventions (DMHIs) offer unique strengths as emerging services with practical applications for adolescents and young adults (AYAs) experiencing depression, anxiety, and stress. Although promising, acceptance and participation in DMHIs vary across interventions, participants, and contexts. It is essential to delineate and synthesize the factors that promote or hinder DMHI use. Objective: This review aims to assess and synthesize the facilitators and barriers to accessing DMHIs for depression, anxiety, and stress in AYAs through a scoping review. Methods: A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, PsycINFO, CNKI, OpenGrey, and APA PsycExtra, up to October 31, 2023. Articles examining facilitators and barriers to DMHIs among AYAs with disorders or symptoms of depression, anxiety, and stress were included. Data synthesis and analysis involved quality assessment, thematic analysis, and relative frequency meta-analysis. Results: A total of 27 records met the eligibility criteria, and 14 facilitators and 13 barriers were identified across the external, intervention, and individual levels. The relative frequency meta-analysis indicated that factors influencing AYAs? use of DMHIs varied based on delivery modes. Among these factors, ?quality and effect? emerged as the predominant theme?high quality and effect served as the primary facilitator, while low quality and effect acted as a barrier across both portable and nonportable devices, as well as single and multiple platforms. Conclusions: The uptake of DMHIs among AYAs is influenced by a complex interplay of facilitators and barriers, particularly those related to quality and effect. Our syntheses provide crucial guidance for intervention designers, emphasizing the importance of user-centered approaches that balance scientific rigor with engaging and adaptive features. Enhancing the alignment of DMHIs with adolescent needs can improve both adoption and real-world mental health impact. Trial Registration: PROSPERO CRD42023479880; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023479880 UR - https://www.jmir.org/2025/1/e62870 UR - http://dx.doi.org/10.2196/62870 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62870 ER - TY - JOUR AU - Thell, Maria AU - Edvardsson, Kerstin AU - Aljeshy, Reem AU - Ibrahim, Kalid AU - Warner, Georgina PY - 2025/3/18 TI - A Trauma Support App for Young People: Co-design and Usability Study JO - JMIR Form Res SP - e57789 VL - 9 KW - co-design KW - young people KW - trauma KW - app development KW - usability testing N2 - Background: One of the most common reasons young people with mental health issues, such as posttraumatic stress disorder, do not seek help is stigma, which digital support tools could help address. However, there is a lack of trauma support apps specifically designed for young people. Involving the target group in such projects has been shown to produce more engaging and effective results. Objective: This study aimed to apply a child rights?based participatory approach to develop a trauma support app with young people. Methods: Seven young people (aged 14-19 years; 3 males and 4 females) with experiences of trauma were recruited as coresearchers. A child rights?based framework guided the working process. The app was developed through a series of Design Studio workshops and home assignments, using the manualized intervention Teaching Recovery Techniques as the foundation for its content. The coresearchers were trained in research methodology and conducted usability testing with other young people (n=11) using the think-aloud method, the System Usability Scale (SUS), and qualitative follow-up questions. Results: A functional app prototype was developed using a no-code platform, incorporating various trauma symptom management techniques. These techniques covered psychoeducation, normalization, relaxation, and cognitive shifting, presented in multiple formats, including text, audio, and video. The contributions of the coresearchers to the design can be categorized into 3 areas: mechanics (rules and interactions shaping the app?s structure), dynamics (user-visible elements, such as the outcome when pressing a button), and aesthetics (the emotional responses the app aimed to evoke in users during interaction). Beyond influencing basic aesthetics, the coresearchers placed significant emphasis on user experience and the emotional responses the app could evoke. SUS scores ranged from 67.5 to 97.5, with the vast majority exceeding 77.5, indicating good usability. However, usability testing revealed several issues, generally of lower severity. For instance, video content required improvements, such as reducing light flickering in some recordings and adding rewind and subtitle selection options. Notably, the feature for listening to others? stories was removed to minimize emotional burden, shifting the focus to text formats with more context. Conclusions: Young people who have experienced trauma can actively participate in the cocreation of a mental health intervention, offering valuable insights into the needs and preferences of their peers. Applying a child rights?based framework to their involvement in a research project supported the fulfillment of the Convention on the Rights of the Child Article 12. UR - https://formative.jmir.org/2025/1/e57789 UR - http://dx.doi.org/10.2196/57789 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57789 ER - TY - JOUR AU - Knapp, A. Ashley AU - Cohen, Katherine AU - Kruzan, P. Kaylee AU - Kornfield, Rachel AU - Herrera, Miguel AU - Pederson, B. Aderonke AU - Lee, Sydney AU - Macapagal, Kathryn AU - Roulston, A. Chantelle AU - Clarke, Kaleigh AU - Wijaya, Clarisa AU - Simmons, Robert AU - Jackson, Latonia AU - Kour, Simrandeep AU - Franco, Sandra AU - Mohr, C. David PY - 2025/3/13 TI - Teen Perspectives on Integrating Digital Mental Health Programs for Teens Into Public Libraries (?I Was Always at the Library?): Qualitative Interview Study JO - JMIR Form Res SP - e67454 VL - 9 KW - public libraries KW - digital mental health KW - teens KW - youth KW - adolescents KW - anxiety KW - mental health KW - implementation KW - safe spaces KW - mobile phone KW - smartphone N2 - Background: Rising rates of anxiety among teens necessitate innovative approaches for implementing evidence-based mental health support. Public libraries, seen as safe spaces for patrons with marginalized identities, offer free public services such as broadband internet access. Many teens spend significant amounts of time in their local libraries due to the safety of this space as well as the trusted adults working there. The American Library Association has shifted its priorities to focus more on mental health through employing social workers and providing mental health programs. As such, public libraries may be promising sites for the implementation of digital mental health (DMH) programs for teens. Objective: This study aimed to examine how teens who attended their local public library experienced and managed their anxiety, what mental health supports they were interested in receiving, and how DMH programs and public libraries can meet their needs. Methods: We interviewed 16 teens aged 12-18 (mean 15.2, SD 2.0) years who used the library frequently at the time of the interviews. Of these teen patrons, 56% (9/16) identified as female, 31% (5/16) identified as male, and 12% (2/16) identified as nonbinary. Most (11/16, 69%) identified as either White or Black or African American individuals, with the remainder (5/16, 31%) identifying as Hispanic or Latino or Chinese American individuals or with ?2 races. The interviews were individual and semistructured, designed to elicit recommendations for designing and implementing digital tools in libraries to improve teen mental health. Interview transcripts were coded by multiple coders using thematic analysis to synthesize key themes. Results: Teens reported experiencing uncontrollability, unpredictability, and anger related to their anxiety, which they managed using strategies such as guided breathing, distress tolerance, and social connection. They also talked about other helpful management techniques (eg, progressive muscle relaxation, journaling, and mood tracking). Teens underscored the importance of pairing mood tracking with daily activities to reveal patterns. They also stressed the significance of context and anxiety severity when choosing anxiety management strategies. Teens underscored the centrality of the public library in their lives and their view of it as a safe space where they can easily access resources and connect with friends and trusted adults. When considering the design of a DMH program implemented in libraries, they suggested including personalization for different identities, gamification, and simple navigation. Teens emphasized the importance of protecting their privacy within digital programs and that their end goal was to use the skills learned in the DMH program offline. Conclusions: Teens who frequently used their local public library expressed interest in receiving digital tools via libraries to help them manage anxiety. Their recommendations will help inform future research on the adaptation and implementation of DMH programs for teens in public libraries. UR - https://formative.jmir.org/2025/1/e67454 UR - http://dx.doi.org/10.2196/67454 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67454 ER - TY - JOUR AU - Dekel, Dana AU - Marchant, Amanda AU - Del Pozo Banos, Marcos AU - Mhereeg, Mohamed AU - Lee, Chim Sze AU - John, Ann PY - 2025/3/12 TI - Exploring the Views of Young People, Including Those With a History of Self-Harm, on the Use of Their Routinely Generated Data for Mental Health Research: Web-Based Cross-Sectional Survey Study JO - JMIR Ment Health SP - e60649 VL - 12 KW - self-harm KW - mental health KW - big data KW - survey KW - youth N2 - Background: Secondary use of routinely collected health care data has great potential benefits in epidemiological studies primarily due to the large scale of preexisting data. Objective: This study aimed to engage respondents with and without a history of self-harm, gain insight into their views on the use of their data for research, and determine whether there were any differences in opinions between the 2 groups. Methods: We examined young people?s views on the use of their routinely collected data for mental health research through a web-based survey, evaluating any differences between those with and without a history of self-harm. Results: A total of 1765 respondents aged 16 to 24 years were included. Respondents? views were mostly positive toward the use and linkage of their data for research purposes for public benefit, particularly with regard to the use of health care data (mental health or otherwise), and generally echoed existing evidence on the opinions of older age groups. Individuals who reported a history of self-harm and subsequently contacted health services more often reported being ?extremely likely? or ?likely? to share mental health data (contacted: 209/609, 34.3%; 95% CI 28.0-41.2; not contacted: 169/782, 21.6%; 95% CI 15.8-28.7) and physical health data (contacted: 117/609, 19.2%; 95% CI 12.7-27.8; not contacted: 96/782, 12.3%; 95% CI 6.7-20.9) compared with those who had not contacted services. Respondents were overall less likely to want to share their social media data, which they considered to be more personal compared to their health care data. Respondents stressed the importance of anonymity and the need for an appropriate ethical framework. Conclusions: Young people are aware, and they care about how their data are being used and for what purposes, irrespective of having a history of self-harm. They are largely positive about the use of health care data (mental or physical) for research and generally echo the opinions of older age groups raising issues around data security and the use of data for the public interest. UR - https://mental.jmir.org/2025/1/e60649 UR - http://dx.doi.org/10.2196/60649 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60649 ER - TY - JOUR AU - Gulec, Hayriye AU - Muzik, Michal AU - Smahel, David AU - Dedkova, Lenka PY - 2025/3/11 TI - Longitudinal Associations Between Adolescents? mHealth App Use, Body Dissatisfaction, and Physical Self-Worth: Random Intercept Cross-Lagged Panel Study JO - JMIR Ment Health SP - e60844 VL - 12 KW - mHealth app KW - body dissatisfaction KW - physical self-worth KW - random intercept cross-lagged panel model KW - RI-CLPM KW - longitudinal study KW - adolescent N2 - Background: Longitudinal investigation of the association between mobile health (mHealth) app use and attitudes toward one?s body during adolescence is scarce. mHealth apps might shape adolescents? body image perceptions by influencing their attitudes toward their bodies. Adolescents might also use mHealth apps based on how they feel and think about their bodies. Objective: This prospective study examined the longitudinal within-person associations between mHealth app use, body dissatisfaction, and physical self-worth during adolescence. Methods: The data were gathered from a nationally representative sample of Czech adolescents aged between 11 and 16 years (N=2500; n=1250, 50% girls; mean age 13.43, SD 1.69 years) in 3 waves with 6-month intervals. Participants completed online questionnaires assessing their mHealth app use, physical self-worth, and body dissatisfaction at each wave. The mHealth app use was determined by the frequency of using sports, weight management, and nutritional intake apps. Physical self-worth was assessed using the physical self-worth subscale of the Physical Self Inventory-Short Form. Body dissatisfaction was measured with the items from the body dissatisfaction subscale of the Eating Disorder Inventory-3. The random intercept cross-lagged panel model examined longitudinal within-person associations between the variables. A multigroup design was used to compare genders. Due to the missing values, the final analyses used data from 2232 adolescents (n=1089, 48.8% girls; mean age 13.43, SD 1.69 years). Results: The results revealed a positive within-person effect of mHealth app use on the physical self-worth of girls: increased mHealth app use predicted higher physical self-worth 6 months later (?=.199, P=.04). However, this effect was not consistent from the 6th to the 12th month: a within-person increase in using apps in the 6th month did not predict changes in girls? physical self-worth in the 12th month (?=.161, P=.07). Regardless of gender, the within-person changes in the frequency of using apps did not influence adolescents? body dissatisfaction. In addition, neither body dissatisfaction nor physical self-worth predicted app use frequency at the within-person level. Conclusions: This study highlighted that within-person changes in using mHealth apps were differentially associated with adolescents? body-related attitudes. While increased use of mHealth apps did not influence body dissatisfaction across genders, it significantly predicted higher physical self-worth in adolescent girls 6 months later. A similar association was not observed among boys after 6 months. These findings indicate that using mHealth apps is unlikely to have a detrimental impact on adolescents? body dissatisfaction and physical self-worth; instead, they may have a positive influence, particularly in boosting the physical self-worth of adolescent girls. UR - https://mental.jmir.org/2025/1/e60844 UR - http://dx.doi.org/10.2196/60844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60844 ER - TY - JOUR AU - Wu, Peng AU - Hurst, H. Jillian AU - French, Alexis AU - Chrestensen, Michael AU - Goldstein, A. Benjamin PY - 2025/3/4 TI - Linking Electronic Health Record Prescribing Data and Pharmacy Dispensing Records to Identify Patient-Level Factors Associated With Psychotropic Medication Receipt: Retrospective Study JO - JMIR Med Inform SP - e63740 VL - 13 KW - electronic health records KW - pharmacy dispensing KW - psychotropic medications KW - prescriptions KW - predictive modeling N2 - Background: Pharmacoepidemiology studies using electronic health record (EHR) data typically rely on medication prescriptions to determine which patients have received a medication. However, such data do not affirmatively indicate whether these prescriptions have been filled. External dispensing databases can bridge this information gap; however, few established methods exist for linking EHR data and pharmacy dispensing records. Objective: We described a process for linking EHR prescribing data with pharmacy dispensing records from Surescripts. As a use case, we considered the prescriptions and resulting fills for psychotropic medications among pediatric patients. We evaluated how dispensing information affects identifying patients receiving prescribed medications and assessing the association between filling prescriptions and subsequent health behaviors. Methods: This retrospective study identified all new psychotropic prescriptions to patients younger than 18 years of age at Duke University Health System in 2021. We linked dispensing to prescribing data using proximate dates and matching codes between RxNorm concept unique identifiers and National Drug Codes. We described demographic, clinical, and service use characteristics to assess differences between patients who did versus did not fill prescriptions. We fit a least absolute shrinkage and selection operator (LASSO) regression model to evaluate the predictability of a fill. We then fit time-to-event models to assess the association between whether a patient filled a prescription and a future provider visit. Results: We identified 1254 pediatric patients with a new psychotropic prescription. In total, 976 (77.8%) patients filled their prescriptions within 30 days of their prescribing encounters. Thus, we set 30 days as a cut point for defining a valid prescription fill. Patients who filled prescriptions differed from those who did not in several key factors. Those who did not fill had slightly higher BMIs, lived in more disadvantaged neighborhoods, were more likely to have public insurance or self-pay, and included a higher proportion of male patients. Patients with prior well-child visits or prescriptions from primary care providers were more likely to fill. Additionally, patients with anxiety diagnoses and those prescribed selective serotonin reuptake inhibitors were more likely to fill prescriptions. The LASSO model achieved an area under the receiver operator characteristic curve of 0.816. The time to the follow-up visit with the same provider was censored at 90 days after the initial encounter. Patients who filled prescriptions showed higher levels of follow-up visits. The marginal hazard ratio of a follow-up visit with the same provider was 1.673 (95% CI 1.463?1.913) for patients who filled their prescriptions. Using the LASSO model as a propensity-based weight, we calculated the weighted hazard ratio as 1.447 (95% CI 1.257?1.665). Conclusions: Systematic differences existed between patients who did versus did not fill prescriptions. Incorporating external dispensing databases into EHR-based studies informs medication receipt and associated health outcomes. UR - https://medinform.jmir.org/2025/1/e63740 UR - http://dx.doi.org/10.2196/63740 ID - info:doi/10.2196/63740 ER - TY - JOUR AU - Miranda, Christina AU - Matheson, Brittany AU - Datta, Nandini AU - Whyte, Aileen AU - Yang, Hyun-Joon AU - Schmiedmayer, Paul AU - Ravi, Vishnu AU - Aalami, Oliver AU - Lock, James PY - 2025/2/28 TI - Enhancing Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study JO - JMIR Form Res SP - e70278 VL - 9 KW - mHealth KW - mobile health KW - mobile application KW - emotion regulation KW - eating disorders KW - family-based treatment KW - distress tolerance KW - mealtimes N2 - Background: Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)?based distress tolerance skills to support adolescents and families during mealtimes. Objective: Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT. Methods: BALANCE was developed collaboratively with Stanford University?s Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app?s usability, perceived effectiveness, and its impact on their distress tolerance. Results: The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app?s broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa. Conclusions: BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a feasible tool for integration into FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes. As distress tolerance skills are relevant to a range of mental health conditions, future research may also expand BALANCE?s application to broader adolescent populations. UR - https://formative.jmir.org/2025/1/e70278 UR - http://dx.doi.org/10.2196/70278 ID - info:doi/10.2196/70278 ER - TY - JOUR AU - Samele, Chiara AU - Urquia, Norman AU - Edwards, Rachel AU - Donnell, Katie AU - Krause, Nihara PY - 2025/2/28 TI - Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre? and Post?Follow-Up Study JO - JMIR Form Res SP - e55603 VL - 9 KW - mental health KW - anxiety KW - depression KW - emotional and behavioral difficulties KW - mobile phone app KW - cognitive behavioral therapy KW - digital tool KW - young people KW - mobile phone N2 - Background: Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people. Objective: We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy. Methods: The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre? and post?follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post?app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis. Results: A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of ?very high? on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t36=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t47=4.5, 95% CI 3.67-9.65; P<.001), representing mostly medium to large standardized effect sizes. Conclusions: The Clear Fear app was found to be usable, acceptable, safe, and effective in helping manage symptoms of anxiety and depression and emotional and behavioral difficulties. UR - https://formative.jmir.org/2025/1/e55603 UR - http://dx.doi.org/10.2196/55603 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053764 ID - info:doi/10.2196/55603 ER - TY - JOUR AU - Murray, Louise Aja AU - Thye, Melissa AU - Obsuth, Ingrid AU - Cai, Shufang AU - Lui, Michael AU - Orr, Corina AU - Saravanan, Anusha PY - 2025/2/27 TI - A Narrative Review to Identify Promising Approaches for Digital Health Interventions to Support Emotion Regulation for Adolescents With Attention-Deficit/Hyperactivity Disorder JO - JMIR Ment Health SP - e56066 VL - 12 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - digital health intervention KW - adolescence KW - emotion regulation KW - emotion dysregulation KW - mobile phone KW - emotion KW - teens KW - youths KW - narrative review KW - support KW - development KW - design KW - regulation KW - young people KW - evaluation KW - neurodiversity KW - neurodivergent KW - attention deficit KW - neurodiverse KW - neuroscience KW - mental health KW - digital mental health UR - https://mental.jmir.org/2025/1/e56066 UR - http://dx.doi.org/10.2196/56066 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053767 ID - info:doi/10.2196/56066 ER - TY - JOUR AU - Ecclestone, Amy AU - Linden, Brooke AU - Rose, Jessica AU - Kullar, Kiran PY - 2025/2/27 TI - Mobilizing Health Promotion Through Canada?s Student Mental Health Network: Concurrent, Mixed Methods Process Evaluation JO - JMIR Form Res SP - e58992 VL - 9 KW - mental health KW - health promotion KW - program evaluation KW - postsecondary KW - knowledge translation N2 - Background: Mental health issues among Canadian postsecondary students are prevalent. In tandem, an increased acknowledgment of the need for upstream mental health support has been highlighted. While the majority of institutions offer some form of mental health promotion, research suggests students are failing to access support due to barriers including lack of awareness, geographical and financial barriers, and lack of relevance in offerings. Canada?s Student Mental Health Network is a web-based knowledge mobilization initiative designed to fill these gaps. With content created and curated ?for-students, by-students? and reviewed by subject matter experts, the Network serves as a one-stop shop for evidence-based, mental health support for postsecondary students. Objective: The goal of this research was to conduct the first component of a comprehensive program evaluation of the Network. This paper details a formative, process evaluation after approximately 1 year of operations, with the goal of assessing acceptability and feasibility. Methods: Using a concurrent mixed methods study design, quantitative and qualitative data were simultaneously collected from students in order to evaluate the acceptability and feasibility of the Network as a mental health promotion resource. Quantitative data were automatically collected through Google Analytics via the website over the course of the first year of operations. Data collected included the number of users accessing the website, user engagement, and user ?stickiness.? Quantitative data were used to evaluate both accessibility and feasibility. Qualitative data were collected via individual, digital interviews conducted with a modest sample of students (n=8) across areas and levels of study. Qualitative data derived more detailed insights into user experience and website attributes, as well as feedback on content delivery, providing evidence used to evaluate feasibility. Results: A total of 1200 users globally accessed the Network within the first year of operations, with Canadian users accounting for nearly 90% of total website traffic. An overall 66% engagement rate was observed, with the average user visiting 7 pages per session. Further support for the acceptability of the Network is demonstrated in the Canada-wide reach of the content development and review team. Evidence for the feasibility of the Network was observed through website use statistics indicating the most frequently viewed pages aligned with our goals: providing mental health education and increasing awareness of available resources. Qualitative feedback provided additional context surrounding the feasibility of the space, including positive feedback on the esthetics, relevance, usability, inclusion, and accessibility. Areas for content expansion and improvements to accessibility were also identified. Conclusions: The results of this study provide evidence in support of the feasibility and acceptability of the Network as a web-based knowledge mobilization initiative in support of postsecondary students? mental health and well-being. Future research will pursue a summative, impact assessment to evaluate utility. UR - https://formative.jmir.org/2025/1/e58992 UR - http://dx.doi.org/10.2196/58992 ID - info:doi/10.2196/58992 ER - TY - JOUR AU - Meyerhoff, Jonah AU - Popowski, A. Sarah AU - Lakhtakia, Tanvi AU - Tack, Emily AU - Kornfield, Rachel AU - Kruzan, P. Kaylee AU - Krause, J. Charles AU - Nguyen, Theresa AU - Rushton, Kevin AU - Pisani, R. Anthony AU - Reddy, Madhu AU - Van Orden, A. Kimberly AU - Mohr, C. David PY - 2025/2/26 TI - Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods JO - JMIR Form Res SP - e69602 VL - 9 KW - mental health services KW - technology KW - therapy KW - computer assisted KW - SMS text messaging N2 - Background: Young adults in the United States are experiencing accelerating rates of suicidal thoughts and behaviors but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with young adults who have lived experience of suicide-related thoughts and behaviors to optimize acceptability and use. Objective: This study aims to identify the needs, preferences, and features for an automated SMS text messaging?based safety planning service to support the self-management of suicide-related thoughts and behaviors among young adults. Methods: We enrolled 30 young adults (age 18-24 years) with recent suicide-related thoughts and behaviors to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants?creating a threaded digital conversation. Researcher-posted prompts centered on participants? experiences with suicide-related thought and behavior-related coping, safety planning, and technologies for suicide-related thought and behavior self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated SMS text messaging?based safety planning tool. Results: Young adult participants indicated that an automated digital SMS text message?based safety planning intervention must meet their needs in 2 ways. First, by empowering them to manage their symptoms on their own and support acquiring and using effective coping skills. Second, by leveraging young adults? existing social connections. Young adult participants also shared 3 key technological needs of an automated intervention: (1) transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program; (2) strong privacy practices?data security around how content within the intervention and how private data created by the intervention would be maintained and used was extremely important to young adult participants given the sensitive nature of suicide-related data; and (3) usability, convenience, and accessibility were particularly important to participants?this includes having an approachable and engaging message tone, customizable message delivery options (eg, length, number, content focus), and straightforward menu navigation. Young adult participants also highlighted specific features that could support core coping skill acquisition (eg, self-tracking, coping skill idea generation, reminders). Conclusions: Engaging young adults in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for suicide-related thoughts and behaviors. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency, and data privacy. UR - https://formative.jmir.org/2025/1/e69602 UR - http://dx.doi.org/10.2196/69602 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69602 ER - TY - JOUR AU - Lynch, Frances AU - Cavese, Julie AU - Fulton, Lucy AU - Vuckovic, Nancy AU - Brent, David PY - 2025/2/26 TI - Provider Perspectives on the Use of Mental Health Apps, and the BritePath App in Particular, With Adolescents at Risk for Suicidal Behavior: Qualitative Study JO - JMIR Hum Factors SP - e64867 VL - 12 KW - depression KW - adolescent KW - suicidality KW - safety plan KW - mental health KW - apps KW - suicide N2 - Background: Many youth with significant mental health concerns face limited access to mental health services. Digital programs, such as mobile apps designed to address mental health issues, have the potential to expand access to strategies for managing these conditions. However, few mental health apps are specifically designed for youth experiencing severe concerns, such as suicidal ideation. BritePath is a new app developed to enhance communication and interaction between providers and youth at risk for suicidal behavior. Objective: This study aims to explore health care providers? opinions and concerns regarding the use of mental health apps for youth at significant risk of suicidal behavior. Methods: We conducted individual semistructured interviews with 17 providers across 7 states. Interviews were conducted via video, recorded, and transcribed. Codes were developed using a team-based approach, with discrepancies resolved through team discussions. Results: Most providers were aware of mental health apps in general and expressed interest in trying the BritePath app with patients experiencing depression, suicidality, or both. Analyses identified 4 key themes related to mental health apps: (1) almost all providers viewed mental health apps as an adjunct to, rather than a replacement for, psychotherapy visits; (2) most providers were concerned about the cost of apps and youth access to them; (3) providers noted the challenge of maintaining patient engagement with apps over time; and (4) providers were concerned about patient privacy, in terms of both data shared with app developers and data privacy within families. Analyses of providers? opinions specifically about the BritePath app identified 4 additional themes: (1) providers believed that access to safety plans within BritePath could be beneficial for youth at risk for suicidal behavior; (2) providers reported that BritePath?s interactive features could enhance communication between providers and youth; (3) providers appreciated BritePath?s flexibility and the ability for both youth and providers to tailor its content to individual needs; and (4) providers expressed concerns about integrating BritePath into clinical workflows within health systems. Conclusions: The use of mental health apps is expanding, yet there is limited understanding of how to effectively integrate these tools into mental health treatment. Providers are increasingly referring patients to mental health apps, and most expressed interest in trying the BritePath app for patients with depression, suicidality, or both. However, providers also identified several concerns, particularly regarding privacy and safety. UR - https://humanfactors.jmir.org/2025/1/e64867 UR - http://dx.doi.org/10.2196/64867 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64867 ER - TY - JOUR AU - Corti, Claudia AU - Papini, Marta AU - Strazzer, Sandra AU - Borgatti, Renato AU - Romaniello, Romina AU - Poggi, Geraldina AU - Storm, Alexander Fabio AU - Urgesi, Cosimo AU - Jansari, Ashok AU - Wade, L. Shari AU - Bardoni, Alessandra PY - 2025/2/21 TI - Examining the Implementation of the Italian Version of the Teen Online Problem-Solving Program Coupled With Remote Psychological Support: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64178 VL - 14 KW - telerehabilitation KW - acquired brain injury KW - executive functioning KW - pediatric KW - problem-solving KW - computer N2 - Background: Pediatric acquired brain injury (ABI) is frequently associated with cognitive and socioemotional alterations. Therefore, targeted rehabilitation to improve everyday functioning, particularly executive functioning (EF), is needed to limit the possible deterioration of cognitive abilities and behavior over time and the associated social and psychological costs. Objective: In this paper, we present the protocol for a phase-2 randomized controlled trial (RCT) aimed at examining the feasibility and efficacy of a web-based intervention (ie, the Italian version of the Teen Online Problem-Solving [I-TOPS] intervention) to improve problem-solving abilities versus an active-control, web-based intervention (ie, wellness intervention) providing health and wellness content. Methods: A double-blinded, phase-2 RCT will be conducted to guarantee controls on data quality and findings. In total, 42 adolescents will be recruited from a rehabilitation institute and individually randomly assigned in a 1:1 ratio to receive the I-TOPS intervention or the web-based wellness intervention. Both interventions will include 10 core sessions and will be delivered remotely using a web-based platform. Participants allocated to both interventions and their caregivers will independently complete the learning modules in an everyday setting using their computer. The I-TOPS intervention?s core sessions will target the EF domain (eg, planning, emotion regulation, and social skills), while all the contents of the wellness intervention will be aimed at providing psychoeducation on ABI sequelae and supporting health and wellness. Participants assigned to the I-TOPS intervention will also receive bimonthly direct training in problem-solving coupled with remote support from a psychologist. Feasibility data and efficacy outcomes on both adolescents? and parents? functioning will be assessed. Cognitive abilities in the EF domain and behavioral and psychological functioning (ie, internalizing and externalizing symptoms) of the adolescents will be evaluated via performance-based measures, administered remotely using the Google Meet platform, and paper-and-pencil questionnaires; parents? well-being will be assessed through paper-and-pencil questionnaires. Efficacy will be evaluated immediately after training and at 6-month follow-up. Results: This study started on February 26, 2021, and ended on February 28, 2023. A total of 42 adolescents were enrolled and randomly assigned to the 2 study groups, 34 (81%) completed the intervention and posttreatment evaluation (I-TOPS: n=19 and wellness intervention: n=15) and 31 performed follow-up evaluation (I-TOPS: n=18 and wellness intervention: n=13). Data analysis on feasibility and efficacy will be performed after protocol publication, and the results will be published in the form of a paper in a relevant journal in 2025. Conclusions: This double-blinded, phase-2 RCT could extend knowledge on the best rehabilitation practices to adopt with the survivors of pediatric ABI by providing evidence-based data currently lacking for the Italian context. If this study yields positive results, a larger, multicenter, phase-3 RCT could be planned and delivered to examine program cost-effectiveness in a larger sample. Trial Registration: ClinicalTrials.gov NCT05169788; https://clinicaltrials.gov/study/NCT05169788 International Registered Report Identifier (IRRID): DERR1-10.2196/64178 UR - https://www.researchprotocols.org/2025/1/e64178 UR - http://dx.doi.org/10.2196/64178 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64178 ER - TY - JOUR AU - Zuair, Areeg PY - 2025/2/19 TI - Effect of the Reassured Self-Compassion?Based School Program on Anxiety, Video Game Addiction, and Body Image Among Rural Female Adolescents: Retrospective Study JO - JMIR Form Res SP - e68840 VL - 9 KW - adolescents KW - rural KW - compassion-focused therapy KW - mental health KW - Saudi Arabia KW - school N2 - Background: The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported. Objective: This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia. Methods: A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children's Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models. Results: Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference ?4.11, 95% CI ?6.98 to ?1.24; P=.005) and video game addiction (mean difference ?1.62, 95% CI ?2.83 to ?0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI ?0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention. Conclusions: The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions. UR - https://formative.jmir.org/2025/1/e68840 UR - http://dx.doi.org/10.2196/68840 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68840 ER - TY - JOUR AU - Stiles-Shields, Colleen AU - Bobadilla, Gabriella AU - Reyes, Karen AU - Gustafson, L. Erika AU - Lowther, Matthew AU - Smith, L. Dale AU - Frisbie, Charles AU - Antognini, Camilla AU - Dyer, Grace AU - MacCarthy, Rae AU - Martinengo, Nicolò AU - Morris, Guy AU - Touranachun, Alissa AU - Wilkens, M. Kimberlee AU - Julion, A. Wrenetha AU - Karnik, S. Niranjan PY - 2025/2/18 TI - Digital Mental Health Screening, Feedback, and Referral System for Teens With Socially Complex Needs: Protocol for a Randomized Controlled Trial Integrating the Teen Assess, Check, and Heal System into Pediatric Primary Care JO - JMIR Res Protoc SP - e65245 VL - 14 KW - teens KW - primary care KW - digital mental health KW - low intensity treatments KW - disparities N2 - Background: Teens with socially complex needs?those who face multiple and potentially overlapping adversities?are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. Objective: This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. Methods: Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. Results: Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. Conclusions: This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. Trial Registration: ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929 International Registered Report Identifier (IRRID): DERR1-10.2196/65245 UR - https://www.researchprotocols.org/2025/1/e65245 UR - http://dx.doi.org/10.2196/65245 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65245 ER - TY - JOUR AU - Hornstein, Silvan AU - Lueken, Ulrike AU - Wundrack, Richard AU - Hilbert, Kevin PY - 2025/2/18 TI - Predicting Satisfaction With Chat-Counseling at a 24/7 Chat Hotline for the Youth: Natural Language Processing Study JO - JMIR AI SP - e63701 VL - 4 KW - digital mental health KW - mental illness KW - mental disorder KW - adolescence KW - chat counseling KW - machine learning KW - artificial intelligence KW - large language model KW - natural language processing KW - deep learning N2 - Background: Chat-based counseling services are popular for the low-threshold provision of mental health support to youth. In addition, they are particularly suitable for the utilization of natural language processing (NLP) for improved provision of care. Objective: Consequently, this paper evaluates the feasibility of such a use case, namely, the NLP-based automated evaluation of satisfaction with the chat interaction. This preregistered approach could be used for evaluation and quality control procedures, as it is particularly relevant for those services. Methods: The consultations of 2609 young chatters (around 140,000 messages) and corresponding feedback were used to train and evaluate classifiers to predict whether a chat was perceived as helpful or not. On the one hand, we trained a word vectorizer in combination with an extreme gradient boosting (XGBoost) classifier, applying cross-validation and extensive hyperparameter tuning. On the other hand, we trained several transformer-based models, comparing model types, preprocessing, and over- and undersampling techniques. For both model types, we selected the best-performing approach on the training set for a final performance evaluation on the 522 users in the final test set. Results: The fine-tuned XGBoost classifier achieved an area under the receiver operating characteristic score of 0.69 (P<.001), as well as a Matthews correlation coefficient of 0.25 on the previously unseen test set. The selected Longformer-based model did not outperform this baseline, scoring 0.68 (P=.69). A Shapley additive explanations explainability approach suggested that help seekers rating a consultation as helpful commonly expressed their satisfaction already within the conversation. In contrast, the rejection of offered exercises predicted perceived unhelpfulness. Conclusions: Chat conversations include relevant information regarding the perceived quality of an interaction that can be used by NLP-based prediction approaches. However, to determine if the moderate predictive performance translates into meaningful service improvements requires randomized trials. Further, our results highlight the relevance of contrasting pretrained models with simpler baselines to avoid the implementation of unnecessarily complex models. Trial Registration: Open Science Framework SR4Q9; https://osf.io/sr4q9 UR - https://ai.jmir.org/2025/1/e63701 UR - http://dx.doi.org/10.2196/63701 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63701 ER - TY - JOUR AU - Corman, Downing Jae AU - Hughto, W. Jaclyn M. AU - Shireman, I. Theresa AU - Baker, Kellan AU - Steinle, Kate AU - Forcier, Michelle PY - 2025/2/14 TI - Mental Health Changes in US Transgender Adults Beginning Hormone Therapy Via Telehealth: Longitudinal Cohort Study JO - J Med Internet Res SP - e64017 VL - 27 KW - transgender KW - LGBT persons KW - telehealth KW - depression KW - anxiety KW - suicide KW - mental health KW - adult KW - virtual care KW - longitudinal cohort study KW - gender-affirming hormone therapy KW - United States KW - observational study KW - adolescent KW - mobile health N2 - Background: Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known. Objective: This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period. Methods: This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks. Results: Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ?10), 36% (120/342) reported anxiety (GAD-7 ?8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (?2.4, 95% CI ?3.0 to ?1.8) and GAD-7 scores (?1.5, 95% CI ?2.0 to ?1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (?50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up. Conclusions: This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care. UR - https://www.jmir.org/2025/1/e64017 UR - http://dx.doi.org/10.2196/64017 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64017 ER - TY - JOUR AU - Kiat, Jun AU - Ahmad, Mahadir AU - Mei Hsien Chan, Caryn AU - Zainalabidin, Satirah AU - Ungar, Michael AU - Subramaniam, Ponnusamy PY - 2025/2/12 TI - Effectiveness of Adaptation of a Resilience-Building Intervention Among Individuals With Adverse Childhood Experience: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e56826 VL - 14 KW - adverse childhood experience KW - resilience KW - resilience-building intervention KW - young adults KW - stress KW - psychological well-being N2 - Background: The impact of adverse childhood experiences (ACEs) has been the focus of most studies for the past decade. There is an indication that developing resilience can help youth overcome these ACEs. Objective: This article presents a study protocol for a randomized controlled trial (RCT) to investigate the effects of a resilience-building intervention on psychological well-being, coping strategies, stress, quality of life, resilience, resource finding, and resilience among individuals affected with ACEs in Malaysia. Methods: The is a 2-armed, single-blind, RCT, whereby 50 participants (25 in each group) with ACEs will be randomly assigned to intervention and control groups. The former will be exposed to a resilience-building program (R2), which entails a multisystemic approach to resilience and recognizes the importance of rugged qualities and access to resources among individuals affected with ACEs. The intervention will be delivered via internet-based by a facilitator and broadly divided into 5 sessions, focusing on self-exploration and social support, coping techniques and coping skills, resource finding, spirituality, and resilience building. Meanwhile, the control group participants will not receive any form of intervention. Saliva samples will also be collected from both groups and assessed for salivary cortisol levels. Outcome measures will be assessed during baseline and postintervention using validated instruments. Another follow-up measurement will be conducted 4 weeks later. Results: The clinical trial has been registered with the Australia New Zealand Clinical Trials Registry. Ethical approval was obtained from the Research Ethics Board at the National University of Malaysia (UKM PPI/111/8/JEP-2021-894). A total of 28 participants have been recruited to the RCT Participant recruitment will be completed by January 2025. The final analysis will be conducted by March 2025. Conclusions: This is among the first studies to provide evidence in the context of RCTs for resilience-building intervention that combines self-report and physiological measures (ie, saliva and heart blood pressure) among individuals with ACEs. The findings will assist relevant authorities in the health and policy sectors to develop effective strategies for addressing the negative impacts of ACEs on the vulnerable population in Malaysia. Trial Registration: ACTRN12622000604707; https://www.anzctr.org.au/Trial/Result/DataSharingStatement.aspx?id=383614 International Registered Report Identifier (IRRID): DERR1-10.2196/56826 UR - https://www.researchprotocols.org/2025/1/e56826 UR - http://dx.doi.org/10.2196/56826 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56826 ER - TY - JOUR AU - Mardini, T. Mamoun AU - Khalil, E. Georges AU - Bai, Chen AU - DivaKaran, Menon Aparna AU - Ray, M. Jessica PY - 2025/2/12 TI - Identifying Adolescent Depression and Anxiety Through Real-World Data and Social Determinants of Health: Machine Learning Model Development and Validation JO - JMIR Ment Health SP - e66665 VL - 12 KW - social determinants of health KW - adolescents KW - anxiety KW - depression KW - machine learning KW - real-world data KW - teenagers KW - youth KW - XGBoost KW - cross-validation technique KW - SHapley Additive exPlanation KW - mental health KW - mental disorder KW - mental illness KW - health outcomes KW - clinical data N2 - Background: The prevalence of adolescent mental health conditions such as depression and anxiety has significantly increased. Despite the potential of machine learning (ML), there is a shortage of models that use real-world data (RWD) to enhance early detection and intervention for these conditions. Objective: This study aimed to identify depression and anxiety in adolescents using ML techniques on RWD and social determinants of health (SDoH). Methods: We analyzed RWD of adolescents aged 10?17 years, considering various factors such as demographics, prior diagnoses, prescribed medications, medical procedures, and laboratory measurements recorded before the onset of anxiety or depression. Clinical data were linked with SDoH at the block-level. Three separate models were developed to predict anxiety, depression, and both conditions. Our ML model of choice was Extreme Gradient Boosting (XGBoost) and we evaluated its performance using the nested cross-validation technique. To interpret the model predictions, we used the Shapley additive explanation method. Results: Our cohort included 52,054 adolescents, identifying 12,572 with anxiety, 7812 with depression, and 14,019 with either condition. The models achieved area under the curve values of 0.80 for anxiety, 0.81 for depression, and 0.78 for both combined. Excluding SDoH data had a minimal impact on model performance. Shapley additive explanation analysis identified gender, race, educational attainment, and various medical factors as key predictors of anxiety and depression. Conclusions: This study highlights the potential of ML in early identification of depression and anxiety in adolescents using RWD. By leveraging RWD, health care providers may more precisely identify at-risk adolescents and intervene earlier, potentially leading to improved mental health outcomes. UR - https://mental.jmir.org/2025/1/e66665 UR - http://dx.doi.org/10.2196/66665 ID - info:doi/10.2196/66665 ER - TY - JOUR AU - Kim, I. Sol AU - Jin, Jae-Chan AU - Yoo, Seo-Koo AU - Han, Hyun Doug PY - 2025/2/11 TI - Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study JO - JMIR Pediatr Parent SP - e66448 VL - 8 KW - coronavirus pandemic KW - internet use pattern KW - internet games KW - short-form videos KW - social network system KW - depressed mood KW - internet use KW - pandemic KW - internet KW - COVID-19 KW - video KW - internet behavior KW - social media KW - internet addiction KW - depression KW - anxiety KW - digital platforms KW - mobile phone N2 - Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents? psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 (?23=8.16, P=.04). Furthermore, this study showed that the Young?s Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. UR - https://pediatrics.jmir.org/2025/1/e66448 UR - http://dx.doi.org/10.2196/66448 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66448 ER - TY - JOUR AU - Chemnad, Khansa AU - Aziz, Maryam AU - Al- Harahsheh, Sanaa AU - Abdelmoneium, Azza AU - Baghdady, Ahmed AU - Alsayed Hassan, Diana AU - Ali, Raian PY - 2025/2/10 TI - Assessing the Relationship Between the Type of Internet Use and Internet Addiction in Early and Middle Adolescents: Cross-Sectional Study From Qatar JO - JMIR Hum Factors SP - e62955 VL - 12 KW - internet addiction KW - internet use KW - early adolescence KW - middle adolescence KW - mobile phone N2 - Background: With the increasing prevalence of digital technology, adolescent internet addiction (IA) has become a global concern. Excessive internet use, especially among adolescents, has been linked to various negative outcomes such as poor academic performance, social isolation, and mental health issues. Conducted among adolescents of Arab origin, our study addressed the limitations of the literature, which predominantly focuses on Western, educated, industrialized, rich, and democratic populations. Objective: This study aimed to differentiate between essential and nonessential internet use and how they relate to IA in early and middle adolescents, as well as the relationship between subjective happiness with the amount of time spent on nonessential internet use and IA. Methods: A cross-sectional survey was conducted among 377 students from 16 schools in Qatar. The survey measured essential and nonessential internet use, subjective happiness with nonessential use, and IA symptoms using the Internet Addiction Diagnostic Questionnaire, as well as participant demographics. To explore age-specific associations, participants were categorized into early (age 11-13 years) and middle (age 14-17 years) adolescents. Factorial analysis, multiple regression, and logistic regression were used for statistical analysis. Results: Nonessential internet use significantly predicted IA in both early (P<.001) and middle (P<.001) adolescents, with early adolescents showing a stronger association. Subjective happiness with nonessential internet use negatively predicted IA only in middle adolescents (P<.001) as greater dissatisfaction led to a higher IA risk. Essential internet use did not predict IA in either group. Conclusions: Differentiating between essential and nonessential internet use is crucial in understanding IA. This study highlights the importance of developmental differences in shaping IA symptoms. The findings suggest that interventions aimed at addressing IA should be age specific and focus on addressing nonessential use specifically rather than considering internet use and screen time in general as a single entity. Cultural and regional factors also play a role in shaping internet use patterns and IA in the Middle East, necessitating context-specific, culturally sensitive approaches to IA prevention. UR - https://humanfactors.jmir.org/2025/1/e62955 UR - http://dx.doi.org/10.2196/62955 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62955 ER - TY - JOUR AU - Liu, Yujie AU - Ge, Xin AU - Wang, Ying AU - Yang, Xue AU - Liu, Shangbin AU - Xu, Chen AU - Xiang, Mi AU - Hu, Fan AU - Cai, Yong PY - 2025/2/7 TI - Urban-Rural Differences in the Association Between Internet Use Trajectories and Depressive Symptoms in Chinese Adolescents: Longitudinal Observational Study JO - J Med Internet Res SP - e63799 VL - 27 KW - internet use KW - trajectory KW - depressive symptoms KW - adolescent KW - urban KW - rural N2 - Background: Internet use exhibits diverse trajectories during adolescence, which may contribute to depressive symptoms. Currently, it remains unclear whether the association between internet use trajectories and depressive symptoms varies between urban and rural areas. Objective: This study aimed to investigate the association between internet use trajectories and adolescent depressive symptoms and to explore variation in this association between urban and rural areas. Methods: This longitudinal study used 3-wave data from the 2014-2018 China Family Panel Study. Weekly hours of internet use and depressive symptoms were measured using self-reported questionnaires. Latent class growth modeling was performed to identify the trajectories of internet use. Multivariable logistic regressions were used to examine the association between internet use trajectories and depressive symptoms, stratified by rural and urban residence. Results: Participants were 2237 adolescents aged 10 to 15 years at baseline (mean age 12.46, SD 1.73 years). Two latent trajectory classes of internet use were identified: the low-growth group (n=2008, 89.8%) and the high-growth group (n=229, 10.2%). The high-growth group was associated with higher odds of depressive symptoms (OR 1.486, 95% CI 1.065-2.076) compared to the low-growth group. In the stratified analysis, the association between internet use trajectories and depressive symptoms was significant solely among rural adolescents (OR 1.856, 95% CI 1.164-2.959). Conclusions: This study elucidates urban-rural differences in the associations between trajectories of internet use and adolescent depressive symptoms. Our findings underscore the importance of prioritizing interventions for rural adolescents? internet use behaviors to mitigate negative effects on their mental health. UR - https://www.jmir.org/2025/1/e63799 UR - http://dx.doi.org/10.2196/63799 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63799 ER - TY - JOUR AU - Ananya, Ananya AU - Tuuli, Janina AU - Perowne, Rachel AU - Gutman, Morrison Leslie PY - 2025/2/5 TI - Barriers and Facilitators to User Engagement and Moderation for Web-Based Peer Support Among Young People: Qualitative Study Using the Behavior Change Wheel Framework JO - JMIR Hum Factors SP - e64097 VL - 12 KW - internet KW - moderation KW - engagement KW - youth KW - teenager KW - adolescent KW - peer support KW - web-based group KW - user engagement KW - support group KW - barrier KW - facilitator KW - Theoretical Domains Framework KW - Behavior Change Wheel KW - qualitative KW - interview KW - behavior change technique KW - thematic analysis N2 - Background: Peer support groups or web-based chats for young people offer anonymous peer support in judgment-free spaces, where users may share their thoughts and feelings with others who may have experienced similar situations. User engagement is crucial for effective web-based peer support; however, levels of engagement vary. While moderation of peer support groups can have a positive impact on the engagement of young people, effective moderation can be challenging to implement. Objective: This study aimed to identify barriers and facilitators to user engagement with, and moderation of, web-based peer support groups among young people aged 16 to 25 years and to provide recommendations for enhancing this service. Methods: Drawing upon the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), this study conducted qualitative interviews and gathered open-ended questionnaires from service users and moderators of The Mix, the United Kingdom?s leading web-based mental health platform providing peer support groups for young people. Semistructured interviews were conducted with 2 service users and 8 moderators, and open-ended questionnaires were completed by 7 service users. Themes were coded using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and the TDF. The BCW tools were then used to identify relevant behavior change techniques to improve user engagement in, and moderation of, the service. Results: Thematic analysis revealed a total of 20 inductive themes within 10 TDF domains?9 (45%) for engagement and 11 (55%) for moderation. Of these 20 themes, 3 (15%) were facilitators of engagement, 7 (35%) were facilitators of moderation, 4 (20%) were barriers to moderation, and 6 (30%) barriers to engagement. Results suggest that skills, knowledge, beliefs about consequences, intentions, emotions, and the social and physical environment are important factors influencing service users and moderators of group chats. In particular, supporting the improvement of memory, attention, and decision-making skills of those involved; adapting the physical environment to facilitate effective interactions; and reducing negative emotions are suggested to optimize the value and effectiveness of peer support groups for young people?s mental health for both the service users and moderators of these services. Conclusions: The study demonstrates the effectiveness of the BCW approach and the use of the TDF and COM-B model to understand the influences on behavior in a systematic manner, especially for mental health and well-being interventions. The findings can be applied to design structured interventions to change behaviors related to the engagement with, and moderation of, web-based peer support groups and, in turn, improve mental health outcomes for young people. UR - https://humanfactors.jmir.org/2025/1/e64097 UR - http://dx.doi.org/10.2196/64097 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64097 ER - TY - JOUR AU - de Graaff, Marijn Anne AU - Habashneh, Rand AU - Fanatseh, Sarah AU - Keyan, Dharani AU - Akhtar, Aemal AU - Abualhaija, Adnan AU - Faroun, Muhannad AU - Aqel, Said Ibrahim AU - Dardas, Latefa AU - Servili, Chiara AU - van Ommeren, Mark AU - Bryant, Richard AU - Carswell, Kenneth PY - 2025/2/5 TI - Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial JO - JMIR Ment Health SP - e63515 VL - 12 KW - chatbot KW - youth KW - depression KW - anxiety KW - feasibility study KW - randomized controlled trial KW - mental health KW - evaluation KW - Jordan KW - CBT KW - psychological treatment KW - digital intervention KW - health intervention KW - mood disorder KW - digital health N2 - Background: Depression and anxiety are a leading cause of disability worldwide and often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organization (WHO) developed a guided, nonartificial intelligence chatbot intervention called Scalable Technology for Adolescents and youth to Reduce Stress (STARS) to reduce symptoms of depression and anxiety among young people affected by adversity. Objective: The objective of this study was to evaluate the feasibility of the STARS intervention and study procedures among young people in Jordan. Methods: A 2-arm, single-blind, feasibility randomized controlled trial was conducted among 60 young people aged 18 years to 21 years living in Jordan with self-reported elevated levels of psychological distress. Immediately after baseline, participants were randomized 1:1 into the STARS intervention or enhanced care as usual (ECAU). STARS consisted of 10 lessons in which participants interacted with a chatbot and learned several cognitive behavioral therapy strategies, with optional guidance by a trained e-helper through 5 weekly phone calls. ECAU consisted of a static web page providing basic psychoeducation. Online questionnaires were administered at baseline (week 0) and postassessment (week 8) to assess depression (Hopkins Symptom Checklist-25 [HSCL-25]), anxiety (HSCL-25), functional impairment (WHO Disability Assessment Schedule [WHODAS] 2.0), psychological well-being (WHO-Five Well-Being Index [WHO-5]), and agency (State Hope Scale). Process evaluation interviews with stakeholders were conducted after the postassessment. Results: Participants were recruited in December 2022 and January 2023. Of 700 screening website visits, 160 participants were eligible, and 60 participants (mean age 19.7, SD 1.16 years; 49/60, 82% female) continued to baseline and were randomized into STARS (n=30) or ECAU (n=30). Of those who received STARS, 37% (11/30) completed at least 8 chatbot lessons, and 13% (4/30) completed all 5 support calls. The research protocol functioned well in terms of balanced randomization, high retention at postassessment (48/60, 80%), and good psychometric properties of the online questionnaires. Process evaluation interviews with STARS participants, ECAU participants, e-helpers, and the clinical supervisor indicated the acceptability of the study procedures and the STARS and ECAU conditions and highlighted several aspects that could be improved, including the e-helper support and features of the STARS chatbot. Conclusions: This study demonstrated the feasibility and acceptability of the STARS intervention and research procedures. A fully powered, definitive randomized controlled trial will be conducted to evaluate the effectiveness of STARS. Trial Registration: ISRCTN ISRCTN19217696; https://doi.org/10.1186/ISRCTN19217696 UR - https://mental.jmir.org/2025/1/e63515 UR - http://dx.doi.org/10.2196/63515 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63515 ER - TY - JOUR AU - Chan, Tai Kai AU - Hui, LM Christy AU - Cheung, Charlton AU - Suen, Nam Yi AU - Wong, Yin Stephanie Ming AU - Wong, SM Corine AU - Kam, PH Bosco AU - Chen, Hai Eric Yu PY - 2025/1/31 TI - Exploring the Differentiation of Self-Concepts in the Physical and Virtual Worlds Using Euclidean Distance Analysis and Its Relationship With Digitalization and Mental Health Among Young People: Cross-Sectional Study JO - JMIR Ment Health SP - e60747 VL - 12 KW - digitalization KW - self KW - identity KW - psychiatric symptomatology KW - youth mental health KW - Euclidean distance analysis KW - self-differentiation KW - smartphone addiction KW - personal attributes N2 - Background: Increasing observation and evidence suggest that the process of digitalization could have profound impact to the development of human mind and self, with potential mental health consequences. Self-differentiation is important in human identity and self-concept formation, which is believed to be involved in the process of digitalization. Objective: This study aimed to investigate the relationship between digitalization and personal attributes in the actual selves in the physical and virtual worlds. Methods: A community cohort of 397 participants aged 15 to 24 years old was recruited consecutively over about 3 months. Assessment was conducted upon the indicators of digitalization (smartphone use time, leisure online time, and age of first smartphone ownership), smartphone addiction, 14 selected personal attributes in the actual selves in the physical and virtual worlds, psychiatric symptomatology and personality traits. Euclidean distance analysis between the personal attributes in the actual selves in the physical and virtual worlds for the similarities of the 2 selves was performed in the analysis. Results: The current primary findings are the negative correlations between the similarity of the personal attributes in the physical actual self and virtual actual self, and smartphone use time, smartphone addiction as well as anxiety symptomatology respectively (P<.05 to P<.01). Conclusions: The current findings provide empirical evidence for the importance of maintaining a congruent self across the physical and virtual worlds, regulating smartphone use time, preventing smartphone addiction, and safeguarding mental health. UR - https://mental.jmir.org/2025/1/e60747 UR - http://dx.doi.org/10.2196/60747 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60747 ER - TY - JOUR AU - MacIsaac, Angela AU - Neufeld, Teagan AU - Malik, Ishaq AU - Toombs, Elaine AU - Olthuis, V. Janine AU - Schmidt, Fred AU - Dunning, Crystal AU - Stasiuk, Kristine AU - Bobinski, Tina AU - Ohinmaa, Arto AU - Stewart, H. Sherry AU - Newton, S. Amanda AU - Mushquash, R. Aislin PY - 2025/1/30 TI - Increasing Access to Mental Health Supports for 18- to 25-Year-Old Indigenous Youth With the JoyPop Mobile Mental Health App: Study Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64745 VL - 14 KW - mental health KW - youth KW - Indigenous KW - First Nations KW - eHealth KW - mHealth KW - JoyPop KW - protocol KW - mobile mental health app KW - mobile app KW - Canada KW - mobile health KW - emotion regulation N2 - Background: Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario. Objective: The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services. Methods: The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use. Results: Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study. Conclusions: This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool. Trial Registration: ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154 International Registered Report Identifier (IRRID): DERR1-10.2196/64745 UR - https://www.researchprotocols.org/2025/1/e64745 UR - http://dx.doi.org/10.2196/64745 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64745 ER - TY - JOUR AU - da Rosa, Teixeira André Luiz Schuh AU - da Costa, Barreto Marina Ribeiro AU - Sorato, Bezerra Gabriela AU - Manjabosco, Moura Felipe de AU - de Bem, Bonganhi Érica AU - Dellazari, Lucas AU - Falcão, Bezerra Arthur AU - Cia, Oliveira Lucas de AU - Bezerra, Sorato Olivia AU - Borges, Boff Rogério AU - Rohde, Augusto Luis AU - Graeff-Martins, Soledade Ana PY - 2025/1/30 TI - Clozapine for Treatment-Resistant Disruptive Behaviors in Youths With Autism Spectrum Disorder Aged 10-17 Years: Protocol for an Open-Label Trial JO - JMIR Res Protoc SP - e58031 VL - 14 KW - neurodevelopmental disorders KW - clozapine KW - psychopharmacology KW - antipsychotic medication KW - autism spectrum disorder KW - youth N2 - Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition emerging in early childhood, characterized by core features such as sociocommunicative deficits and repetitive, rigid behaviors, interests, and activities. In addition to these, disruptive behaviors (DB), including aggression, self-injury, and severe tantrums, are frequently observed in pediatric patients with ASD. The atypical antipsychotics risperidone and aripiprazole, currently the only Food and Drug Administration?approved treatments for severe DB in patients with ASD, often encounter therapeutic failure or intolerance. Given this, exploring pharmacological alternatives for more effective management of DB associated with ASD is essential. Clozapine, noted for its unique antiaggressive effects in schizophrenia and in various treatment-resistant neuropsychiatric disorders, independent from its antipsychotic efficacy, remains underexplored in youths with ASD facing severe and persistent DB. Objective: This study aimed to evaluate the efficacy, tolerability, and safety of clozapine for treatment-resistant DB in youths with ASD. Methods: This is a prospective, single-center, noncontrolled, open-label trial. After a cross-titration phase, 31 patients with ASD aged 10-17 years and with treatment-resistant DB received a flexible dosage regimen of clozapine (up to 600 mg/day) for 12 weeks. Standardized instruments were applied before, during, and after the treatment, and rigorous clinical monitoring was performed weekly. The primary outcome was assessed using the Irritability Subscale of the Aberrant Behavior Checklist. Other efficacy measures include the Clinical Global Impression Severity and Improvement, the Swanson, Nolan, and Pelham questionnaire-IV, the Childhood Autism Rating Scale, and the Vineland Adaptive Behavior Scale. Safety and tolerability measures comprised adverse events, vital signs, electrocardiography, laboratory tests, physical measurements, and extrapyramidal symptoms with the Simpsons-Angus Scale. Statistical analysis will include chi-square tests with Monte Carlo simulation for categorical variables, paired t tests or Wilcoxon tests for continuous variables, and multivariate linear mixed models to evaluate the primary outcome, adjusting for confounders. Results: Recruitment commenced in February 2023. Data collection was concluded by April 2024, with analysis ongoing. This article presents the protocol of the initially planned study to provide a detailed methodological description. The results of this trial will be published in a future paper. Conclusions: The urgent need for effective pharmacological therapies in mitigating treatment-resistant DB in pediatric patients with ASD underscores the importance of this research. Our study represents the first open-label trial to explore the anti-aggressive effects of clozapine in this specific demographic, marking a pioneering step in clinical investigation. Adopting a pragmatic approach, this trial protocol aims to mirror real-world clinical settings, thereby enhancing the applicability and relevance of our findings. The preliminary nature of future results from this research has the potential to pave the way for more robust studies and emphasize the need for continued innovation in ASD treatment. Trial Registration: Brazilian Clinical Trials Registry RBR-54j3726; https://ensaiosclinicos.gov.br/rg/RBR-54j3726 International Registered Report Identifier (IRRID): DERR1-10.2196/58031 UR - https://www.researchprotocols.org/2025/1/e58031 UR - http://dx.doi.org/10.2196/58031 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58031 ER - TY - JOUR AU - Sankesara, Heet AU - Denyer, Hayley AU - Sun, Shaoxiong AU - Deng, Qigang AU - Ranjan, Yatharth AU - Conde, Pauline AU - Rashid, Zulqarnain AU - Asherson, Philip AU - Bilbow, Andrea AU - Groom, J. Madeleine AU - Hollis, Chris AU - Dobson, B. Richard J. AU - Folarin, Amos AU - Kuntsi, Jonna PY - 2025/1/29 TI - Identifying Digital Markers of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Remote Monitoring Setting: Prospective Observational Study JO - JMIR Form Res SP - e54531 VL - 9 KW - ADHD KW - smartphones KW - wearable devices KW - mobile health KW - mHealth KW - remote monitoring KW - surveillance KW - digital markers KW - attention-deficit/hyperactivity disorder KW - behavioral data KW - real world KW - adult KW - adolescent KW - participants KW - digital signals KW - restlessness KW - severity KW - predicting outcomes N2 - Background: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)?base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. Objective: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. Methods: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. Results: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). Conclusions: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes. UR - https://formative.jmir.org/2025/1/e54531 UR - http://dx.doi.org/10.2196/54531 ID - info:doi/10.2196/54531 ER - TY - JOUR AU - Feusner, D. Jamie AU - Farrell, R. Nicholas AU - Nunez, Mia AU - Lume, Nicholas AU - MacDonald, W. Catherine AU - McGrath, B. Patrick AU - Trusky, Larry AU - Smith, Stephen AU - Rhode, Andreas PY - 2025/1/27 TI - Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study JO - J Med Internet Res SP - e66715 VL - 27 KW - digital behavioral health KW - youth KW - cognitive-behavioral therapy KW - exposure and response prevention KW - CBT KW - ERP KW - OCD KW - psychiatry KW - clinical trial KW - psychology KW - video therapy KW - teletherapy KW - e-therapy KW - e-counseling KW - cyber-counseling KW - adolescents KW - adolescence KW - obsessive-compulsive disorder KW - retrospective study KW - longitudinal study KW - observational study KW - ERP therapy N2 - Background: An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings. Objective: This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date. Methods: Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models. Results: Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54. Conclusions: These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD. UR - https://www.jmir.org/2025/1/e66715 UR - http://dx.doi.org/10.2196/66715 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66715 ER - TY - JOUR AU - Charlton, Jaidyn AU - Malik, Ishaq AU - Ashley, M. Angela AU - Newton, Amanda AU - Toombs, Elaine AU - Schmidt, Fred AU - Olthuis, V. Janine AU - Stasiuk, Kristine AU - Bobinski, Tina AU - Mushquash, Aislin PY - 2025/1/23 TI - Identifying the Minimal Clinically Important Difference in Emotion Regulation Among Youth Using the JoyPop App: Survey Study JO - JMIR Form Res SP - e64483 VL - 9 KW - mHealth KW - mobile health KW - app KW - psychometrics KW - emotion regulation KW - Indigenous mental health KW - Indigenous youth KW - mental health interventions KW - resilience KW - clinical psychology KW - adolescent mental health KW - mental health KW - JoyPop KW - pediatrics KW - mobile phone N2 - Background: The minimal clinically important difference (MCID) is an important threshold to consider when evaluating the meaningfulness of improvement following an intervention. The JoyPop app is an evidence-based smartphone app designed to improve resilience and emotion regulation. Information is needed regarding the JoyPop app?s MCID among culturally diverse youth. Objective: This study aims to calculate the MCID for youth using the JoyPop app and to explore how the MCID may differ for a subset of Indigenous youth. Methods: Youth (N=36; aged 12-18 years) were recruited to use the JoyPop app for up to 4 weeks as part of a larger pilot evaluation. Results were based on measures completed after 2 weeks of app use. The MCID was calculated using emotion regulation change scores (Difficulties in Emotion Regulation?Short Form [DERS-SF]) and subjective ratings on the Global Rating of Change Scale (GRCS). This MCID calculation was completed for youth overall and separately for Indigenous youth only. Results: A significant correlation between GRCS scores and change scores on the DERS-SF supported face validity (r=?0.37; P=.04). The MCID in emotion regulation following the use of the JoyPop app for youth overall was 2.80 on the DERS-SF. The MCID for Indigenous youth was 4.29 on the DERS-SF. In addition, most youth reported improved emotion regulation after using the JoyPop app. Conclusions: These MCID findings provide a meaningful threshold for improvement in emotion regulation for the JoyPop app. They provide potential effect sizes and can aid in sample size estimations for future research with the JoyPop app or e-mental health technologies in general. The difference between overall youth and Indigenous youth MCID values also highlights the importance of patient-oriented ratings of symptom improvement as well as cultural considerations when conducting intervention research and monitoring new interventions in clinical practice. UR - https://formative.jmir.org/2025/1/e64483 UR - http://dx.doi.org/10.2196/64483 UR - http://www.ncbi.nlm.nih.gov/pubmed/39847426 ID - info:doi/10.2196/64483 ER - TY - JOUR AU - March, Sonja AU - Spence, H. Susan AU - Myers, Larry AU - Ford, Martelle AU - Smith, Genevieve AU - Donovan, L. Caroline PY - 2025/1/22 TI - Integrating Videoconferencing Therapist Guidance Into Stepped Care Internet-Delivered Cognitive Behavioral Therapy for Child and Adolescent Anxiety: Noninferiority Randomized Controlled Trial JO - JMIR Ment Health SP - e57405 VL - 12 KW - internet-delivered cognitive behavioral therapy KW - ICBT KW - anxiety KW - child KW - adolescent KW - stepped care KW - videoconferencing N2 - Background: Self-guided internet-delivered cognitive behavioral therapy (ICBT) achieves greater reach than ICBT delivered with therapist guidance, but demonstrates poorer engagement and fewer clinical benefits. Alternative models of care are required that promote engagement and are effective, accessible, and scalable. Objective: This randomized trial evaluated whether a stepped care approach to ICBT using therapist guidance via videoconferencing for the step-up component (ICBT-SC[VC]) is noninferior to ICBT with full therapist delivery by videoconferencing (ICBT-TG[VC]) for child and adolescent anxiety. Methods: Participants included 137 Australian children and adolescents aged 7 to 17 years (male: n=61, 44.5%) with a primary anxiety disorder who were recruited from participants presenting to the BRAVE Online website. This noninferiority randomized trial compared ICBT-SC[VC] to an ICBT-TG[VC] program, with assessments conducted at baseline, 12 weeks, and 9 months after treatment commencement. All ICBT-TG[VC] participants received therapist guidance (videoconferencing) after each session for all 10 sessions. All ICBT-SC[VC] participants completed the first 5 sessions online without therapist guidance. If they demonstrated response to treatment after 5 sessions (defined as reductions in anxiety symptoms to the nonclinical range), they continued sessions without therapist guidance. If they did not respond, participants were stepped up to receive supplemental therapist guidance (videoconferencing) for the remaining sessions. The measures included a clinical diagnostic interview (Anxiety Disorders Interview Schedule) with clinician-rated severity rating as the primary outcome and parent- and child-reported web-based surveys assessing anxiety and anxiety-related interference (secondary outcomes). Results: Although there were no substantial differences between the treatment conditions on primary and most secondary outcome measures, the noninferiority of ICBT-SC[VC] compared to ICBT-TG[VC] could not be determined. Significant clinical benefits were evident for participants in both treatments, although this was significantly higher for the ICBT-TG[VC] participants. Of the 89 participants (38 in ICBT-SC[VC] and 51 in ICBT-TG[VC]) who remained in the study, 26 (68%) in ICBT-SC[VC] and 45 (88%) in ICBT-TG[VC] were free of their primary anxiety diagnosis by the 9-month follow-up. For the intention-to-treat sample (N=137), 41% (27/66) ICBT-SC[VC], and 69% (49/71) ICBT-TG[VC] participants were free of their primary anxiety diagnosis. Therapy compliance was lower for the ICBT-SC[VC] participants (mean 7.39, SD 3.44 sessions) than for the ICBT-TG[VC] participants (mean 8.73, SD 3.08 sessions), although treatment satisfaction was moderate to high in both conditions. Conclusions: This study provided further support for the benefits of low-intensity ICBT for children and adolescents with a primary anxiety disorder and highlighted the excellent treatment outcomes that can be achieved through therapist-guided ICBT delivered via videoconferencing. Although noninferiority of the stepped care adaptive approach could not be determined, it was acceptable to families, produced good outcomes, and could assist in increasing access to evidence-based care. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001418268; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001418268 UR - https://mental.jmir.org/2025/1/e57405 UR - http://dx.doi.org/10.2196/57405 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57405 ER - TY - JOUR AU - Amsalem, Doron AU - Greuel, Merlin AU - Liu, Shuyan AU - Martin, Andrés AU - Adam, Maya PY - 2025/1/20 TI - Effect of a Short, Animated Storytelling Video on Transphobia Among US Parents: Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e66496 VL - 11 KW - public health communication KW - vulnerable population KW - stigma reduction KW - stigma KW - transphobia KW - transgender KW - gender diverse KW - LGBTQ KW - parent KW - mental health KW - mental illness KW - transgender children KW - children KW - youth KW - adolescent KW - storytelling KW - animation N2 - Background: Parents play a pivotal role in supporting transgender and gender diverse (TGD) youth. Yet only 35% of TGD youth describe their home as a gender-affirming place. Lack of parental support contributes to recent findings that TGD youth are approximately three times more likely to attempt suicide than their cisgender peers. In contrast, parents? affirmation of their children?s gender identity significantly improves their mental health outcomes, by reducing anxiety, depression, and suicidality. Objective: Addressing the urgent need for effective, scalable interventions, this study evaluates a novel digital approach: short, animated storytelling videos. We hypothesized that our 2.5-minute video intervention would reduce antitransgender stigma, or transphobia, and improve attitudes toward gender diverse children among US parents. Methods: We recruited 1267 US parents, through the Prolific Academic (Prolific) online research platform, and randomized them into video intervention or control groups. We measured transphobia using the Transgender Stigma Scale, and attitudes toward transgender children using the gender thermometer, before and after watching the video. We compared outcomes between the two groups using 2 × 3 ANOVA. Both groups were invited to return 30 days later for follow-up assessment, before being offered posttrial access to the intervention video, which portrayed an authentic conversation between a mother and her transgender child. Results: Single exposure to a short, animated story video significantly reduced transphobia and improved attitudes toward transgender children among US parents, immediately post intervention. We observed a significant group-by-time interaction in mean Transgender Stigma Scale scores (F2,1=3.7, P=.02) and significant between-group changes when comparing the video and control groups from baseline to post intervention (F1=27.4, P<.001). Effect sizes (Cohen d) indicated small to moderate immediate changes in response to the 2.5-minute video, though the effect was no longer observed at the 30-day follow-up. Gender thermometer scores revealed significant immediate improvements in the attitudes of participants in the video intervention arm, and this improvement was sustained at the 30-day time point. Conclusions: Short, animated storytelling is a novel digital approach with the potential to boost support and affirmation of transgender children, by offering authentic insights into the lived experiences of TGD youth. Repeated exposures to such interventions may be necessary to sustain improvements over time. Future studies could test a series of short, animated storytelling videos featuring the lived experiences of several TGD youth. Evaluating the effect of such a series could contribute to the fields of digital health communication and transgender health. Digital approaches, such as short, animated storytelling videos, that support empathy and acceptance of TGD youth could foster a more inclusive society in which every child can thrive. Trial Registration: AsPredicted.org 159248; https://aspredicted.org/ptmd-3kfs.pdf UR - https://publichealth.jmir.org/2025/1/e66496 UR - http://dx.doi.org/10.2196/66496 ID - info:doi/10.2196/66496 ER - TY - JOUR AU - Zhu, Shimin AU - Qi, Di PY - 2025/1/15 TI - Reciprocal Relationship Between Self-Control Belief and Gaming Disorder in Children and Adolescents: Longitudinal Survey Study JO - JMIR Serious Games SP - e59441 VL - 13 KW - growth mindset KW - gaming disorder KW - cross-lagged panel model KW - children KW - self-control KW - adolescents N2 - Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. It is essential to identify the modifiable psychosocial factors influencing gaming disorder development. The lay theories of self-control (ie, the beliefs about whether self-control can be improved, also called self-control mindsets) may interplay with self-control and gaming disorder and serve as a promising influential factor for gaming disorder. Objective: This study aims to answer the research questions ?Does believing one?s self-control is unchangeable predict more severe gaming disorder symptoms later?? and ?Does the severity of gaming disorder symptoms prospectively predict self-control mindsets?? with a 1-year, 2-wave, school-based longitudinal survey. Methods: A total of 3264 students (338 in grades 4?5 and 2926 in grades 7?10) from 15 schools in Hong Kong participated in the classroom surveys. We used cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity (the cross-lagged path from mindsets to gaming disorder: regression coefficients [b] with 95% CI [0.070, 0.020-0.12o, P=.006]; and from gaming disorder to mindsets: b with 95% CI [0.11, 0.060-0.160, P<.001]). Subgroup analyses of boy and girl participants revealed that more growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls (b=0.12, 95% CI 0.053-0.190, P=.001) but not in boys (b=0.025, 95% CI ?0.050 to 0.100, P=.51), while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys (b=0.15, 95% CI 0.069-0.230, P<.001) and girls (b=0.098, 95% CI 0.031-0.170, P=.004) after 1 year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one?s self-control malleability beliefs and implied that promoting a growth mindset regarding self-control might be a promising strategy for gaming disorder prevention and early intervention, especially for girls. UR - https://games.jmir.org/2025/1/e59441 UR - http://dx.doi.org/10.2196/59441 ID - info:doi/10.2196/59441 ER - TY - JOUR AU - Zheng, Yi Wu AU - Shvetcov, Artur AU - Slade, Aimy AU - Jenkins, Zoe AU - Hoon, Leonard AU - Whitton, Alexis AU - Logothetis, Rena AU - Ravindra, Smrithi AU - Kurniawan, Stefanus AU - Gupta, Sunil AU - Huckvale, Kit AU - Stech, Eileen AU - Agarwal, Akash AU - Funke Kupper, Joost AU - Cameron, Stuart AU - Rosenberg, Jodie AU - Manoglou, Nicholas AU - Senadeera, Manisha AU - Venkatesh, Svetha AU - Mouzakis, Kon AU - Vasa, Rajesh AU - Christensen, Helen AU - Newby, M. Jill PY - 2025/1/14 TI - Recruiting Young People for Digital Mental Health Research: Lessons From an AI-Driven Adaptive Trial JO - J Med Internet Res SP - e60413 VL - 27 KW - recruitment KW - Facebook KW - retention, COVID-19 KW - artificial intelligence N2 - Background: With increasing adoption of remote clinical trials in digital mental health, identifying cost-effective and time-efficient recruitment methodologies is crucial for the success of such trials. Evidence on whether web-based recruitment methods are more effective than traditional methods such as newspapers, media, or flyers is inconsistent. Here we present insights from our experience recruiting tertiary education students for a digital mental health artificial intelligence?driven adaptive trial?Vibe Up. Objective: We evaluated the effectiveness of recruitment via Facebook and Instagram compared to traditional methods for a treatment trial and compared different recruitment methods? retention rates. With recruitment coinciding with COVID-19 lockdowns across Australia, we also compared the cost-effectiveness of social media recruitment during and after lockdowns. Methods: Recruitment was completed for 2 pilot trials and 6 minitrials from June 2021 to May 2022. To recruit participants, paid social media advertising on Facebook and Instagram was used, alongside mailing lists of university networks and student organizations or services, media releases, announcements during classes and events, study posters or flyers on university campuses, and health professional networks. Recruitment data, including engagement metrics collected by Meta (Facebook and Instagram), advertising costs, and Qualtrics data on recruitment methods and survey completion rates, were analyzed using RStudio with R (version 3.6.3; R Foundation for Statistical Computing). Results: In total, 1314 eligible participants (aged 22.79, SD 4.71 years; 1079, 82.1% female) were recruited to 2 pilot trials and 6 minitrials. The vast majority were recruited via Facebook and Instagram advertising (n=1203; 92%). Pairwise comparisons revealed that the lead institution?s website was more effective in recruiting eligible participants than Facebook (z=3.47; P=.003) and Instagram (z=4.23; P<.001). No differences were found between recruitment methods in retaining participants at baseline, at midpoint, and at study completion. Wilcoxon tests found significant differences between lockdown (pilot 1 and pilot 2) and postlockdown (minitrials 1-6) on costs incurred per link click (lockdown: median Aus $0.35 [US $0.22], IQR Aus $0.27-$0.47 [US $0.17-$0.29]; postlockdown: median Aus $1.00 [US $0.62], IQR Aus $0.70-$1.47 [US $0.44-$0.92]; W=9087; P<.001) and the amount spent per hour to reach the target sample size (lockdown: median Aus $4.75 [US $2.95], IQR Aus $1.94-6.34 [US $1.22-$3.97]; postlockdown: median Aus $13.29 [US $8.26], IQR Aus $4.70-25.31 [US $2.95-$15.87]; W=16044; P<.001). Conclusions: Social media advertising via Facebook and Instagram was the most successful strategy for recruiting distressed tertiary students into this artificial intelligence?driven adaptive trial, providing evidence for the use of this recruitment method for this type of trial in digital mental health research. No recruitment method stood out in terms of participant retention. Perhaps a reflection of the added distress experienced by young people, social media recruitment during the COVID-19 lockdown period was more cost-effective. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001092886; https://tinyurl.com/39f2pdmd; Australian New Zealand Clinical Trials Registry ACTRN12621001223820; https://tinyurl.com/bdhkvucv UR - https://www.jmir.org/2025/1/e60413 UR - http://dx.doi.org/10.2196/60413 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60413 ER - TY - JOUR AU - Kakon, Hafiz Shahria AU - Soron, Rashid Tanjir AU - Hossain, Sharif Mohammad AU - Haque, Rashidul AU - Tofail, Fahmida PY - 2025/1/14 TI - Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e62943 VL - 8 KW - screen time KW - parental supervision KW - Strength and Difficulties Questionnaire KW - Spencer Children Anxiety Scale KW - Pittsburgh Sleep Quality Scale KW - children KW - sleep quality KW - headache KW - behavioral problems N2 - Background: Children?s screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6?14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1% versus 161/336 students, 47.9%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3%) and peer difficulties (121/420 students, 28.8%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools. UR - https://pediatrics.jmir.org/2025/1/e62943 UR - http://dx.doi.org/10.2196/62943 ID - info:doi/10.2196/62943 ER - TY - JOUR AU - Martin-Moratinos, Marina AU - Bella-Fernández, Marcos AU - Rodrigo-Yanguas, María AU - González-Tardón, Carlos AU - Li, Chao AU - Wang, Ping AU - Royuela, Ana AU - Lopez-Garcia, Pilar AU - Blasco-Fontecilla, Hilario PY - 2025/1/8 TI - Effectiveness of a Virtual Reality Serious Video Game (The Secret Trail of Moon) for Emotional Regulation in Children With Attention-Deficit/Hyperactivity Disorder: Randomized Clinical Trial JO - JMIR Serious Games SP - e59124 VL - 13 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - emotional regulation KW - serious video games KW - virtual reality KW - cognitive training KW - music KW - chess N2 - Background: Difficulties in emotional regulation are often observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. The Secret Trail of Moon (MOON) is a serious video game developed by a multidisciplinary team featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire. Objective: We hypothesize that patients with ADHD using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group; additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to the web) will not affect emotional regulation scores; and (6) the video game will not cause any clinically significant side effects. Methods: This was a prospective, unicentric, randomized, unblinded, pre- and postintervention study with block-randomized sequence masking. Participants included individuals aged between 7 and 18 years who had a clinical diagnosis of ADHD and were receiving pharmacological treatment. They were randomized into 2 groups using an electronic case report form: the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game, and the control group, receiving standard pharmacological treatment. We provided both the groups with psychoeducational support on ADHD. Analysis was conducted using the Student 2-tailed t test and 2-factor ANOVA. An independent monitor supervised the study. Results: A total of 76 patients with ADHD participated in the trial, with an equal randomization (MOON: n=38, 50% and control: n=38, 50%) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global Strengths and Difficulties Questionnaire score, was not met. However, significant improvements were observed in material organization (P=.03), working memory (P=.04), and inhibition (P=.05), particularly among patients more engaged with the MOON treatment. Conclusions: Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD. Trial Registration: ClinicalTrials.gov NCT06006871; https://clinicaltrials.gov/study/NCT06006871 International Registered Report Identifier (IRRID): RR2-10.2196/53191 UR - https://games.jmir.org/2025/1/e59124 UR - http://dx.doi.org/10.2196/59124 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59124 ER - TY - JOUR AU - Skovslund Nielsen, Eva AU - Kallesøe, Karen AU - Bennedsen Gehrt, Tine AU - Bjerre-Nielsen, Ellen AU - Lalouni, Maria AU - Frostholm, Lisbeth AU - Bonnert, Marianne AU - Rask, Ulrikka Charlotte PY - 2025/1/7 TI - Trajectories of Change, Illness Understanding, and Parental Worries in Children and Adolescents Undergoing Internet-Delivered Cognitive-Behavioral Therapy for Functional Abdominal Pain Disorders: Protocol for a Single-Case Design and Explorative Pilot Study JO - JMIR Res Protoc SP - e58563 VL - 14 KW - functional abdominal pain disorders KW - abdominal pain KW - internet-based intervention KW - cognitive behavioral therapy KW - interoception KW - attentional bias KW - parental distress KW - single case study KW - children KW - adolescents KW - youth KW - study protocol KW - quality of life KW - treatment KW - medication KW - psychological treatment KW - psychology N2 - Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment. Objective: This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect. Methods: Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3). Results: Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Trial Registration: ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7 International Registered Report Identifier (IRRID): DERR1-10.2196/58563 UR - https://www.researchprotocols.org/2025/1/e58563 UR - http://dx.doi.org/10.2196/58563 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58563 ER - TY - JOUR AU - Schafer, Moa AU - Lachman, Jamie AU - Zinser, Paula AU - Calderón Alfaro, Antonio Francisco AU - Han, Qing AU - Facciola, Chiara AU - Clements, Lily AU - Gardner, Frances AU - Haupt Ronnie, Genevieve AU - Sheil, Ross PY - 2025/1/3 TI - A Digital Parenting Intervention With Intimate Partner Violence Prevention Content: Quantitative Pre-Post Pilot Study JO - JMIR Form Res SP - e58611 VL - 9 KW - intimate partner violence KW - SMS text messaging KW - chatbot KW - user engagement KW - parenting KW - violence KW - mobile phone N2 - Background: Intimate partner violence (IPV) and violence against children are global issues with severe consequences. Intersections shared by the 2 forms of violence have led to calls for joint programming efforts to prevent both IPV and violence against children. Parenting programs have been identified as a key entry point for addressing multiple forms of family violence. Building on the IPV prevention material that has been integrated into the parenting program ParentText, a digital parenting chatbot, this pilot study seeks to explore parents? engagement with the IPV prevention content in ParentText and explore preliminary changes in IPV. Objective: This study aimed to assess parents? and caregivers? level of engagement with the IPV prevention material in the ParentText chatbot and explore preliminary changes in experiences and perpetration of IPV, attitudes toward IPV, and gender-equitable behaviors following the intervention. Methods: Caregivers of children aged between 0 and 18 years were recruited through convenience sampling by research assistants in Cape Town, South Africa, and by UNICEF (United Nations Children's Fund) Jamaica staff in 3 parishes of Jamaica. Quantitative data from women in Jamaica (n=28) and South Africa (n=19) and men in South Africa (n=21) were collected electronically via weblinks sent to caregivers? phones using Open Data Kit. The primary outcome was IPV experience (women) and perpetration (men), with secondary outcomes including gender-equitable behaviors and attitudes toward IPV. Descriptive statistics were used to report sociodemographic characteristics and engagement outcomes. Chi-square tests and 2-tailed paired dependent-sample t tests were used to investigate potential changes in IPV outcomes between pretest and posttest. Results: The average daily interaction rate with the program was 0.57 and 0.59 interactions per day for women and men in South Africa, and 0.21 for women in Jamaica. The rate of completion of at least 1 IPV prevention topic was 25% (5/20) for women and 5% (1/20) for men in South Africa, and 21% (6/28) for women in Jamaica. Exploratory analyses indicated significant pre-post reductions in overall IPV experience among women in South Africa (P=.01) and Jamaica (P=.01) and in men?s overall harmful IPV attitudes (P=.01) and increases in men?s overall gender-equitable behaviors (P=.02) in South Africa. Conclusions: To the best of our knowledge, this is the first pilot study to investigate user engagement with and indicative outcomes of a digital parenting intervention with integrated IPV prevention content. Study findings provide valuable insights into user interactions with the chatbot and shed light on challenges related to low levels of chatbot engagement. Indicative results suggest promising yet modest reductions in IPV and improvements in attitudes after the program. Further research using a randomized controlled trial is warranted to establish causality. UR - https://formative.jmir.org/2025/1/e58611 UR - http://dx.doi.org/10.2196/58611 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58611 ER - TY - JOUR AU - Li, Sihong AU - Jin, Xingyue AU - Song, Lintong AU - Fan, Tianqing AU - Shen, Yanmei AU - Zhou, Jiansong PY - 2025/1/3 TI - The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study JO - J Med Internet Res SP - e52083 VL - 27 KW - adolescents KW - pathological internet use KW - internet addiction KW - suicide attempts KW - risk factors KW - cohort study N2 - Background: Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents. Objective: This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents. Methods: A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants? demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale?21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale?Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. ?2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association. Results: The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01%) and more than half being male (426/782, 54.48%). Most participants had no previous history of depression (541/782, 69.18%), anxiety (415/782, 53.07%), or stress (618/782, 79.03%). The rate of newly reported suicide attempts was 4.6% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model. Conclusions: This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention. UR - https://www.jmir.org/2025/1/e52083 UR - http://dx.doi.org/10.2196/52083 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52083 ER - TY - JOUR AU - Larsson, Anna AU - Weineland, Sandra AU - Nissling, Linnea AU - Lilja, L. Josefine PY - 2025/1/3 TI - The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study JO - JMIR Pediatr Parent SP - e59489 VL - 8 KW - adolescents KW - parental support KW - anxiety KW - depression KW - primary care KW - mental health KW - ACT KW - acceptance and commitment therapy KW - iACT KW - internet-delivered acceptance and commitment therapy N2 - Background: Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support. Objective: This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning. Methods: Adolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children?s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children?s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution. Results: The iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children?s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: ?2.94; P=.003; r=?0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: ?2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children?s Global Assessment Scale were found. Conclusions: The results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study. UR - https://pediatrics.jmir.org/2025/1/e59489 UR - http://dx.doi.org/10.2196/59489 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752209 ID - info:doi/10.2196/59489 ER - TY - JOUR AU - Segal, Hila AU - Benis, Arriel AU - Saar, Shirley AU - Shachar-Lavie, Iris AU - Fennig, Silvana PY - 2024/12/26 TI - Digital Platform for Pediatric Mental Health Support During Armed Conflicts: Development and Usability Study JO - JMIR Form Res SP - e63777 VL - 8 KW - pediatric mental health KW - digital platform KW - pediatricians KW - prevention KW - early intervention N2 - Background: The prevalence of mental health disorders among children and adolescents presents a significant public health challenge. Children exposed to armed conflicts are at a particularly high risk of developing mental health problems, necessitating prompt and robust intervention. The acute need for early intervention in these situations is well recognized, as timely support can mitigate long-term negative outcomes. Pediatricians are particularly suited to deliver such interventions due to their role as primary health care providers and their frequent contact with children and families. However, barriers such as limited training and resources often hinder their ability to effectively address these issues. Objectives: This study aimed to describe the rapid development of a digital mental health tool for community pediatricians, created in response to the urgent need for accessible resources following the October 7th terror attack in Israel. The goal was to create a comprehensive resource that addresses a wide range of emotional and behavioral challenges in children and adolescents, with a particular focus on those affected by armed conflict and significant trauma exposure. In addition, the study aimed to evaluate the platform?s usability and relevance through feedback from primary users, thereby assessing its potential for implementation in pediatric practice. Methods: A digital platform was developed using a collaborative approach that involved pediatricians and mental health professionals from various hospital clinics. The initial framework for the modules was drafted based on key emotional and behavioral issues identified through prior research. Following this, the detailed content of each module was cocreated with input from specialized mental health clinics within the hospital, ensuring comprehensive and practical guidance for community pediatricians. A focus group of 7 primary users, selected for their relevant hospital and community roles, provided feedback on the platform?s user experience, content relevance, and layout. The evaluation was conducted using a structured questionnaire complemented by qualitative comments. Results: Fifteen detailed modules were created, each providing information, including anamnesis, initial intervention strategies, parental guidance, and referral options. The focus group feedback demonstrated high satisfaction, indicating a very good user experience (mean 4.57, SD 0.53), content relevance (mean 4.71, SD 0.48), and layout suitability (mean 4.66, SD 0.52). Specific feedback highlighted the value of concise, actionable content and the inclusion of medication information. Participants expressed a strong willingness to regularly use the platform in their practice (mean 4.40, SD 0.53), suggesting its potential for broad application. Conclusions: This study demonstrates the effectiveness of a collaborative development process in creating a digital tool that addresses the mental health needs of children in crisis situations. The positive feedback from pediatricians indicated that the platform has the potential to become a valuable resource for early recognition, crisis intervention, and parental support in community pediatric settings. Future research will focus on broader implementation and assessing the platform?s impact on clinical outcomes. UR - https://formative.jmir.org/2024/1/e63777 UR - http://dx.doi.org/10.2196/63777 ID - info:doi/10.2196/63777 ER - TY - JOUR AU - Radley, Jessica AU - Penhallow, Jessica AU - Wickersham, Alice AU - Morris, Anna AU - Colling, Craig AU - Downs, Johnny PY - 2024/12/26 TI - Factors Affecting Usability and Acceptability of an Online Platform Used by Caregivers in Child and Adolescent Mental Health Services: Mixed Methods Study JO - JMIR Pediatr Parent SP - e60042 VL - 7 KW - child mental health KW - caregivers KW - digital technology KW - digital health KW - technology use KW - digital skill KW - digital literacy KW - digital divides KW - online systems KW - online survey KW - pediatric KW - mental health KW - usability KW - platform KW - survey KW - questionnaire KW - children KW - youth KW - adolescent KW - informal care KW - family care KW - acceptability KW - System Usability Scale KW - SUS KW - mobile phone N2 - Background: Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the ?virtual waiting room? module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources. Objective: This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics. Methods: A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE. Results: A total of 680 caregivers responded, of whom 45% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98%) used a mobile phone to access myHealthE, and many had not accessed the platform?s full functionality, including the new ?virtual waiting room? module. Household income was a significant predictor of caregivers? levels of comfort using technology; caregivers were 13% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95% CI 1.00?1.29). Themes generated from caregivers? feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual?s needs. Conclusions: Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services. UR - https://pediatrics.jmir.org/2024/1/e60042 UR - http://dx.doi.org/10.2196/60042 ID - info:doi/10.2196/60042 ER - TY - JOUR AU - Meisel, N. Samuel AU - Hogue, Aaron AU - Kelly, F. John AU - McQuaid, Elizabeth AU - Miranda Jr, Robert PY - 2024/12/20 TI - Examining Caregiver Practices During Adolescent Outpatient Alcohol Use and Co-Occurring Mental Health Treatment: Protocol for a Dyadic Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e63399 VL - 13 KW - adolescent KW - caregiver KW - ecological momentary assessment KW - alcohol KW - co-occurring disorders treatment KW - treatment KW - older adult KW - aging KW - alcohol use KW - mental health KW - assessment KW - protocol KW - alcohol use disorder KW - drinking KW - substance use KW - data collection N2 - Background: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). Objective: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. Methods: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. Results: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ?80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ?80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. Conclusions: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. International Registered Report Identifier (IRRID): PRR1-10.2196/63399 UR - https://www.researchprotocols.org/2024/1/e63399 UR - http://dx.doi.org/10.2196/63399 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63399 ER - TY - JOUR AU - Taylor, V. Kayla AU - Garchitorena, Laurent AU - Scaramutti-Gladfelter, Carolina AU - Wyrick, Mykayla AU - Grill, B. Katherine AU - Seixas, A. Azizi PY - 2024/12/19 TI - A Digital Mental Health Solution to Improve Social, Emotional, and Learning Skills for Youth: Protocol for an Efficacy and Usability Study JO - JMIR Res Protoc SP - e59372 VL - 13 KW - mental health KW - digital health KW - mHealth KW - usability KW - pilot study KW - United States KW - mental health crisis KW - Science Technology Engineering Math and Social and Emotional Learning KW - STEMSEL KW - efficacy KW - well-being KW - barriers KW - facilitators KW - resources KW - youth KW - adolescents KW - teenagers KW - students KW - feasibility KW - adoption KW - evidence-based KW - intervention KW - anxiety KW - depression KW - Neolth KW - digital app N2 - Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth?s functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study?s completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention?s efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/59372 UR - https://www.researchprotocols.org/2024/1/e59372 UR - http://dx.doi.org/10.2196/59372 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59372 ER - TY - JOUR AU - R Pozuelo, Julia AU - Nabulumba, Christine AU - Sikoti, Doreen AU - Davis, Meghan AU - Gumikiriza-Onoria, Louise Joy AU - Kinyanda, Eugene AU - Moffett, Bianca AU - van Heerden, Alastair AU - O'Mahen, A. Heather AU - Craske, Michelle AU - AU - Sulaiman, Munshi AU - Stein, Alan PY - 2024/12/19 TI - A Narrative-Gamified Mental Health App (Kuamsha) for Adolescents in Uganda: Mixed Methods Feasibility and Acceptability Study JO - JMIR Serious Games SP - e59381 VL - 12 KW - adolescents KW - mental health KW - Uganda KW - gamified app KW - digital interventions KW - mobile phone KW - user-centered design KW - low- and middle-income countries N2 - Background: Many adolescents in Uganda are affected by common mental disorders, but only a few affordable treatment options are available. Digital mental health interventions offer promising opportunities to reduce these large treatment gaps, but interventions specifically tailored for Ugandan adolescents are limited. Objective: This study aimed to determine the feasibility and acceptability of the Kuamsha program, an intervention delivered through a gamified app with low-intensity telephonic guidance, as a way to promote mental health among adolescents from the general population in Uganda. Methods: A 3-month pre-post single-arm trial was conducted with adolescents aged between 15 and 19 years living in Wakiso District, Central Uganda. The intervention was coproduced with adolescents from the study site to ensure that it was culturally acceptable. The feasibility and acceptability of the intervention were evaluated using an explanatory sequential mixed methods approach. Feasibility was assessed by collecting data on trial retention rates and treatment adherence rates. Acceptability was assessed through a questionnaire and in-depth interviews with participants following the conclusion of the intervention period. As a secondary objective, we explored the changes in participants? mental health before and after the intervention. Results: A total of 31 adolescents were recruited for the study. Results from the study showed high levels of feasibility and acceptability. Trial retention rates exceeded 90%, and treatment adherence was ?80%. These results, evaluated against our predefined trial progression criteria, indicate a successful feasibility study, with all criteria exceeding the thresholds necessary to progress to a larger trial. App engagement metrics, such as time spent on the app and modules completed, exceeded existing literature benchmarks, and many adolescents continued to use the app after the intervention. In-depth interviews and questionnaire responses revealed high acceptability levels. Depressive symptoms trended toward reduction (mean difference: 1.41, 95% CI ?0.60 to 3.42, Cohen d=0.30), although this was not statistically significant (P=.16). Supporting this trend, we also observed a reduction in the proportion of participants with moderate depressive symptoms from 32% (10/31) to 17% (5/29) after the intervention, but this change was also not significant (P=.10). Conclusions: This study presents evidence to support the Kuamsha program as a feasible and acceptable digital mental health program for adolescents in Uganda. A fully powered randomized controlled trial is needed to assess its effectiveness in improving adolescents? mental health. UR - https://games.jmir.org/2024/1/e59381 UR - http://dx.doi.org/10.2196/59381 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59381 ER - TY - JOUR AU - Chong, K. Min AU - Hickie, B. Ian AU - Ottavio, Antonia AU - Rogers, David AU - Dimitropoulos, Gina AU - LaMonica, M. Haley AU - Borgnolo, J. Luke AU - McKenna, Sarah AU - Scott, M. Elizabeth AU - Iorfino, Frank PY - 2024/12/18 TI - A Digital Approach for Addressing Suicidal Ideation and Behaviors in Youth Mental Health Services: Observational Study JO - J Med Internet Res SP - e60879 VL - 26 KW - mental health service KW - youth mental health KW - suicide management KW - clinical decision support KW - primary care KW - personalization KW - suicide KW - suicidal KW - youth KW - mental health KW - mental health care KW - suicide prevention KW - digital technology KW - online assessment KW - clinician KW - digital health KW - health informatics KW - clinical information N2 - Background: Long wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality. Objective: The primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors. Methods: Young people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed. Results: A total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness. Conclusions: The digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people?s mental health. UR - https://www.jmir.org/2024/1/e60879 UR - http://dx.doi.org/10.2196/60879 UR - http://www.ncbi.nlm.nih.gov/pubmed/39693140 ID - info:doi/10.2196/60879 ER - TY - JOUR AU - Colder Carras, Michelle AU - Aljuboori, Dahlia AU - Shi, Jing AU - Date, Mayank AU - Karkoub, Fatima AU - García Ortiz, Karla AU - Abreha, Molla Fasika AU - Thrul, Johannes PY - 2024/12/18 TI - Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review JO - J Med Internet Res SP - e59968 VL - 26 KW - digital well-being KW - internet addiction KW - gaming disorder KW - social media KW - screen time KW - prevention KW - children KW - adolescents KW - mobile phone KW - PRISMA N2 - Background: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. Objective: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. Methods: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. Results: We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. Conclusions: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. Trial Registration: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387 UR - https://www.jmir.org/2024/1/e59968 UR - http://dx.doi.org/10.2196/59968 UR - http://www.ncbi.nlm.nih.gov/pubmed/39693138 ID - info:doi/10.2196/59968 ER - TY - JOUR AU - Mabaso, Siza Wakithi AU - Hein, Sascha AU - Pavarini, Gabriela AU - AU - Fazel, Mina PY - 2024/12/17 TI - Exploring the Relationship Between Public Social Media Accounts, Adolescent Mental Health, and Parental Guidance in England: Large Cross-Sectional School Survey Study JO - J Med Internet Res SP - e57154 VL - 26 KW - social media KW - adolescent health KW - privacy KW - parental guidance KW - mood disorders KW - adolescent KW - anxiety KW - depression KW - cross-sectional KW - mental health KW - public KW - account KW - school-going KW - school KW - England KW - survey KW - logistic regression KW - observational N2 - Background: Although associations between social media use and adolescent mental health have been described, more information is needed on the potential components characterizing this complex exposure, in particular, those related to maintaining a public social media account. Objective: This study aims to investigate the association between having a public social media account and anxiety and depression in school-going adolescents. Methods: Overall, 80 secondary schools and further education colleges in England were sampled using a cross-sectional web-based survey as part of the 2023 OxWell Student Survey. Social media exposure was categorized among the adolescents as having a public social media account versus not having a public social media account. The risk of clinical anxiety and depression was determined using the Revised Child Anxiety and Depression Scale-11. Adolescents self-reported the content and platforms accessed in the previous 24 hours. Associations between having a public social media account and symptoms of anxiety and depression were assessed using logistic regression controlling for age, sex, the experience of being bullied, parental guidance of online behavior (describing perceived parental approaches to adolescents? online activity), the proportion of close friendships engaged with online, poverty status, and placement in statutory care. Age, sex, and parental guidance of online behavior were assessed for primary association effect modification. Results: Data collected from 16,655 adolescents (aged 11-18 y) were analyzed. Of these 16,655 adolescents, 6734 (40.43%) had a public social media account, while 9921 (59.57%) either had a private social media account or no social media account. Moreover, 32.6% (5429/16,655) of the adolescents screened positive for symptoms of anxiety and depression. Those with a public social media account had higher odds of anxiety and depression (odds ratio [OR] 1.41, 95% CI 1.32-1.50) than those without a public social media account in an unadjusted and fully adjusted model (OR 1.39, 95% CI 1.29-1.49). Adolescents reporting active parental guidance had lower odds of anxiety and depression (OR 0.85, 95% CI 0.75-0.93) than those reporting no parental guidance, and these parental approaches to online behaviors significantly modified the association between having a public social media account and symptoms of anxiety and depression (P=.004; ?22=11.1). Conclusions: Our OxWell study findings suggest a potential mental health risk for adolescents with a public social media account. We show evidence indicating some protection from anxiety and depression among adolescents who do not have a public social media account and those reporting some form of parental guidance of their online behavior. This was pronounced in adolescents reporting active parental guidance compared to stricter regulatory approaches or no guidance at all. The specific roles that social media account choices and parental guidance of online behavior may play in supporting the mental health of adolescents are highlighted for further investigation. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-052717 UR - https://www.jmir.org/2024/1/e57154 UR - http://dx.doi.org/10.2196/57154 UR - http://www.ncbi.nlm.nih.gov/pubmed/39688898 ID - info:doi/10.2196/57154 ER - TY - JOUR AU - Pisani, R. Anthony AU - Wyman, A. Peter AU - Cero, Ian AU - Kelberman, Caroline AU - Gurditta, Kunali AU - Judd, Emily AU - Schmeelk-Cone, Karen AU - Mohr, David AU - Goldston, David AU - Ertefaie, Ashkan PY - 2024/12/6 TI - Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e56407 VL - 11 KW - suicide prevention KW - text messaging KW - self-violence KW - self-harm KW - suicidal behavior KW - randomized controlled trial KW - adolescent KW - teenager KW - student KW - school KW - United States KW - Text4Strength KW - help-seeking attitude KW - coping KW - awareness KW - depression KW - mood disorder KW - mental health N2 - Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength?a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363 UR - https://mental.jmir.org/2024/1/e56407 UR - http://dx.doi.org/10.2196/56407 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56407 ER - TY - JOUR AU - Liu, Zhongling AU - Li, Jinkai AU - Zhang, Yuanyuan AU - Wu, Dan AU - Huo, Yanyan AU - Yang, Jianxin AU - Zhang, Musen AU - Dong, Chuanfei AU - Jiang, Luhui AU - Sun, Ruohan AU - Zhou, Ruoyin AU - Li, Fei AU - Yu, Xiaodan AU - Zhu, Daqian AU - Guo, Yao AU - Chen, Jinjin PY - 2024/11/29 TI - Auxiliary Diagnosis of Children With Attention-Deficit/Hyperactivity Disorder Using Eye-Tracking and Digital Biomarkers: Case-Control Study JO - JMIR Mhealth Uhealth SP - e58927 VL - 12 KW - attention deficit disorder with hyperactivity KW - eye-tracking KW - auxiliary diagnosis KW - digital biomarker KW - antisaccade KW - machine learning N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children. The lack of objective biomarkers for ADHD often results in missed diagnoses or misdiagnoses, which lead to inappropriate or delayed interventions. Eye-tracking technology provides an objective method to assess children?s neuropsychological behavior. Objective: The aim of this study was to develop an objective and reliable auxiliary diagnostic system for ADHD using eye-tracking technology. This system would be valuable for screening for ADHD in schools and communities and may help identify objective biomarkers for the clinical diagnosis of ADHD. Methods: We conducted a case-control study of children with ADHD and typically developing (TD) children. We designed an eye-tracking assessment paradigm based on the core cognitive deficits of ADHD and extracted various digital biomarkers that represented participant behaviors. These biomarkers and developmental patterns were compared between the ADHD and TD groups. Machine learning (ML) was implemented to validate the ability of the extracted eye-tracking biomarkers to predict ADHD. The performance of the ML models was evaluated using 5-fold cross-validation. Results: We recruited 216 participants, of whom 94 (43.5%) were children with ADHD and 122 (56.5%) were TD children. The ADHD group showed significantly poorer performance (for accuracy and completion time) than the TD group in the prosaccade, antisaccade, and delayed saccade tasks. In addition, there were substantial group differences in digital biomarkers, such as pupil diameter fluctuation, regularity of gaze trajectory, and fixations on unrelated areas. Although the accuracy and task completion speed of the ADHD group increased over time, their eye-movement patterns remained irregular. The TD group with children aged 5 to 6 years outperformed the ADHD group with children aged 9 to 10 years, and this difference remained relatively stable over time, which indicated that the ADHD group followed a unique developmental pattern. The ML model was effective in discriminating the groups, achieving an area under the curve of 0.965 and an accuracy of 0.908. Conclusions: The eye-tracking biomarkers proposed in this study effectively identified differences in various aspects of eye-movement patterns between the ADHD and TD groups. In addition, the ML model constructed using these digital biomarkers achieved high accuracy and reliability in identifying ADHD. Our system can facilitate early screening for ADHD in schools and communities and provide clinicians with objective biomarkers as a reference. UR - https://mhealth.jmir.org/2024/1/e58927 UR - http://dx.doi.org/10.2196/58927 UR - http://www.ncbi.nlm.nih.gov/pubmed/39477792 ID - info:doi/10.2196/58927 ER - TY - JOUR AU - Münchenberg, Sarah Pauline AU - Yessimova, Dinara AU - Panteli, Dimitra AU - Kurth, Tobias PY - 2024/11/28 TI - Digital Health Interventions for Informal Family Caregivers of People With First-Episode Psychosis: Systematic Review on User Experience and Effectiveness JO - JMIR Ment Health SP - e63743 VL - 11 KW - first-episode psychosis KW - early psychosis KW - digital health interventions KW - telepsychiatry KW - informal caregivers KW - family caregivers KW - telehealth KW - severe mental disorders KW - psychosis KW - digital intervention KW - digital health KW - mental health KW - psychoeducation KW - mobile phone N2 - Background: First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective: This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods: A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results: The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions?web-based, videoconferences, and mHealth?were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions: The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration: PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9 UR - https://mental.jmir.org/2024/1/e63743 UR - http://dx.doi.org/10.2196/63743 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63743 ER - TY - JOUR AU - Backman, Anna AU - Roll-Pettersson, Lise AU - Mellblom, Are AU - Norman-Claesson, Elisabet AU - Sundqvist, Emma AU - Zander, Eric AU - Vigerland, Sarah AU - Hirvikoski, Tatja PY - 2024/11/28 TI - Internet-Delivered Psychoeducation (SCOPE) for Transition-Aged Autistic Youth: Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e49305 VL - 26 KW - autism KW - internet based KW - young adult KW - intervention KW - digital communication KW - life satisfaction KW - codeveloped KW - ASD KW - autism spectrum disorder KW - autistic KW - RCT KW - randomized controlled trial KW - randomized KW - psychoeducation KW - patient education N2 - Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention. Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants? understanding of autism and, in doing so, increase their quality of life (QoL). Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module?s topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants? autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points. Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: ?0.13, 95% CI ?1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression. Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation. Trial Registration: ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363 UR - https://www.jmir.org/2024/1/e49305 UR - http://dx.doi.org/10.2196/49305 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49305 ER - TY - JOUR AU - Giguere, Sabrina AU - Beaudoin, Mélissa AU - Dellazizzo, Laura AU - Phraxayavong, Kingsada AU - Potvin, Stéphane AU - Dumais, Alexandre PY - 2024/11/27 TI - Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial JO - JMIR Ment Health SP - e58499 VL - 11 KW - cannabis use disorder KW - cannabis use KW - virtual reality therapy KW - virtual reality KW - addiction intervention KW - relational therapy KW - avatar KW - digital mental health N2 - Background: The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. Objective: This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD. Methods: Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model. Results: Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. Conclusions: Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention. Trial Registration: ClinicalTrials.gov NCT05726617; https://clinicaltrials.gov/study/NCT05726617 UR - https://mental.jmir.org/2024/1/e58499 UR - http://dx.doi.org/10.2196/58499 ID - info:doi/10.2196/58499 ER - TY - JOUR AU - Valentine, Lee AU - Arnold, Chelsea AU - Nicholas, Jennifer AU - Castagnini, Emily AU - Malouf, Jessi AU - Alvarez-Jimenez, Mario AU - Bell, H. Imogen PY - 2024/11/27 TI - A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People?s Experience JO - J Med Internet Res SP - e63732 VL - 26 KW - repetitive negative thinking KW - rumination KW - anxiety KW - depression KW - mobile app KW - just-in-time adaptive interventions KW - youth mental health KW - adolescent KW - mobile phone N2 - Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data. Objective: This study explores young people?s experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety. Methods: Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants? experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data. Results: The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people?s experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app?s self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling ?stuck? in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app. Conclusions: Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques. UR - https://www.jmir.org/2024/1/e63732 UR - http://dx.doi.org/10.2196/63732 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63732 ER - TY - JOUR AU - Hall, A. Jeffrey PY - 2024/11/25 TI - Ten Myths About the Effect of Social Media Use on Well-Being JO - J Med Internet Res SP - e59585 VL - 26 KW - social media KW - well-being KW - health promotion KW - depressive disorder KW - depression KW - anxiety KW - adolescent KW - mental health UR - https://www.jmir.org/2024/1/e59585 UR - http://dx.doi.org/10.2196/59585 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59585 ER - TY - JOUR AU - Aldridge, Grace AU - Wu, Ling AU - Seguin, Paolo Joshua AU - Robinson, Jennifer AU - Battaglia, Elizabeth AU - Olivier, Patrick AU - Yap, H. Marie B. PY - 2024/11/22 TI - Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study JO - JMIR Form Res SP - e55639 VL - 8 KW - co-design KW - service design KW - intervention KW - digital technology KW - parenting KW - children KW - technology KW - parenting program KW - health care services KW - adverse childhood experience KW - ACE KW - mental disorder KW - innovate KW - social services KW - community health KW - evidence-based KW - parenting intervention N2 - Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent?s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite?s design. Results: PaRK-Lite?s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents? empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. UR - https://formative.jmir.org/2024/1/e55639 UR - http://dx.doi.org/10.2196/55639 UR - http://www.ncbi.nlm.nih.gov/pubmed/39576676 ID - info:doi/10.2196/55639 ER - TY - JOUR AU - Park, Jinyoung AU - Lee, Jungeun AU - Noh, Dabok PY - 2024/11/21 TI - Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach JO - JMIR Hum Factors SP - e64681 VL - 11 KW - out-of-home youth KW - mental health intervention KW - mobile app KW - intervention mapping KW - youth KW - mental health KW - mHealth KW - mobile health KW - app KW - interview KW - need KW - focus group KW - emotion KW - emotional KW - young adult KW - independent living KW - emotional support KW - tool KW - emotion regulation KW - user KW - app usage N2 - Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app?s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app?s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app?s effectiveness in real-world settings and refine it continuously based on user input. UR - https://humanfactors.jmir.org/2024/1/e64681 UR - http://dx.doi.org/10.2196/64681 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64681 ER - TY - JOUR AU - Gerchow, Lauren AU - Lanier, Yzette AU - Fayard, Anne-Laure AU - Squires, Allison PY - 2024/11/19 TI - Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City JO - JMIR Pediatr Parent SP - e60692 VL - 7 KW - adolescent KW - reproductive health KW - sexual health KW - cocreation KW - co-design KW - human-centered design N2 - Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. UR - https://pediatrics.jmir.org/2024/1/e60692 UR - http://dx.doi.org/10.2196/60692 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60692 ER - TY - JOUR AU - Yu, Yanqiu AU - Ng, Hoi-Yuk Joyce AU - Li, Ji-bin AU - Zhang, Jianxin AU - Lau, F. Joseph T. PY - 2024/11/14 TI - Cognitive Mechanisms Between Psychosocial Resources and the Behavioral Intention of Professional Help-Seeking for Internet Gaming Disorder Among Chinese Adolescent Gamers: Cross-Sectional Mediation Study JO - JMIR Public Health Surveill SP - e52478 VL - 10 KW - professional help-seeking KW - behavioral intention KW - internet gaming disorder KW - IGD KW - perception KW - China KW - mental health KW - psychosocial resource KW - secondary school KW - gamer KW - cross-sectional survey N2 - Background: Internet gaming disorder (IGD) is a global public health concern for adolescents due to its potential severe negative consequences. Professional help-seeking is important for early screening, diagnosis, and treatment of IGD. However, research on the factors associated with professional help-seeking for IGD as well as relevant mediation mechanisms among adolescents is limited. Objective: Based on the stress coping theory, the conservation of resource theory, and behavioral change theories, this study investigated the prevalence and factors influencing the behavioral intention of professional help-seeking for internet gaming disorder (BI-PHSIGD). The research also explored the underlying mechanisms, including psychosocial resources like resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy, in professional help-seeking among adolescent internet gamers. Methods: A cross-sectional survey was conducted among secondary school students who were internet gamers in 2 Chinese cities from October 2019 to January 2020. Data from the full sample (N=1526) and a subsample of 256 IGD cases (according to the 9-item DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] IGD Checklist) were analyzed. Multivariate logistic regression analysis was conducted to examine the factors of BI-PHSIGD, while structural equation modeling was performed to test the proposed mediation mechanisms. Results: The prevalence of BI-PHSIGD was 54.3% (829/1526) in the full sample and 40.6% (104/256) in the IGD subsample (vs 708/1239, 57.1% among non-IGD cases). In the full sample, psychosocial resources of resilience (adjusted odds ratio [aOR] 1.03, 95% CI 1.02-1.05) and social support (aOR 1.03, 95% CI 1.02-1.04) as well as self-efficacy in professional help-seeking (aOR 1.64, 95% CI 1.49-1.81) were positively associated with BI-PHSIGD, while perceived resource loss due to reduced gaming time was negatively associated with BI-PHSIGD (aOR 0.97, 95% CI 0.96-0.98); the positive association between psychosocial resources and BI-PHSIGD was fully mediated via 2 single-mediator indirect paths (via self-efficacy in professional help-seeking alone: effect size=53.4%; indirect effect/total effect=0.10/0.19 and via perceived resource loss due to reduced gaming time alone: effect size=17.8%; indirect effect/total effect=0.03/0.19) and one 2-mediator serial indirect path (first via perceived resource loss due to reduced gaming time then via self-efficacy in professional help-seeking: effect size=4.7%; indirect effect/total effect=0.009/0.19). In the IGD subgroup, a full mediation via self-efficacy in professional help-seeking alone but not the other 2 indirect paths was statistically significant. Conclusions: Many adolescent internet gamers, especially those with IGD, were unwilling to seek professional help; as a result, early treatment is often difficult to achieve. To increase BI-PHSIGD, enhancing psychosocial resources such as resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy in professional help-seeking may be effective. Future longitudinal and intervention studies are needed to confirm and extend the findings. UR - https://publichealth.jmir.org/2024/1/e52478 UR - http://dx.doi.org/10.2196/52478 ID - info:doi/10.2196/52478 ER - TY - JOUR AU - Yu, Yanqiu AU - Yen, Y. Stefanie H. AU - Wang, Baofeng Deborah AU - Wu, S. Anise M. AU - Chen, Honglei Juliet AU - Zhang, Guohua AU - Du, Mengni AU - Du, Dajin AU - Du, Mingxuan AU - Lau, F. Joseph T. PY - 2024/11/12 TI - School Climate and School Identification as Determinants of Internet Gaming Disorder Among Chinese Adolescent Internet Gamers: Cross-Sectional Mediation Study JO - JMIR Serious Games SP - e50418 VL - 12 KW - school climate KW - school identification KW - adolescent KW - structural equation modeling KW - internet gaming disorder N2 - Background: School climate and school identification are important features of the school environment and potential determinants of adolescent internet gaming disorder (IGD). Objective: This novel study investigated their joint effects on IGD and related mediation mechanisms via the interpersonal factor of teacher-student relationship and the individual factors of academic stress and anxiety. Methods: A large-scale cross-sectional study was conducted among adolescent internet gamers of junior, senior, and vocational middle schools in Taizhou City, China, from February to March 2022 (N=5778). Participants self-administered an anonymous, structured questionnaire in classrooms. Adjusted logistic regression and structural equation modeling (SEM) were used for data analysis. Results: Among all participants, the prevalence of IGD was 8% (461/5778). The 4 school climate subscales (student-student relationship subscale: adjusted odds ratio [ORa] 0.88, 95% CI 0.85-0.91; student-staff relations subscale: ORa 0.87, 95% CI 0.84-0.90; academic emphasis subscale: ORa 0.88, 95% CI 0.85-0.91; shared values approach: ORa 0.88, 95% CI 0.85-0.90), the school identification subscale (ORa 0.85, 95% CI 0.83-0.88), and teacher-student relationship (ORa 0.80, 95% CI 0.76-0.84) were significant protective factors against IGD, while academic stress (ORa 1.18, 95% CI 1.14-1.23) and anxiety (ORa 1.16, 95% CI 1.14-1.18) were risk factors of IGD. The SEM showed that the negative associations between school climate and IGD and between school identification and IGD were mediated via (1) three 2-step paths, each involving a single mediator?teacher-student relationship, academic stress, and anxiety, respectively?and (2) two 3-step paths involving 2 mediators?teacher-student relationship and academic stress first, respectively, and then anxiety. The direct effect of school climate on IGD was statistically nonsignificant (ie, full mediation with effect size ranging from 4.2% to 20.4%), while that of school identification was statistically significant (ie, partial mediation with effect size ranging from 4.5% to 38.2%). Conclusions: The relatively high prevalence of IGD among Chinese adolescents may be reduced through school-based interventions to improve school climate and school identification. Such improvements may reduce the levels of risk factors of IGD (poor teacher-student relationship, academic stress, and anxiety) and hence the risk of IGD. Future longitudinal and intervention studies are needed to confirm the findings. UR - https://games.jmir.org/2024/1/e50418 UR - http://dx.doi.org/10.2196/50418 ID - info:doi/10.2196/50418 ER - TY - JOUR AU - Akhtar, Aemal AU - de Graaff, Marijn Anne AU - Habashneh, Rand AU - Keyan, Dharani AU - Abualhaija, Adnan AU - Fanatseh, Sarah AU - Faroun, Muhannad AU - Aqel, Said Ibrahim AU - Dardas, Latefa AU - Servili, Chiara AU - van Ommeren, Mark AU - Bryant, Richard AU - Carswell, Kenneth PY - 2024/11/8 TI - Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e54585 VL - 13 KW - mHealth KW - psychosocial intervention KW - youths KW - depression KW - anxiety KW - minimally guided digital intervention KW - low- and middle-income countries KW - barriers KW - access KW - mental health KW - digital self-help KW - chatbots KW - conversational agents KW - effectiveness KW - Scalable Technology for Adolescents and Youth to Reduce Stress KW - randomized controlled trial KW - Jordan KW - psychological distress KW - mental disorders KW - disability N2 - Background: Young people in low- and middle-income countries encounter significant barriers to accessing mental health support due to various factors, including a substantial treatment gap and limited health care budgets allocated to mental health. Using innovative strategies, such as scalable digital self-help psychological interventions, offers a potential solution for improving access to mental health support. However, digital mental health interventions come with their own set of challenges, including issues related to low user engagement. Chatbots, with their interactive and engaging nature, may present a promising avenue for the delivery of these interventions. Objective: This study aims to explore the effectiveness of a newly developed World Health Organization (WHO) digital mental health intervention, titled Scalable Technology for Adolescents and Youth to Reduce Stress (STARS). Methods: A single-blind, 2-arm randomized controlled trial will be conducted nationally across Jordan. Participants will include 344 young adults, aged 18-21 years, currently residing in Jordan. Inclusion criteria are heightened levels of psychological distress as determined through the 10-item Kessler Psychological Distress Scale (?20). Assessment measures will be conducted at baseline, 1-week post intervention, and 3-month follow-up. Following baseline assessments, eligible participants will be randomized to receive STARS or enhanced usual care. The primary outcomes are the reduction of symptoms of depression and anxiety (Hopkins Symptom Checklist, 25 subscales) at 3-month follow-up. Secondary outcomes include general functioning (WHO Disability Assessment Schedule 2.0), well-being (WHO-5 Well-Being Index), personal problems (Psychological Outcomes Profile), and agency (State Hope Scale subscale). Results: The study was funded in January 2020 by the Research for Health in Humanitarian Crises Programme (Elhra) and recruitment for the trial started on July 16, 2023. As of November 15, 2023, we randomized 228 participants. Conclusions: This trial intends to contribute to the growing digital mental health evidence base by exploring technological solutions to address global public health challenges. Given the widespread use of technology globally, even in resource-constrained settings, and the high adoption rates among adolescents and young individuals, digital initiatives such as STARS present promising opportunities for the future of mental health care in low- and middle-income countries. Trial Registration: ISRCTN Registry ISRCTN10152961; https://www.isrctn.com/ISRCTN10152961 International Registered Report Identifier (IRRID): DERR1-10.2196/54585 UR - https://www.researchprotocols.org/2024/1/e54585 UR - http://dx.doi.org/10.2196/54585 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54585 ER - TY - JOUR AU - Straand, J. Ingjerd AU - Følstad, Asbjørn AU - Wünsche, C. Burkhard PY - 2024/11/8 TI - A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study JO - JMIR Form Res SP - e59158 VL - 8 KW - web-based intervention KW - positive psychology KW - mental health KW - user experience KW - persuasive design N2 - Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users? motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. UR - https://formative.jmir.org/2024/1/e59158 UR - http://dx.doi.org/10.2196/59158 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59158 ER - TY - JOUR AU - Beele, Gesa AU - Liesong, Paula AU - Bojanowski, Sabine AU - Hildebrand, Kristian AU - Weingart, Malte AU - Asbrand, Julia AU - Correll, U. Christoph AU - Morina, Nexhmedin AU - Uhlhaas, J. Peter PY - 2024/11/5 TI - Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study JO - JMIR Ment Health SP - e56235 VL - 11 KW - virtual reality exposure therapy KW - VRET KW - school anxiety KW - social anxiety KW - adolescents KW - virtual reality KW - VR KW - autonomic arousal KW - exposure therapy KW - posttreatment KW - digital health KW - simulation N2 - Background: Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking. Objective: A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of ?being there,? during VR exposure with anxiety measures and treatment response was examined. Methods: In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured. Results: The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (?2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response. Conclusions: Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents. UR - https://mental.jmir.org/2024/1/e56235 UR - http://dx.doi.org/10.2196/56235 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56235 ER - TY - JOUR AU - McAlister, L. Kelsey AU - Beatty, C. Clare AU - Smith-Caswell, E. Jacqueline AU - Yourell, L. Jacqlyn AU - Huberty, L. Jennifer PY - 2024/11/4 TI - Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors JO - JMIR Ment Health SP - e64626 VL - 11 KW - adolescent social media KW - social media bans KW - emotion regulation KW - youth KW - adolescent KW - media use KW - social platform KW - social network KW - self-regulation KW - behavioral health KW - mental health KW - digital health KW - technology KW - digital literacy UR - https://mental.jmir.org/2024/1/e64626 UR - http://dx.doi.org/10.2196/64626 ID - info:doi/10.2196/64626 ER - TY - JOUR AU - Albert, L. Stephanie AU - Massar, E. Rachel AU - Cassidy, Omni AU - Fennelly, Kayla AU - Jay, Melanie AU - Massey, M. Philip AU - Bragg, A. Marie PY - 2024/11/4 TI - Body Positivity, Physical Health, and Emotional Well-Being Discourse on Social Media: Content Analysis of Lizzo?s Instagram JO - JMIR Form Res SP - e60541 VL - 8 KW - weight stigma KW - body positivity KW - health at every size KW - emotional well-being KW - social media KW - qualitative content analysis KW - well-being KW - influencers KW - mental health outcomes KW - psychological health KW - body shaming KW - bullying N2 - Background: Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. Objective: We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. Methods: We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo?s posts and Instagram users? comments for their sentiments on the 3 domains. Replies to Instagram users? comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of ?likes,? were also collected. Results: The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo?s content included body positive sentiments (34%) and emotional well-being (18%); no posts dealt explicitly with physical health. A substantial amount Instagram users? comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo?s body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo?s health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. Conclusions: This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies. UR - https://formative.jmir.org/2024/1/e60541 UR - http://dx.doi.org/10.2196/60541 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60541 ER - TY - JOUR AU - Fong, CT Ted AU - Cui, Kunjie AU - Yip, SF Paul PY - 2024/11/4 TI - Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study JO - J Med Internet Res SP - e59490 VL - 26 KW - Chinese KW - impulsivity KW - interaction effects KW - internet gaming disorder KW - latent moderation KW - meaning in life KW - self-control KW - temper N2 - Background: Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning. Objective: This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model. Methods: A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning. Results: All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (?=.20, P=.01), temper (?=.25, P<.001), and search for meaning (?=.11, P=.048) and significantly and negatively associated with presence of meaning (?=?.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (?=?.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (?=.08, SE .04; P=.03) and search for MIL (?=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL. Conclusions: This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning. UR - https://www.jmir.org/2024/1/e59490 UR - http://dx.doi.org/10.2196/59490 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59490 ER - TY - JOUR AU - Bennett, E. Sarah AU - Johnston, H. Milly AU - Treneman-Evans, Georgia AU - Denison-Day, James AU - Duffy, Anthony AU - Brigden, Amberly AU - Kuberka, Paula AU - Christoforou, Nicholas AU - Ritterband, Lee AU - Koh, Jewel AU - Meadows, Robert AU - Alamoudi, Doaa AU - Nabney, Ian AU - Yardley, Lucy PY - 2024/10/31 TI - Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study JO - JMIR Hum Factors SP - e63341 VL - 11 KW - behavior change KW - digital intervention KW - insomnia KW - depression KW - anxiety KW - sleep KW - qualitative research KW - mobile phone N2 - Background: Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Methods: Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. Results: A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported ?prefer not to say.? Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Conclusions: Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout. UR - https://humanfactors.jmir.org/2024/1/e63341 UR - http://dx.doi.org/10.2196/63341 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63341 ER - TY - JOUR AU - Ramirez, Ana AU - Kramer, Justin AU - Hazim, Katrina AU - Roberge, Jason PY - 2024/10/31 TI - Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation JO - JMIR Form Res SP - e60317 VL - 8 KW - telemedicine KW - telepsychiatry KW - adolescents KW - mental health KW - psychiatry KW - coaching KW - qualitative assessment KW - patient satisfaction KW - family engagement KW - depression KW - anxiety KW - suicidal ideation N2 - Background: Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management (?Youth and Family Engagement? [YFE] program). Objective: This study aims to explore patients? and parents? perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Methods: Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants? preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. Results: The YFE program?s structure was often mentioned as promoting engagement, with telephone appointments and health coaches? ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents? nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches? ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Conclusions: Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach?participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement. UR - https://formative.jmir.org/2024/1/e60317 UR - http://dx.doi.org/10.2196/60317 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60317 ER - TY - JOUR AU - Wani, Carolina AU - McCann, Lisa AU - Lennon, Marilyn AU - Radu, Caterina PY - 2024/10/29 TI - Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review JO - J Med Internet Res SP - e51376 VL - 26 KW - adolescents KW - mental health KW - low- and middle-income countries KW - LMICs KW - digital mental health interventions KW - DMHIs KW - cultural appropriateness KW - implementation KW - design KW - evaluation KW - mobile phone N2 - Background: Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations? Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. Objective: This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. Methods: The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population "adolescents," concept "digital mental health interventions," and context "LMICs." We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. Results: We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. Conclusions: While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this. UR - https://www.jmir.org/2024/1/e51376 UR - http://dx.doi.org/10.2196/51376 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51376 ER - TY - JOUR AU - Kvestad, Ingrid AU - Adolfsen, Frode AU - Angeles, Corinne Renira AU - Brandseth, Lekve Oda AU - Breivik, Kyrre AU - Evertsen, Grete Janne AU - Foer, Kvåle Irene AU - Haaland, Morten AU - Homola, Millerjord Birgit AU - Hoseth, Elisabeth Gro AU - Jonsson, Josefine AU - Kjerstad, Egil AU - Kyrrestad, Henriette AU - Martinussen, Monica AU - Moberg, Annelene AU - Moberg, Karianne AU - Skogstrand, Anita AU - Solberg, Remme Line AU - Aasheim, Merete PY - 2024/10/24 TI - Effectiveness of a Bullying Intervention (Be-Prox) in Norwegian Early Childhood and Education Care Centers: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e60626 VL - 13 KW - peer bullying in early childhood education and care KW - The Bernese Program KW - cluster randomized controlled trial KW - bullying KW - child KW - preschool KW - program evaluation N2 - Background: A new and growing body of research has studied bullying among children in early childhood education and care centers (ECECs). The Bernese Program (Be-Prox) is designed to systematically prevent and handle bullying between children in Swiss ECECs. However, the effectiveness of the Be-Prox intervention has not yet been explored in a Norwegian ECEC setting. Objective: This study aims to evaluate the effectiveness of Be-Prox in preventing and handling bullying among peers in Norwegian ECECs. Methods: ECECs from 2 Norwegian municipalities were invited to participate in a cluster randomized controlled trial (RCT) to evaluate the effectiveness of the Be-Prox intervention on peer bullying in Norwegian ECECs. After baseline measures were taken, project ECECs were randomized to either an intervention or a control arm. The Be-Prox intervention was introduced to ECECs in the intervention arm through 6 modules over a 9-month period immediately after the randomization. ECECs in the control arm participated in the data collection and were offered the Be-Prox intervention the following year. The primary outcome of the effect evaluation is the mean sum of negative behavior between peers after the Be-Prox training is completed in the intervention arm. Secondary outcomes include child bystander behavior, teacher self-efficacy, and ECEC?s authoritative climate. An extensive implementation and process evaluation, as well as cost-effectiveness analyses, will be conducted alongside the RCT. Results: Baseline data collection was conducted in September 2023, and the postintervention data collection started in May 2024. At baseline, we collected data on 708 children and 413 personnel from 38 project ECECs in the 2 Norwegian municipalities. The results from the study will be available in late 2024 at the earliest. Conclusions: The proposed project includes a comprehensive evaluation of the effectiveness of Be-Prox in Norwegian ECECs directly targeting the prevention and handling of bullying, including implementation and cost-effectiveness evaluations. The results from the project have the potential to fill in identified knowledge gaps in the understanding of negative behavior and bullying between peers in ECECs, and how these may be prevented. If proven efficient, our ambition is to offer Be-Prox to Norwegian ECECs as an evidence-based practice to prevent and handle bullying among preschool children. Trial Registration: ClinicalTrials.gov NCT06040437; https://clinicaltrials.gov/study/NCT06040437 International Registered Report Identifier (IRRID): DERR1-10.2196/60626 UR - https://www.researchprotocols.org/2024/1/e60626 UR - http://dx.doi.org/10.2196/60626 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60626 ER - TY - JOUR AU - Cho, Minseo AU - Park, Doeun AU - Choo, Myounglee AU - Kim, Jinwoo AU - Han, Hyun Doug PY - 2024/10/24 TI - Development and Initial Evaluation of a Digital Phenotype Collection System for Adolescents: Proof-of-Concept Study JO - JMIR Form Res SP - e59623 VL - 8 KW - adolescents KW - adolescent mental health KW - smartphone apps KW - self-monitoring KW - qualitative research KW - phenotypes KW - proof of concept KW - digital phenotyping KW - phenotype data KW - ecological momentary assessment N2 - Background: The growing concern on adolescent mental health calls for proactive early detection and intervention strategies. There is a recognition of the link between digital phenotypes and mental health, drawing attention to their potential use. However, the process of collecting digital phenotype data presents challenges despite its promising prospects. Objective: This study aims to develop and validate system concepts for collecting adolescent digital phenotypes that effectively manage inherent challenges in the process. Methods: In a formative investigation (N=34), we observed adolescent self-recording behaviors and conducted interviews to develop design goals. These goals were then translated into system concepts, which included planners resembling interfaces, simplified data input with tags, visual reports on behaviors and moods, and supportive ecological momentary assessment (EMA) prompts. A proof-of-concept study was conducted over 2 weeks (n=16), using tools that simulated the concepts to record daily activities and complete EMA surveys. The effectiveness of the system was evaluated through semistructured interviews, supplemented by an analysis of the frequency of records and responses. Results: The interview findings revealed overall satisfaction with the system concepts, emphasizing strong support for self-recording. Participants consistently maintained daily records throughout the study period, with no missing data. They particularly valued the recording procedures that aligned well with their self-recording goal of time management, facilitated by the interface design and simplified recording procedures. Visualizations during recording and subsequent report viewing further enhanced engagement by identifying missing data and encouraging deeper self-reflection. The average EMA compliance reached 72%, attributed to a design that faithfully reflected adolescents? lives, with surveys scheduled at convenient times and supportive messages tailored to their daily routines. The high compliance rates observed and positive feedback from participants underscore the potential of our approach in addressing the challenges of collecting digital phenotypes among adolescents. Conclusions: Integrating observations of adolescents? recording behavior into the design process proved to be beneficial for developing an effective and highly compliant digital phenotype collection system. UR - https://formative.jmir.org/2024/1/e59623 UR - http://dx.doi.org/10.2196/59623 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446465 ID - info:doi/10.2196/59623 ER - TY - JOUR AU - Li, Huilun AU - Lu, Zhaohui AU - Zhang, Erliang AU - Zhang, Jie AU - Cui, Shuheng AU - Takahashi, Masaki AU - Xiang, Mi PY - 2024/10/23 TI - Meal Timing and Depression Among Chinese Children and Adolescents: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e54275 VL - 10 KW - mental health KW - meal timing KW - chrononutrition KW - depression KW - mhealth KW - meal time KW - children KW - adolescent KW - cross-sectional study KW - China KW - schedule of meal KW - metabolic disorder KW - correlation KW - survey KW - breakfast skipping KW - food intake KW - daily eating KW - analysis KW - logistic regression N2 - Background: Depression in children and adolescents is a rising concern in China. Dietary behavior is a critical determinant of mental health. Meal timing, or the schedule of meal consumption, has been related to several metabolic disorders. However, the effect of meal timing on mental health is scarce, particularly in children and adolescents who are in a critical period of physical and psychological development. Objective: This research examined the relationship between meal timing and depression in children and adolescents in China. Methods: Children and adolescents from grades 1 to 9 were recruited from 16 districts in Shanghai, China, from January 3 to January 21, 2020. Ten schools attended the study. A survey was distributed to the students and their parents to collect demographic and health-related information. Depression was measured by the Children?s Depression Inventory-Short Form. Breakfast consumption was analyzed as a binary outcome. Participants were defined as breakfast consumers if they never skipped breakfast during the week. They were otherwise defined as breakfast skippers if they skipped breakfast at least once per week. A similar categorization was applied to analyze food intake proximal to bed. Daily eating windows were calculated using the last food intake time frame?the first food intake time frame. Participants were classified into eating window groups of less than 10 hours, 10-12 hours, and more than 12 hours. A logistic regression model was used to compute the odds ratio (OR) and 95% CI. Results: A total of 6874 participants were included in the analysis. Participants who skipped breakfast were associated with a 2.70 times higher occurrence of depression (OR 2.70, 95% CI 2.24?3.26; P<.001). The prevalence of depression was 1.28 times higher in participants who ate before bed than in those who never ate before bed (OR 1.28, 95% CI 1.08?1.50; P<.001). The occurrence of depression was 1.37 times higher if the eating time window was shorter than 10 hours (OR 1.37, 95% CI 1.08?1.73; P=.009) and 1.23 times higher if the eating time window was longer than 12 hours (OR 1.23, 95% CI 1.01?1.50; P=.004). The lowest occurrence of depression was observed at 11.5 hours. Subgroup analysis showed that such relationships remained significant in adolescents aged 10 years or older. In children, only skipping breakfast was associated with a higher odds of depression (OR 2.77, 95% CI 1.94?3.96; P<.001). Conclusions: Breakfast skipping and eating before bed significantly increase the occurrence of depression. The optimal daily eating window to lower the occurrence of depression is 11.5 hours in children and adolescents. Daily eating windows longer than 12 hours or shorter than 10 hours are associated with an elevated occurrence of depression. Current findings advocate evidence-based dietary strategies to prevent and treat depression in children and adolescents. UR - https://publichealth.jmir.org/2024/1/e54275 UR - http://dx.doi.org/10.2196/54275 ID - info:doi/10.2196/54275 ER - TY - JOUR AU - Kumar, Komal AU - Childs, W. Amber AU - Kohlmeier, Jonathan AU - Kroll, Elizabeth AU - Zant, Izabella AU - Stolzenbach, Stephanie AU - Fenkel, Caroline PY - 2024/10/23 TI - Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative JO - JMIR Form Res SP - e58994 VL - 8 KW - measurement-based care KW - MBC KW - remote KW - intensive outpatient program KW - IOP KW - mental health KW - implementation N2 - Background: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. Objective: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. Methods: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. Results: The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Conclusions: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings. UR - https://formative.jmir.org/2024/1/e58994 UR - http://dx.doi.org/10.2196/58994 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441653 ID - info:doi/10.2196/58994 ER - TY - JOUR AU - Gee, Brioney AU - Teague, Bonnie AU - Laphan, Andrew AU - Clarke, Tim AU - Coote, Georgianna AU - Garner, Jessica AU - Wilson, Jon PY - 2024/10/22 TI - Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation JO - JMIR Ment Health SP - e52866 VL - 11 KW - anxiety KW - children KW - young people KW - exposure therapy KW - graded exposures KW - cognitive behavioural therapy KW - digital intervention KW - mobile app KW - gaming KW - real-world evaluation KW - gaming technology KW - real-world implementation N2 - Background: Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7?12 years through a mobile app incorporating immersive gaming technology. Objective: We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service?funded mental health services. Methods: We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7?12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of ?challenges? completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Results: Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3?12) and the median time spent engaging with the intervention was 42 (IQR 15?79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25?0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27?0.65) between the first and last data points. Two in 5 young people?s scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. Conclusions: This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7?12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn. UR - https://mental.jmir.org/2024/1/e52866 UR - http://dx.doi.org/10.2196/52866 ID - info:doi/10.2196/52866 ER - TY - JOUR AU - Arai, Takahiro AU - Tsubaki, Hiroe AU - Wakano, Ayako AU - Shimizu, Yasuyuki PY - 2024/10/21 TI - Association Between School-Related Google Trends Search Volume and Suicides Among Children and Adolescents in Japan During 2016-2020: Retrospective Observational Study With a Time-Series Analysis JO - J Med Internet Res SP - e51710 VL - 26 KW - adolescent KW - children KW - COVID-19 KW - Google Trends KW - internet KW - Japan KW - monitoring KW - suicide KW - surveillance KW - time series analysis N2 - Background: Suicide is the leading cause of death among children and adolescents in Japan. Internet search volume may be useful in detecting suicide risk. However, few studies have shown an association between suicides attempted by children and adolescents and their internet search volume. Objective: This study aimed to examine the relationship between the number of suicides and the volume of school-related internet searches to identify the search terms that could serve as the leading indicators of suicide prevention among children and adolescents. Methods: We used data on weekly suicides attempted by elementary, middle, and high school students in Japan from 2016 to 2020, provided by the National Police Agency. Internet search volume was weekly data for 20 school-related terms obtained from Google Trends. Granger causality and cross-correlation analysis were performed to estimate the temporal back-and-forth and lag between suicide deaths and search volume for the related terms. Results: The search queries ?I do not want to go to school? and ?study? showed Granger causality with suicide incidences. The cross-correlation analysis showed significant positive correlations in the range of ?2 to 2 for ?I do not want to go to school? (highest value at time lag 0, r=0.28), and ?1 to 2 for ?study? (highest value at time lag ?1, r=0.18), indicating that the search volume increased as the number of suicides increased. Furthermore, during the COVID-19 pandemic period (January-December 2020), the search trend for ?I do not want to go to school,? unlike ?study,? was highly associated with suicide frequency. Conclusions: Monitoring the volume of internet searches for ?I do not want to go to school? could be useful for the early detection of suicide risk among children and adolescents and for optimizing web-based helpline displays. UR - https://www.jmir.org/2024/1/e51710 UR - http://dx.doi.org/10.2196/51710 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51710 ER - TY - JOUR AU - Brogden, Josephine AU - de Haan, Zsofi AU - Gorban, Carla AU - Hockey, J. Samuel AU - Hutcheon, Alexis AU - Iorfino, Frank AU - Song, C. Yun Ju AU - Scott, Elizabeth AU - Hickie, B. Ian AU - McKenna, Sarah PY - 2024/10/18 TI - Enhancing Research Involvement of Young People With Lived Expertise: Reflecting on Experiences in Digital Mental Health Research JO - J Med Internet Res SP - e55441 VL - 26 KW - youth mental health KW - digital mental health KW - lived expertise KW - young people KW - youth KW - adolescence KW - technologies KW - university KW - universities KW - Sydney KW - real-world KW - engagement KW - work environment UR - https://www.jmir.org/2024/1/e55441 UR - http://dx.doi.org/10.2196/55441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55441 ER - TY - JOUR AU - Rachmayanti, D. Riris AU - Dewi, Tetra Fatwa Sari AU - Setiyawati, Diana AU - Megatsari, Hario AU - Diana, Rian AU - Vinarti, Retno PY - 2024/10/16 TI - Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e58681 VL - 13 KW - adolescents KW - digital media KW - mental health KW - resilience KW - scoping review N2 - Background: Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems. Objective: This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths. Methods: The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted. Results: The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education. Conclusions: The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents? resilience skills. International Registered Report Identifier (IRRID): DERR1-10.2196/58681 UR - https://www.researchprotocols.org/2024/1/e58681 UR - http://dx.doi.org/10.2196/58681 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58681 ER - TY - JOUR AU - Cahill, Christopher AU - Connolly, Jennifer AU - Appleton, Shelley AU - White, Jade Melanie PY - 2024/10/15 TI - Perspectives of Children and Adolescents on Engaging With a Web-Based Mental Health Program: Focus Group Study JO - JMIR Pediatr Parent SP - e48910 VL - 7 KW - motivation KW - demotivation KW - external motivation KW - internal motivation KW - digital health interventions KW - engagement KW - internet interventions KW - mental health KW - eHealth KW - youth KW - children KW - adolescents N2 - Background: Despite accessibility and clinical benefits, open access trials of self-guided digital health interventions (DHIs) for young people have been plagued by high drop-out rates, with some DHIs recording completion rates of less than 3%. Objective: The aim of this study was to explore how young people motivate themselves to complete an unpleasant task and to explore perceived motivators and demotivators for engaging with a DHI. Methods: In this qualitative research study, 30 children and adolescents aged between 7 and 17 years were recruited to participate in 7 focus groups conducted over a 3-month period. Focus group activities and discussions explored sources of motivation to complete tasks and engage in a hypothetical 6-week DHI for anxiety. Results: Children (aged 7-11 years) reported greater reliance on external motivators such as following parent instruction to complete unpleasant tasks, while adolescents (aged 12-17 years) reported greater internal motivation such as self-discipline. Program factors, such as engaging content, were the most commonly mentioned motivators for engaging with a DHI across both age groups. After that, internal sources of motivation were most commonly mentioned, such as perceived future benefits. External factors were the most commonly mentioned demotivators across all ages, with time commitment being the most frequently mentioned. Conclusions: The study?s findings have implications for enhancing adherence in future DHIs targeted to children and adolescents. Recommendations include the need for supportive parental involvement for children, while adolescents would likely benefit from mechanisms that promote autonomy, establish a supportive environment, and align with personal interests and values. Belief that a DHI will provide short-term benefits is important to both children and adolescents, as well as having confidence that future benefits will be realized. UR - https://pediatrics.jmir.org/2024/1/e48910 UR - http://dx.doi.org/10.2196/48910 ID - info:doi/10.2196/48910 ER - TY - JOUR AU - Folk, B. Johanna AU - Valencia-Ayala, Cynthia AU - Holloway, D. Evan AU - Anvar, Sarah AU - Czopp, Alison AU - Tolou-Shams, Marina PY - 2024/10/15 TI - Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation JO - JMIR Form Res SP - e57939 VL - 8 KW - family-based intervention KW - affect management KW - child welfare system KW - telehealth KW - formative evaluation KW - trauma exposure KW - substance misuse KW - adverse childhood experiences KW - trauma-informed care KW - adolescent health N2 - Background: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. Objective: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Methods: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Results: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. Conclusions: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. Trial Registration: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523 UR - https://formative.jmir.org/2024/1/e57939 UR - http://dx.doi.org/10.2196/57939 UR - http://www.ncbi.nlm.nih.gov/pubmed/39405104 ID - info:doi/10.2196/57939 ER - TY - JOUR AU - Pokorna, Nikola AU - Palmer, Melanie AU - Pearson, Oliver AU - Beckley-Hoelscher, Nicholas AU - Shearer, James AU - Kostyrka-Allchorne, Katarzyna AU - Robertson, Olly AU - Koch, Marta AU - Slovak, Petr AU - Day, Crispin AU - Byford, Sarah AU - Waite, Polly AU - Creswell, Cathy AU - Sonuga-Barke, S. Edmund J. AU - Goldsmith, Kimberley PY - 2024/10/8 TI - Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e53864 VL - 7 KW - parenting KW - intervention KW - smartphone app KW - randomized controlled trial KW - COVID-19 pandemic KW - moderators KW - conduct problems KW - emotional problems N2 - Background: A smartphone app, Parent Positive, was developed to help parents manage their children?s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children?s emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive?s effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=?0.41, 95% CI ?0.82 to 0.0004; P=.05) or significant (T3: B=?0.76, 95% CI ?1.22 to ?0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive?s potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 UR - https://pediatrics.jmir.org/2024/1/e53864 UR - http://dx.doi.org/10.2196/53864 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378100 ID - info:doi/10.2196/53864 ER - TY - JOUR AU - Horita, Hideki AU - Seki, Yoichi AU - Yamaguchi, Takumi AU - Shiko, Yuki AU - Kawasaki, Yohei AU - Shimizu, Eiji PY - 2024/10/3 TI - Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e60604 VL - 7 KW - internet addiction KW - adolescents KW - parents KW - cognitive behavioral therapy KW - digital health N2 - Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent?s problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents? hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 UR - https://pediatrics.jmir.org/2024/1/e60604 UR - http://dx.doi.org/10.2196/60604 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361415 ID - info:doi/10.2196/60604 ER - TY - JOUR AU - Feng, Yonggang AU - Xue, Qihui AU - Yu, Peng AU - Peng, Lanxiang PY - 2024/10/2 TI - The Relationship Between Epidemic Perception and Cyberbullying Behaviors of Chinese Adolescents During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e54066 VL - 10 KW - COVID-19 KW - epidemic perception KW - cyberbullying behaviors KW - insomnia KW - anxiety and depression N2 - Background: In response to the COVID-19 outbreak, the government initiated measures for social distancing, leading to a gradual transition of adolescents? social interactions toward web-based platforms. Consequently, web-based behaviors, particularly cyberbullying, have become a prominent concern. Considering that adolescents experience more intense feelings, the widely increased negative emotions and strains perceived from the COVID-19 pandemic may end up engaging in cyberbullying behaviors. In addition, during the COVID-19 pandemic, adolescents experiencing insomnia and negative affect are more prone to diminished self-control, which is associated with cyberbullying behaviors. Objective: This study aims to investigate the relationship between epidemic perception and cyberbullying behaviors, while also examining the serial mediating roles of insomnia and negative affect on the relationship between epidemic perception and cyberbullying behaviors. Methods: This study presents a large-scale web-based survey conducted during the period of concentrated COVID-19 outbreaks, encompassing 20,000 Chinese adolescents. A total of 274 submitted questionnaires were discarded because of high levels of missing data or their answers were clearly fictitious or inconsistent. The final count of valid participants amounted to 19,726 (10,371 boys, age range: 12?18 years; mean 14.80, SD 1.63 years). The Perceptions of COVID-19 Scale, Negative Affect Scale, Insomnia Scale, and Cyberbullying Behavior Scale were used to assess participants? responses on the Questionnaire Star platform. Results: The results show that epidemic perception is positively correlated with cyberbullying behaviors (r=0.13; P<.001), insomnia (r=0.19; P<.001), and negative affect (r=0.25; P<.001). Insomnia is positively correlated with negative affect (r=0.44; P<.001) and cyberbullying behaviors (r=0.30; P<.001). Negative affect is positively correlated with cyberbullying behaviors (r=0.25; P<.001). And insomnia and negative affect play independent mediating and serial mediating roles in epidemic perception and cyberbullying behaviors. Conclusions: This study provides additional empirical evidence on the relationship between the perception of COVID-19 pandemic and cyberbullying in adolescents. In addition, the study offers recommendations for implementing interventions targeted at mitigating cyberbullying in adolescents during the COVID-19 pandemic. UR - https://publichealth.jmir.org/2024/1/e54066 UR - http://dx.doi.org/10.2196/54066 ID - info:doi/10.2196/54066 ER - TY - JOUR AU - Iyer, Priya AU - Iyer, Lina AU - Carter, Nicole AU - Iyer, Ranjani AU - Stirling, Amy AU - Priya, Lakshmi AU - Sriraman, Ushma PY - 2024/9/30 TI - Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study JO - JMIR Form Res SP - e56355 VL - 8 KW - Heartfulness, anxiety, loneliness, high school, satisfaction with life KW - self-care KW - develop KW - stress KW - stress management KW - effectiveness KW - life satisfaction KW - students KW - student KW - support KW - web-based program KW - time management KW - educational KW - mental health KW - tool KW - tools N2 - Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder?Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 UR - https://formative.jmir.org/2024/1/e56355 UR - http://dx.doi.org/10.2196/56355 UR - http://www.ncbi.nlm.nih.gov/pubmed/39047180 ID - info:doi/10.2196/56355 ER - TY - JOUR AU - Nakagami, Yukako AU - Uwatoko, Teruhisa AU - Shimamoto, Tomonari AU - Sakata, Masatsugu AU - Toyomoto, Rie AU - Yoshida, Kazufumi AU - Luo, Yan AU - Shiraishi, Nao AU - Tajika, Aran AU - Sahker, Ethan AU - Horikoshi, Masaru AU - Noma, Hisashi AU - Iwami, Taku AU - Furukawa, A. Toshi PY - 2024/9/24 TI - Long-Term Effects of Internet-Based Cognitive Behavioral Therapy on Depression Prevention Among University Students: Randomized Controlled Factorial Trial JO - JMIR Ment Health SP - e56691 VL - 11 KW - iCBT KW - depression prevention KW - student mental health KW - factorial randomized controlled trial KW - mobile phone N2 - Background: Internet-based cognitive behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear. Objective: We aim to evaluate the effects of iCBT components in preventing depression among university students. Methods: Using a smartphone cognitive behavioral therapy (CBT) app, we randomly allocated university students to the presence or absence of 5 different iCBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. The active intervention lasted 8 weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and the follow-up after 52 weeks, as assessed with the computerized World Health Organization Composite International Diagnostic Interview. Secondary outcomes included changes in the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, and CBT Skills Scale. Results: During the 12-month follow-up, 133 of 1301 (10.22%) participants reported the onset of an MDE. There were no significant differences in the incidence of MDEs between the groups with or without each component (hazard ratios ranged from 0.85, 95% CI 0.60?1.20, for assertiveness training to 1.26, 95% CI 0.88?1.79, for self-monitoring). Furthermore, there were no significant differences in the changes on the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up. Conclusions: In this study, we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period, but all participants with and without intervention of each iCBT component demonstrated significant improvements in depressive and anxiety symptoms. Further research is needed to explore the potential impact of frequency of psychological assessments, nonspecific intervention effects, natural change in the mental state, and the baseline depression level. Trial Registration: UMINCTR UMIN000031307; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035735 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2719-z UR - https://mental.jmir.org/2024/1/e56691 UR - http://dx.doi.org/10.2196/56691 ID - info:doi/10.2196/56691 ER - TY - JOUR AU - Magnuson, I. Katherine AU - Li, Kexin AU - Beuley, Grace AU - Ryan-Pettes, R. Stacy PY - 2024/9/24 TI - The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review JO - JMIR Mhealth Uhealth SP - e51273 VL - 12 KW - behavioral parent training KW - mobile health KW - mHealth KW - mobile app KW - adolescent KW - substance use KW - child mental health condition KW - mobile phone N2 - Background: The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. Objective: This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. Results: Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. Conclusions: Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings. UR - https://mhealth.jmir.org/2024/1/e51273 UR - http://dx.doi.org/10.2196/51273 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316435 ID - info:doi/10.2196/51273 ER - TY - JOUR AU - Li, Juanjuan AU - Sun, Weidi AU - Luo, Zeyu AU - Liu, Yi AU - Huang, Xuanyin AU - Jiang, Denan AU - Li, Shuting AU - Meng, Jia AU - Gu, Fang AU - Zhang, Ronghua AU - Song, Peige PY - 2024/9/23 TI - Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e53101 VL - 10 KW - internet use KW - internet addiction KW - depression KW - children KW - adolescents KW - China KW - depressive symptoms N2 - Background: Children?s lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95% CI 1.34?1.74) and girls using internet for 1.1?2 hours/day (OR 1.22, 95% CI 1.06?1.39) and >2 hours/day (OR 1.70, 95% CI 1.50?1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95% CI 1.83?2.21; 2 IA behaviors: 2.91, 95% CI 2.57?3.29; and ?3 IA behaviors: 4.72, 95% CI 4.26?5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. UR - https://publichealth.jmir.org/2024/1/e53101 UR - http://dx.doi.org/10.2196/53101 ID - info:doi/10.2196/53101 ER - TY - JOUR AU - Turkington, Robin AU - Potts, Courtney AU - Mulvenna, Maurice AU - Bond, Raymond AU - O'Neill, Siobhán AU - Ennis, Edel AU - Hardcastle, Katie AU - Scowcroft, Elizabeth AU - Moore, Ciaran AU - Hamra, Louise PY - 2024/9/19 TI - Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis JO - JMIR Ment Health SP - e58162 VL - 11 KW - crisis helplines KW - call duration KW - mental health KW - suicide KW - suicidal KW - suicide prevention KW - population-based KW - help-seeking behavior KW - Samaritans KW - UK KW - telephony KW - telephone KW - telephones KW - one-way analysis KW - call KW - calls KW - talk time KW - support KW - talk time differences N2 - Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom?s 4 countries or regions. Objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller?s current region (intraregional calls) or routed to a branch that is in a different region from that of the caller?s current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene?s test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service. UR - https://mental.jmir.org/2024/1/e58162 UR - http://dx.doi.org/10.2196/58162 ID - info:doi/10.2196/58162 ER - TY - JOUR AU - Yu, Yanqiu AU - Wu, S. Anise M. AU - Fong, I. Vivian W. AU - Zhang, Jianxin AU - Li, Ji-bin AU - Lau, F. Joseph T. PY - 2024/9/19 TI - Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study JO - JMIR Serious Games SP - e48439 VL - 12 KW - internet gaming disorder KW - suicidal ideation KW - adolescents KW - mediation KW - structural equation modelling KW - resilience KW - loneliness KW - social support KW - social anxiety N2 - Background: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. Objective: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. Methods: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: ?Have you ever considered committing suicide in the past 12 months?? Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. Results: Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant. Conclusions: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study. UR - https://games.jmir.org/2024/1/e48439 UR - http://dx.doi.org/10.2196/48439 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48439 ER - TY - JOUR AU - Murgueitio, Nicolas AU - Tate, Maresa AU - Lurie, Lucy AU - Priddy, Zoe AU - Boda, Sneha AU - Shipkova, Michelle AU - Rodriguez, Micaela AU - Machlin, Laura AU - Furlong, Sarah AU - Mitchell, Amanda AU - McLaughlin, Katie AU - Sheridan, Margaret PY - 2024/9/17 TI - Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study JO - JMIR Res Protoc SP - e59636 VL - 13 KW - early adversity KW - psychopathology KW - neurodevelopment KW - adverse childhood events KW - child development N2 - Background: Early adversity, broadly defined as a set of negative exposures during childhood, is extremely common and increases risk for psychopathology across the life span. Previous research suggests that separate dimensions of adversity increase risk through developmental plasticity mechanisms shaping unique neurobiological pathways. Specifically, research suggests that deprivation is associated with deficits in higher order cognition, while threat is associated with atypicality in fear learning and emotion dysregulation. However, most of this research has been conducted in adolescent and adult samples, long after exposure to adversity occurs and far from periods of peak developmental plasticity. Objective: The Wellness Health and Life Experiences (WHALE) study examines the neurobiological and behavioral mechanisms by which deprivation, threat, and unpredictability increase risk for psychopathology in early childhood (age 4-7 years) directly following periods of peak developmental plasticity. The objective of this study is to describe the study rationale and aims, the research design and procedures, and the analytical plan to test the study hypotheses. Methods: This is a retrospective cohort study that examines associations between exposure to deprivation and threat and their hypothesized neurobiological mechanisms, how these neurobiological mechanisms link early adversity and psychopathology, and associations between unpredictability, reward learning, and psychopathology. The sample was a convenience sample of children (aged 4-7 years) and their families, identified through flyers, email blasts to listserves, school-based advertising, and involvement in community events. Data were collected during a home visit, a subsequent laboratory visit, and a final neuroimaging visit. Planned analyses include linear regression, path analyses, and functional magnetic resonance imaging analyses to explore the role of neural function in the association between early adversity and psychopathology. Results: Participants (N=301) have been recruited into the study, and data collection has commenced. The expected results will be available in 2024. Conclusions: The findings of this study will help elucidate the neurobiological mechanisms by which early adversity increases risk for psychopathology in early childhood. This study represents the earliest test of an influential theory of biological embedding of early adversity. International Registered Report Identifier (IRRID): DERR1-10.2196/59636 UR - https://www.researchprotocols.org/2024/1/e59636 UR - http://dx.doi.org/10.2196/59636 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59636 ER - TY - JOUR AU - Hogue, Aaron AU - Bobek, Molly AU - Porter, P. Nicole AU - MacLean, Alexandra AU - Henderson, E. Craig AU - Jensen-Doss, Amanda AU - Diamond, M. Gary AU - Southam-Gerow, A. Michael AU - Ehrenreich-May, Jill PY - 2024/9/16 TI - Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study JO - JMIR Res Protoc SP - e64332 VL - 13 KW - adolescent substance use KW - adolescent anxiety and depression KW - cooccurring disorders KW - adjunctive treatment KW - family-based interventions KW - usual care N2 - Background: Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receiving community-based treatment for substance use disorders (SUDs). For such clients, interventions that do not holistically address both SUDs and IDs are less effective. Objective: This pilot treatment development study aims to develop and test a modular treatment protocol for addressing cooccurring IDs among adolescents (aged 13 to 18 years) enrolled in routine care for substance use problems: Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians to markedly alter existing base practices for SUD. It will be anchored by 3 evidence-based foundations for treating cooccurring adolescent IDs: family engagement techniques, transdiagnostic individual cognitive behavioral therapy techniques, and family psychoeducation and safety planning. Methods: This quasi-experimental study will proceed in 2 stages. The pilot stage will use rapid-cycle prototyping methods in collaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources, solicit provider and client input on protocol content and delivery via cognitive interviewing, and pilot prototype components on 4 to 6 cases. The second stage will be an interrupted time series study for 60 comorbid SUD+ID cases across 2 sites serving diverse adolescents: 30 will receive treatment as usual (TAU); following clinician training in the protocol, 30 new cases will receive TAU enhanced by Fam-AID. For aim 1, the focus is on evaluating the acceptability of the Fam-AID protocol through therapist and client interviews as well as assessing fidelity benchmarks using therapist- and observer-reported protocol fidelity data. For aim 2, the plan is to compare the effects of TAU only cases versus TAU+Fam-AID cases on family treatment attendance and on adolescent ID and substance use symptoms, with measurements taken at baseline and at 3-month and 6-month follow-ups. Results: Study recruitment will begin in April 2025. Conclusions: We anticipate that Fam-AID will contain 5 treatment modules that can be delivered in any sequence to meet client needs: family engagement of primary supports in treatment planning and services; relational reframing of family constraints, resiliencies, and social capital connected to the adolescent?s ID symptoms; functional analysis of the adolescent?s ID symptoms and related behaviors; cognitive behavioral therapy to address the adolescent?s ID symptoms and functional needs, featuring 3 core techniques (emotion acceptance, emotional exposure, and behavioral activation) to address negative affect and emotional dysregulation; and family psychoeducation and safety planning focused on education about comorbid SUD+ID and prevention of adolescent self-harm. If the abovementioned modules are found to be feasible and effective, Fam-AID will offer a set of pragmatic interventions to SUD clinicians for treating cooccurring IDs in adolescent clients. Trial Registration: ClinicalTrials.gov NCT06413979; https://www.clinicaltrials.gov/study/NCT06413979 International Registered Report Identifier (IRRID): PRR1-10.2196/64332 UR - https://www.researchprotocols.org/2024/1/e64332 UR - http://dx.doi.org/10.2196/64332 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64332 ER - TY - JOUR AU - Lyzwinski, Lynnette AU - Zwicker, D. Jennifer AU - Mcdonald, Sheila AU - Tough, Suzanne PY - 2024/9/13 TI - Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination JO - JMIR Pediatr Parent SP - e59171 VL - 7 KW - positive psychology KW - mindfulness KW - resilience KW - mental health KW - flourishing KW - knowledge translation KW - depression KW - anxiety KW - stress N2 - Background: There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health. Objective: The aims of this review were to evaluate positive psychological interventions for child and youth mental health implemented during the COVID-19 pandemic and assess overall effectiveness for mental health and knowledge. Methods: We undertook a literature search of PubMed, MEDLINE, and Google Scholar for all eligible studies on digital and hybrid in-person psychological interventions for youth mental health during the COVID-19 pandemic. A particular emphasis was placed on positive psychological interventions or interventions that had components of positive psychology, including gratitude, acceptance, positive emotions, or resilience building. Results: A total of 41 interventions were included in this review. Most of the interventions were digital. Overall, most of the interventions assisted with one or more mental health or psychological indicators, such as depression, anxiety, posttraumatic stress disorder, stress, and resilience. However, findings were mixed when it came to targeting both depression and anxiety together. The interventions that promoted youth mental health most often had a range of diverse positive psychology components and were evidence based. Not all studies measured changes in mindfulness. Few studies examined knowledge acquired on mental health self-care, managing mental health problems, knowledge of positive psychological techniques, mindfulness knowledge, or mental health self-efficacy. Conclusions: Diverse multicomponent interventions appear to assist with youth mental health overall, although their effects on both depression and anxiety are less clear. There is also a need for more research on knowledge gains to determine whether the interventions improved knowledge on mental health?supportive behaviors, which may be sustained beyond the intervention. Finally, more studies need to evaluate whether the interventions assisted with increasing self-efficacy for practicing positive psychological techniques as well as changes in mindfulness levels. Future studies should not only assess effectiveness for mental health outcomes but also assess knowledge translation, with valid measures of knowledge and self-efficacy for mental health?supportive behaviors and positive psychological skills acquired (eg, the ability to practice mindfulness). UR - https://pediatrics.jmir.org/2024/1/e59171 UR - http://dx.doi.org/10.2196/59171 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59171 ER - TY - JOUR AU - Kang, Boyoung AU - Hong, Munpyo PY - 2024/9/12 TI - Digital Interventions for Reducing Loneliness and Depression in Korean College Students: Mixed Methods Evaluation JO - JMIR Form Res SP - e58791 VL - 8 KW - loneliness KW - depression KW - digital interventions KW - college students KW - mental health KW - mixed methods evaluation KW - Woebot KW - Happify N2 - Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot (Woebot Health, Inc) and Happify (Twill Inc), have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed methods approach was used over 4 months. A total of 63 participants aged 18 to 27 years from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with an inclusion criterion of University of California, Los Angeles (UCLA) Loneliness Scale score ?34. The final sample consisted of 27 participants due to attrition. Participants were randomly assigned to Woebot (15/27, 55%); Happify (9/27, 33%); or a control group using Bondee (Metadream), a metaverse social network messenger app (3/27, 11%). Quantitative measures (UCLA Loneliness Scale and Patient Health Questionnaire-9) and qualitative assessments (user feedback and focused interviews) were used. Results: Although mean decreases in loneliness and depression were observed in the control and intervention groups after the intervention, the differences between the control and intervention groups were not statistically significant (UCLA Loneliness: P=.67; Patient Health Questionnaire-9: P=.35). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, this study highlights the potential of well-designed digital interventions in alleviating college students? loneliness and depression. The findings contribute to the growing body of research on accessible digital mental health tools and underscore the importance of comprehensive support systems. Further research with larger and more diverse samples is needed to better understand the effectiveness and optimization of such interventions. Trial Registration: Clinical Research Information Service KCT0009449; https://bit.ly/4d2e4Bu UR - https://formative.jmir.org/2024/1/e58791 UR - http://dx.doi.org/10.2196/58791 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58791 ER - TY - JOUR AU - Dolling-Boreham, M. Roberta AU - Mohan, Akshay AU - Abdelhack, Mohamed AU - Elton-Marshall, Tara AU - Hamilton, A. Hayley AU - Boak, Angela AU - Felsky, Daniel PY - 2024/9/12 TI - Identifying Psychosocial and Ecological Determinants of Enthusiasm In Youth: Integrative Cross-Sectional Analysis Using Machine Learning JO - JMIR Public Health Surveill SP - e48705 VL - 10 KW - subjective well-being KW - Ontario Student Drug Use and Health Survey (OSDUHS) KW - machine learning KW - Shapley additive explanations (SHAP) KW - extreme gradient boosting (XGBoost) KW - psychosocial KW - ecological KW - determinants KW - enthusiasm KW - mental health KW - well-being KW - youth KW - public health KW - student KW - self-reported N2 - Background: Understanding the factors contributing to mental well-being in youth is a public health priority. Self-reported enthusiasm for the future may be a useful indicator of well-being and has been shown to forecast social and educational success. Typically, cross-domain measures of ecological and health-related factors with relevance to public policy and programming are analyzed either in isolation or in targeted models assessing bivariate interactions. Here, we capitalize on a large provincial data set and machine learning to identify the sociodemographic, experiential, behavioral, and other health-related factors most strongly associated with levels of subjective enthusiasm for the future in a large sample of elementary and secondary school students. Objective: The aim of this study was to identify the sociodemographic, experiential, behavioral, and other health-related factors associated with enthusiasm for the future in elementary and secondary school students using machine learning. Methods: We analyzed data from 13,661 participants in the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (grades 7-12) with complete data for our primary outcome: self-reported levels of enthusiasm for the future. We used 50 variables as model predictors, including demographics, perception of school experience (i.e., school connectedness and academic performance), physical activity and quantity of sleep, substance use, and physical and mental health indicators. Models were built using a nonlinear decision tree?based machine learning algorithm called extreme gradient boosting to classify students as indicating either high or low levels of enthusiasm. Shapley additive explanations (SHAP) values were used to interpret the generated models, providing a ranking of feature importance and revealing any nonlinear or interactive effects of the input variables. Results: The top 3 contributors to higher self-rated enthusiasm for the future were higher self-rated physical health (SHAP value=0.62), feeling that one is able to discuss problems or feelings with their parents (SHAP value=0.49), and school belonging (SHAP value=0.32). Additionally, subjective social status at school was a top feature and showed nonlinear effects, with benefits to predicted enthusiasm present in the mid-to-high range of values. Conclusions: Using machine learning, we identified key factors related to self-reported enthusiasm for the future in a large sample of young students: perceived physical health, subjective school social status and connectedness, and quality of relationship with parents. A focus on perceptions of physical health and school connectedness should be considered central to improving the well-being of youth at the population level. UR - https://publichealth.jmir.org/2024/1/e48705 UR - http://dx.doi.org/10.2196/48705 UR - http://www.ncbi.nlm.nih.gov/pubmed/39264706 ID - info:doi/10.2196/48705 ER - TY - JOUR AU - Guo, Yufang AU - Yue, Fangyan AU - Lu, Xiangyu AU - Sun, Fengye AU - Pan, Meixing AU - Jia, Yannan PY - 2024/9/10 TI - COVID-19?Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey JO - J Med Internet Res SP - e52978 VL - 26 KW - COVID-19 pandemic KW - internet gaming disorder KW - self-control KW - social isolation KW - university students KW - game KW - gaming KW - games KW - addict KW - addictive KW - addiction KW - addictions KW - university KW - universities KW - college KW - colleges KW - postsecondary KW - higher education KW - student KW - students KW - China KW - Chinese KW - isolation KW - isolated KW - self-compassion KW - mental health KW - association KW - associations KW - correlation KW - causal KW - correlated KW - correlations N2 - Background: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. Objective: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. Methods: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. Results: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=?0.355; P<.001) and internet gaming disorder (r=?0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder (?=?.185, 95% CI ?.295 to ?.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. Conclusions: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed. UR - https://www.jmir.org/2024/1/e52978 UR - http://dx.doi.org/10.2196/52978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52978 ER - TY - JOUR AU - Jeffery, C. Mairi AU - Deighton, Jessica AU - Lereya, Tanya Suzet PY - 2024/9/9 TI - Establishing Priorities for Improving Data Collection and Measurement of Mental Health and Well-Being of Adolescents With Special Educational Needs Within Nonmainstream Schools: Protocol for a Delphi Study JO - JMIR Res Protoc SP - e58610 VL - 13 KW - special educational needs KW - special schools KW - alternative provision KW - mental health KW - well-being KW - school-based measurement N2 - Background: There are more than 1.5 million children and young people in England with special educational needs (SEN), with over 160,000 young people in the United Kingdom attending a special school or alternative provision (AP) setting. Young people with SEN have been found to be at risk for poorer mental health and well-being than non-SEN peers. However, there is a range of both school-related and research challenges associated with identifying difficulties in a timely manner. Objective: This Delphi study aims to determine a list of stakeholder priorities for improving school-based measurement of mental health and well-being among young people with SEN, at an aggregated level, within secondary special school or AP settings. A secondary objective is to inform the implementation of school-based well-being surveys, improve engagement in special schools or AP settings, and improve survey response rates among children and young people with SEN. Methods: A mixed methods Delphi study will be conducted, including a scoping review and preliminary focus groups with school staff members and researchers to establish key issues. This will be followed by a 2-round Delphi survey to determine a list of stakeholder priorities for improving the measurement of mental health and well-being at an aggregate level within special schools and AP settings. A final stakeholder workshop will be held to discuss the findings. A list of recommendations will be drafted as a report for special schools and AP settings. Results: The study has received ethical approval from the University College London Research Ethics Committee. The stage 1 scoping review has commenced. Recruitment for focus groups will begin in Autumn 2024. The first round of the Delphi survey will commence in early 2025, and the second round of the Delphi survey in the spring of 2025. The final workshop will commence in mid-2025 with final results expected in late 2025. Conclusions: There is a need for clear recommendations for special schools and AP settings on priorities for improving the measurement of mental health and well-being problems among young people with SEN. There is also a need for recommendations to researchers implementing school-based well-being surveys, including the #BeeWell program, to enable them to improve their engagement in special schools and AP settings and ensure surveys are accessible. International Registered Report Identifier (IRRID): PRR1-10.2196/58610 UR - https://www.researchprotocols.org/2024/1/e58610 UR - http://dx.doi.org/10.2196/58610 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250211 ID - info:doi/10.2196/58610 ER - TY - JOUR AU - Donisi, Valeria AU - Salerno, Laura AU - Delvecchio, Elisa AU - Brugnera, Agostino PY - 2024/9/9 TI - Problematic Social Media Use Among Italian Midadolescents: Protocol and Rationale of the SMART Project JO - JMIR Res Protoc SP - e58739 VL - 13 KW - adolescents KW - social media KW - problematic social media use KW - psychological distress KW - wellbeing promotion KW - eHealth interventions KW - co-creation KW - qualitative research KW - biomarkers N2 - Background: Social media (SM) use constitutes a large portion of midadolescents? daily lives as a way of peer interaction. A significant percentage of adolescents experience intense or problematic social media use (PSMU), an etiologically complex behavior potentially associated with psychological distress. To date, studies longitudinally testing for risk or protective factors of PSMU, and collecting qualitative data are still scarce among midadolescents. Self-help interventions specifically targeting PSMU in this population and involving midadolescents in co-creation are needed. Objective: The 2-year SMART multicenter project aims to (1) advance knowledge on PSMU; (2) co-design an unguided self-help app for promoting awareness and functional SM use; and (3) test feasibility and provide preliminary findings on its effectiveness to further improve and adapt the app. Methods: The SMART project is organized in 3 phases: phase 1 will focus on knowledge advancement on PSMU and its risk and protective factors using a longitudinal design; phase 2 will explore adolescents perspectives using qualitative approach and will co-design an unguided self-help app for reducing PSMU, which will be evaluated and adapted in phase 3. Around 1500 midadolescents (aged 14-18 years) will be recruited in northern, central, and southern Italy to investigate the potential intra- and interpersonal psychological risk and protective factors for PSMU and define specific PSMU profiles and test for its association with psychological distress. Subjective (self-report) PSMU?s psychosocial risk or protective factors will be assessed at 3 different time points and Ecological Momentary Assessment (EMA) will be used. Moreover, focus groups will be performed in a subsample of midadolescents to collect the adolescents? unique point of view on PSMU and experiences with SM. Those previous results will inform the self-help app, which will be co-designed through working groups with adolescents. Subsequently, the SMART app will be deployed and adapted, after testing its feasibility and potential effectiveness in a pilot study. Results: The project is funded by the Italian Ministry of University and Research as part of a national grant (PRIN, ?Progetti di Rilevante Interesse Nazionale?). The research team received an official notice of research funding approval in July 2023 (Project Code 2022LC4FT7). The project was preregistered on Open Science Framework, while the ethics approval was obtained in November 2023. We started the enrollments in December 2023, with the final follow-up data to be collected within May 2025. Conclusions: The innovative aspects of the SMART project will deepen the conceptualization of PSMU and of its biopsychosocial antecedents among midadolescents, with relevant scientific, technological, and socioeconomic impacts. The advancement of knowledge and the developed self-help app for PSMU will timely respond to midadolescents? increased loneliness and psychological burden due to COVID-19 pandemic and humanitarian crisis. Trial Registration: OSF Registries; https://osf.io/2ucnk/ International Registered Report Identifier (IRRID): DERR1-10.2196/58739 UR - https://www.researchprotocols.org/2024/1/e58739 UR - http://dx.doi.org/10.2196/58739 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58739 ER - TY - JOUR AU - Zhu, Shimin AU - Hu, Yuxi AU - Wang, Ruobing AU - Qi, Di AU - Lee, Paul AU - Ngai, Wa So AU - Cheng, Qijin AU - Wong, Ching Paul Wai PY - 2024/8/30 TI - Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial JO - JMIR Res Protoc SP - e63220 VL - 13 KW - implicit theory KW - fixed mindset KW - mental health KW - secondary school students KW - belief in change N2 - Background: Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children?s affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child?s internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Objective: Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children?s academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. Methods: A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Results: Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. Conclusions: This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/63220 UR - https://www.researchprotocols.org/2024/1/e63220 UR - http://dx.doi.org/10.2196/63220 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63220 ER - TY - JOUR AU - Theopilus, Yansen AU - Al Mahmud, Abdullah AU - Davis, Hilary AU - Octavia, Renny Johanna PY - 2024/8/30 TI - Preventive Interventions for Internet Addiction in Young Children: Systematic Review JO - JMIR Ment Health SP - e56896 VL - 11 KW - children KW - digital device KW - internet addiction KW - intervention KW - prevention KW - problematic internet use KW - technology KW - young children KW - problematic use KW - preventive KW - interventions KW - systematic review KW - internet KW - addiction KW - prevent KW - reduce KW - risk KW - risks KW - database KW - databases KW - child KW - PICOS KW - thematic analysis KW - Population, Intervention, Comparison, Outcome, and Study type N2 - Background: In this digital age, children typically start using the internet in early childhood. Studies highlighted that young children are vulnerable to internet addiction due to personal limitations and social influence (eg, family and school). Internet addiction can have long-term harmful effects on children?s health and well-being. The high risk of internet addiction for vulnerable populations like young children has raised questions about how best to prevent the problem. Objective: This review study aimed to investigate the existing interventions and explore future directions to prevent or reduce internet addiction risks in children younger than 12 years. Methods: The systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for relevant literature from 4 research databases (Scopus, Web of Science, PubMed, and PsycINFO). We included 14 primary studies discussing the interventions to prevent or reduce internet addiction risks in young children and their efficacy outcomes. Results: The preventive interventions identified were categorized into four approaches as follows: (1) children?s education, (2) parenting strategy, (3) strategic physical activity, and (4) counseling. Ten interventions showed promising efficacy in preventing or reducing internet addiction risks with small-to-medium effect sizes. Interventions that enhance children?s competencies in having appropriate online behaviors and literacy were more likely to show better efficacy than interventions that force children to reduce screen time. Interventions that shift children?s focus from online activities to real-world activities also showed promising efficacy in reducing engagement with the internet, thereby preventing addictive behaviors. We also identified the limitations of each approach (eg, temporariness, accessibility, and implementation) as valuable considerations in developing future interventions. Conclusions: The findings suggest the need to develop more sustainable and accessible interventions to encourage healthy online behaviors through education, appropriate parenting strategies, and substitutive activities to prevent children?s overdependence on the internet. Developing digital tools and social support systems can be beneficial to improve the capability, efficiency, and accessibility of the interventions. Future interventions also need to consider their appropriateness within familial context or culture and provide adequate implementation training. Last, policy makers and experts can also contribute by making design guidelines to prevent digital product developers from making products that can encourage overuse in children. UR - https://mental.jmir.org/2024/1/e56896 UR - http://dx.doi.org/10.2196/56896 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56896 ER - TY - JOUR AU - Rajan, Sonali AU - Buttar, Navjot AU - Ladhani, Zahra AU - Caruso, Jennifer AU - Allegrante, P. John AU - Branas, Charles PY - 2024/8/28 TI - School Violence Exposure as an Adverse Childhood Experience: Protocol for a Nationwide Study of Secondary Public Schools JO - JMIR Res Protoc SP - e56249 VL - 13 KW - adolescents KW - adverse childhood experiences KW - gun violence KW - health outcomes KW - injury prevention KW - school violence N2 - Background: Poor mental health and adverse childhood experiences (ACEs) predict extensive adverse outcomes in youth, including increases in long-term risk for chronic disease and injury, impaired emotional development, and poor academic outcomes. Exposure to school violence, specifically intentional gun violence, is an increasingly prevalent ACE. The anticipation of school shootings has led to the implementation of school safety and security interventions that may increase anxiety, depression, and other indicators of poor mental well-being among students and staff alike. Despite this, the association between exposure to existing school safety interventions and early adolescent student mental health outcomes, while accounting for one's history of ACEs, has not been previously investigated. Objective: The study protocol described here aims to determine whether there is a significant difference in the prevalence of mental health outcomes, perceived school safety, and academic engagement between adolescent students (grades 6-12) at schools who have experienced a school shooting and those who have not; whether existing interventions to promote school safety and security are associated with poor mental health outcomes among students and school staff; and what the strength of the association between school safety interventions and mental health outcomes among students and teachers is in schools that have experienced a school shooting versus schools that have never experienced a school shooting. Methods: This observational study will collect cross-sectional survey data from a nationwide sample of students, teachers, and principals at 12 secondary public schools across the United States. The participants come from 6 randomly selected exposure schools that have either experienced a recent (<2 years ago) intentional school shooting or have experienced an intentional school shooting less recently (>2 years ago). Data from these schools are being directly compared with 6 secondary schools that have never experienced a school shooting. Results: Institutional review board approval for this research project was obtained and the study subsequently began its recruitment and data collection phase in January 2024. Data collection is currently ongoing and the expected completion date is January 2025. The analytic plan is designed to determine if the strength of the association between school safety interventions and mental health outcomes differs among students and school staff in schools with varying levels of school violence exposure. Analyses will be used to evaluate the role of ACEs on the relationships among exposure to an intentional school shooting, exposure to school safety strategies, and student outcomes (ie, mental health and well-being, perceptions of school safety, and educational outcomes). Conclusions: The results from this study promise to generate meaningful and novel findings on the extent to which having a prior history of ACEs moderates the relationships among exposure to intentional school gun violence, school safety strategies, and student outcomes (ie, mental health and well-being, and perceptions of school safety). Trial Registration: ClinicalTrials.gov NCT06153316; https://clinicaltrials.gov/study/NCT06153316 International Registered Report Identifier (IRRID): DERR1-10.2196/56249 UR - https://www.researchprotocols.org/2024/1/e56249 UR - http://dx.doi.org/10.2196/56249 UR - http://www.ncbi.nlm.nih.gov/pubmed/39196631 ID - info:doi/10.2196/56249 ER - TY - JOUR AU - Vakili, Negar AU - Curran, A. Janet AU - Walls, Roisin AU - Phillips, Debbie AU - Miller, Alanna AU - Cassidy, Christine AU - Wozney, Lori PY - 2024/8/27 TI - Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study JO - JMIR Form Res SP - e51690 VL - 8 KW - patient satisfaction KW - satisfaction KW - cross-sectional KW - survey KW - surveys KW - engagement KW - usage KW - technology use KW - transitional KW - transition KW - coordinated care KW - service KW - services KW - feature KW - features KW - need KW - needs KW - transitional care KW - information science KW - human-computer interaction KW - health behavior KW - text-messaging KW - messaging KW - text messages KW - text message KW - SMS KW - mental health KW - persuasive system design KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers N2 - Background: For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message?based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. Objective: This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. Methods: A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. Results: A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Conclusions: Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions. UR - https://formative.jmir.org/2024/1/e51690 UR - http://dx.doi.org/10.2196/51690 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190437 ID - info:doi/10.2196/51690 ER - TY - JOUR AU - Grummitt, Lucinda AU - Bailey, Sasha AU - Kelly, V. Erin AU - Birrell, Louise AU - Gardner, A. Lauren AU - Halladay, Jillian AU - Chapman, Cath AU - Andrews, L. Jack AU - Champion, E. Katrina AU - Hunter, Emily AU - Egan, Lyra AU - Conroy, Chloe AU - Tiko, Raaya AU - Nguyen, An AU - Teesson, Maree AU - Newton, C. Nicola AU - Barrett, L. Emma PY - 2024/8/21 TI - Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process JO - JMIR Pediatr Parent SP - e54637 VL - 7 KW - mental health KW - prevention KW - school KW - depression KW - anxiety KW - proportionate universalism N2 - Background: Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. Objective: This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). Methods: Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. Results: Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. Conclusions: The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools. UR - https://pediatrics.jmir.org/2024/1/e54637 UR - http://dx.doi.org/10.2196/54637 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54637 ER - TY - JOUR AU - Jackson, M. Hayley AU - Batterham, J. Philip AU - Calear, L. Alison AU - Ohan, L. Jeneva AU - Farrer, M. Louise PY - 2024/8/21 TI - Skill Enactment Among University Students Using a Brief Video-Based Mental Health Intervention: Mixed Methods Study Within a Randomized Controlled Trial JO - JMIR Ment Health SP - e53794 VL - 11 KW - university students KW - young people KW - internet KW - computer-assisted therapy KW - engagement KW - skill enactment KW - depression KW - anxiety KW - randomized controlled trial KW - mobile phone N2 - Background: Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions can increase students? access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (ie, skill enactment) or about the impact of skill enactment on outcomes. Objective: This study aims to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment influences symptoms of depression and anxiety (secondary aim). The study also qualitatively explored participants? experiences of, and motivations for, engaging with the therapeutic techniques. Methods: We analyzed data from a randomized controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants were recruited from universities across Australia and randomly assigned to 6 weeks of self-guided use of UVC-Lite (243/487, 49.9%) or an attention-control program (244/487, 50.1%). Quantitative data on skill enactment, depression, and anxiety were collected through baseline, postintervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention-group participants through open-ended questions during postintervention surveys (n=17, 59%) and semistructured interviews (n=12, 41%) after the intervention period concluded. Results: Mixed model repeated measures ANOVA demonstrated that the intervention did not significantly improve skill enactment (F3,215.36=0.50; P=.68). Skill enactment was also not found to influence change in symptoms of depression (F3,241.10=1.69; P=.17) or anxiety (F3,233.71=1.11; P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F1,541.87=134.61; P<.001; anxiety: F1,535.11=73.08; P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past. Conclusions: The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention?s impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in digital mental health interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://tinyurl.com/7b9ar54r UR - https://mental.jmir.org/2024/1/e53794 UR - http://dx.doi.org/10.2196/53794 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53794 ER - TY - JOUR AU - Lawrence-Sidebottom, Darian AU - Huffman, Goodgame Landry AU - Beam, Brenna Aislinn AU - McAlister, Kelsey AU - Guerra, Rachael AU - Parikh, Amit AU - Roots, Monika AU - Huberty, Jennifer PY - 2024/8/16 TI - Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study JO - JMIR Form Res SP - e54816 VL - 8 KW - suicide KW - self-harm KW - collaborative care KW - behavioral health KW - telehealth KW - telemedicine KW - eHealth KW - collaborative KW - collaboration KW - suicidal KW - self-injury KW - crisis KW - crises KW - mental health KW - self-injurious KW - anxiety KW - depression KW - pediatric KW - pediatrics KW - child KW - children KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - mobile phone N2 - Background: Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. Objective: To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. Methods: This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). Results: Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; ?21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; ?21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=?0.08; P=.99) symptoms. Conclusions: This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents. UR - https://formative.jmir.org/2024/1/e54816 UR - http://dx.doi.org/10.2196/54816 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54816 ER - TY - JOUR AU - Landman, Benjamin AU - Khoury, Elie AU - Cohen, Alicia AU - Trebossen, Vincent AU - Michel, Alexandre AU - Lefebvre, Aline AU - Delorme, Richard PY - 2024/8/15 TI - Acceptance of a French e?Mental Health Information Website (CléPsy) for Families: A Web-Based Survey JO - JMIR Pediatr Parent SP - e50978 VL - 7 KW - mental health education KW - children KW - family KW - child KW - pediatrics KW - pediatric KW - mental health KW - parent KW - parents KW - parenting KW - psychiatry KW - website KW - acceptance KW - patient education KW - online information KW - health information KW - ease of use KW - usefulness KW - survey KW - surveys KW - user KW - experience KW - questionnaire KW - questionnaires KW - families N2 - Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children?s difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. UR - https://pediatrics.jmir.org/2024/1/e50978 UR - http://dx.doi.org/10.2196/50978 ID - info:doi/10.2196/50978 ER - TY - JOUR AU - Saboor, Sundas AU - Medina, Adrian AU - Marciano, Laura PY - 2024/8/14 TI - Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials JO - JMIR Ment Health SP - e56045 VL - 11 KW - positive psychology KW - digital interventions KW - ill-being KW - well-being KW - systematic review KW - meta-analysis KW - smartphone KW - mobile phone N2 - Background: The rising prevalence of mental health issues in children, adolescents, and young adults has become an escalating public health issue, impacting approximately 10%-20% of young people on a global scale. Positive psychology interventions (PPIs) can act as powerful mental health promotion tools to reach wide-ranging audiences that might otherwise be challenging to access. This increased access would enable prevention of mental disorders and promotion of widespread well-being by enhancing self-efficacy, thereby supporting the achievement of tangible objectives. Objective: We aimed to conduct a comprehensive synthesis of all randomized controlled trials and controlled trials involving children, adolescents, and young adults, encompassing both clinical and nonclinical populations, to comprehensively evaluate the effectiveness of digital PPIs in this age group. Methods: After a literature search in 9 electronic databases until January 12, 2023, and gray literature until April 2023, we carried out a systematic review of 35 articles, of which 18 (51%) provided data for the meta-analysis. We included randomized controlled trials and controlled trials mainly based on web-based, digital, or smartphone-based interventions using a positive psychology framework as the main component. Studies included participants with a mean age of <35 years. Outcomes of PPIs were classified into indicators of well-being (compassion, life satisfaction, optimism, happiness, resilience, emotion regulation and emotion awareness, hope, mindfulness, purpose, quality of life, gratitude, empathy, forgiveness, motivation, and kindness) and ill-being (depression, anxiety, stress, loneliness, and burnout). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the selection of studies and data extraction. Quality assessment was performed following the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results: For well-being outcomes, meta-analytic results showed that PPIs augmented the feeling of purpose, gratitude, and hope (Hedges g=0.555), compassion (Hedges g=0.447), positive coping behaviors (Hedges g=0.421), body image?related outcomes (Hedges g=0.238), and positive mindset predisposition (Hedges g=0.304). For ill-being outcomes, PPIs reduced cognitive biases (Hedges g=?0.637), negative emotions and mood (Hedges g=?0.369), and stress levels (Hedges g=?0.342). Of note, larger effect sizes were found when a waiting list control group was considered versus a digital control group. A funnel plot showed no publication bias. Meta-regression analyses showed that PPIs tended to show a larger effect size on well-being outcomes in studies including young adults, whereas no specific effect was found for ill-being outcomes. Conclusions: Revised evidence suggests that PPIs benefit young people?s well-being and mitigate ill-being symptoms. Digital platforms offer a unique way to address their mental health challenges, although not without limitations. Future research should explore how they work for the needs of the young population and further examine what specific PPIs or combination of interventions is most beneficial with respect to other digital control groups. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023420092; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420092 UR - https://mental.jmir.org/2024/1/e56045 UR - http://dx.doi.org/10.2196/56045 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56045 ER - TY - JOUR AU - Edge, Daniel AU - Watkins, Edward AU - Newbold, Alexandra AU - Ehring, Thomas AU - Frost, Mads AU - Rosenkranz, Tabea PY - 2024/8/13 TI - Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e51932 VL - 12 KW - worry KW - rumination KW - repetitive negative thinking KW - prevention-mechanism KW - well-being KW - depression KW - anxiety KW - mobile-based interventions KW - mobile phone KW - mobile health application KW - app KW - application N2 - Background: Delivery of preventative interventions via mobile phone apps offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT). Objective: This was a prevention mechanism trial that aimed to investigate whether an RNT-targeting self-help mobile phone app (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being. Methods: A web-based, single-blind, 2-arm parallel-group randomized controlled trial was conducted with 236 people aged between 16 and 24 years, who self-reported high levels of worry or rumination. Eligible participants were randomized to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after 6 weeks, n=117). The primary outcome was changes in worry and rumination 6 weeks after randomization. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after 6 weeks and changes in all measures after 12 weeks. Results: Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference ?2.92, 95% CI ?5.57 to ?0.28; P=.03; ?p2=0.02) and worry (mean difference ?3.97, 95% CI ?6.21 to ?1.73; P<.001; ?p2=0.06) at 6-week follow-up, relative to the waitlist control. Similar differences were observed for well-being (P<.001), anxiety (P=.03), and depression (P=.04). The waitlist control group also showed improvement when given access to the app after 6 weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point. Conclusions: The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce RNT. This app, therefore, has potential for the prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated. Trial Registration: ClinicalTrials.gov NCT04950257; https://www.clinicaltrials.gov/ct2/show/NCT04950257 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03536-0 UR - https://mhealth.jmir.org/2024/1/e51932 UR - http://dx.doi.org/10.2196/51932 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51932 ER - TY - JOUR AU - Farrer, M. Louise AU - Jackson, M. Hayley AU - Gulliver, Amelia AU - Calear, L. Alison AU - Leach, Liana AU - Hasking, Penelope AU - Katruss, Natasha AU - Batterham, J. Philip PY - 2024/8/13 TI - A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial JO - J Med Internet Res SP - e53598 VL - 26 KW - university students KW - internet-based intervention KW - randomized controlled trial KW - mental health KW - transdiagnostic N2 - Background: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. Objective: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. Methods: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. Results: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ?15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. Conclusions: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146 UR - https://www.jmir.org/2024/1/e53598 UR - http://dx.doi.org/10.2196/53598 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137012 ID - info:doi/10.2196/53598 ER - TY - JOUR AU - Motreff, Yvon AU - Marillier, Maude AU - Saoudi, Abdessattar AU - Verdot, Charlotte AU - Seconda, Louise AU - Pognon, Damien AU - Khireddine-Medouni, Imane AU - Richard, Jean-Baptiste AU - Kovess-Masfety, Viviane AU - Delorme, Richard AU - Decio, Valentina AU - Perrine, Anne-Laure AU - El Haddad, Maria AU - Gallay, Anne AU - Monnier-Besnard, Stéphanie AU - Regnault, Nolwenn AU - PY - 2024/8/13 TI - Implementation of a Novel Epidemiological Surveillance System for Children?s Mental Health and Well-Being in France: Protocol for the National ?Enabee? Cross-Sectional Study JO - JMIR Public Health Surveill SP - e57584 VL - 10 KW - child KW - mental health KW - epidemiological surveillance KW - well-being N2 - Background: Children?s mental health, including their well-being, is a major public health concern, as the burden of related disorders may last throughout one?s life. Although epidemiological mental health surveillance systems for children and adolescents have been implemented in several countries, they are sorely lacking in France. Objective: This study aims to describe the first step of the implementation of a novel surveillance system in France called Enabee (Etude nationale sur le bien-être des enfants), which focuses on the issue of mental health in children. The system aims to (1) describe the temporal trends in the population-based prevalence of the main mental health disorders and well-being in children aged 3 to 11 years, (2) explore their major determinants, and (3) assess mental health care use by this population. To do this, Enabee will rely on results from a recurrent national cross-sectional homonymous study. This paper presents the protocol for the first edition of this study (called Enabee 2022), as well as initial results regarding participation. Methods: Enabee 2022 is a national cross-sectional study that was implemented in French schools in 2022. It used a probabilistic, multistage, stratified, and balanced sampling plan as follows: first, schools were randomly drawn and stratified according to the type of school. Up to 4 classes per school were then randomly drawn, and finally, all the pupils within each class were selected. The study covered children from preschool and kindergarten (aged 3 to 6 years, US grading system) to fifth grade (aged 6 to 11 years). Children from first to fifth grades provided a self-assessment of their mental health using 2 validated self-administered questionnaires: the Dominic Interactive (DI) and the KINDL. Parents and teachers completed a web-based questionnaire, including the Strengths and Difficulties Questionnaire. Parents also answered additional questions about their parenting attitudes; their own mental health; known social, economic, and environmental determinants of mental health in children; and their child?s life habits. Health, education, and family stakeholders were involved in designing and implementing the study as part of a large consultation group. Results: Data were collected from May 2, 2022, to July 31, 2022, in 399 schools across metropolitan France. Teachers completed questionnaires for 5721 pupils in preschool and kindergarten and for 15,263 pupils from first to fifth grades. Parents completed questionnaires for 3785 children in preschool and kindergarten and for 9227 children from first to fifth grades. Finally, 15,206 children from first to fifth grades completed the self-administered questionnaire. Conclusions: Enabee 2022 constitutes the first milestone in the development of a novel national epidemiological surveillance system, paving the way for improved children?s mental health policies in France. UR - https://publichealth.jmir.org/2024/1/e57584 UR - http://dx.doi.org/10.2196/57584 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137010 ID - info:doi/10.2196/57584 ER - TY - JOUR AU - Thomas, V. Glenn AU - Camacho, Elena AU - Masood, A. Fatimah AU - Huang, Yungui AU - Valleru, Jahnavi AU - Bridge, A. Jeffrey AU - Ackerman, John PY - 2024/8/13 TI - Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study JO - JMIR Pediatr Parent SP - e51570 VL - 7 KW - mental health KW - suicide prevention KW - adolescent KW - caring contacts KW - mHealth KW - Zero Suicide KW - quality improvement KW - care transitions KW - safety plan KW - behavioral health KW - mobile phone N2 - Background: Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. ?Caring contacts? validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. Objective: This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. Methods: We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital?s Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital?s electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Results: Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). Conclusions: This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies. UR - https://pediatrics.jmir.org/2024/1/e51570 UR - http://dx.doi.org/10.2196/51570 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137019 ID - info:doi/10.2196/51570 ER - TY - JOUR AU - Campos, Susana AU - Nuñez, Daniel AU - Pérez, Carola J. AU - Robinson, Jo PY - 2024/8/8 TI - Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study JO - JMIR Form Res SP - e57038 VL - 8 KW - web-based screening KW - adolescents KW - psychopathology KW - suicidal ideation KW - early detection KW - detection KW - screening KW - teens KW - youths KW - suicide KW - mental health KW - screening tool KW - Latin American KW - Latino KW - psychiatric KW - psychiatric symptoms KW - psychological risk N2 - Background: Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health?related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. Objective: The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. Methods: A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar ?2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. Results: Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles?one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. Conclusions: WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions. UR - https://formative.jmir.org/2024/1/e57038 UR - http://dx.doi.org/10.2196/57038 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57038 ER - TY - JOUR AU - Campos-Castillo, Celeste AU - Tamla Rai, Vijaya AU - Laestadius, I. Linnea PY - 2024/8/5 TI - The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey JO - JMIR Form Res SP - e55759 VL - 8 KW - mental health KW - school modality KW - race and ethnicity KW - confidants KW - sleep KW - equity KW - remote learning KW - virtual learning KW - racial justice KW - anxiety KW - depression KW - depressive KW - student KW - students KW - school KW - schools KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - race KW - racial KW - eLearning KW - online learning KW - education KW - equality KW - inequality KW - inequity KW - disparity KW - disparities KW - teaching KW - ethnic KW - ethnicities N2 - Background: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts. Objective: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health. Methods: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model. Results: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (?=?.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (?=?.121; P=.01) and depression (?=?.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (?=?.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (?=.601; P<.001) and depression (?=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant. Conclusions: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic?s impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports. UR - https://formative.jmir.org/2024/1/e55759 UR - http://dx.doi.org/10.2196/55759 UR - http://www.ncbi.nlm.nih.gov/pubmed/39102274 ID - info:doi/10.2196/55759 ER - TY - JOUR AU - Varaona, Andrea AU - Alvarez-Mon, Angel Miguel AU - Serrano-Garcia, Irene AU - Díaz-Marsá, Marina AU - Looi, L. Jeffrey C. AU - Molina-Ruiz, M. Rosa PY - 2024/8/1 TI - Exploring the Relationship Between Instagram Use and Self-Criticism, Self-Compassion, and Body Dissatisfaction in the Spanish Population: Observational Study JO - J Med Internet Res SP - e51957 VL - 26 KW - Instagram KW - self-compassion KW - self-esteem KW - self-criticism KW - self-worth KW - body dissatisfaction KW - dissatisfaction KW - satisfaction KW - appearance KW - psychological KW - social media KW - body KW - mental health KW - mental wellbeing KW - Spain KW - Spanish KW - Hispanic KW - depression KW - depressive KW - usage KW - correlation KW - association N2 - Background: The widespread use of online social networks, particularly among the younger demographic, has catalyzed a growing interest in exploring their influence on users? psychological well-being. Instagram (Meta), a visually oriented platform, has garnered significant attention. Prior research has consistently indicated that Instagram usage correlates with heightened levels of perfectionism, body dissatisfaction, and diminished self-esteem. Perfectionism is closely linked to self-criticism, which entails an intense self-scrutiny and is often associated with various psychopathologies. Conversely, self-compassion has been linked to reduced levels of perfectionism and stress, while fostering greater positive affect and overall life satisfaction. Objective: This study investigates the relationship between Instagram usage (time of use and content exposure) and users? levels of self-compassion, self-criticism, and body dissatisfaction. Methods: This study comprised 1051 adult participants aged between 18 and 50 years, either native to Spain or residing in the country for at least a decade. Each participant completed a tailored questionnaire on Instagram usage, along with abbreviated versions of the Self-Compassion Scale, the Body Shape Questionnaire, and the Depressive Experiences Questionnaire, spanning from January 23 to February 25, 2022. Results: A positive correlation was observed between daily Instagram usage and self-criticism scores. Participants of all age groups who spent over 3 hours per day on Instagram exhibited higher self-criticism scores than users who spent less than 1 hour or between 1 and 3 hours per day. Contrary to previous findings, no significant relationship was detected between Instagram usage time and levels of self-compassion or body dissatisfaction. Furthermore, content centered around physical appearance exhibited a positive correlation with self-criticism and body dissatisfaction scores. Among younger participants (aged 18-35 years), those who primarily viewed beauty or fashion content reported higher self-criticism scores than those consuming science-related content. However, this association was not significant for participants aged 35-50 years. Conversely, individuals who predominantly engaged with sports or fitness or family or friends content exhibited higher levels of body dissatisfaction than those focusing on science-related content. No significant associations were observed between self-compassion scores and daily Instagram usage or most-viewed content categories. Conclusions: The findings of this study underscore the considerable impact of Instagram usage on self-criticism and body dissatisfaction?2 variables known to influence users? psychological well-being and be associated with various symptoms and psychological disorders. UR - https://www.jmir.org/2024/1/e51957 UR - http://dx.doi.org/10.2196/51957 UR - http://www.ncbi.nlm.nih.gov/pubmed/39088263 ID - info:doi/10.2196/51957 ER - TY - JOUR AU - Yang, Yunjuan AU - Zha, Shun AU - Li, Tunan PY - 2024/7/31 TI - Secular Trends in Depressive Symptoms in Adolescents in Yunnan, Southwest China From Before COVID-19 to During the COVID-19 Pandemic: Longitudinal, Observational Study JO - JMIR Public Health Surveill SP - e52683 VL - 10 KW - COVID-19 exposure KW - depressive symptom KW - adolescent KW - epidemic trend KW - prevalence KW - observational study KW - epidemic KW - COVID-19 KW - depression KW - symptoms KW - teen KW - youth KW - China KW - mental health KW - psychological KW - logistic regression KW - lifestyle intervention N2 - Background: Yunnan province borders Myanmar, Laos, and Vietnam, giving it one of the longest borders in China. We aimed to determine the trends in prevalence and impact of COVID-19 on depressive symptoms among adolescents (12-18 years) from 2018 to 2022 in Yunnan, southwest China. Objective: We evaluated the impact of the COVID-19 epidemic on adolescents? mental health, with the aim of reducing the effect of psychological emergency syndrome and promoting healthy, happy adolescent growth. Methods: This longitudinal, observational study used Students? Health Survey data on adolescents? depressive symptoms from 2018 to 2022 (before and during COVID-19) in Yunnan. We used multistage, stratified sampling in 3 prefectures in 2018 and 16 prefectures from 2019 to 2022. In each prefecture, the study population was classified by gender and residence (urban or rural), and each group was of equal size. Depressive symptoms were diagnosed based on Center for Epidemiological Studies Depression Scale (CES-D) scores. We used ANOVA to assess the differences in mean CES-D scores stratified by gender, age, residence, grade, and ethnicity. Chi-square tests were used to compare depressive symptoms by different variables. For comparability, the age-standard and gender-standard population prevalences were calculated using the 2010 China Census as the standard population. The association between COVID-19 and the risk of a standardized prevalence of depressive symptoms was identified using unconditional logistic regression analysis. Results: The standardized prevalence of depressive symptoms for all participants was 32.98%: 28.26% in 2018, 30.89% in 2019, 29.81% in 2020, 28.77% in 2021, 36.33% in 2022. The prevalences were 30.49% before COVID-19,29.29% in early COVID-19, and 36.33% during the COVID-19 pandemic. Compared with before COVID-19, the risks of depressive symptoms were 0.793 (95% CI 0.772-0.814) times higher in early COVID-19 and 1.071 (95% CI 1.042-1.100) times higher than during COVID-19. The average annual increase in depressive symptoms was 1.61%. During the epidemic, the prevalence of depressive symptoms in girls (36.87%) was higher than that in boys (28.64%), and the acceleration rate of girls was faster than that of boys. The prevalences of depressive symptoms and acceleration rates by age group were as follows: 27.14% and 1.09% (12-13 years), 33.99% and 1.8% (14-15 years), 36.59% and 1.65% (16-18 years). Prevalences did not differ between Han (32.89%) and minority (33.10%) populations. However, the acceleration rate was faster for the former than for the latter. The rate for senior high school students was the highest (34.94%). However, the acceleration rate for vocational high school students was the fastest (2.88%), followed by that for junior high school students (2.32%). Rural residents (35.10%) had a higher prevalence and faster acceleration than urban residents (30.16%). Conclusions: From 2018 to 2022, there was a significant, continuous increase in the prevalence of depressive symptoms among adolescents in Yunnan, China, especially during the COVID-19 pandemic. This represents an emergency public health problem that should be given more attention. Effective, comprehensive psychological and lifestyle intervention measures should be used to reduce the prevalence of mental health issues in adolescents. UR - https://publichealth.jmir.org/2024/1/e52683 UR - http://dx.doi.org/10.2196/52683 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083344 ID - info:doi/10.2196/52683 ER - TY - JOUR AU - Bear, Alice Holly AU - Ayala Nunes, Lara AU - Ramos, Giovanni AU - Manchanda, Tanya AU - Fernandes, Blossom AU - Chabursky, Sophia AU - Walper, Sabine AU - Watkins, Edward AU - Fazel, Mina PY - 2024/7/30 TI - The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study JO - J Med Internet Res SP - e48964 VL - 26 KW - adolescent mental health KW - marginalized groups KW - smartphone apps KW - engagement KW - implementation science KW - mobile app KW - smartphone KW - mobile health KW - mHealth KW - mental health KW - challenges KW - acceptability KW - young KW - effectiveness KW - mobile phone N2 - Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users? objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in ?real-world? settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241 UR - https://www.jmir.org/2024/1/e48964 UR - http://dx.doi.org/10.2196/48964 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078699 ID - info:doi/10.2196/48964 ER - TY - JOUR AU - Verlenden, Jorge AU - Pampati, Sanjana AU - Heim Viox, Melissa AU - Brener, Nancy AU - Licitis, Laima AU - Dittus, Patricia AU - Ethier, Kathleen PY - 2024/7/26 TI - Measuring Population-Level Adolescent Mental Health Using a Single-Item Indicator of Experiences of Sadness and Hopelessness: Cross-Sectional Study JO - JMIR Form Res SP - e54288 VL - 8 KW - adolescents KW - mental health KW - surveillance KW - teens KW - sadness KW - hopelessness N2 - Background: Population-level monitoring of adolescent mental health is a critical public health activity used to help define local, state, and federal priorities. The Youth Risk Behavior Surveillance System includes a single-item measure of experiences of sadness or hopelessness as an indicator of risk to mental health. In 2021, 42% of high school students reported having felt sad or hopeless for 2 weeks or more during the past 12 months. The high prevalence of US high school students with this experience has been highlighted in recent studies and media reports. Objective: This study seeks to examine associations between this single-item measure of experiences of sadness or hopelessness with other indicators of poor mental health including frequent mental distress and depressive symptoms. Methods: We analyzed survey data from a national sample of 737 adolescents aged 15-19 years as a part of the Teen and Parent Surveys of Health. Participants were recruited from AmeriSpeak, a probability-based panel designed to be representative of the US household population. Feeling sad or hopeless was operationalized as a ?yes? response to the item, ?During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?? Unadjusted and adjusted prevalence ratios (aPRs) were calculated to examine associations between the single-item measure of having felt sad or hopeless almost every day for 2 weeks with moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health. Adjusted models controlled for age, race and ethnicity, sex assigned at birth, and sexual identity. Results: Overall, 17.3% (unweighted: 138/735) of adolescents reported that they felt sad or hopeless for 2 weeks or more during the past 12 months, 30.2% (unweighted: 204/716) reported moderate to severe depressive symptoms, 18.4% (unweighted: 126/732) reported frequent mental distress, and 15.4% (unweighted: 107/735) reported functional limitation due to poor mental health. After adjusting for demographics, adolescents who reported that they felt sad or hopeless for 2 weeks or more were 3.3 times as likely to report moderate to severe depressive symptoms (aPR 3.28, 95% CI 2.39-4.50), 4.8 times as likely to indicate frequent mental distress (aPR 4.75, 95% CI 2.92-7.74), and 7.8 times as likely to indicate mental health usually or always interfered with their ability to do things (aPR 7.78, 95% CI 4.88-12.41). Conclusions: Associations between having felt sad or hopeless for 2 weeks or more and moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health suggest the single-item indicator may represent relevant symptoms associated with poor mental health and be associated with unmet health needs. Findings suggest the single-item indicator provides a population-level snapshot of adolescent experiences of poor mental health. UR - https://formative.jmir.org/2024/1/e54288 UR - http://dx.doi.org/10.2196/54288 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54288 ER - TY - JOUR AU - Matsumoto, Kazuki AU - Hamatani, Sayo AU - Shiga, Kiko AU - Iiboshi, Kiyoko AU - Kasai, Makiko AU - Kimura, Yasuhiro AU - Yokota, Satoshi AU - Watanabe, Katsunori AU - Kubo, Yoko AU - Nakamura, Masayuki PY - 2024/7/22 TI - Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Subthreshold Social Anxiety Disorder in Adolescents and Young Adults: Multicenter Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e55786 VL - 7 KW - adolescent KW - social anxiety disorder KW - general anxiety KW - adolescents KW - teens KW - social anxiety KW - teenagers KW - internet-based cognitive behavioral therapy KW - self-help KW - randomized controlled trials KW - young adults KW - cognitive behavioral therapy KW - anxiety KW - mental health KW - students KW - colleges KW - universities KW - social socialize KW - anxious KW - fear KW - mobile phone N2 - Background: Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. Objective: This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. Methods: A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. Results: In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. Conclusions: The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. Trial Registration: UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035 UR - https://pediatrics.jmir.org/2024/1/e55786 UR - http://dx.doi.org/10.2196/55786 UR - http://www.ncbi.nlm.nih.gov/pubmed/39037759 ID - info:doi/10.2196/55786 ER - TY - JOUR AU - Ng, Yi Mei AU - Frederick, A. Jennifer AU - Fisher, J. Aaron AU - Allen, B. Nicholas AU - Pettit, W. Jeremy AU - McMakin, L. Dana PY - 2024/7/16 TI - Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study JO - JMIR Res Protoc SP - e43931 VL - 13 KW - adolescents KW - depression KW - idiographic assessment KW - network modeling KW - treatment personalization KW - ecological momentary assessment KW - mobile sensing KW - digital phenotyping KW - actigraphy KW - smartphones N2 - Background: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. Objective: This study leverages adolescents? everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. Methods: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent?s person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. Results: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. Conclusions: This study leverages depressed adolescents? everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. International Registered Report Identifier (IRRID): DERR1-10.2196/43931 UR - https://www.researchprotocols.org/2024/1/e43931 UR - http://dx.doi.org/10.2196/43931 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012691 ID - info:doi/10.2196/43931 ER - TY - JOUR AU - Deshpande, Swasti AU - Sachdev, Ashmeet AU - Maharana, Anwesha AU - Zadey, Siddhesh AU - Dharmadhikari, P. Surabhi AU - Ghate, Swati AU - Godatwar, Pawankumar AU - Ojha, Kumari Nisha AU - Sharma, Sanjeev PY - 2024/7/16 TI - Screen Use Time and Its Association With Mental Health Issues in Young Adults in India: Protocol for a Cross-Sectional Study JO - JMIR Res Protoc SP - e39707 VL - 13 KW - mental health KW - India KW - screen use KW - computer use KW - screen time KW - depression KW - stress KW - anxiety KW - low- and middle-income country KW - LMIC KW - questionnaire KW - survey KW - instrument KW - young adult KW - mental well-being KW - cross sectional KW - internet use KW - phone use KW - young adults N2 - Background: Screen use time has increased in the past decade owing to the increased availability and accessibility of digital devices and the internet. Several studies have shown an association between increased screen use time and mental health issues such as anxiety and depression. However, studies in the young adult population?a demographic with high screen use?and in low- and middle-income country settings are limited. Objective: This protocol describes a study that aims to measure self-reported screen use times and patterns in young adults (18-24 y) in India and assess if increased screen use time is associated with poorer mental well-being. Methods: This protocol describes a cross-sectional study of a pan-India, web-based convenience sample of young adults (18-24 y) with access to digital devices with a screen and a minimum of secondary school education. Participants will be recruited through people in the professional networks of the investigators, which includes pediatricians. The survey will also be distributed via the social media pages of our organization (X [X Corp], Instagram [Meta], Facebook [Meta], etc). Sociodemographic details will be collected through a questionnaire designed by the authors; screen use time and patterns will be assessed using an adaptation of the Screen Time Questionnaire to include data on different apps and websites used on digital devices; and mental health parameters will be gauged using the Warwick-Edinburgh Mental Well-Being Scale, Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Patient Health Questionnaire. For statistical analysis, we will consider the following variables: (1) the primary independent variable is screen use time; (2) other independent variables include age, gender, residence: rural or urban, educational qualifications, employment status, stress associated with familial financial status, average sleep time, number of people living in a house or rooms in that house, BMI, substance use, and past psychiatric history; and (3) dependent variables include mental well-being, depression, anxiety, and perceived stress. To quantify the association between screen use time and mental health, we will perform a Bayesian multivariate multiple regression analysis that models the possibility of multiple alternative hypotheses while accounting for relevant sociodemographic covariables. Results: The survey instrument has been designed, and feedback has been obtained from the domain experts and members of our organization whose profile is similar to the potential study participants. The final data received after this study has been conducted will be analyzed and shared. As of January 2023, we have not yet initiated the data collection. Conclusions: Based on the findings of this study, we will be able to establish a correlation between device- and use-specific screen use time and various mental health parameters. This will provide a direction to develop screen use time and mental health guidelines among young adults. International Registered Report Identifier (IRRID): PRR1-10.2196/39707 UR - https://www.researchprotocols.org/2024/1/e39707 UR - http://dx.doi.org/10.2196/39707 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012657 ID - info:doi/10.2196/39707 ER - TY - JOUR AU - Turuba, Roxanne AU - Cormier, Willow AU - Zimmerman, Rae AU - Ow, Nikki AU - Zenone, Marco AU - Quintana, Yuri AU - Jenkins, Emily AU - Ben-David, Shelly AU - Raimundo, Alicia AU - Marcon, R. Alessandro AU - Mathias, Steve AU - Henderson, Jo AU - Barbic, Skye PY - 2024/7/5 TI - Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth JO - JMIR Infodemiology SP - e53233 VL - 4 KW - youth KW - adolescents KW - young adults KW - mental health KW - TikTok KW - social media KW - qualitative research N2 - Background: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. Objective: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. Methods: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. Results: A total of 3 overarching themes were identified describing youth?s experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. Conclusions: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online. UR - https://infodemiology.jmir.org/2024/1/e53233 UR - http://dx.doi.org/10.2196/53233 UR - http://www.ncbi.nlm.nih.gov/pubmed/38967966 ID - info:doi/10.2196/53233 ER - TY - JOUR AU - Ferro, A. Mark AU - Chan, Y. Christy K. AU - Browne, T. Dillon AU - Colman, Ian AU - Dubin, A. Joel AU - Duncan, Laura PY - 2024/7/4 TI - Suicidal Ideation and Attempts Among Youth With Physical-Mental Comorbidity in Canada: Proposal for an Epidemiological Study JO - JMIR Res Protoc SP - e57103 VL - 13 KW - adolescents KW - children KW - chronic disease KW - epidemiology KW - mental health KW - suicidality N2 - Background: Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality. Objective: This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only). Methods: Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design. Results: Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life. Conclusions: Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels?information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth. International Registered Report Identifier (IRRID): DERR1-10.2196/57103 UR - https://www.researchprotocols.org/2024/1/e57103 UR - http://dx.doi.org/10.2196/57103 UR - http://www.ncbi.nlm.nih.gov/pubmed/38963692 ID - info:doi/10.2196/57103 ER - TY - JOUR AU - Wang, JianLi AU - Kharrat, Zadeh Fatemeh Gholi AU - Gariépy, Geneviève AU - Gagné, Christian AU - Pelletier, Jean-François AU - Massamba, Kubuta Victoria AU - Lévesque, Pascale AU - Mohammed, Mada AU - Lesage, Alain PY - 2024/6/28 TI - Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study JO - JMIR Public Health Surveill SP - e52773 VL - 10 KW - population risk prediction KW - case-control KW - development KW - validation KW - health administrative data KW - suicide KW - depression KW - anxiety KW - Quebec KW - Canada KW - mental health KW - suicide prevention KW - prevention KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - male KW - female N2 - Background: Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual?s risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed. Objective: This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system?, and community-level predictors. Methods: We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system?, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions. Results: The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years. Conclusions: Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system?, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level. UR - https://publichealth.jmir.org/2024/1/e52773 UR - http://dx.doi.org/10.2196/52773 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52773 ER - TY - JOUR AU - Lyzwinski, Lynnette AU - Mcdonald, Sheila AU - Zwicker, Jennifer AU - Tough, Suzanne PY - 2024/6/25 TI - Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis JO - JMIR Pediatr Parent SP - e55100 VL - 7 KW - mental health KW - knowledge translation KW - KT KW - flourishing KW - youth KW - teenagers KW - mindfulness KW - positive psychology KW - telehealth KW - implementation KW - knowledge dissemination KW - pandemic KW - COVID-19 KW - service delivery N2 - Background: The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective: The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. Methods: We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). Results: A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. Conclusions: There is an opportunity to reduce the barriers to implementing tele?mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele?mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation. UR - https://pediatrics.jmir.org/2024/1/e55100 UR - http://dx.doi.org/10.2196/55100 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916946 ID - info:doi/10.2196/55100 ER - TY - JOUR AU - Das Swain, Vedant AU - Ye, Jingjing AU - Ramesh, Karthik Siva AU - Mondal, Abhirup AU - Abowd, D. Gregory AU - De Choudhury, Munmun PY - 2024/6/25 TI - Leveraging Social Media to Predict COVID-19?Induced Disruptions to Mental Well-Being Among University Students: Modeling Study JO - JMIR Form Res SP - e52316 VL - 8 KW - social media KW - mental health KW - linguistic markers KW - digital phenotyping KW - COVID-19 KW - disaster well-being KW - well-being KW - machine learning KW - temporal trends KW - disruption N2 - Background: Large-scale crisis events such as COVID-19 often have secondary impacts on individuals? mental well-being. University students are particularly vulnerable to such impacts. Traditional survey-based methods to identify those in need of support do not scale over large populations and they do not provide timely insights. We pursue an alternative approach through social media data and machine learning. Our models aim to complement surveys and provide early, precise, and objective predictions of students disrupted by COVID-19. Objective: This study aims to demonstrate the feasibility of language on private social media as an indicator of crisis-induced disruption to mental well-being. Methods: We modeled 4124 Facebook posts provided by 43 undergraduate students, spanning over 2 years. We extracted temporal trends in the psycholinguistic attributes of their posts and comments. These trends were used as features to predict how COVID-19 disrupted their mental well-being. Results: The social media?enabled model had an F1-score of 0.79, which was a 39% improvement over a model trained on the self-reported mental state of the participant. The features we used showed promise in predicting other mental states such as anxiety, depression, social, isolation, and suicidal behavior (F1-scores varied between 0.85 and 0.93). We also found that selecting the windows of time 7 months after the COVID-19?induced lockdown presented better results, therefore, paving the way for data minimization. Conclusions: We predicted COVID-19?induced disruptions to mental well-being by developing a machine learning model that leveraged language on private social media. The language in these posts described psycholinguistic trends in students? online behavior. These longitudinal trends helped predict mental well-being disruption better than models trained on correlated mental health questionnaires. Our work inspires further research into the potential applications of early, precise, and automatic warnings for individuals concerned about their mental health in times of crisis. UR - https://formative.jmir.org/2024/1/e52316 UR - http://dx.doi.org/10.2196/52316 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916951 ID - info:doi/10.2196/52316 ER - TY - JOUR AU - Koelen, Jurrijn AU - Klein, Anke AU - Wolters, Nine AU - Bol, Eline AU - De Koning, Lisa AU - Roetink, Samantha AU - Van Blom, Jorien AU - Boutin, Bruno AU - Schaaf, Jessica AU - Grasman, Raoul AU - Van der Heijde, Maria Claudia AU - Salemink, Elske AU - Riper, Heleen AU - Karyotaki, Eirini AU - Cuijpers, Pim AU - Schneider, Silvia AU - Rapee, Ronald AU - Vonk, Peter AU - Wiers, Reinout PY - 2024/6/19 TI - Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial JO - JMIR Ment Health SP - e50503 VL - 11 KW - internet-based cognitive behavioral intervention KW - iCBT KW - university students KW - transdiagnostic KW - human guidance KW - technological guidance N2 - Background: Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. Objective: This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. Methods: A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use?related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test?10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. Results: In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). Conclusions: The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. Trial Registration: International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795 UR - https://mental.jmir.org/2024/1/e50503 UR - http://dx.doi.org/10.2196/50503 UR - http://www.ncbi.nlm.nih.gov/pubmed/38896474 ID - info:doi/10.2196/50503 ER - TY - JOUR AU - Nielsen, Stecher Martine AU - Steinsbekk, Aslak AU - Nøst, Hatlen Torunn PY - 2024/6/6 TI - Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study JO - JMIR Ment Health SP - e57965 VL - 11 KW - electronic health record KW - EHR KW - electronic health records KW - EHRs KW - electronic medical record KW - EMR KW - electronic medical records KW - EMRs KW - patient record KW - health record KW - health records KW - personal health record KW - PHR KW - online access to electronic health records KW - open notes KW - clinical notes KW - adolescent mental health care KW - adolescent mental health KW - child mental health KW - mental health KW - mental illness KW - mental illnesses KW - mental disorder KW - mental disorders KW - recommendations KW - Delphi study KW - digital mental health KW - e-health KW - eHealth KW - e?mental health KW - health care professionals KW - digital health care N2 - Background: In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective: The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals? digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods: A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results: Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions: A total of 17 recommendations related to key aspects of health care professionals? digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice. UR - https://mental.jmir.org/2024/1/e57965 UR - http://dx.doi.org/10.2196/57965 ID - info:doi/10.2196/57965 ER - TY - JOUR AU - Sawyer, Chelsea AU - Carney, Rebekah AU - Hassan, Lamiece AU - Bucci, Sandra AU - Sainsbury, John AU - Lovell, Karina AU - Torous, John AU - Firth, Joseph PY - 2024/6/5 TI - Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals JO - JMIR Hum Factors SP - e53406 VL - 11 KW - digital health KW - behavior change KW - mental health care professionals KW - physical health KW - lifestyle intervention KW - qualitative KW - thematic analysis KW - service optimization KW - mobile phone N2 - Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients? readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. UR - https://humanfactors.jmir.org/2024/1/e53406 UR - http://dx.doi.org/10.2196/53406 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837191 ID - info:doi/10.2196/53406 ER - TY - JOUR AU - Shimkhada, Riti AU - Ponce, A. Ninez PY - 2024/5/23 TI - Social Media Use and Serious Psychological Distress Among Adolescents JO - JMIR Pediatr Parent SP - e57041 VL - 7 KW - social media KW - socials KW - youth KW - adolescents KW - teens KW - teenager KW - mental health KW - mental illness KW - mental disease KW - mental illnesses KW - psychological distress KW - psychological KW - psychology UR - https://pediatrics.jmir.org/2024/1/e57041 UR - http://dx.doi.org/10.2196/57041 ID - info:doi/10.2196/57041 ER - TY - JOUR AU - Kim, Hyejun AU - Son, Yejun AU - Lee, Hojae AU - Kang, Jiseung AU - Hammoodi, Ahmed AU - Choi, Yujin AU - Kim, Jin Hyeon AU - Lee, Hayeon AU - Fond, Guillaume AU - Boyer, Laurent AU - Kwon, Rosie AU - Woo, Selin AU - Yon, Keon Dong PY - 2024/5/17 TI - Machine Learning?Based Prediction of Suicidal Thinking in Adolescents by Derivation and Validation in 3 Independent Worldwide Cohorts: Algorithm Development and Validation Study JO - J Med Internet Res SP - e55913 VL - 26 KW - adolescent KW - machine learning KW - Shapley additive explanations KW - SHAP value KW - suicidal thinking KW - XGBoost KW - mental health KW - predictive model KW - risk behavior N2 - Background: Suicide is the second-leading cause of death among adolescents and is associated with clusters of suicides. Despite numerous studies on this preventable cause of death, the focus has primarily been on single nations and traditional statistical methods. Objective: This study aims to develop a predictive model for adolescent suicidal thinking using multinational data sets and machine learning (ML). Methods: We used data from the Korea Youth Risk Behavior Web-based Survey with 566,875 adolescents aged between 13 and 18 years and conducted external validation using the Youth Risk Behavior Survey with 103,874 adolescents and Norway?s University National General Survey with 19,574 adolescents. Several tree-based ML models were developed, and feature importance and Shapley additive explanations values were analyzed to identify risk factors for adolescent suicidal thinking. Results: When trained on the Korea Youth Risk Behavior Web-based Survey data from South Korea with a 95% CI, the XGBoost model reported an area under the receiver operating characteristic (AUROC) curve of 90.06% (95% CI 89.97-90.16), displaying superior performance compared to other models. For external validation using the Youth Risk Behavior Survey data from the United States and the University National General Survey from Norway, the XGBoost model achieved AUROCs of 83.09% and 81.27%, respectively. Across all data sets, XGBoost consistently outperformed the other models with the highest AUROC score, and was selected as the optimal model. In terms of predictors of suicidal thinking, feelings of sadness and despair were the most influential, accounting for 57.4% of the impact, followed by stress status at 19.8%. This was followed by age (5.7%), household income (4%), academic achievement (3.4%), sex (2.1%), and others, which contributed less than 2% each. Conclusions: This study used ML by integrating diverse data sets from 3 countries to address adolescent suicide. The findings highlight the important role of emotional health indicators in predicting suicidal thinking among adolescents. Specifically, sadness and despair were identified as the most significant predictors, followed by stressful conditions and age. These findings emphasize the critical need for early diagnosis and prevention of mental health issues during adolescence. UR - https://www.jmir.org/2024/1/e55913 UR - http://dx.doi.org/10.2196/55913 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758578 ID - info:doi/10.2196/55913 ER - TY - JOUR AU - Zhao, Licong AU - Agazzi, Heather AU - Du, Yasong AU - Meng, Hongdao AU - Maku, Renya AU - Li, Ke AU - Aspinall, Peter AU - Garvan, Wilson Cynthia AU - Fang, Shuanfeng PY - 2024/5/10 TI - A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial JO - J Med Internet Res SP - e55569 VL - 26 KW - school-age children KW - cognitive training KW - exercise therapy KW - gamification KW - ADHD KW - attention deficit KW - attention-deficit/hyperactivity disorder KW - RCT KW - randomized controlled trial KW - executive function KW - digital intervention KW - AR KW - augmented reality N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. Objective: The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. Methods: This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Results: Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants? average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (?=?12.203, 95% CI ?17.882 to ?6.523; P<.001), owing to lower scores on the subscales Inattention (?=?3.966, 95% CI ?6.285 to ?1.647; P<.001), Hyperactivity/Impulsivity (?=?5.735, 95% CI ?8.334 to ?3.137; P<.001), and Oppositional Defiant Disorder (?=?2.995, 95% CI ?4.857 to ?1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (?=?6.312, 95% CI ?10.973 to ?1.650; P=.006) and Global Executive Composite (?=?5.952, 95% CI ?10.214 to ?1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. Conclusions: This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Trial Registration: Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806 UR - https://www.jmir.org/2024/1/e55569 UR - http://dx.doi.org/10.2196/55569 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728075 ID - info:doi/10.2196/55569 ER - TY - JOUR AU - De Jaegere, Eva AU - van Heeringen, Kees AU - Emmery, Peter AU - Mommerency, Gijs AU - Portzky, Gwendolyn PY - 2024/5/9 TI - Effects of a Serious Game for Adolescent Mental Health on Cognitive Vulnerability: Pilot Usability Study JO - JMIR Serious Games SP - e47513 VL - 12 KW - e-health KW - cognitive psychology KW - cognitive distortion KW - cognitive vulnerability KW - digital health KW - serious games KW - adolescent mental health KW - prototype KW - adolescent KW - prevention KW - eHealth N2 - Background: Adolescent mental health is of utmost importance. E-mental health interventions, and serious games in particular, are appealing to adolescents and can have beneficial effects on their mental health. A serious game aimed at improving cognitive vulnerability (ie, beliefs or attitudes), which can predispose an individual to mental health problems, can contribute to the prevention of these problems in adolescents. Objective: This study aimed to assess the feasibility of the prototype of a serious game called ?Silver.? Methods: The prototype of the serious game was developed using a user-centered participatory design. The prototype of Silver focused on 1 aspect of a serious game for improving cognitive vulnerability in adolescents, that is, the recognition and identification of cognitive distortions. Through the game, players were required to identify and classify the character?s thoughts as helpful or unhelpful. Upon successful advancement to the next level, the task becomes more challenging, as players must also identify specific types of cognitive distortions. A pre- and posttest uncontrolled design was used to evaluate the game, with a 1-week intervention phase in which participants were asked to play the game. Participants aged 12-16 years were recruited in schools. The outcomes of interest were the recognition of cognitive distortions and presence of participants? cognitive distortions. The game was also evaluated on its effects, content, and usefulness. Results: A total of 630 adolescents played Silver and completed the assessments. Adolescents were significantly better at recognizing cognitive distortions at the pretest (mean 13.09, SD 4.08) compared to the posttest (mean 13.82, SD 5.09; t629=?4.00, P<.001). Furthermore, their cognitive distortions decreased significantly at the posttest (mean 38.73, SD 12.79) compared to the pretest (mean 41.43, SD 10.90; t629=7.98, P<.001). Participants also indicated that the game helped them recognize cognitive distortions. Many participants considered the game appealing (294/610, 48.2%) but boring (317/610, 52%) and preferred a more comprehensive game (299/610, 49%). Conclusions: Findings from this study suggest that a serious game may be an effective tool for improving cognitive vulnerability in adolescents. The development of such a serious game, based on the prototype, is recommended. It may be an important and innovative tool for the universal prevention of mental health problems in adolescents. Future research on the effects of the game is warranted. UR - https://games.jmir.org/2024/1/e47513 UR - http://dx.doi.org/10.2196/47513 ID - info:doi/10.2196/47513 ER - TY - JOUR AU - Cho, Kwangsu AU - Kim, Minah AU - Cho, Youngeun AU - Hur, Ji-Won AU - Kim, Hyung Do AU - Park, Seonghyeon AU - Park, Sunghyun AU - Jang, Moonyoung AU - Lee, Chang-Gun AU - Kwon, Soo Jun PY - 2024/4/29 TI - Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study JO - JMIR Ment Health SP - e50259 VL - 11 KW - adolescents KW - digital biomarkers KW - digital phenotyping KW - digital psychiatry KW - early detection KW - IGD KW - internet gaming disorder KW - pediatric psychiatry KW - proactive medicine KW - secondary school KW - universal screening N2 - Background: Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7% and 15.6%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges. Objective: This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases. Methods: A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53% (89/168) female and 47% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes. Results: A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=?0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23% of the IGDS score variance: stroke acceleration (?=.33; P<.001), time interval between keys (?=?0.26; P=.01), word spacing (?=?0.25; P<.001), deletion (?=?0.24; P<.001), and horizontal length of strokes (?=0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD. Conclusions: The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures. UR - https://mental.jmir.org/2024/1/e50259 UR - http://dx.doi.org/10.2196/50259 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683658 ID - info:doi/10.2196/50259 ER - TY - JOUR AU - Theopilus, Yansen AU - Al Mahmud, Abdullah AU - Davis, Hilary AU - Octavia, Renny Johanna PY - 2024/4/26 TI - Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives JO - JMIR Pediatr Parent SP - e55364 VL - 7 KW - addiction therapist KW - children KW - digital intervention KW - internet addiction KW - digital devices KW - parents KW - parental control KW - mobile phone N2 - Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps? functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children?s competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children?s internet use, providing tailored or personalized content to suit users? characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. UR - https://pediatrics.jmir.org/2024/1/e55364 UR - http://dx.doi.org/10.2196/55364 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669672 ID - info:doi/10.2196/55364 ER - TY - JOUR AU - Eckardt, Peter Jens PY - 2024/4/25 TI - Therapeutic Uses of Gaming in Mental Health: An Untapped Potential JO - JMIR Serious Games SP - e57714 VL - 12 KW - digital mental health interventions KW - mental health KW - psychiatry KW - gaming KW - serious games KW - casual video games KW - commercial games KW - exergames KW - adolescent KW - anxiety KW - teenage KW - video game KW - youth UR - https://games.jmir.org/2024/1/e57714 UR - http://dx.doi.org/10.2196/57714 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662422 ID - info:doi/10.2196/57714 ER - TY - JOUR AU - Lemmer, Diana AU - Moessner, Markus AU - Arnaud, Nicolas AU - Baumeister, Harald AU - Mutter, Agnes AU - Klemm, Sarah-Lena AU - König, Elisa AU - Plener, Paul AU - Rummel-Kluge, Christine AU - Thomasius, Rainer AU - Kaess, Michael AU - Bauer, Stephanie PY - 2024/4/24 TI - The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial JO - J Med Internet Res SP - e54478 VL - 26 KW - help seeking KW - mental health KW - stigma KW - mental health literacy KW - psychoeducation KW - web-based experiment KW - web-based randomized controlled trial KW - microinterventions KW - video-based interventions N2 - Background: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. Objective: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. Methods: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. Results: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Conclusions: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. Trial Registration: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110 UR - https://www.jmir.org/2024/1/e54478 UR - http://dx.doi.org/10.2196/54478 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656779 ID - info:doi/10.2196/54478 ER - TY - JOUR AU - Soneson, Emma AU - Howarth, Emma AU - Weir, Alison AU - Jones, B. Peter AU - Fazel, Mina PY - 2024/4/23 TI - Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study JO - J Med Internet Res SP - e46764 VL - 26 KW - mental health KW - children KW - schools KW - teachers KW - training KW - digital intervention KW - pupil mental health KW - mental health training KW - intervention KW - empowerment KW - student KW - pupil KW - support KW - school staff KW - web-based training N2 - Background: Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. Objective: We aimed to explore the feasibility of Kognito?s At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff?s knowledge and skills in supporting pupil mental health. Methods: We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff?s self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff?s identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. Results: A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. Conclusions: The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support. UR - https://www.jmir.org/2024/1/e46764 UR - http://dx.doi.org/10.2196/46764 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652534 ID - info:doi/10.2196/46764 ER - TY - JOUR AU - Latu, Ioana AU - S?l?gean, Nastasia AU - Larsen, B. Torill M. AU - Isbasoiu, Bogdana Andreea AU - Sava, Alin Florin PY - 2024/4/23 TI - Testing the Effectiveness of an Intervention to Improve Romanian Teachers? LGBT+-Related Attitudes, Cognitions, Behaviors, and Affect: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e54254 VL - 13 KW - discrimination KW - intervention KW - school KW - lesbian, gay, bisexual, and transgender KW - attitude KW - behavior KW - cognition KW - stigma KW - stigmatization KW - negative impact KW - physical health KW - mental health KW - minority stress model KW - European KW - Europe KW - Romania KW - stress KW - young KW - student KW - students KW - undergraduate KW - bias KW - data analysis KW - online intervention KW - lesbian, gay, bisexual, and transgender stigma KW - sentiment N2 - Background: Repeated stigmatization due to group membership constitutes a recurrent stressor with negative impact on physical and mental health (minority stress model). Among European countries, Romania ranks low on LGBT+ (lesbian, gay, bisexual, and transgender people. The ?+? represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) inclusion, with 45% of Romanian LGBT+ respondents reporting discrimination in at least 1 area of life in the year preceding the survey. Importantly, while all LGBT+ people might experience minority stress, younger sexual minority individuals are more prone to the detrimental impacts of stigma on their mental and physical health. As such, interventions are necessary to improve the inclusion climate within schools, where young people spend most of their time. Until now, most interventions addressing this topic have been conducted on undergraduate students in Western countries, with no studies conducted in countries that have widespread anti-LGBT+ attitudes. Objective: This paper describes the research protocol for a randomized controlled trial investigating whether LGBT+ stigma and bias among Romanian school teachers can be reduced using an internet-based intervention focusing on education and contact as primary training elements. Methods: A sample of 175 school teachers will be randomly assigned to either the control or experimental group. The experimental group participants will receive the intervention first and then complete the outcome measures, whereas the control group will complete the outcome measures first and then receive the intervention. The 1-hour multimedia intervention is developed for internet-based delivery under controlled conditions. It includes 2 interactive exercises, 2 recorded presentations, animations, and testimonies from LGBT+ individuals. Data for attitudinal, behavioral, cognitive, and affective measures will be collected during the same session (before or after the intervention, depending on the condition). We also plan to conduct a brief mixed methods follow-up study at 6 to 8 months post participation to investigate potential long-term effects of training. However, due to attrition and lack of experimental control (all participants will have completed the intervention, regardless of the condition), these data will be analyzed and reported separately using a mixed methods approach. Results: This paper details the protocol for the teacher intervention study. Data collection began in December 2022 and was completed by February 2023. Data analysis will be performed upon protocol acceptance. Follow-up measures will be completed in 2024. Results are expected to be submitted for publication following analysis in the spring of 2024. Conclusions: The findings of this study will establish the effectiveness of an internet-based intervention intended to lessen anti-LGBT stigma and sentiment in a nation where these views have long been prevalent. If successful, the intervention could end up serving as a resource for Romanian teachers and guidance counselors in high schools. Trial Registration: ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049 International Registered Report Identifier (IRRID): DERR1-10.2196/54254 UR - https://www.researchprotocols.org/2024/1/e54254 UR - http://dx.doi.org/10.2196/54254 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652533 ID - info:doi/10.2196/54254 ER - TY - JOUR AU - Björling, A. Elin AU - Sonney, Jennifer AU - Zade, Himanshu AU - Rodriguez, Sofia AU - Pullmann, D. Michael AU - Moon, Hyun Soo PY - 2024/4/22 TI - Using Virtual Reality to Reduce Stress in Adolescents: Mixed Methods Usability Study JO - JMIR XR Spatial Comput SP - e49171 VL - 1 KW - virtual reality KW - adolescents KW - perceived stress KW - participatory design KW - depression N2 - Background: Adolescent mental health is a national mental health emergency amid surging rates of anxiety and depression. Given the scarcity and lack of scalable mental health services, the use of self-administered, evidence-based technologies to support adolescent mental health is both timely and imperative. Objective: The goal of this study was 2-fold: (1) to determine the feasibility, usability, and engagement of a participatory designed, nature-based virtual reality (VR) environment and (2) to determine the preliminary outcomes of our self-administered VR environment on depression, mindfulness, perceived stress, and momentary stress and mood. Methods: We conducted a within-person, 3-week, in-home study with a community-based sample of 44 adolescents. Participants completed surveys of perceived stress, depression, cognitive fusion, and mindfulness at intake, postintervention, and a 3-week follow-up. Participants were invited to use a nature-based, VR environment that included 6 evidence-based activities 3 to 5 times per week. They completed momentary stress and mood surveys 5 times each day and before and after each VR session. Postintervention, participants completed surveys on system and intervention usability and their experiences with using the VR system. Quantitative data were analyzed using descriptive statistics and mixed effects modeling to explore the effect of the VR environment on stress. Qualitative data were analyzed using collaborative thematic analysis. Results: Participants? use of the VR environment ranged from 1 session to 24 sessions (mean 6.27 sessions) at home over a 3-week period. The 44 participants completed all study protocols, indicating our protocol was feasible and the VR environment was engaging for most. Both the use of the VR system and novel VR intervention received strong usability ratings (mean 74.87 on the System Usability Scale). Most teens indicated that they found the tool to be easily administered, relaxing, and helpful with stress. For some, it offered space to process difficult emotions. The themes calm, regulating, and forget about everything resulted from open-ended exit interview data. Although the Relaxation Environment for Stress in Teens (RESeT) did not significantly affect repeated survey measurements of depression, mindfulness, nor cognitive fusion, it did positively affect momentary mood (pre-intervention: 10.8, post-intervention: 12.0, P=.001) and decrease momentary stress (pre-intervention: 37.9, post-intervention: 20.6, P=.001). We found a significant reduction in within-day momentary stress that strengthened with increased VR use over time during the study period (P=.03). Conclusions: These preliminary data inform our own VR environment design but also provide evidence of the potential for self-administered VR as a promising tool to support adolescent mental health. Self-administered VR for mental health may be an effective intervention for reducing adolescent stress. However, understanding barriers (including disengagement) to using VR, as well as further encouraging participatory design with teens, may be imperative to the success of future mental health interventions. UR - https://xr.jmir.org/2024/1/e49171 UR - http://dx.doi.org/10.2196/49171 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49171 ER - TY - JOUR AU - Wang, Hao AU - Du, Huaidong AU - Guan, Yunqi AU - Zhong, Jieming AU - Li, Na AU - Pan, Jin AU - Yu, Min PY - 2024/4/17 TI - Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e50996 VL - 10 KW - depression symptoms KW - muscle-strengthening exercise KW - adolescents KW - cross-sectional study N2 - Background: Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory. Objective: This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China. Methods: A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms. Results: Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ?3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively. Conclusions: The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms. UR - https://publichealth.jmir.org/2024/1/e50996 UR - http://dx.doi.org/10.2196/50996 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630529 ID - info:doi/10.2196/50996 ER - TY - JOUR AU - O'Sullivan, Shaunagh AU - McEnery, Carla AU - Cagliarini, Daniela AU - Hinton, X. Jordan D. AU - Valentine, Lee AU - Nicholas, Jennifer AU - Chen, A. Nicola AU - Castagnini, Emily AU - Lester, Jacqueline AU - Kanellopoulos, Esta AU - D'Alfonso, Simon AU - Gleeson, F. John AU - Alvarez-Jimenez, Mario PY - 2024/4/1 TI - A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study JO - JMIR Ment Health SP - e49217 VL - 11 KW - digital intervention KW - blended care KW - youth mental health KW - transdiagnostic intervention KW - psychotic disorders KW - borderline personality disorder KW - digital health KW - mobile phone N2 - Background: Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people?s preferences and calls for integration of these services, current mental health services rarely offer blended models of care. Objective: This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. Methods: A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. Results: eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians? competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. Conclusions: eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services. UR - https://mental.jmir.org/2024/1/e49217 UR - http://dx.doi.org/10.2196/49217 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557432 ID - info:doi/10.2196/49217 ER - TY - JOUR AU - Boucher, M. Eliane AU - Ward, Haley AU - Miles, J. Cynthia AU - Henry, D. Robert AU - Stoeckl, Elizabeth Sarah PY - 2024/3/29 TI - Effects of a Digital Mental Health Intervention on Perceived Stress and Rumination in Adolescents Aged 13 to 17 Years: Randomized Controlled Trial JO - J Med Internet Res SP - e54282 VL - 26 KW - digital intervention KW - adolescents KW - adolescent KW - stress management KW - mental health KW - mobile phone KW - mobile health KW - mHealth KW - teen KW - teens KW - teenager KW - teenagers KW - stress KW - rumination KW - brooding KW - randomized controlled trial KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - digital mental health intervention KW - DMHI KW - digital health N2 - Background: Although adolescents report high levels of stress, they report engaging in few stress management techniques. Consequently, developing effective and targeted programs to help address this transdiagnostic risk factor in adolescence is particularly important. Most stress management programs for adolescents are delivered within schools, and the evidence for these programs is mixed, suggesting a need for alternative options for stress management among adolescents. Objective: The aim of the study is to test the short-term effects of a self-guided digital mental health intervention (DMHI) designed for adolescents on perceived stress and rumination (ie, brooding). Methods: This was a 12-week, 2-arm decentralized randomized controlled trial of adolescents aged 13 to 17 years who presented with elevated levels of perceived stress and brooding. Participants were randomly assigned to engage with a self-guided DMHI (Happify for Teens) or to a waitlist control. Participants assigned to the intervention group were given access to the program for 12 weeks. Happify for Teens consists of various evidence-based activities drawn from therapeutic modalities such as cognitive behavioral therapy, positive psychology, and mindfulness, which are then organized into several programs targeting specific areas of concern (eg, Stress Buster 101). Participants in the waitlist control received access to this product for 12 weeks upon completing the study. Participants in both groups completed measures of perceived stress, brooding, optimism, sleep disturbance, and loneliness at baseline, 4 weeks, 8 weeks, and 12 weeks. Changes in outcomes between the intervention and waitlist control groups were assessed using repeated-measures multilevel models. Results: Of the 303 participants included in data analyses, 132 were assigned to the intervention and 171 to the waitlist. There were significantly greater improvements in the intervention condition for perceived stress (intervention: B=?1.50; 95% CI ?1.82 to ?1.19; P<.001 and control: B=?0.09; 95% CI ?0.44 to 0.26; P=.61), brooding (intervention: B=?0.84; 95% CI ?1.00 to ?0.68; P<.001 and control: B=?0.30; 95% CI ?0.47 to ?0.12; P=.001), and loneliness (intervention: B=?0.96; 95% CI ?1.2 to ?0.73; P<.001 and control: B=?0.38; 95% CI: ?0.64 to ?0.12; P=.005) over the 12-week study period. Changes in optimism and sleep disturbance were not significantly different across groups (Ps?.096). Conclusions: Happify for Teens was effective at reducing perceived stress, rumination, and loneliness among adolescents over 12 weeks when compared to a waitlist control group. Our data reveal the potential benefits of DMHIs for adolescents, which may present a more scalable, destigmatized, and cost-effective alternative to school-based programs. Trial Registration: ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888 International Registered Report Identifier (IRRID): RR2-10.2196/25545 UR - https://www.jmir.org/2024/1/e54282 UR - http://dx.doi.org/10.2196/54282 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551617 ID - info:doi/10.2196/54282 ER - TY - JOUR AU - Xu, Joy AU - Khanotia, Areej AU - Juni, Shmuel AU - Ku, Josephine AU - Sami, Hana AU - Lin, Vallen AU - Walterson, Roberta AU - Payne, Evelyn AU - Jo, Helen AU - Rahimpoor-Marnani, Parmin PY - 2024/3/29 TI - Effectiveness of Virtual Reality?Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review JO - JMIR Ment Health SP - e52186 VL - 11 KW - well-being KW - virtual reality KW - VR KW - stress, nature KW - academic KW - student KW - intervention KW - young adults KW - teens KW - adolescent KW - stressors KW - stress management KW - systematic review KW - accessible KW - accessibility KW - students KW - affordable N2 - Background: Adolescents can be especially vulnerable to various stressors as they are still in their formative years and transitioning into adulthood. Hence, it is important for them to have effective stress management strategies. Objective: This systematic review investigates current well-being interventions that are aimed at reducing stress among young adults. In particular, interventions using the medium of virtual reality (VR) are explored. Methods: This mixed methods systematic review follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, and papers were gathered from databases such as PsycINFO, PubMed, Science Direct, Web of Science, OpenGrey, and Edutopia. Predetermined criteria and specific keywords were used to search for the papers. Search results were screened and extracted with all article screening or extraction delegated among all authors. Any disagreements after reconciliation were settled by a third author. The quality and risk of bias of included studies were assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Tool for Quantitative Studies. Studies were analyzed qualitatively. Results: In total, 20 studies were included, and qualitative analysis was performed to evaluate the effectiveness of VR-based interventions in 3 domains: nature, stress, and academics. Conclusions: Studies using VR interventions, overall, promoted a reduction in stress and an increase in well-being. The findings suggest that VR may serve as an accessible and affordable medium of stress reduction for students and young adults. Larger sample sizes, and a greater number of included studies, may be required in future directions. UR - https://mental.jmir.org/2024/1/e52186 UR - http://dx.doi.org/10.2196/52186 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551625 ID - info:doi/10.2196/52186 ER - TY - JOUR AU - Castro Ribeiro, Thais AU - García Pagès, Esther AU - Ballester, Laura AU - Vilagut, Gemma AU - García Mieres, Helena AU - Suárez Aragonès, Víctor AU - Amigo, Franco AU - Bailón, Raquel AU - Mortier, Philippe AU - Pérez Sola, Víctor AU - Serrano-Blanco, Antoni AU - Alonso, Jordi AU - Aguiló, Jordi PY - 2024/3/29 TI - Design of a Remote Multiparametric Tool to Assess Mental Well-Being and Distress in Young People (mHealth Methods in Mental Health Research Project): Protocol for an Observational Study JO - JMIR Res Protoc SP - e51298 VL - 13 KW - mental health KW - mental well-being KW - mobile health KW - mHealth KW - remote monitoring KW - physiological variables KW - experimental protocol KW - depression KW - anxiety N2 - Background: Mental health conditions have become a substantial cause of disability worldwide, resulting in economic burden and strain on the public health system. Incorporating cognitive and physiological biomarkers using noninvasive sensors combined with self-reported questionnaires can provide a more accurate characterization of the individual?s well-being. Biomarkers such as heart rate variability or those extracted from the electrodermal activity signal are commonly considered as indices of autonomic nervous system functioning, providing objective indicators of stress response. A model combining a set of these biomarkers can constitute a comprehensive tool to remotely assess mental well-being and distress. Objective: This study aims to design and validate a remote multiparametric tool, including physiological and cognitive variables, to objectively assess mental well-being and distress. Methods: This ongoing observational study pursues to enroll 60 young participants (aged 18-34 years) in 3 groups, including participants with high mental well-being, participants with mild to moderate psychological distress, and participants diagnosed with depression or anxiety disorder. The inclusion and exclusion criteria are being evaluated through a web-based questionnaire, and for those with a mental health condition, the criteria are identified by psychologists. The assessment consists of collecting mental health self-reported measures and physiological data during a baseline state, the Stroop Color and Word Test as a stress-inducing stage, and a final recovery period. Several variables related to heart rate variability, pulse arrival time, breathing, electrodermal activity, and peripheral temperature are collected using medical and wearable devices. A second assessment is carried out after 1 month. The assessment tool will be developed using self-reported questionnaires assessing well-being (short version of Warwick-Edinburgh Mental Well-being Scale), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) as the reference. We will perform correlation and principal component analysis to reduce the number of variables, followed by the calculation of multiple regression models. Test-retest reliability, known-group validity, and predictive validity will be assessed. Results: Participant recruitment is being carried out on a university campus and in mental health services. Recruitment commenced in October 2022 and is expected to be completed by June 2024. As of July 2023, we have recruited 41 participants. Most participants correspond to the group with mild to moderate psychological distress (n=20, 49%), followed by the high mental well-being group (n=13, 32%) and those diagnosed with a mental health condition (n=8, 20%). Data preprocessing is currently ongoing, and publication of the first results is expected by September 2024. Conclusions: This study will establish an initial framework for a comprehensive mental health assessment tool, taking measurements from sophisticated devices, with the goal of progressing toward a remotely accessible and objectively measured approach that maintains an acceptable level of accuracy in clinical practice and epidemiological studies. Trial Registration: OSF Registries N3GCH; https://doi.org/10.17605/OSF.IO/N3GCH International Registered Report Identifier (IRRID): DERR1-10.2196/51298 UR - https://www.researchprotocols.org/2024/1/e51298 UR - http://dx.doi.org/10.2196/51298 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551647 ID - info:doi/10.2196/51298 ER - TY - JOUR AU - Karkosz, Stanis?aw AU - Szyma?ski, Robert AU - Sanna, Katarzyna AU - Micha?owski, Jaros?aw PY - 2024/3/20 TI - Effectiveness of a Web-based and Mobile Therapy Chatbot on Anxiety and Depressive Symptoms in Subclinical Young Adults: Randomized Controlled Trial JO - JMIR Form Res SP - e47960 VL - 8 KW - chatbots KW - conversational agents KW - chatbot KW - conversational agent KW - artificial intelligence KW - mental health KW - depression KW - anxiety KW - depressive KW - cognitive distortions KW - young adults KW - randomized control trial KW - RCT KW - user experience KW - CBT KW - psychotherapy KW - cognitive behavioral therapy N2 - Background: There has been an increased need to provide specialized help for people with depressive and anxiety symptoms, particularly teenagers and young adults. There is evidence from a 2-week intervention that chatbots (eg, Woebot) are effective in reducing depression and anxiety, an effect that was not detected in the control group that was provided self-help materials. Although chatbots are a promising solution, there is limited scientific evidence for the efficacy of agent-guided cognitive behavioral therapy (CBT) outside the English language, especially for highly inflected languages. Objective: This study aimed to measure the efficacy of Fido, a therapy chatbot that uses the Polish language. It targets depressive and anxiety symptoms using CBT techniques. We hypothesized that participants using Fido would show a greater reduction in anxiety and depressive symptoms than the control group. Methods: We conducted a 2-arm, open-label, randomized controlled trial with 81 participants with subclinical depression or anxiety who were recruited via social media. Participants were divided into experimental (interacted with a fully automated Fido chatbot) and control (received a self-help book) groups. Both intervention methods addressed topics such as general psychoeducation and cognitive distortion identification and modification via Socratic questioning. The chatbot also featured suicidal ideation identification and redirection to suicide hotlines. We used self-assessment scales to measure primary outcomes, including the levels of depression, anxiety, worry tendencies, satisfaction with life, and loneliness at baseline, after the 2-week intervention and at the 1-month follow-up. We also controlled for secondary outcomes, including engagement and frequency of use. Results: There were no differences in anxiety and depressive symptoms between the groups at enrollment and baseline. After the intervention, depressive and anxiety symptoms were reduced in both groups (chatbot: n=36; control: n=38), which remained stable at the 1-month follow-up. Loneliness was not significantly different between the groups after the intervention, but an exploratory analysis showed a decline in loneliness among participants who used Fido more frequently. Both groups used their intervention technique with similar frequency; however, the control group spent more time (mean 117.57, SD 72.40 minutes) on the intervention than the Fido group (mean 79.44, SD 42.96 minutes). Conclusions: We did not replicate the findings from previous (eg, Woebot) studies, as both arms yielded therapeutic effects. However, such results are in line with other research of Internet interventions. Nevertheless, Fido provided sufficient help to reduce anxiety and depressive symptoms and decreased perceived loneliness among high-frequency users, which is one of the first pieces of evidence of chatbot efficacy with agents that use a highly inflected language. Further research is needed to determine the long-term, real-world effectiveness of Fido and its efficacy in a clinical sample. Trial Registration: ClinicalTrials.gov NCT05762939; https://clinicaltrials.gov/study/NCT05762939; Open Science Foundation Registry 2cqt3; https://osf.io/2cqt3 UR - https://formative.jmir.org/2024/1/e47960 UR - http://dx.doi.org/10.2196/47960 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506892 ID - info:doi/10.2196/47960 ER - TY - JOUR AU - McMaughan, Jones Darcy AU - Lewis, Casey AU - McGehee, Amy AU - Noreen, Dani AU - Parker, Elliot AU - Criss, M. Michael PY - 2024/3/14 TI - Meaningful Social Inclusion and Mental Well-Being Among Autistic Adolescents and Emerging Adults: Protocol for a Community-Based Mixed Methods Study JO - JMIR Res Protoc SP - e52658 VL - 13 KW - autism KW - community-based KW - mixed methods KW - social inclusion KW - well-being N2 - Background: In the United States, autistic people face high rates of co-occurring mental illnesses and premature death due to self-harm, which are indicators of threats to mental well-being. Social inclusion may enhance mental well-being and resilience among autistic people. According to Simplican and colleague?s (2015) model of social inclusion for people with intellectual and developmental disabilities, social inclusion is an interaction between community participation and interpersonal relationships. There is limited research on social inclusion that includes the integration of interpersonal relationships and community participation among autistic people or the impact of social inclusion on the well-being of autistic people. Additionally, little evidence exists regarding how autistic people prefer to be included in the community or form interpersonal relationships. Objective: The long-term objective of this project is to improve social inclusion factors to support the mental well-being of autistic people. This protocol describes a community-based, mixed methods pilot study to develop a definition of meaningful social inclusion for autistic people and to understand the relationship between meaningful social inclusion and mental well-being among autistic adolescents and emerging adults. Methods: The project uses a community-based, sequential mixed methods design with a formative phase (Phase 1) that informs a survey phase (Phase 2) and concludes with a process evaluation of the community engagement process (Phase 3). During Phase 1, we will recruit 10 community partners (autistic adults and stakeholders) and conduct sharing sessions to cocreate a definition of meaningful social inclusion and a survey of meaningful social inclusion and well-being. During Phase 2, we will recruit 200 participants (100 autistic adolescents and emerging adults and 100 caregivers) to complete the survey. We will examine whether meaningful social inclusion predicts well-being given sociodemographic factors using ordered logistic regression, with well-being categorized as low, medium, and high. During Phase 3, the community partners from Phase 1 will complete a survey on their experiences with the project. Results: Ethics approval was obtained for this project in March 2023. We have recruited community partners and started the Phase 1 focus groups as of September 2023. Phase 2 and Phase 3 have not yet started. We expect to complete this study by March 2025. Conclusions: Using a community-based, mixed methods approach, we intended to develop a definition of meaningful social inclusion for autistic people and understand the role meaningful social inclusion plays in the well-being of autistic people. International Registered Report Identifier (IRRID): PRR1-10.2196/52658 UR - https://www.researchprotocols.org/2024/1/e52658 UR - http://dx.doi.org/10.2196/52658 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483470 ID - info:doi/10.2196/52658 ER - TY - JOUR AU - Nabunya, Proscovia AU - Cavazos-Rehg, Patricia AU - Mugisha, James AU - Kasson, Erin AU - Namuyaba, Imelda Olive AU - Najjuuko, Claire AU - Nsubuga, Edward AU - Filiatreau, M. Lindsey AU - Mwebembezi, Abel AU - Ssewamala, M. Fred PY - 2024/3/8 TI - An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e54635 VL - 13 KW - depression KW - adherence KW - mHealth KW - cognitive behavioral therapy KW - antiretroviral therapy KW - youth living with HIV KW - Uganda N2 - Background: People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. Objective: The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths? outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. Methods: Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. Results: Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants? feedback. Conclusions: This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. Trial Registration: ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245 International Registered Report Identifier (IRRID): DERR1-10.2196/54635 UR - https://www.researchprotocols.org/2024/1/e54635 UR - http://dx.doi.org/10.2196/54635 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457202 ID - info:doi/10.2196/54635 ER - TY - JOUR AU - Lawrence-Sidebottom, Darian AU - Huffman, Goodgame Landry AU - Beam, Brenna Aislinn AU - Guerra, Rachael AU - Parikh, Amit AU - Roots, Monika AU - Huberty, Jennifer PY - 2024/2/27 TI - Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time JO - JMIR Pediatr Parent SP - e55560 VL - 7 KW - collaborative care model KW - telehealth KW - childhood trauma KW - DMHI KW - digital health KW - mental health KW - telemedicine KW - trauma KW - traumatic KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - child KW - children KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - retrospective KW - anxiety KW - depression KW - depressive KW - co-occurring KW - comorbid KW - comorbidity KW - comorbidities KW - association KW - associations KW - correlation KW - correlations KW - correlate N2 - Background: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. Objective: This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non?posttraumatic DMHI is linked to reductions in PTS symptoms. Methods: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children?s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. Results: Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. Conclusions: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment. UR - https://pediatrics.jmir.org/2024/1/e55560 UR - http://dx.doi.org/10.2196/55560 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412001 ID - info:doi/10.2196/55560 ER - TY - JOUR AU - Schibbye, Robert AU - Hedman-Lagerlöf, Erik AU - Kaldo, Viktor AU - Dahllöf, Göran AU - Shahnavaz, Shervin PY - 2024/2/21 TI - Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental or Injection Phobia: Randomized Controlled Trial JO - J Med Internet Res SP - e42322 VL - 26 KW - adolescents KW - cognitive behavioral therapy KW - CBT KW - children KW - dental anxiety KW - dental fear KW - internet KW - specific phobia N2 - Background: Dental phobia (DP) and injection phobia (IP) are common in children and adolescents and are considered some of the biggest obstacles to successful treatment in pediatric dentistry. Cognitive behavioral therapy (CBT) is an evidence-based treatment for anxiety and phobias. As the availability of CBT in dentistry is low, internet-based CBT (ICBT) was developed. Open trials have shown that ICBT is a promising intervention, but randomized trials are lacking. Objective: This randomized controlled trial tests whether therapist-guided ICBT supported by a parent could reduce fear, allowing children and adolescents with DP or IP to receive dental treatment. Methods: We enrolled 33 participants (mean age 11.2, SD 1.9 y) whom a clinical psychologist had diagnosed with DP, IP, or both. After inclusion, participants were randomized to either ICBT (17/33, 52%) or a control group of children on a waitlist (16/33, 48%). ICBT was based on exposure therapy and comprised a 12-week at-home program combined with visits to their regular dental clinic. Participants corresponded weekly with their therapist after completing each module, and 1 parent was designated as a coach to support the child in the assignments during treatment. All participants completed measurements of the outcome variables before treatment start and after 12 weeks (at treatment completion). The measurements included a structured diagnostic interview with a clinical psychologist. Our primary outcome measure was the Picture-Guided Behavioral Avoidance Test (PG-BAT), which assesses the ability to approach 17 dental clinical procedures, and a positive clinical diagnosis. Secondary outcome measures included self-report questionnaires that measured self-efficacy and levels of dental and injection anxiety. The children and their parents completed the questionnaires. Results: All participants underwent the 12-week follow-up. After treatment, 41% (7/17) of the participants in the ICBT group no longer met the diagnostic criteria for DP or IP, whereas all participants in the control group did (P=.004). Repeated-measure ANOVAs showed that ICBT led to greater improvements on the PG-BAT compared with the control group; between-group effect sizes for the Cohen d were 1.6 (P<.001) for the child-rated PG-BAT and 1.0 (P=.009) for the parent-rated PG-BAT. Reductions in our secondary outcomes?dental fear and anxiety (P<.001), negative cognitions (P=.001), and injection fear (P=.011)?as well as improvements in self-efficacy (P<.001), were all significantly greater among children in the ICBT group than in the controls. No participants reported adverse events. Conclusions: ICBT seems to be an effective treatment for DP and IP in children and adolescents. It reduced fear and anxiety and enabled participants to willingly receive dental treatment. ICBT should be seriously considered in clinical practice to increase accessibility; this therapy may reduce the need for sedation and restraint and lead to better dental health in children and adolescents. Trial Registration: ClinicalTrials.gov NCT02588079; https://clinicaltrials.gov/study/NCT02588079 UR - https://www.jmir.org/2024/1/e42322 UR - http://dx.doi.org/10.2196/42322 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381476 ID - info:doi/10.2196/42322 ER - TY - JOUR AU - Haack, M. Lauren AU - Armstrong, C. Courtney AU - Travis, Kate AU - Aguilera, Adrian AU - Darrow, M. Sabrina PY - 2024/2/19 TI - HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let?s Text!): Pilot Feasibility and Acceptability Study JO - JMIR Ment Health SP - e49317 VL - 11 KW - depression KW - adolescents KW - evidence-based intervention KW - texting KW - SMS text message KW - cognitive behavioral therapy KW - CBT KW - group CBT KW - shelter-in-place KW - COVID-19 KW - mobile health KW - mHealth KW - therapy KW - cognitive KW - behavior KW - web-based therapy KW - e-therapy KW - youth KW - young adults KW - mobile phone N2 - Background: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants? texts. Objective: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system?s impact on adolescents? group CBT engagement and, ultimately, depression outcomes. Methods: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. Results: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. Conclusions: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants? qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research. UR - https://mental.jmir.org/2024/1/e49317 UR - http://dx.doi.org/10.2196/49317 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373030 ID - info:doi/10.2196/49317 ER - TY - JOUR AU - Pine, Russell AU - Mbinta, James AU - Te Morenga, Lisa AU - Fleming, Theresa PY - 2024/2/12 TI - A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study JO - JMIR Serious Games SP - e46697 VL - 12 KW - adolescent KW - anxiety KW - casual video games KW - digital mental health interventions KW - gaming KW - mental health KW - micro interventions KW - serious game KW - teenage KW - video game KW - youth N2 - Background: Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored. Objective: This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents. Methods: We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] M?ori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children?s Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4. Results: Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI ?0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI ?2.71 to 4.31; P=.64) for GHSQ; ?1.09 (95% CI ?2.83 to 0.66; P=.21) for FS; and ?3.42 (95% CI ?6.84 to ?0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful. Conclusions: The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation. International Registered Report Identifier (IRRID): RR2-10.2196/31588 UR - https://games.jmir.org/2024/1/e46697 UR - http://dx.doi.org/10.2196/46697 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345848 ID - info:doi/10.2196/46697 ER - TY - JOUR AU - Peake, Emily AU - Miller, Ian AU - Flannery, Jessica AU - Chen, Lang AU - Lake, Jessica AU - Padmanabhan, Aarthi PY - 2024/2/7 TI - Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial JO - J Med Internet Res SP - e48467 VL - 26 KW - adolescent KW - depression KW - randomized controlled trial KW - mobile phone KW - digital therapeutics KW - mobile app KW - cognitive behavioral therapy KW - behavioral activation KW - mobile health N2 - Background: Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. Objective: This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. Methods: An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy?based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. Results: A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8?10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean ?5.08, 95% CI ?6.72 to ?3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; ?21=6.2; P=.01; false discovery rate?adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate?adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ?5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. Conclusions: There is initial evidence that a self-guided, cognitive behavioral therapy?based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. Trial Registration: ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598 UR - https://www.jmir.org/2024/1/e48467 UR - http://dx.doi.org/10.2196/48467 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324367 ID - info:doi/10.2196/48467 ER - TY - JOUR AU - Shen, Chen AU - Smith, B. Rachel AU - Heller, Joel AU - Spiers, V. Alexander D. AU - Thompson, Rhiannon AU - Ward, Helen AU - Roiser, P. Jonathan AU - Nicholls, Dasha AU - Toledano, B. Mireille PY - 2024/2/7 TI - Depression and Anxiety in Adolescents During the COVID-19 Pandemic in Relation to the Use of Digital Technologies: Longitudinal Cohort Study JO - J Med Internet Res SP - e45114 VL - 26 KW - COVID-19 KW - depression KW - anxiety KW - public health KW - adolescence KW - digital technology use KW - sleep KW - mobile phone N2 - Background: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. Objective: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. Methods: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. Results: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3%; anxiety: 125/425, 29.4%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5%; anxiety: 58/425, 13.6%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95% CI 1.5-4.18) and anxiety (OR 2.11, 95% CI 1.23-3.61) at T2. A high level of total mobile phone use at T1 was associated with developing depression at T2 (OR 1.89, 95% CI 1.02-3.49). Social network site use was associated with depression and anxiety cross-sectionally at T1 and T2 but did not appear to be associated with developing depression or anxiety longitudinally. Insufficient sleep at T1 was associated with developing depression at T2 (OR 2.26, 95% CI 1.31-3.91). Conclusions: The mental health of this large sample of adolescents from London deteriorated during the pandemic without noticeable variations relating to public health measures. The deterioration was exacerbated in girls, those with preexisting high total mobile phone use, and those with preexisting disrupted sleep. Our findings suggest the necessity for allocating resources to address these modifiable factors and target high-risk groups. UR - https://www.jmir.org/2024/1/e45114 UR - http://dx.doi.org/10.2196/45114 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324379 ID - info:doi/10.2196/45114 ER - TY - JOUR AU - Park, Y. Susanna AU - Do, Bridgette AU - Yourell, Jacqlyn AU - Hermer, Janice AU - Huberty, Jennifer PY - 2024/2/6 TI - Digital Methods for the Spiritual and Mental Health of Generation Z: Scoping Review JO - Interact J Med Res SP - e48929 VL - 13 KW - Generation Z KW - Gen Z KW - spiritual health KW - digital mental health KW - spirituality N2 - Background: Generation Z (Gen Z) includes individuals born between 1995 and 2012. These individuals experience high rates of anxiety and depression. Most Gen Z individuals identify with being spiritual, and aspects from religion and spirituality can be integrated into mental health treatment and care as both are related to lower levels of depression. However, research on the spiritual and mental health of Gen Z is sparse. To date, there are no systematic or scoping reviews on digital methods to address the spiritual and mental health of Gen Z. Objective: This scoping review aimed to describe the current state of digital methods to address spiritual and mental health among Gen Z, identify the knowledge gaps, and make suggestions for how to leverage digital spiritual and mental health interventions for Gen Z. Methods: A comprehensive literature search was conducted in PubMed, Scopus, PsycInfo, CINAHL, Education Full Text, Google Scholar, SocIndex, and Sociological Abstracts. The inclusion criteria were as follows: (1) study population born between 1995 and 2012 (ie, Gen Z); (2) reporting on spiritual health or well-being, spirituality or religion, and mental health or well-being; (3) reporting on using digital methods; (4) publication in 1996 or beyond; (5) human subject research; (6) full text availability in English; (7) primary research study design; and (8) peer-reviewed article. Two authors screened articles and subsequently extracted data from the included articles to describe the available evidence. Results: A total of 413 articles were screened at the title and abstract levels, of which 27 were further assessed with full text for eligibility. Five studies met the inclusion criteria, and data were extracted to summarize study characteristics and findings. The studies were performed across 4 different countries. There were 2 mixed-methods studies (South Africa and Canada), 2 cross-sectional studies (China and United States), and 1 randomized controlled trial (United States). Of these studies, only 2 discussed digital interventions (a text messaging?based intervention to improve spiritual and mental health, and a feasibility study for a mental health app). Other studies had a digital component with minor or unclear spiritual and mental health measures. Overall, there was a lack of consistency in how spiritual and mental health were measured. Conclusions: Few studies have focused on assessing the spiritual and mental health of Gen Z in the digital context, and no research to date has examined a digital spiritual and mental health application among Gen Z. Research is needed to inform the development and evaluation of approaches to address the spiritual and mental health of Gen Z via digital means (eg, mobile apps). UR - https://www.i-jmr.org/2024/1/e48929 UR - http://dx.doi.org/10.2196/48929 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261532 ID - info:doi/10.2196/48929 ER - TY - JOUR AU - Dimitropoulos, Gina AU - Bassi, M. Emilie AU - Bright, S. Katherine AU - Gondziola, Jason AU - Bradley, Jessica AU - Fersovitch, Melanie AU - Stamp, Leanne AU - LaMonica, M. Haley AU - Iorfino, Frank AU - Gaskell, Tanya AU - Tomlinson, Sara AU - Johnson, Wyatt David PY - 2024/1/17 TI - Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders JO - JMIR Ment Health SP - e49099 VL - 11 KW - electronic mental health KW - eMH KW - digital mental health KW - youth and young adult mental health KW - secondary schools KW - implementation science KW - qualitative descriptive methods KW - mental health platform KW - mental health KW - mobile phone N2 - Background: Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person?s life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. Objective: The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. Methods: Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. Results: Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. Conclusions: Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase. UR - https://mental.jmir.org/2024/1/e49099 UR - http://dx.doi.org/10.2196/49099 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231558 ID - info:doi/10.2196/49099 ER - TY - JOUR AU - Høgsdal, Helene AU - Kyrrestad, Henriette AU - Rye, Marte AU - Kaiser, Sabine PY - 2024/1/15 TI - Exploring Adolescents? Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study JO - JMIR Form Res SP - e50222 VL - 8 KW - mental health applications KW - mental health KW - adolescents KW - adolescent KW - youth KW - mobile health KW - app KW - apps KW - application KW - applications KW - opinion KW - opinions KW - cross sectional KW - survey KW - surveys KW - questionnaire N2 - Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents? attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, ?What do you think about mental health apps in general??). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. UR - https://formative.jmir.org/2024/1/e50222 UR - http://dx.doi.org/10.2196/50222 UR - http://www.ncbi.nlm.nih.gov/pubmed/38224474 ID - info:doi/10.2196/50222 ER - TY - JOUR AU - Efe, Zeki AU - Baldofski, Sabrina AU - Kohls, Elisabeth AU - Eckert, Melanie AU - Saee, Shadi AU - Thomas, Julia AU - Wundrack, Richard AU - Rummel-Kluge, Christine PY - 2024/1/12 TI - Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study JO - JMIR Form Res SP - e51795 VL - 8 KW - e-mental health KW - chat counseling KW - crisis KW - helpline KW - linguistic KW - language KW - Linguistic Inquiry and Word Count KW - LIWC KW - psychiatric symptoms N2 - Background: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person?s mental health state and is known to be a marker for psychopathology. Objective: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. Methods: For this study, the anonymized chat content of a German messenger?based psychosocial chat counseling service for children and adolescents (?krisenchat?) between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. Results: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. Conclusions: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users? psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services. UR - https://formative.jmir.org/2024/1/e51795 UR - http://dx.doi.org/10.2196/51795 UR - http://www.ncbi.nlm.nih.gov/pubmed/38214955 ID - info:doi/10.2196/51795 ER - TY - JOUR AU - Peart, Natalie AU - Hetrick, Sarah AU - Gibson, Kerry AU - Stasiak, Karolina PY - 2023/12/25 TI - Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study JO - JMIR Form Res SP - e46579 VL - 7 KW - counseling KW - distress KW - empathize KW - internet KW - mental health KW - online text KW - proactive KW - qualitative study KW - risk assessment KW - self-harm KW - social media KW - suicide KW - validation KW - youth N2 - Background: Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality. Objective: Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context. Methods: We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke?s reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention. Results: A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person?s post and emojis to further conversations and build rapport. Conclusions: The findings highlight the importance of the counselor?s role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person?s experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively. UR - https://formative.jmir.org/2023/1/e46579 UR - http://dx.doi.org/10.2196/46579 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145477 ID - info:doi/10.2196/46579 ER - TY - JOUR AU - Kreniske, Philip AU - Namuyaba, Imelda Olive AU - Kasumba, Robert AU - Namatovu, Phionah AU - Ssewamala, Fred AU - Wingood, Gina AU - Wei, Ying AU - Ybarra, L. Michele AU - Oloya, Charlotte AU - Tindyebwa, Costella AU - Ntulo, Christina AU - Mujune, Vincent AU - Chang, W. Larry AU - Mellins, A. Claude AU - Santelli, S. John PY - 2023/12/19 TI - Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e49352 VL - 12 KW - adolescence KW - PrEP KW - pre-exposure prophylaxis KW - HIV KW - mental health KW - substance use KW - sexual health KW - mobile phones KW - randomized controlled trial KW - adaptation KW - Uganda N2 - Background: East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. Objective: This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo?s effectiveness in increasing HIV testing and linking users to mental health counselors. Methods: We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message?based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention?s impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. Results: Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. Conclusions: Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. Trial Registration: ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151 International Registered Report Identifier (IRRID): DERR1-10.2196/49352 UR - https://www.researchprotocols.org/2023/1/e49352 UR - http://dx.doi.org/10.2196/49352 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113102 ID - info:doi/10.2196/49352 ER - TY - JOUR AU - Lawrence-Sidebottom, Darian AU - Huffman, Goodgame Landry AU - Beam, Aislinn AU - Guerra, Rachael AU - Parikh, Amit AU - Roots, Monika AU - Huberty, Jennifer PY - 2023/12/18 TI - Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis JO - JMIR Form Res SP - e52804 VL - 7 KW - adolescents KW - anxiety KW - children KW - depression KW - digital mental health intervention KW - reliable change N2 - Background: Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth. Objective: This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression. Methods: We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms. Results: Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents. Conclusions: Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people. UR - https://formative.jmir.org/2023/1/e52804 UR - http://dx.doi.org/10.2196/52804 UR - http://www.ncbi.nlm.nih.gov/pubmed/38109174 ID - info:doi/10.2196/52804 ER - TY - JOUR AU - Karnik, Varun AU - Henderson, Hamish AU - Khan, Raza Urooj AU - Boyd, James PY - 2023/12/14 TI - Phone-Based Text Therapy for Youth Mental Health: Rapid Review JO - Interact J Med Res SP - e47250 VL - 12 KW - text therapy KW - mHealth KW - adolescent health KW - distance counseling KW - mental illness KW - mobile health intervention KW - adolescent KW - health promotion KW - digital mental health intervention N2 - Background: Mental illness has become a prevalent issue impacting adolescents worldwide. Many barriers, including stigma and poor health literacy, prevent this population group from accessing reliable mental health care services. Synchronous text?therapy counseling is an underused therapeutic approach in combating adolescent mental illness. Phone-based text therapy is uniquely placed to offer personalized counseling to adolescents through a familiar and engaging treatment modality. Objective: This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health. Methods: Cochrane CENTRAL, Embase, PubMed, and PsycINFO were used to search for suitable literature. Five groups of keywords were used: those related to (1) ?therapy,? (2) ?text,? (3) ?phone,? (4) ?youth,? and (5) ?mental health.? Eligibility criteria were formed through the PICO (Population, Intervention, Control, and Outcome) framework. Studies were included if a synchronous phone-based text therapy intervention was used in an adolescent population, with an age range of 12-24 years. Only literature available in full-text, English, and a peer-reviewed journal was considered. Furthermore, a date limit of 5 years was set to reflect the recent development of digital interventions for mental health. Pertinent information from each study was tabulated, and a narrative synthesis was used to assess, describe, and organize the included studies comprehensively and concisely. Results: Of the 771 studies dual screened, 7 studies were included in this rapid review. Most of the exclusions occurred due to the use of the wrong intervention, such as asynchronous messaging. The selected studies had a low risk of bias and were suitable for the review. All interventional trials demonstrated reductions in mental health symptoms, primarily depression and anxiety. Most studies displayed high usability among participants, while data were unclear regarding accessibility. Conclusions: This review reveals the high potential of phone-based text therapy as an intervention for adolescents experiencing mental illness. We hope that this review promotes further refinement of text-based phone therapies and encourages future research on this subject matter. UR - https://www.i-jmr.org/2023/1/e47250 UR - http://dx.doi.org/10.2196/47250 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096012 ID - info:doi/10.2196/47250 ER - TY - JOUR AU - van Doorn, Marilon AU - Monsanto, Anne AU - Wang, Lu Chen AU - Verfaillie, J. Sander C. AU - van Amelsvoort, J. Thérèse A. M. AU - Popma, Arne AU - Jaspers, M. Monique W. AU - Öry, Ferko AU - Alvarez-Jimenez, Mario AU - Gleeson, F. John AU - Nieman, H. Dorien PY - 2023/12/13 TI - The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study JO - JMIR Mhealth Uhealth SP - e50636 VL - 11 KW - indicative prevention KW - youth mental health KW - Moderated Online Social Therapy KW - MOST+ KW - eHealth KW - well-being KW - early detection and intervention KW - Engage Young People Early KW - ENYOY N2 - Background: To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. Objective: This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. Methods: Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54% and the dropout rate 62.6% (82/131). Results: The primary analysis (77/131, 58.8%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; ?p2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; ?p2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P?.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38% (39/102) of cases, no change in 54.9% (56/102) of cases, and worsening in 5.9% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50% (51/102), 43.1% (44/102), and 6.9% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5% (77/102) of cases for distress and 89.2% (91/102) for functioning. Conclusions: This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03315-x UR - https://mhealth.jmir.org/2023/1/e50636 UR - http://dx.doi.org/10.2196/50636 UR - http://www.ncbi.nlm.nih.gov/pubmed/38090802 ID - info:doi/10.2196/50636 ER - TY - JOUR AU - Abraham, Olufunmilola AU - McCarthy, James Tyler AU - Zaborek, Jen PY - 2023/12/7 TI - Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study JO - JMIR Form Res SP - e51812 VL - 7 KW - adolescent KW - opioid KW - medication safety KW - serious games KW - gamification KW - health behavior N2 - Background: The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families. Objective: This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents. Methods: A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team. Results: A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents? and parents? concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups. Conclusions: The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies. UR - https://formative.jmir.org/2023/1/e51812 UR - http://dx.doi.org/10.2196/51812 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060287 ID - info:doi/10.2196/51812 ER - TY - JOUR AU - Pozuelo, R. Julia AU - Moffett, D. Bianca AU - Davis, Meghan AU - Stein, Alan AU - Cohen, Halley AU - Craske, G. Michelle AU - Maritze, Meriam AU - Makhubela, Princess AU - Nabulumba, Christine AU - Sikoti, Doreen AU - Kahn, Kathleen AU - Sodi, Tholene AU - AU - van Heerden, Alastair AU - O?Mahen, A. Heather PY - 2023/11/30 TI - User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study JO - JMIR Form Res SP - e51423 VL - 7 KW - depression KW - adolescents KW - mental health app KW - behavioral activation KW - user-centered design KW - low- and middle-income countries KW - mobile phone N2 - Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (?episodes?) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention?s feasibility, acceptability, and efficacy in reducing depressive symptoms. UR - https://formative.jmir.org/2023/1/e51423 UR - http://dx.doi.org/10.2196/51423 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032691 ID - info:doi/10.2196/51423 ER - TY - JOUR AU - Klein Schaarsberg, E. Renée AU - Ribberink, Z. Amber AU - Osinga, Babette AU - van Dam, Levi AU - Lindauer, L. Ramón J. AU - Popma, Arne PY - 2023/11/28 TI - Treatment Responsivity in Adolescents With Disruptive Behavior Problems: Co-Creation of a Virtual Reality?Based Add-On Intervention JO - JMIR Form Res SP - e46592 VL - 7 KW - virtual reality KW - role-playing KW - cognitive behavioral therapy KW - co-creation KW - disruptive behavior KW - mentalization KW - adolescence KW - mental health KW - child KW - youth KW - clinical practice KW - intervention N2 - Background: We developed Street Temptations (ST) as an add-on intervention to increase the treatment responsivity of adolescents with disruptive behavior problems. ST?s primary aim is to improve adolescents? mentalizing abilities in order to help them engage in and benefit from psychotherapy. Additionally, virtual reality (VR) is used to work in a more visual, less verbal, fashion. Objective: By recapping the lessons learned while developing ST so far, we aim to design the following study on ST. Furthermore, we aim to enhance the development and study of new health care interventions in clinical practice, together with adolescents as their end users. Methods: We followed an iterative co-creation process to develop a prototype of ST, in collaboration with adolescents and professionals from a secured residential facility in Amsterdam, the Netherlands. The prototype was tested during a pilot phase, involving 2 test runs, in which 4 adolescents and 4 professionals participated. Qualitative data were collected through interviews with the adolescents and by conducting a group interview with the professionals, in order to gain first insights into ST?s usability, feasibility, and its added value to clinical practice. In between the first and second test runs, the prototype was enhanced. On the basis of the complete pilot phase, we reflected on the future development and implementation of ST to design a subsequent study. Results: Over the course of 6 months, ST?s first prototype was developed during multiple creative sessions. Included was the development of a short 360° VR video, to serve as a base for the mentalization exercises. The final version of ST consisted of 7 individual therapy sessions, incorporating both the VR video and a VR StreetView app. On the basis of the qualitative data collected during the pilot phase, we found preliminary signs of ST?s potential to support adolescents? perspective-taking abilities specifically. Additionally, using VR to focus on real-life situations that adolescents encounter in their daily lives possibly helps to facilitate communication. However, several challenges and requests concerning the VR hardware and software and the implementation of ST emerged, pointing toward further development of ST as an add-on intervention. These challenges currently limit large-scale implementation, resulting in specific requirements regarding a subsequent study. Conclusions: In order to gather more extensive information to shape further development and study treatment effects, a small-scale and individually oriented research design seems currently more suitable than a more standard between-subjects design. Using the reflection on the lessons learned described in this report, a research protocol for a forthcoming study on ST has been developed. By presenting our co-creation journey thus far, we hope to be of inspiration for a more co-creative mindset and in that way contribute to the mutual reinforcement of science and clinical practice. UR - https://formative.jmir.org/2023/1/e46592 UR - http://dx.doi.org/10.2196/46592 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015607 ID - info:doi/10.2196/46592 ER - TY - JOUR AU - Demetry, Youstina AU - Wasteson, Elisabet AU - Lindegaard, Tomas AU - Abuleil, Amjad AU - Geranmayeh, Anahita AU - Andersson, Gerhard AU - Shahnavaz, Shervin PY - 2023/11/24 TI - Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study JO - JMIR Form Res SP - e46253 VL - 7 KW - internet-based interventions KW - cultural adaptation KW - Arabic KW - youth KW - depression KW - anxiety KW - refugees KW - mental health KW - Arabic-speaking youth KW - mental disorder KW - psychological intervention N2 - Background: Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. Objective: This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. Methods: A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. Results: The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. Conclusions: The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation. UR - https://formative.jmir.org/2023/1/e46253 UR - http://dx.doi.org/10.2196/46253 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999955 ID - info:doi/10.2196/46253 ER - TY - JOUR AU - Miller, Ian AU - Peake, Emily AU - Strauss, Gabriel AU - Vierra, Elise AU - Koepsell, Xin AU - Shalchi, Brandon AU - Padmanabhan, Aarthi AU - Lake, Jessica PY - 2023/11/22 TI - Self-Guided Digital Intervention for Depression in Adolescents: Feasibility and Preliminary Efficacy Study JO - JMIR Form Res SP - e43260 VL - 7 KW - depression KW - adolescents KW - young adults KW - cognitive behavioral therapy KW - behavioral activation KW - digital health KW - mobile interventions KW - mobile phone N2 - Background: Depression in adolescents is a large and growing problem; however, access to effective mental health care continues to be a challenge. Digitally based interventions may serve to bridge this access gap for adolescents in need of care. Digital interventions that deliver components of cognitive behavioral therapy (CBT) have been shown to reduce symptoms of depression, and virtual reality (VR) may be a promising adjunctive component. However, research on these types of treatments in adolescents and young adults is limited. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of Spark (v1.0), a 5-week, self-guided, CBT-based digital program using a mobile app and VR experiences to target symptoms of depression in adolescents. Methods: A single-arm, open-label study of the Spark program was conducted with a community sample of 30 adolescents and young adults aged 12 to 21 years with self-reported moderate to severe depression symptoms. Participants completed a weekly depression assessment (Patient Health Questionnaire-8) in the app during the 5-week intervention period as well as web-based baseline, postintervention, and 1-month follow-up self-report assessments. The participants also completed a qualitative postintervention interview. For participants aged <18 years, caregivers completed assessments at baseline and postintervention time points. Feasibility outcomes included recruitment rate (the proportion of participants who enrolled in the study divided by the total number of participants screened for eligibility) and retention rate (the proportion of participants who completed postintervention assessments divided by the total number of participants who received the intervention). Acceptability outcomes included engagement with the program and quantitative and qualitative feedback about the program. Preliminary efficacy was evaluated based on the Patient Health Questionnaire-8. Results: The study recruitment (31/66, 47%) and retention (29/30, 97%) rates were high. Participants provided higher ratings for the ease of use of the Spark program (8.76 out of 10) and their enjoyment of both the mobile app (7.00 out of 10) and VR components (7.48 out of 10) of the program, whereas they provided lower ratings for the program?s ability to improve mood (4.38 out of 10) or fit into their daily routines (5.69 out of 10). We observed a clinically and statistically significant reduction in depression scores at postintervention (mean difference 5.36; P<.001) and 1-month follow-up (mean difference 6.44; P<.001) time points. Conclusions: The Spark program was found to be a feasible and acceptable way to deliver a self-guided CBT-focused intervention to adolescents and young adults with symptoms of depression. Preliminary data also indicated that the Spark program reduced the symptoms of depression in adolescents and young adults. Future studies should evaluate the efficacy of this intervention in an adequately powered randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04165681; https://classic.clinicaltrials.gov/ct2/show/NCT04165681 UR - https://formative.jmir.org/2023/1/e43260 UR - http://dx.doi.org/10.2196/43260 UR - http://www.ncbi.nlm.nih.gov/pubmed/37991839 ID - info:doi/10.2196/43260 ER - TY - JOUR AU - Rheinberger, Demee AU - Baffsky, Rachel AU - McGillivray, Lauren AU - Zbukvic, Isabel AU - Dadich, Ann AU - Larsen, Erik Mark AU - Lin, Ping-I AU - Gan, Q. Daniel Z. AU - Kaplun, Catherine AU - Wilcox, C. Holly AU - Eapen, Valsamma AU - Middleton, M. Paul AU - Torok, Michelle PY - 2023/11/16 TI - Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals JO - JMIR Form Res SP - e51398 VL - 7 KW - mobile health KW - mHealth KW - digital health KW - mental health KW - suicide prevention KW - self-harm KW - young people KW - hospitals KW - mobile phone N2 - Background: Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability. Objective: This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration. Methods: We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems. Results: Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration. Conclusions: Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation. UR - https://formative.jmir.org/2023/1/e51398 UR - http://dx.doi.org/10.2196/51398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37971790 ID - info:doi/10.2196/51398 ER - TY - JOUR AU - Liang, Haiyan AU - Wang, Xi AU - An, Ruopeng PY - 2023/11/13 TI - Influence of Pokémon GO on Physical Activity and Psychosocial Well-Being in Children and Adolescents: Systematic Review JO - J Med Internet Res SP - e49019 VL - 25 KW - Pokémon GO KW - artificial intelligence KW - physical activity KW - psychosocial well-being KW - children KW - adolescent N2 - Background: Pokémon GO, an augmented reality game with widespread popularity, can potentially influence players? physical activity (PA) levels and psychosocial well-being. Objective: This review aims to systematically examine the scientific evidence regarding the impact of Pokémon GO on PA and psychosocial well-being in children and adolescents. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, we conducted keyword and reference searches in the PubMed, CINAHL, Web of Science, and Scopus databases. We performed title and abstract screening, full-text review, evidence synthesis, and identified research gaps. Results: Our review included 10 studies that explored the effect of Pokémon GO on PA or psychosocial well-being among children and adolescents. These studies used diverse designs across multiple countries and regions. Pokémon GO use measures encompassed frequency, experience, adherence, and motivation. PA assessment methods ranged from self-reported questionnaires to technology-based evaluations and qualitative approaches. Psychosocial well-being measures included emotional intelligence, personal well-being, self-control, emotionality, and sociability. In general, the estimated impact of Pokémon GO on PA was positive, with gaming elements and engagement correlating with increased PA levels. However, the effect on psychosocial well-being presented mixed results, with positive associations for sociability but a complex relationship involving well-being and internet gaming disorder. The limitations of these studies comprised the absence of randomized controlled trials, heterogeneity in study designs and outcome measures, and potential confounding bias. Conclusions: Overall, Pokémon GO tends to positively affect PA levels, while the impact on psychosocial well-being remains complex and requires further investigation. Future research should investigate the mechanisms connecting Pokémon GO use with PA and psychosocial well-being and the potential risks of excessive gameplay. These findings can help inform public health interventions to harness gaming technologies for promoting PA and enhancing well-being among the younger generation. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023412032; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=412032 UR - https://www.jmir.org/2023/1/e49019 UR - http://dx.doi.org/10.2196/49019 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955949 ID - info:doi/10.2196/49019 ER - TY - JOUR AU - Gliske, Kate AU - Ballard, Jaime AU - Berry, R. Katie AU - Killian, Michael AU - Kroll, Elizabeth AU - Fenkel, Caroline PY - 2023/11/9 TI - Reduction of Mental Health?Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis JO - JMIR Form Res SP - e47895 VL - 7 KW - mental health KW - emergency room KW - emergency department KW - ED KW - readmission KW - intensive outpatient treatment KW - IOP KW - pediatric KW - youth KW - young adult KW - emergency KW - evaluation KW - sexual identity KW - race KW - ethnicity KW - care KW - outpatient KW - treatment N2 - Background: Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth?s mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED?s in order to prevent readmissions. Objective: The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Methods: Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). Results: Mental health?related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health?related ED admissions at IOP intake reported no mental health?related ED admissions at 3 months after discharge from treatment (?21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. Conclusions: This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults. UR - https://formative.jmir.org/2023/1/e47895 UR - http://dx.doi.org/10.2196/47895 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943600 ID - info:doi/10.2196/47895 ER - TY - JOUR AU - Cross, Shane AU - Nicholas, Jennifer AU - Mangelsdorf, Shaminka AU - Valentine, Lee AU - Baker, Simon AU - McGorry, Patrick AU - Gleeson, John AU - Alvarez-Jimenez, Mario PY - 2023/11/3 TI - Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study JO - JMIR Form Res SP - e49846 VL - 7 KW - adolescence KW - adolescent KW - blended care KW - blended KW - co-design KW - development KW - digital health KW - digital intervention KW - digital mental health KW - framework KW - hybrid KW - mental health KW - model KW - platform KW - self-determination theory KW - service KW - services KW - theory of change KW - therapy KW - youth mental health KW - youth N2 - Background: Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. Objective: The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. Methods: We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. Results: The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. Conclusions: The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact. UR - https://formative.jmir.org/2023/1/e49846 UR - http://dx.doi.org/10.2196/49846 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921858 ID - info:doi/10.2196/49846 ER - TY - JOUR AU - Xu, Yi AU - Yang, Hongshen AU - Jin, Zhou AU - Xiang, Jian AU - Xu, Haiyun AU - Pokay, Huang Yili AU - Mao, Haibo AU - Cai, Xugong AU - Wu, Yili AU - Wang, Baofeng Deborah PY - 2023/10/26 TI - Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation JO - JMIR Form Res SP - e46494 VL - 7 KW - adolescents KW - digital mental health clinic KW - emotional distress KW - mental health service KW - secondary school N2 - Background: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. Objective: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. Methods: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. Results: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. Conclusions: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended. UR - https://formative.jmir.org/2023/1/e46494 UR - http://dx.doi.org/10.2196/46494 UR - http://www.ncbi.nlm.nih.gov/pubmed/37883144 ID - info:doi/10.2196/46494 ER - TY - JOUR AU - Caulley, Desmond AU - Alemu, Yared AU - Burson, Sedara AU - Cárdenas Bautista, Elizabeth AU - Abebe Tadesse, Girmaw AU - Kottmyer, Christopher AU - Aeschbach, Laurent AU - Cheungvivatpant, Bryan AU - Sezgin, Emre PY - 2023/10/23 TI - Objectively Quantifying Pediatric Psychiatric Severity Using Artificial Intelligence, Voice Recognition Technology, and Universal Emotions: Pilot Study for Artificial Intelligence-Enabled Innovation to Address Youth Mental Health Crisis JO - JMIR Res Protoc SP - e51912 VL - 12 KW - pediatric KW - trauma KW - voice AI KW - machine learning KW - mental health KW - predictive modeling KW - artificial intelligence KW - social determinants of health KW - speech-recognition KW - adverse childhood experiences KW - trauma and emotional distress KW - voice marker KW - speech biomarker KW - pediatrics KW - at-risk youth N2 - Background: Providing Psychotherapy, particularly for youth, is a pressing challenge in the health care system. Traditional methods are resource-intensive, and there is a need for objective benchmarks to guide therapeutic interventions. Automated emotion detection from speech, using artificial intelligence, presents an emerging approach to address these challenges. Speech can carry vital information about emotional states, which can be used to improve mental health care services, especially when the person is suffering. Objective: This study aims to develop and evaluate automated methods for detecting the intensity of emotions (anger, fear, sadness, and happiness) in audio recordings of patients? speech. We also demonstrate the viability of deploying the models. Our model was validated in a previous publication by Alemu et al with limited voice samples. This follow-up study used significantly more voice samples to validate the previous model. Methods: We used audio recordings of patients, specifically children with high adverse childhood experience (ACE) scores; the average ACE score was 5 or higher, at the highest risk for chronic disease and social or emotional problems; only 1 in 6 have a score of 4 or above. The patients? structured voice sample was collected by reading a fixed script. In total, 4 highly trained therapists classified audio segments based on a scoring process of 4 emotions and their intensity levels for each of the 4 different emotions. We experimented with various preprocessing methods, including denoising, voice-activity detection, and diarization. Additionally, we explored various model architectures, including convolutional neural networks (CNNs) and transformers. We trained emotion-specific transformer-based models and a generalized CNN-based model to predict emotion intensities. Results: The emotion-specific transformer-based model achieved a test-set precision and recall of 86% and 79%, respectively, for binary emotional intensity classification (high or low). In contrast, the CNN-based model, generalized to predict the intensity of 4 different emotions, achieved test-set precision and recall of 83% for each. Conclusions: Automated emotion detection from patients? speech using artificial intelligence models is found to be feasible, leading to a high level of accuracy. The transformer-based model exhibited better performance in emotion-specific detection, while the CNN-based model showed promise in generalized emotion detection. These models can serve as valuable decision-support tools for pediatricians and mental health providers to triage youth to appropriate levels of mental health care services. International Registered Report Identifier (IRRID): RR1-10.2196/51912 UR - https://www.researchprotocols.org/2023/1/e51912 UR - http://dx.doi.org/10.2196/51912 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870890 ID - info:doi/10.2196/51912 ER - TY - JOUR AU - Giovanelli, Alison AU - Sanchez Karver, Tahilin AU - Roundfield, D. Katrina AU - Woodruff, Sean AU - Wierzba, Catherine AU - Wolny, J. AU - Kaufman, R. Michelle PY - 2023/10/4 TI - The Appa Health App for Youth Mental Health: Development and Usability Study JO - JMIR Form Res SP - e49998 VL - 7 KW - digital mental health KW - youth mentoring KW - cognitive behavioral therapy KW - teenager KW - adolescent KW - mobile phone N2 - Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa?s 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers? characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. UR - https://formative.jmir.org/2023/1/e49998 UR - http://dx.doi.org/10.2196/49998 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792468 ID - info:doi/10.2196/49998 ER - TY - JOUR AU - Gómez-Restrepo, Carlos AU - Sarmiento-Suárez, José María AU - Alba-Saavedra, Magda AU - Calvo-Valderrama, Gabriela Maria AU - Rincón-Rodríguez, Javier Carlos AU - Bird, Jane Victoria AU - Priebe, Stefan AU - van Loggerenberg, Francois PY - 2023/10/4 TI - Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post?Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial JO - JMIR Form Res SP - e46757 VL - 7 KW - mental health KW - digital intervention KW - psychosocial intervention KW - armed conflict KW - adolescents KW - school KW - DIALOG+ KW - DIALOG+S KW - mobile phone N2 - Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post?armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 UR - https://formative.jmir.org/2023/1/e46757 UR - http://dx.doi.org/10.2196/46757 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792465 ID - info:doi/10.2196/46757 ER - TY - JOUR AU - Cascio, N. Christopher AU - Selkie, Ellen AU - Moreno, A. Megan PY - 2023/9/13 TI - Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study JO - JMIR Res Protoc SP - e50984 VL - 12 KW - social media KW - adolescents KW - teenagers KW - health KW - well-being KW - risk behavior KW - brain KW - functional magnetic resonance imaging KW - fMRI KW - mobile phone N2 - Background: Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as ?digital natives,? since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM?s connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. Objective: This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. Methods: We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non?sexual and gender minority adolescents. Results: Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. Conclusions: This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. International Registered Report Identifier (IRRID): DERR1-10.2196/50984 UR - https://www.researchprotocols.org/2023/1/e50984 UR - http://dx.doi.org/10.2196/50984 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703071 ID - info:doi/10.2196/50984 ER - TY - JOUR AU - Chong, K. Min AU - Hickie, B. Ian AU - Cross, P. Shane AU - McKenna, Sarah AU - Varidel, Mathew AU - Capon, William AU - Davenport, A. Tracey AU - LaMonica, M. Haley AU - Sawrikar, Vilas AU - Guastella, Adam AU - Naismith, L. Sharon AU - Scott, M. Elizabeth AU - Iorfino, Frank PY - 2023/9/8 TI - Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study JO - JMIR Form Res SP - e45161 VL - 7 KW - clinical staging KW - digital health solution KW - online diagnosis KW - service transformation KW - staged care KW - stratified care KW - youth mental health N2 - Background: As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals? risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. Objective: The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. Methods: We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm?s allocation based on a multidimensional self-report questionnaire. Results: Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts? ratings, with a substantial interrater agreement (?=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. Conclusions: This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention. UR - https://formative.jmir.org/2023/1/e45161 UR - http://dx.doi.org/10.2196/45161 UR - http://www.ncbi.nlm.nih.gov/pubmed/37682588 ID - info:doi/10.2196/45161 ER - TY - JOUR AU - Gliske, Kate AU - Berry, R. Katie AU - Ballard, Jaime AU - Schmidt, Clare AU - Kroll, Elizabeth AU - Kohlmeier, Jonathan AU - Killian, Michael AU - Fenkel, Caroline PY - 2023/9/7 TI - Predicting Youth and Young Adult Treatment Engagement in a Transdiagnostic Remote Intensive Outpatient Program: Latent Profile Analysis JO - JMIR Form Res SP - e47917 VL - 7 KW - youth KW - young adult KW - virtual KW - mental health KW - intensive outpatient treatment KW - latent profile analysis KW - personalized treatment N2 - Background: The youth mental health crisis in the United States continues to worsen, and research has shown poor mental health treatment engagement. Despite the need for personalized engagement strategies, there is a lack of research involving youth. Due to complex youth developmental milestones, there is a need to better understand clinical presentation and factors associated with treatment engagement to effectively identify and tailor beneficial treatments. Objective: This quality improvement investigation sought to identify subgroups of clients attending a remote intensive outpatient program (IOP) based on clinical acuity data at intake, to determine the factors associated with engagement outcomes for clients who present in complex developmental periods and with cooccurring conditions. The identification of these subgroups was used to inform programmatic decisions within this remote IOP system. Methods: Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Participants included clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using 5 indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic factors and treatment engagement outcomes. Results: Among the 2924 participants, 4 profiles of clinical acuity were identified: a low-acuity profile (n=943, 32.25%), characterized by minimal anxiety, depression, and self-harm, and 3 high-acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm (high acuity+low self-harm: n=1452, 49.66%; high acuity+moderate self-harm: n=203, 6.94%; high acuity+high self-harm: n=326, 11.15%). Age, gender, transgender identity, and sexual orientation were significantly associated with profile membership. Clients identified as sexually and gender-marginalized populations were more likely to be classified into high-acuity profiles than into the low-acuity profile (eg, for clients who identified as transgender, high acuity+low self-harm: odds ratio [OR] 2.07, 95% CI 1.35-3.18; P<.001; high acuity+moderate self-harm: OR 2.85, 95% CI 1.66-4.90; P<.001; high acuity+high self-harm: OR 3.67, 95% CI 2.45-5.51; P<.001). Race was unrelated to the profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low-acuity and high-acuity+low?self-harm profiles attended an average of 4 fewer treatment sessions compared with youth in the high-acuity+moderate?self-harm and high-acuity+high?self-harm profiles (?23=27.6, P<.001). Individuals in the high-acuity+low?self-harm profile completed treatment at a significantly lower rate relative to the other 2 high-acuity profiles (?23=13.4, P=.004). Finally, those in the high-acuity+high?self-harm profile were significantly less likely to disengage early relative to youth in all other profiles (?23=71.12, P<.001). Conclusions: This investigation represents a novel application for identifying subgroups of adolescents and young adults based on clinical acuity data at intake to identify patterns in treatment engagement outcomes. Identifying subgroups that differentially engage in treatment is a critical first step toward targeting engagement strategies for complex populations. UR - https://formative.jmir.org/2023/1/e47917 UR - http://dx.doi.org/10.2196/47917 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676700 ID - info:doi/10.2196/47917 ER - TY - JOUR AU - Listiyandini, Arruum Ratih AU - Andriani, Annisa AU - Kusristanti, Chandradewi AU - Moulds, Michelle AU - Mahoney, Alison AU - Newby, M. Jill PY - 2023/8/31 TI - Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study JO - JMIR Form Res SP - e47126 VL - 7 KW - psychological distress KW - mindfulness KW - cultural adaptation KW - internet-delivered KW - students KW - Indonesia KW - mobile phone N2 - Background: Psychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress at scale. Unfortunately, evidence-based, internet-delivered mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based, internet-delivered mindfulness interventions is needed. Objective: In this paper, we describe the process of culturally adapting an Australian internet-delivered mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students? psychological distress. Methods: To assist the cultural adaptation process, we used a systematic cultural adaptation framework and a mixed methods approach combining quantitative and qualitative methods. In study 1 (information gathering), we administered an internet-delivered questionnaire to Indonesian university students (n=248) to examine their preferences regarding an internet-delivered mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders (n=25) included local Indonesian mindfulness and mental health professionals (n=6) and university students (n=19), who were selected to maximize sample representativeness regarding personal and professional characteristics. To evaluate the initial design and cultural congruence of the internet-delivered mindfulness program in the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire. Results: In study 1, most Indonesian university students (240/248, 96.8%) reported openness to an internet-delivered mindfulness program. Most of interested students (127/240, 52.9%) preferred the length of the program to be 3 to 4 sessions, with 45.8% (110/240) preferring brief lessons taking only 15 to 30 minutes to complete. They (194/240, 80.8%) recommended that the program be accessible both through websites and mobile phones. In study 2, Indonesian stakeholders generally found the internet-delivered program to be highly culturally appropriate in terms of language, concepts, context, treatment goals, and depictions of students? emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the program?s delivery model (eg, combining visual and audio modalities when delivering psychoeducation), cultural components (eg, including more social and spiritual activities), program practicality (eg, including rewards to promote engagement), and design elements (eg, including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian internet-delivered mindfulness program called Program Intervensi Mindfulness Daring Mahasiswa Indonesia was created. Conclusions: This study highlights the process and importance of cultural adaptation of an evidence-based mindfulness treatment and demonstrates how this may be achieved for internet-delivered psychotherapy programs. We found that a culturally adapted internet-delivered mindfulness program was relevant for Indonesian students with some adjustments to the programs? content and delivery. Future research is now needed to evaluate the clinical benefit of this program. UR - https://formative.jmir.org/2023/1/e47126 UR - http://dx.doi.org/10.2196/47126 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651168 ID - info:doi/10.2196/47126 ER - TY - JOUR AU - Prochaska, J. Judith AU - Wang, Yixin AU - Bowdring, A. Molly AU - Chieng, Amy AU - Chaudhary, P. Neha AU - Ramo, E. Danielle PY - 2023/8/28 TI - Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study JO - JMIR Mhealth Uhealth SP - e47183 VL - 11 KW - adolescents KW - mobile app KW - depression KW - anxiety KW - resilience KW - digital intervention KW - digital mental health KW - mobile phone N2 - Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people?s mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents? mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization?Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe?s content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe?s content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. UR - https://mhealth.jmir.org/2023/1/e47183 UR - http://dx.doi.org/10.2196/47183 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639293 ID - info:doi/10.2196/47183 ER - TY - JOUR AU - Litke, Grace Shannon AU - Resnikoff, Annie AU - Anil, Ashley AU - Montgomery, Meredith AU - Matta, Rishabh AU - Huh-Yoo, Jina AU - Daly, P. Brian PY - 2023/8/23 TI - Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity JO - JMIR Ment Health SP - e46949 VL - 10 KW - mHealth KW - mobile app KW - children KW - adolescents KW - mental health KW - effectiveness KW - efficacy KW - scoping review KW - mobile phone N2 - Background: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. Objective: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? Methods: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app?based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. Results: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. Conclusions: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process. UR - https://mental.jmir.org/2023/1/e46949 UR - http://dx.doi.org/10.2196/46949 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610818 ID - info:doi/10.2196/46949 ER - TY - JOUR AU - Ardi, Zadrian AU - Eseadi, Chiedu AU - Yuniarti, Elsa AU - Yendi, Meivilona Frischa AU - Murni, Widya Arina PY - 2023/8/22 TI - Efficacy of Cognitive Behavioral Therapy With Local Wisdom and Web-Based Counseling on Generalized Anxiety Disorders and Functional Gastrointestinal Disorders in Adolescent College Girls: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e50316 VL - 12 KW - adolescent college girls KW - cognitive behavioral therapy KW - CBT KW - functional gastrointestinal disorders KW - FGIDs KW - generalized anxiety disorders KW - GADs KW - local wisdom KW - web-based counseling N2 - Background: The high academic demands experienced by students will often have an impact on the quality of their mental and physical health. The most common health problems reported are gastrointestinal disorders. This condition tends to manifest in the emergence of generalized anxiety disorders (GADs) and reduces the quality of life and productivity. The population that experiences this disorder the most is female adolescents, and this condition occurs in both South African and Indonesian populations. The use of drugs, especially benzodiazepines, often causes psychological conditions as side effects. For this reason, it is necessary to have a solution in the form of a targeted and efficient approach to reduce psychological symptoms that arise from functional gastrointestinal disorders (FGIDs) in the form of anxiety. Objective: The purpose of this study is to produce and implement a counseling intervention model to assist female students with GADs caused by FGID factors using an approach combining cognitive behavioral therapy (CBT), web-based counseling, and local wisdom in Indonesian and South African populations. Methods: The research subjects will comprise 118 female adolescent students from Indonesia and 118 female adolescent students from South Africa, making a total sample of 236 participants, and the study will use a prospective, parallel randomized controlled trial design. The recruitment process will begin in July 2023, and the trial will begin in August 2023. The posttest assessment data gathering will take place by November 2023. Questionnaires that will be used in this study include the Functional Gastrointestinal Disorder Checklist (FGI-Checklist) to collect data related to FGIDs and the Generalized Anxiety Disorder 7-item (GAD-7) to measure the anxiety conditions experienced by respondents. Results: By adopting the intention-to-treat principle, there will be significant mean changes in GAD scores and FGID scores after exposure to this combined approach in the Indonesian and South African populations. Implementing this comprehensive intervention will improve the students? psychological symptoms related to FGIDs and ultimately enhance their overall well-being. Conclusions: This study will develop and implement a model of counseling intervention for female students with GADs obtained from FGIDs using a combination approach to CBT, web-based counseling, and local wisdom in both the Indonesian and South African populations. The trial findings will contribute to our understanding of the effects of CBT combined with local wisdom and web-based counseling approaches that mental health counselors can use to treat GAD-affected adolescent girls who have FGIDs. Trial Registration: UMIN Clinical Trial Registry UMIN000051386; https://tinyurl.com/yjwz8kht International Registered Report Identifier (IRRID): PRR1-10.2196/50316 UR - https://www.researchprotocols.org/2023/1/e50316 UR - http://dx.doi.org/10.2196/50316 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606989 ID - info:doi/10.2196/50316 ER - TY - JOUR AU - Plackett, Ruth AU - Blyth, Alexandra AU - Schartau, Patricia PY - 2023/8/11 TI - The Impact of Social Media Use Interventions on Mental Well-Being: Systematic Review JO - J Med Internet Res SP - e44922 VL - 25 KW - review KW - social media KW - mental well-being KW - mental health KW - addiction KW - intervention KW - mobile phone N2 - Background: There is some evidence that more social media use is related to poorer mental well-being and that social media use can become problematic when it starts to interfere with a person?s daily life and mental well-being. To address this issue and improve users? mental well-being, social media use interventions (eg, abstinence from social media) have been developed and evaluated. However, there is limited understanding of the effectiveness of these interventions in improving mental well-being. Objective: This systematic review aimed to synthesize the literature on the effectiveness of social media use interventions in improving mental well-being in adults. Methods: A systematic search (January 1, 2004, to July 31, 2022) was completed across 3 databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Experimental studies evaluating the impact of social media use interventions on mental well-being in adults were included. Outcomes related to mental well-being, such as depression, anxiety, stress, and loneliness, were included. A narrative synthesis without meta-analysis was completed to summarize the study characteristics and effectiveness by outcome and intervention type. The Effective Public Health Practice Project Quality Assessment Tool was used to measure the quality of the studies. Results: Of the 2785 studies identified through the systematic search, 23 (0.83%) were included in the analysis. Many of the included studies (9/23, 39%) found improvements in mental well-being, some (7/23, 30%) found mixed effects, and others (7/23, 30%) found no effect on mental well-being. Therapy-based interventions that used techniques such as cognitive behavioral therapy were more effective than limiting use of social media or full abstinence from social media, with 83% (5/6) of these studies showing improvements in mental well-being compared with 20% (1/5) and 25% (3/12), respectively. Depression was the most frequently investigated and improved outcome with 70% (7/10) of the studies showing a significant improvement in depression after the intervention, whereas other outcomes showed more varied results. Quality was poor, with 96% (22/23) of the studies receiving a weak global score, mostly for issues related to selection bias because most of the studies (16/23, 70%) used a convenience sampling of university students. Conclusions: This review provides some evidence that social media use interventions are effective in improving mental well-being, especially for depression and when using therapy-based interventions. Further experimental and longitudinal research is needed with representative samples to investigate who may benefit most from social media use interventions. This will help to develop guidance and recommendations for policy makers and clinicians on how best to manage problematic social media use. UR - https://www.jmir.org/2023/1/e44922 UR - http://dx.doi.org/10.2196/44922 UR - http://www.ncbi.nlm.nih.gov/pubmed/37565693 ID - info:doi/10.2196/44922 ER - TY - JOUR AU - Yam-Ubon, Umaporn AU - Thongseiratch, Therdpong PY - 2023/7/28 TI - Using a Design Thinking Approach to Develop a Social Media?Based Parenting Program for Parents of Children With Attention-Deficit/Hyperactivity Disorder: Mixed Methods Study JO - JMIR Pediatr Parent SP - e48201 VL - 6 IS - 1 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - parenting programs KW - human-centered design thinking KW - online interventions KW - COVID-19 pandemic KW - children KW - development KW - online parenting program KW - parenting KW - behavior KW - support KW - feasibility KW - social media KW - prototype KW - testing KW - design N2 - Background: Parenting programs have proven effective in improving the behavior of children with attention-deficit/hyperactivity disorder (ADHD). However, barriers such as job and transportation constraints hinder parents from attending face-to-face therapy appointments. The COVID-19 pandemic has further exacerbated these challenges. Objective: This study aimed to develop and test the feasibility of a social media?based parenting program for parents of children with ADHD, considering both the pre-existing challenges faced by parents and the additional barriers imposed by the COVID-19 pandemic. Methods: This study used a 5-stage design thinking process, encompassing empathizing with parents, defining their needs, ideating innovative solutions, prototyping the program, and testing the program with parents. Qualitative interviews were conducted with 18 parents of children with ADHD to understand their unique needs and values. Brainstorming techniques were used to generate creative ideas, leading to the creation of a prototype that was tested with 32 parents. Participants? engagement with the program was measured, and posttraining feedback was collected to assess the program?s effectiveness. Results: Parents of children with ADHD encounter specific challenges, including managing impulsive behavior and difficulties in emotion regulation. The social media?based parenting program was delivered through the LINE app (Line Corporation) and consisted of 7 modules addressing topics related to ADHD management and effective parenting strategies. The program exhibited a high completion rate, with 84% (27/32) of participants successfully finishing it. Program provider?participant interaction peaked during the first week and gradually decreased over time. Qualitative feedback indicated that the program was feasible, accessible, and well received by participants. The LINE app was found to be convenient and helpful, and participants preferred content delivery once or twice per week, expressing acceptance for various content formats. Conclusions: This study emphasizes the significance of adopting a human-centered design thinking approach to develop parenting programs that cater to the unique needs and values of parents. By leveraging social media platforms, such as LINE, a parenting program can overcome the challenges posed by the COVID-19 pandemic and other constraints faced by parents. LINE offers a viable and feasible option for supporting parents of children with ADHD, with the potential for customization and widespread dissemination beyond the pandemic context. UR - https://pediatrics.jmir.org/2023/1/e48201 UR - http://dx.doi.org/10.2196/48201 ID - info:doi/10.2196/48201 ER - TY - JOUR AU - Sharrad, Kelsey AU - Martini, Caitlin AU - Tai, Andrew AU - Spurrier, Nicola AU - Smith, Ross AU - Esterman, Adrian AU - Gwilt, Ian AU - Sandford, Debra AU - Carson-Chahhoud, Kristin PY - 2023/7/26 TI - Mixed Reality Technology to Deliver Psychological Interventions to Adolescents With Asthma: Qualitative Study Using the Theoretical Framework of Acceptability JO - JMIR Hum Factors SP - e34629 VL - 10 KW - asthma KW - augmented reality KW - virtual reality KW - mixed reality KW - psychological distress KW - adolescent KW - cognitive behavioral therapies KW - mental health N2 - Background: Interactive, mixed reality technologies such as augmented reality, virtual reality, and holographic technology may provide a novel solution to fast-track the translation of evidence into practice. They may also help overcome barriers to both mental health and asthma management service uptake, such as cost, availability of appointments, fear of judgment, and quality of care. Objective: This study aimed to investigate if mixed reality technology is an acceptable mechanism for the delivery of a component of cognitive and behavioral therapies for the management of elevated psychological distress among young people with asthma. Methods: To explore the perceived acceptability of these technologies, mixed reality tools were evaluated via qualitative, 1-on-1 interviews with young people with asthma and symptoms of psychological distress, parents/caregivers of young people with asthma and symptoms of psychological distress, and relevant health professionals. The Theoretical Framework of Acceptability was used for the deductive coding of the recorded interview transcripts. Results: This study enrolled the following participants: (1) 3 adolescents with asthma and symptoms of psychological distress with a mean age of 14 (SD 1.7) years; (2) 4 parents/caregivers of adolescents with asthma with a mean age of 55 (SD 14.6) years; and (3) 6 health professionals with a mean age of 40.8 (SD 4.3) years. A total of 4 constructs?experienced affective attitude, experienced effectiveness, self-efficacy, and intervention coherence?were coded in all participant transcripts. The most frequently coded constructs were experienced affective attitude and intervention coherence, which were reported a total of 96 times. The least frequently coded construct was anticipated opportunity cost, which was reported a total of 5 times. Participants were mostly positive about the mixed reality resources. However, some concerns were raised regarding ethicality, particularly regarding privacy, accessibility, and messaging. Participants noted the need for technology to be used in conjunction with face-to-face engagement with health professionals and that some patients would respond to this type of delivery mechanism better than others. Conclusions: These results suggest that mixed reality technology to deliver psychological interventions may be an acceptable addition to current health care practices for young people with asthma and symptoms of psychological distress. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12620001109998; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380427 UR - https://humanfactors.jmir.org/2023/1/e34629 UR - http://dx.doi.org/10.2196/34629 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494096 ID - info:doi/10.2196/34629 ER - TY - JOUR AU - Edgcomb, Beni Juliet AU - Tseng, Chi-hong AU - Pan, Mengtong AU - Klomhaus, Alexandra AU - Zima, T. Bonnie PY - 2023/7/21 TI - Assessing Detection of Children With Suicide-Related Emergencies: Evaluation and Development of Computable Phenotyping Approaches JO - JMIR Ment Health SP - e47084 VL - 10 KW - child mental health KW - suicide KW - self-harm KW - machine learning KW - phenotyping N2 - Background: Although suicide is a leading cause of death among children, the optimal approach for using health care data sets to detect suicide-related emergencies among children is not known. Objective: This study aimed to assess the performance of suicide-related International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and suicide-related chief complaint in detecting self-injurious thoughts and behaviors (SITB) among children compared with clinician chart review. The study also aimed to examine variations in performance by child sociodemographics and type of self-injury, as well as develop machine learning models trained on codified health record data (features) and clinician chart review (gold standard) and test model detection performance. Methods: A gold standard classification of suicide-related emergencies was determined through clinician manual review of clinical notes from 600 emergency department visits between 2015 and 2019 by children aged 10 to 17 years. Visits classified with nonfatal suicide attempt or intentional self-harm using the Centers for Disease Control and Prevention surveillance case definition list of ICD-10-CM codes and suicide-related chief complaint were compared with the gold standard classification. Machine learning classifiers (least absolute shrinkage and selection operator?penalized logistic regression and random forest) were then trained and tested using codified health record data (eg, child sociodemographics, medications, disposition, and laboratory testing) and the gold standard classification. The accuracy, sensitivity, and specificity of each detection approach and relative importance of features were examined. Results: SITB accounted for 47.3% (284/600) of the visits. Suicide-related diagnostic codes missed nearly one-third (82/284, 28.9%) and suicide-related chief complaints missed more than half (153/284, 53.9%) of the children presenting to emergency departments with SITB. Sensitivity was significantly lower for male children than for female children (0.69, 95% CI 0.61-0.77 vs 0.84, 95% CI 0.78-0.90, respectively) and for preteens compared with adolescents (0.66, 95% CI 0.54-0.78 vs 0.86, 95% CI 0.80-0.92, respectively). Specificity was significantly lower for detecting preparatory acts (0.68, 95% CI 0.64-0.72) and attempts (0.67, 95% CI 0.63-0.71) than for detecting ideation (0.79, 95% CI 0.75-0.82). Machine learning?based models significantly improved the sensitivity of detection compared with suicide-related codes and chief complaint alone. Models considering all 84 features performed similarly to models considering only mental health?related ICD-10-CM codes and chief complaints (34 features) and models considering non?ICD-10-CM code indicators and mental health?related chief complaints (53 features). Conclusions: The capacity to detect children with SITB may be strengthened by applying a machine learning?based approach to codified health record data. To improve integration between clinical research informatics and child mental health care, future research is needed to evaluate the potential benefits of implementing detection approaches at the point of care and identifying precise targets for suicide prevention interventions in children. UR - https://mental.jmir.org/2023/1/e47084 UR - http://dx.doi.org/10.2196/47084 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477974 ID - info:doi/10.2196/47084 ER - TY - JOUR AU - Wang, Meng AU - Mou, Xingyue AU - Li, Tingting AU - Zhang, Yi AU - Xie, Yang AU - Tao, Shuman AU - Wan, Yuhui AU - Tao, Fangbiao AU - Wu, Xiaoyan PY - 2023/7/5 TI - Association Between Comorbid Anxiety and Depression and Health Risk Behaviors Among Chinese Adolescents: Cross-Sectional Questionnaire Study JO - JMIR Public Health Surveill SP - e46289 VL - 9 KW - health risk behaviors KW - anxiety KW - depression KW - comorbidity KW - adolescent KW - mental health KW - children KW - intervention KW - lifestyle behavior KW - mental disorder KW - public health KW - cross-sectional study N2 - Background: Comorbidity of psychiatric disorders such as depression and anxiety is very common among children and adolescents. Few studies have examined how comorbid anxiety and depression are associated with health risk behaviors (HRBs) in adolescents, which could inform preventative approaches for mental health. Objective: We evaluated the association between HRBs and comorbid anxiety and depression in a large adolescent cohort. Methods: We used data from 22,868 adolescents in the National Youth Cohort (China). Anxiety and depression symptoms were assessed using the 9-item Patient Health Questionnaire scale and the 7-item Generalized Anxiety Disorder scale, respectively. Comorbidity was determined by the coexistence of anxiety and depression. HRBs including poor diet, smoking, physical inactivity, and poor sleep, as well as the above HRB scores, were added to obtain the total HRB score (HRB risk index). Based on single and total HRB scores, we divided participants into low-, medium-, and high-risk groups. Potential confounders included gender, presence of siblings, regional economic level, educational status, self-rated health, parental education level, self-reported family income, number of friends, learning burden, and family history of psychosis. Correlation analysis was used to explore associations between single risk behaviors. Binary logistic regression estimated the association between HRBs and anxiety-depression comorbidity before and after adjusting for potential confounders. Results: The comorbidity rate of anxiety and depression among Chinese adolescents was 31.6% (7236/22,868). There was a statistically significant association between each HRB (P<.05), and HRBs were positively associated with comorbid anxiety and depression in the above population. For single HRBs, adolescents with poor diet, smoking, and poor sleep (medium-risk) were more prone to anxiety-depression comorbidity after adjusting for confounders compared to low-risk adolescents. However, adolescents with all high-risk HRBs were more likely to have comorbid anxiety and depression after adjusting for confounders (poor diet odds ratio [OR] 1.50, 95% CI 1.39-1.62; smoking OR 2.17, 95% CI 1.67-2.81; physical inactivity OR 1.16, 95% CI 1.06-1.28; poor sleep OR 1.84, 95% CI 1.70-2.01). Moreover, in both unadjusted (medium risk OR 1.79, 95% CI 1.56-2.05; high risk OR 3.09, 95% CI 2.72-3.52) and adjusted (medium risk OR 1.57, 95% CI 1.37-1.80; high risk OR 2.33, 95% CI 2.03-2.68) models, HRB risk index, like clustered HRBs, was positively associated with anxiety-depression comorbidity, and the strength of the association was stronger than for any single HRB. In addition, we found that compared to girls, the association between clustered HRBs and anxiety-depression comorbidity was stronger in boys after adjustment. Conclusions: We provide evidence that HRBs are related to comorbid anxiety and depression. Interventions that decrease HRBs may support mental health development in adolescence, with the potential to improve health and well-being through to adulthood. UR - https://publichealth.jmir.org/2023/1/e46289 UR - http://dx.doi.org/10.2196/46289 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405826 ID - info:doi/10.2196/46289 ER - TY - JOUR AU - Byrne, Simon AU - Richardson, Meg AU - Riba, Marcos AU - Imuta, Kana PY - 2023/6/29 TI - Parent Versus Individual Cognitive Behavioral Therapy for Youth Anxiety: Protocol for an Overview of Systematic Reviews Over Time JO - JMIR Res Protoc SP - e48077 VL - 12 KW - anxiety KW - cognitive behavioral therapy KW - systematic review KW - youth KW - overview KW - review N2 - Background: Cognitive behavioral therapy (CBT) has shown to be highly effective for treating youth anxiety; yet, there is ongoing debate as to whether involving parents improves outcomes. For example, parents who attend may learn CBT skills to help their child in an ongoing way; yet, they could also distract their child from treatment depending on how they interact. As evidence has accumulated, reviews and meta-analyses have attempted to examine the most effective treatment format. These reviews often have high impact in the field; however, they use varied methodologies and draw on different primary studies. Different formats of CBT for youth anxiety have been developed in relation to parental involvement, including youth-only CBT (Y-CBT; where the youth alone attends treatment), youth and parent or family CBT (F-CBT; where youths and their parents attend together), and, most recently, parent-only CBT (P-CBT; where the parent alone attends). Objective: This protocol describes an overview of systematic reviews comparing the relative efficacy of different formats of CBT for youth anxiety (Y-CBT, F-CBT, and P-CBT) over the study period. The protocol will also examine the moderating effects of variables on the efficacy of different formats; for example, youths? age and long-term outcomes. Methods: We will analyze the results of systematic reviews that compare different levels and types of parental involvement in CBT for youth anxiety over the study period. A systematic review of medical and psychological databases (PsycINFO, PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase) will identify reviews comparing the efficacy of different formats of parent involvement in CBT for youth anxiety. Data extraction will include (1) author names (and year of publication), (2) review design, (3) age range, (4) analysis type, (5) conclusions, and (6) moderators. This overview will present the relative efficacy of formats chronologically in a table and then describe the main results longitudinally in a narrative summary. A Measurement Tool to Assess Systematic Reviews, 2nd Edition (AMSTAR 2), quality rating will be given to each review, and the amount of primary study overlap across reviews will be quantified. Results: The last search was conducted on July 1, 2022. The reviews were published between 2005 and 2022. We found a total of 3529 articles, of which we identified 25 for the final analysis. Conclusions: This overview will compare and report the relative efficacy of Y-CBT, P-CBT, and F-CBT for youth anxiety over the study period, describe the heterogeneity across reviews and primary studies, and consider the moderating effect of relevant variables. It will describe the limitations of an overview, including the potential for nuance in the data to be lost, and provide conclusions and recommendations for conducting systematic reviews regarding parental involvement for CBT for youth anxiety. International Registered Report Identifier (IRRID): RR1-10.2196/48077 UR - https://www.researchprotocols.org/2023/1/e48077 UR - http://dx.doi.org/10.2196/48077 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384370 ID - info:doi/10.2196/48077 ER - TY - JOUR AU - Babichenko, Dmitriy AU - Radovic, Ana AU - Patel, Ravi AU - Hester, Alexis AU - Powell, Koehler AU - Eggers, Nicholas AU - Happe, David PY - 2023/6/27 TI - Evaluating the Feasibility of a Multiplayer Role-Playing Game as a Behavioral Health Intervention in Adolescent Patients With Chronic Physical or Mental Conditions: Protocol for a Cohort Study JO - JMIR Res Protoc SP - e43987 VL - 12 KW - role-playing games KW - social isolation KW - depression KW - game-based interventions KW - development KW - intervention KW - game KW - teen KW - patient KW - chronic KW - mental condition KW - quality of life KW - engagement KW - symptoms KW - data KW - clinical N2 - Background: Numerous studies have revealed that adolescents with chronic physical or mental conditions (CPMCs) are at an increased risk for depression and anxiety, with serious direct and indirect negative effects on treatment adherence, family functioning, and health-related quality of life. As game-based approaches are effective interventions in treating anxiety and depression, we propose to explore the use of a multiplayer role-playing game (RPG) as a potential intervention for social isolation, anxiety, and depression. Objective: The objectives of this study were to (1) determine the feasibility of using Masks, a multiplayer RPG, as an intervention for social isolation, anxiety, and depression in adolescents with CPMCs; (2) evaluate the viability of the research process; and (3) gauge participation in and engagement with RPG-based interventions. Methods: This study is a remote synchronous game-based intervention for adolescents with CPMCs aged 14-19 years. Eligible participants completed a web-based baseline survey to assess anxiety, depression, and social isolation and to identify their gaming habits. After completing the baseline survey, they participated in 5 moderated Masks game sessions. In Masks, players assume the roles of young superheroes; select their character types, superpowers; and perform actions determined by the game?s rule system and dice rolls. All game sessions were played using Discord, a communication platform commonly used by gaming communities. Games were led and moderated by game masters (GMs). After each game session, participants completed surveys to assess changes in anxiety, depression, and social isolation, and their attitude toward the game and the user experience. The participants also completed an exit survey after all 5 game sessions (modified version of the Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire, and 17 open-ended questions). The GMs rated each game session and reported on gameplay, player behavior, comfort, and engagement levels of the players. Results: As of March 2020, six participants were recruited for the pilot study to participate in moderated web-based game sessions of Masks; 3 completed all game sessions and all required assessments. Although the number of participants was too low to draw generalizable conclusions, self-reported clinical outcomes did seem to indicate a positive change in depression, anxiety, and social isolation symptoms. Qualitative analysis of postgame survey data from participants and GMs indicated high levels of engagement and enjoyment. Furthermore, the participants provided feedback about improved mood and engagement related to weekly participation in Masks. Lastly, responses to the exit survey showed interest in future RPG-related studies. Conclusions: We established a workflow for gameplay and evaluated a research protocol for evaluating the impact of RPG participation on isolation, anxiety, and depression symptoms in adolescents with CPMCs. Preliminary data collected from the pilot study support the validity of the research protocol and the use of RPG-based interventions in larger clinical studies. International Registered Report Identifier (IRRID): RR1-10.2196/43987 UR - https://www.researchprotocols.org/2023/1/e43987 UR - http://dx.doi.org/10.2196/43987 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368477 ID - info:doi/10.2196/43987 ER - TY - JOUR AU - Kadirvelu, Balasundaram AU - Bellido Bel, Teresa AU - Wu, Xiaofei AU - Burmester, Victoria AU - Ananth, Shayma AU - Cabral C C Branco, Bianca AU - Girela-Serrano, Braulio AU - Gledhill, Julia AU - Di Simplicio, Martina AU - Nicholls, Dasha AU - Faisal, Aldo A. PY - 2023/6/26 TI - Mindcraft, a Mobile Mental Health Monitoring Platform for Children and Young People: Development and Acceptability Pilot Study JO - JMIR Form Res SP - e44877 VL - 7 KW - mobile mental health KW - passive sensing KW - smartphone apps for mental health KW - children and young people KW - adolescents KW - digital tools KW - mobile apps N2 - Background: Children and young people's mental health is a growing public health concern, which is further exacerbated by the COVID-19 pandemic. Mobile health apps, particularly those using passive smartphone sensor data, present an opportunity to address this issue and support mental well-being. Objective: This study aimed to develop and evaluate a mobile mental health platform for children and young people, Mindcraft, which integrates passive sensor data monitoring with active self-reported updates through an engaging user interface to monitor their well-being. Methods: A user-centered design approach was used to develop Mindcraft, incorporating feedback from potential users. User acceptance testing was conducted with a group of 8 young people aged 15-17 years, followed by a pilot test with 39 secondary school students aged 14-18 years, which was conducted for a 2-week period. Results: Mindcraft showed encouraging user engagement and retention. Users reported that they found the app to be a friendly tool helping them to increase their emotional awareness and gain a better understanding of themselves. Over 90% of users (36/39, 92.5%) answered all active data questions on the days they used the app. Passive data collection facilitated the gathering of a broader range of well-being metrics over time, with minimal user intervention. Conclusions: The Mindcraft app has shown promising results in monitoring mental health symptoms and promoting user engagement among children and young people during its development and initial testing. The app's user-centered design, the focus on privacy and transparency, and a combination of active and passive data collection strategies have all contributed to its efficacy and receptiveness among the target demographic. By continuing to refine and expand the app, the Mindcraft platform has the potential to contribute meaningfully to the field of mental health care for young people. UR - https://formative.jmir.org/2023/1/e44877 UR - http://dx.doi.org/10.2196/44877 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358901 ID - info:doi/10.2196/44877 ER - TY - JOUR AU - Barzilay, Shira AU - Fine, Shai AU - Akhavan, Shannel AU - Haruvi-Catalan, Liat AU - Apter, Alan AU - Brunstein-Klomek, Anat AU - Carmi, Lior AU - Zohar, Mishael AU - Kinarty, Inbar AU - Friedman, Talia AU - Fennig, Silvana PY - 2023/6/26 TI - Real-Time Real-World Digital Monitoring of Adolescent Suicide Risk During the Six Months Following Emergency Department Discharge: Protocol for an Intensive Longitudinal Study JO - JMIR Res Protoc SP - e46464 VL - 12 KW - suicide KW - suicide ideation KW - suicide prevention KW - adolescents KW - real-time assessment KW - digital phenotyping KW - risk assessment KW - mobile phone N2 - Background: Suicide is the second leading cause of death in adolescents, and self-harm is one of the strongest predictors of death by suicide. The rates of adolescents presenting to emergency departments (EDs) for suicidal thoughts and behaviors (STBs) have increased. Still, existing follow-up after ED discharge is inadequate, leaving a high-risk period for reattempts and suicide. There is a need for innovative evaluation of imminent suicide risk factors in these patients, focusing on continuous real-time evaluations with low assessment burden and minimal reliance on patient disclosure of suicidal intent. Objective: This study examines prospective longitudinal associations between observed real-time mobile passive sensing, including communication and activity patterns, and clinical and self-reported assessments of STB over 6 months. Methods: This study will include 90 adolescents recruited on their first outpatient clinic visit following their discharge from the ED due to a recent STB. Participants will complete brief weekly assessments and be monitored continuously for their mobile app usage, including mobility, activity, and communication patterns, over 6 months using the iFeel research app. Participants will complete 4 in-person visits for clinical assessment at baseline and at the 1-, 3-, and 6-month follow-ups. The digital data will be processed, involving feature extraction, scaling, selection, and dimensionality reduction. Passive monitoring data will be analyzed using both classical machine learning models and deep learning models to identify proximal associations between real-time observed communication, activity patterns, and STB. The data will be split into a training and validation data set, and predictions will be matched against the clinical evaluations and self-reported STB events (ie, labels). To use both labeled and unlabeled digital data (ie, passively collected), we will use semisupervised methods in conjunction with a novel method that is based on anomaly detection notions. Results: Participant recruitment and follow-up started in February 2021 and are expected to be completed by 2024. We expect to find prospective proximal associations between mobile sensor communication, activity data, and STB outcomes. We will test predictive models for suicidal behaviors among high-risk adolescents. Conclusions: Developing digital markers of STB in a real-world sample of high-risk adolescents presenting to ED can inform different interventions and provide an objective means to assess the risk of suicidal behaviors. The results of this study will be the first step toward large-scale validation that may lead to suicide risk measures that aid psychiatric follow-up, decision-making, and targeted treatments. This novel assessment could facilitate timely identification and intervention to save young people?s lives. International Registered Report Identifier (IRRID): DERR1-10.2196/46464 UR - https://www.researchprotocols.org/2023/1/e46464 UR - http://dx.doi.org/10.2196/46464 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358906 ID - info:doi/10.2196/46464 ER - TY - JOUR AU - Walder, Noemi AU - Berger, Thomas AU - Schmidt, J. Stefanie PY - 2023/6/21 TI - Prevention and Treatment of Social Anxiety Disorder in Adolescents: Protocol for a Randomized Controlled Trial of the Online Guided Self-Help Intervention SOPHIE JO - JMIR Res Protoc SP - e44346 VL - 12 KW - prevention KW - treatment KW - social anxiety disorder KW - internet-based KW - adolescent KW - online intervention KW - anxiety KW - psychotherapy KW - youth KW - child KW - comorbid KW - mental health KW - social phobia KW - mobile phone N2 - Background: Social anxiety symptoms are highly prevalent among adolescents and are associated with poor quality of life and low psychosocial functioning. If untreated, social anxiety often persists into adulthood and increases the risk for comorbid disorders. Therefore, early interventions for social anxiety to prevent negative long-term consequences are critical. However, adolescents rarely seek help and often avoid face-to-face psychotherapeutic interventions due to the perceived lack of autonomy and anonymity. Thus, online interventions represent a promising opportunity to reach adolescents who have social anxiety but do not seek help yet. Objective: This study aims to evaluate the efficacy, moderators, and mediators of an online intervention developed to reduce social anxiety in adolescents. Methods: A total of 222 adolescents aged 11-17 years with subclinical social anxiety (N=166) or with a diagnosis of social anxiety disorder (N=56) are randomly assigned to the online intervention or a care-as-usual control group. The 8-week guided online intervention is based on the Cognitive Model of Social Phobia and evidence-based online interventions for social anxiety adapted to the specific needs of adolescents. The care-as-usual group will be given access to the online intervention after the follow-up assessment. Participants are assessed at baseline, at 4 and 8 weeks post intervention, and at 3-month follow-up assessment on the primary outcome, that is, social anxiety, on secondary outcomes (eg, level of functioning, fear and avoidance, general anxiety, depression, quality of life, self-esteem, and negative effects of the intervention), on potential moderators (eg, therapy motivation, therapy expectancy, and satisfaction with the intervention), and potential mediators (eg, therapeutic alliance and adherence to the intervention). Data will be analyzed based on an intention-to-treat approach and both groups (intervention and care-as-usual) will be compared at each assessment time point. Furthermore, potential mechanisms of change and generalization of intervention effects on daily life are assessed using an ecological momentary assessment procedure that includes items on maintaining mechanisms of social anxiety, social context, and affect. Participants are prompted 3 times a day during the first 8 weeks of the study and again for 2 weeks following the follow-up assessment. Results: Recruitment is ongoing; initial results are expected in 2024. Conclusions: Results are discussed considering the potential of online interventions as a low-threshold prevention and treatment option for adolescents with social anxiety and in light of current advances in dynamic modeling of change processes and mechanisms in early intervention and psychotherapy in adolescents. Trial Registration: ClinicalTrials.gov NCT04782102; https://clinicaltrials.gov/ct2/show/NCT04782102 International Registered Report Identifier (IRRID): DERR1-10.2196/44346 UR - https://www.researchprotocols.org/2023/1/e44346 UR - http://dx.doi.org/10.2196/44346 UR - http://www.ncbi.nlm.nih.gov/pubmed/37342086 ID - info:doi/10.2196/44346 ER - TY - JOUR AU - Hasnain, Anila AU - Hajek, John AU - Borschmann, Rohan PY - 2023/6/20 TI - Impact of Cultural and Linguistic Maintenance on Mental Health Outcomes in Migrant Adolescents: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e40143 VL - 12 KW - PRISMA KW - PRISMA-ScR KW - PRISMA-P KW - youth KW - risk factors KW - protective factors KW - suicide KW - depression KW - culture KW - language knowledge KW - acculturation KW - heritage N2 - Background: There is no consensus on how the disruption or maintenance of heritage culture and language affect mental health outcomes in adolescents with a migrant (also known as ?immigrant? or ?international migrant?) background. Even though previous literature reviews have investigated the association between acculturation and mental health in migrants, none have explicitly focused on adolescents. Objective: The aim of the scoping review described in this protocol is to understand (1) the focus, scope, and nature of quantitative empirical research investigating heritage cultural maintenance, including linguistic maintenance, and mental health outcomes in adolescents with a migrant background worldwide and (2) the potential effects of cultural and linguistic maintenance or disruption on migrant adolescent mental health outcomes. Methods: A total of 11 key electronic health, medical, social science, and language databases (APA PsycArticles Full Text; Embase Classic+Embase; Ovid MEDLINE All and Epub Ahead of Print, In-Process, In-Data-Review and Other Non-Indexed Citations and Daily; Ovid MEDLINE All; APA PsycInfo; University of Melbourne full-text journals; Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Scopus; Linguistics and Language Behavior Abstracts) were searched. Databases were searched without time restrictions from the beginning of their coverage. Publication date, location, and quantitative study design (except for literature reviews) were not restricted; however, the search was only conducted in English. Data from included studies will be extracted using a template with predefined data items, and results will be summarized in a structured, narrative summary. Results: A search was conducted on April 20, 2021, returning 2569 results. We are currently at the final stages of screening titles and abstracts of our search results, which will be followed by a full-text review and the data extraction of included studies. We expect to submit the full review for publication by the end of 2023. Conclusions: The scoping review aims to provide a better understanding of existing research on the association between cultural (including linguistic) maintenance and mental health in migrant adolescents. It will help identify gaps in the existing literature and develop hypotheses that could inform future research, eventually facilitating the development of targeted prevention initiatives and improving migrant adolescents? well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/40143 UR - https://www.researchprotocols.org/2023/1/e40143 UR - http://dx.doi.org/10.2196/40143 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338960 ID - info:doi/10.2196/40143 ER - TY - JOUR AU - Fernandes, Blossom AU - Neelakantan, Lakshmi AU - Shah, Himani AU - Sumant, Sushmita AU - Collins, Y. Pamela AU - Velloza, Jennifer AU - Bampton, Emily AU - Ranganathan, Swetha AU - Sibisi, Refiloe AU - Bashir, Toiba AU - Bowes, Joshua AU - David, Larisa Esther AU - Kaur, Harsimar AU - Malik, Umairah AU - Shannon, Issy AU - Gurumayum, Suvlaxmi AU - Burn, Anne-Marie AU - Sieberts, K. Solveig AU - AU - Fazel, Mina PY - 2023/6/19 TI - Evidencing the Impact of Web-Based Coproduction With Youth on Mental Health Research: Qualitative Findings From the MindKind Study JO - JMIR Public Health Surveill SP - e42963 VL - 9 KW - web-based youth coproduction KW - mental health KW - public involvement KW - young people KW - advisory groups N2 - Background: Public involvement in research is a growing phenomenon as well as a condition of research funding, and it is often referred to as coproduction. Coproduction involves stakeholder contributions at every stage of research, but different processes exist. However, the impact of coproduction on research is not well understood. Web-based young people?s advisory groups (YPAGs) were established as part of the MindKind study at 3 sites (India, South Africa, and the United Kingdom) to coproduce the wider research study. Each group site, led by a professional youth advisor, conducted all youth coproduction activities collaboratively with other research staff. Objective: This study aimed to evaluate the impact of youth coproduction in the MindKind study. Methods: To measure the impact of web-based youth coproduction on all stakeholders, the following methods were used: analysis of project documents, capturing the views of stakeholders using the Most Significant Change technique, and impact frameworks to assess the impact of youth coproduction on specific stakeholder outcomes. Data were analyzed in collaboration with researchers, advisors, and YPAG members to explore the impact of youth coproduction on research. Results: The impact was recorded on 5 levels. First, at the paradigmatic level, a novel method of conducting research allowed for a widely diverse group of YPAG representations, influencing study priorities, conceptualization, and design. Second, at the infrastructural level, the YPAG and youth advisors meaningfully contributed to the dissemination of materials; infrastructural constraints of undertaking coproduction were also identified. Third, at the organizational level, coproduction necessitated implementing new communication practices, such as a web-based shared platform. This meant that materials were easily accessible to the whole team and communication streams remained consistent. Fourth, at the group level, authentic relationships developed between the YPAG members, advisors, and the rest of the team, facilitated by regular web-based contact. Finally, at the individual level, participants reported enhanced insights into mental well-being and appreciation for the opportunity to engage in research. Conclusions: This study revealed several factors that shape the creation of web-based coproduction, with clear positive outcomes for advisors, YPAG members, researchers, and other project staff. However, several challenges of coproduced research were also encountered in multiple contexts and amid pressing timelines. For systematic reporting of the impact of youth coproduction, we propose that monitoring, evaluation, and learning systems be designed and implemented early. UR - https://publichealth.jmir.org/2023/1/e42963 UR - http://dx.doi.org/10.2196/42963 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335609 ID - info:doi/10.2196/42963 ER - TY - JOUR AU - Ding, Xiaoxu AU - Wuerth, Kelli AU - Sakakibara, Brodie AU - Schmidt, Julia AU - Parde, Natalie AU - Holsti, Liisa AU - Barbic, Skye PY - 2023/6/16 TI - Understanding Mobile Health and Youth Mental Health: Scoping Review JO - JMIR Mhealth Uhealth SP - e44951 VL - 11 KW - adolescent KW - COVID-19 KW - engagement KW - health outcome KW - illness KW - implementation KW - mental disorder KW - mental health KW - mHealth intervention KW - mHealth tools KW - mHealth KW - policy KW - scoping review KW - young adult KW - youth N2 - Background: A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. Objective: The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth?s access to mental health services and health outcomes. Methods: Guided by the methods of Arksey and O?Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. Results: The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non?youth-centered approaches to implementing results. Conclusions: This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths? engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time. UR - https://mhealth.jmir.org/2023/1/e44951 UR - http://dx.doi.org/10.2196/44951 UR - http://www.ncbi.nlm.nih.gov/pubmed/37220197 ID - info:doi/10.2196/44951 ER - TY - JOUR AU - Beames, R. Joanne AU - Werner-Seidler, Aliza AU - Hodgins, Michael AU - Brown, Lyndsay AU - Fujimoto, Hiroko AU - Bartholomew, Alexandra AU - Maston, Kate AU - Huckvale, Kit AU - Zbukvic, Isabel AU - Torok, Michelle AU - Christensen, Helen AU - Batterham, J. Philip AU - Calear, L. Alison AU - Lingam, Raghu AU - Boydell, M. Katherine PY - 2023/6/12 TI - Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study JO - JMIR Pediatr Parent SP - e42349 VL - 6 KW - implementation KW - youth KW - digital KW - depression KW - secondary school KW - qualitative KW - consolidated framework for implementation research KW - teacher KW - educator KW - perspective KW - mental health KW - student KW - child KW - adolescent KW - adolescence KW - school KW - social work N2 - Background: Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. Objective: The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). Methods: Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. Results: Staff perceived the FPP as a novel (?innovative approach?) and appropriate way to address an unmet need within schools (?right place at the right time?). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution (?ways of working within schools?). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools (?reflecting on past experiences?). Conclusions: Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-042133 UR - https://pediatrics.jmir.org/2023/1/e42349 UR - http://dx.doi.org/10.2196/42349 UR - http://www.ncbi.nlm.nih.gov/pubmed/37307051 ID - info:doi/10.2196/42349 ER - TY - JOUR AU - Gan, Q. Daniel Z. AU - McGillivray, Lauren AU - Larsen, Erik Mark AU - Bloomfield, Taylor AU - Torok, Michelle PY - 2023/6/6 TI - Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach JO - JMIR Form Res SP - e45234 VL - 7 KW - eHealth KW - digital mental health KW - smartphone app KW - engagement KW - youth suicide prevention KW - qualitative methods KW - suicide KW - development KW - youth KW - mental health KW - support KW - user-centered KW - design KW - survey KW - interview KW - prototype KW - prevention KW - participatory design KW - mobile phone N2 - Background: Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions. Objective: This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy?a smartphone app that helps young people manage suicidal thoughts. Methods: Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings?from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population?with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops. Results: Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components. Conclusions: This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health. UR - https://formative.jmir.org/2023/1/e45234 UR - http://dx.doi.org/10.2196/45234 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279058 ID - info:doi/10.2196/45234 ER - TY - JOUR AU - Kim, Sung Jae AU - Wang, Bohyun AU - Kim, Meelim AU - Lee, Jung AU - Kim, Hyungjun AU - Roh, Danyeul AU - Lee, Hwa Kyung AU - Hong, Soon-Beom AU - Lim, Shik Joon AU - Kim, Jae-Won AU - Ryan, Neal PY - 2023/5/24 TI - Prediction of Diagnosis and Treatment Response in Adolescents With Depression by Using a Smartphone App and Deep Learning Approaches: Usability Study JO - JMIR Form Res SP - e45991 VL - 7 KW - major depressive disorder KW - adolescent KW - deep learning KW - smart health care KW - suicide KW - risk factor KW - antidepressant treatment KW - depression KW - machine learning KW - smartphone KW - mobile health KW - mHealth N2 - Background: Lack of quantifiable biomarkers is a major obstacle in diagnosing and treating depression. In adolescents, increasing suicidality during antidepressant treatment further complicates the problem. Objective: We sought to evaluate digital biomarkers for the diagnosis and treatment response of depression in adolescents through a newly developed smartphone app. Methods: We developed the Smart Healthcare System for Teens At Risk for Depression and Suicide app for Android-based smartphones. This app passively collected data reflecting the social and behavioral activities of adolescents, such as their smartphone usage time, physical movement distance, and the number of phone calls and text messages during the study period. Our study consisted of 24 adolescents (mean age 15.4 [SD 1.4] years, 17 girls) with major depressive disorder (MDD) diagnosed with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and 10 healthy controls (mean age 13.8 [SD 0.6] years, 5 girls). After 1 week?s baseline data collection, adolescents with MDD were treated with escitalopram in an 8-week, open-label trial. Participants were monitored for 5 weeks, including the baseline data collection period. Their psychiatric status was measured every week. Depression severity was measured using the Children?s Depression Rating Scale-Revised and Clinical Global Impressions-Severity. The Columbia Suicide Severity Rating Scale was administered in order to assess suicide severity. We applied the deep learning approach for the analysis of the data. Deep neural network was employed for diagnosis classification, and neural network with weighted fuzzy membership functions was used for feature selection. Results: We could predict the diagnosis of depression with training accuracy of 96.3% and 3-fold validation accuracy of 77%. Of the 24 adolescents with MDD, 10 responded to antidepressant treatments. We predicted the treatment response of adolescents with MDD with training accuracy of 94.2% and 3-fold validation accuracy of 76%. Adolescents with MDD tended to move longer distances and use smartphones for longer periods of time compared to controls. The deep learning analysis showed that smartphone usage time was the most important feature in distinguishing adolescents with MDD from controls. Prominent differences were not observed in the pattern of each feature between the treatment responders and nonresponders. The deep learning analysis revealed that the total length of calls received as the most important feature predicting antidepressant response in adolescents with MDD. Conclusions: Our smartphone app demonstrated preliminary evidence of predicting diagnosis and treatment response in depressed adolescents. This is the first study to predict the treatment response of adolescents with MDD by examining smartphone-based objective data with deep learning approaches. UR - https://formative.jmir.org/2023/1/e45991 UR - http://dx.doi.org/10.2196/45991 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223978 ID - info:doi/10.2196/45991 ER - TY - JOUR AU - O'Sullivan, Shaunagh AU - van Berkel, Niels AU - Kostakos, Vassilis AU - Schmaal, Lianne AU - D'Alfonso, Simon AU - Valentine, Lee AU - Bendall, Sarah AU - Nelson, Barnaby AU - Gleeson, F. John AU - Alvarez-Jimenez, Mario PY - 2023/5/22 TI - Understanding What Drives Long-term Engagement in Digital Mental Health Interventions: Secondary Causal Analysis of the Relationship Between Social Networking and Therapy Engagement JO - JMIR Ment Health SP - e44812 VL - 10 KW - digital intervention KW - digital health KW - youth mental health KW - psychotic disorders KW - usage metrics KW - log data KW - social networking N2 - Background: Low engagement rates with digital mental health interventions are a major challenge in the field. Multicomponent digital interventions aim to improve engagement by adding components such as social networks. Although social networks may be engaging, they may not be sufficient to improve clinical outcomes or lead users to engage with key therapeutic components. Therefore, we need to understand what components drive engagement with digital mental health interventions overall and what drives engagement with key therapeutic components. Objective: Horyzons was an 18-month digital mental health intervention for young people recovering from first-episode psychosis, incorporating therapeutic content and a private social network. However, it is unclear whether use of the social network leads to subsequent use of therapeutic content or vice versa. This study aimed to determine the causal relationship between the social networking and therapeutic components of Horyzons. Methods: Participants comprised 82 young people (16-27 years) recovering from first-episode psychosis. Multiple convergent cross mapping was used to test causality, as a secondary analysis of the Horyzons intervention. Multiple convergent cross mapping tested the direction of the relationship between each pair of social and therapeutic system usage variables on Horyzons, using longitudinal usage data. Results: Results indicated that the social networking aspects of Horyzons were most engaging. Posting on the social network drove engagement with all therapeutic components (r=0.06-0.36). Reacting to social network posts drove engagement with all therapeutic components (r=0.39-0.65). Commenting on social network posts drove engagement with most therapeutic components (r=0.11-0.18). Liking social network posts drove engagement with most therapeutic components (r=0.09-0.17). However, starting a therapy pathway led to commenting on social network posts (r=0.05) and liking social network posts (r=0.06), and completing a therapy action led to commenting on social network posts (r=0.14) and liking social network posts (r=0.15). Conclusions: The online social network was a key driver of long-term engagement with the Horyzons intervention and fostered engagement with key therapeutic components and ingredients of the intervention. Online social networks can be further leveraged to engage young people with therapeutic content to ensure treatment effects are maintained and to create virtuous cycles between all intervention components to maintain engagement. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12614000009617; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12614000009617 UR - https://mental.jmir.org/2023/1/e44812 UR - http://dx.doi.org/10.2196/44812 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213197 ID - info:doi/10.2196/44812 ER - TY - JOUR AU - Baldofski, Sabrina AU - Kohls, Elisabeth AU - Efe, Zeki AU - Eckert, Melanie AU - Saee, Shadi AU - Thomas, Julia AU - Wundrack, Richard AU - Rummel-Kluge, Christine PY - 2023/5/17 TI - The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study JO - JMIR Ment Health SP - e43780 VL - 10 KW - online intervention KW - e-mental health KW - online chat KW - hotline KW - text-based KW - children KW - adolescents KW - young adults KW - psychopathology KW - help-seeking N2 - Background: Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person. Objective: This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking. Methods: This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey. Results: The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3%), a school psychologist or school social worker (52/225, 23.1%), and the user?s parents (45/225, 20.0%). Of the 247 users, 120 (48.6%) indicated that they contacted the recommended service or person, and of these, 87 (72.5%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0%), improvement of self-efficacy (55/120, 45.8%), and symptom recognition (40/120, 33.3%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2%), lack of mental health literacy (59/127, 46.5%), need for self-reliance and autonomy (53/127, 41.7%), and negative family beliefs regarding help services (53/127, 41.7%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being. Conclusions: The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy. Trial Registration: Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68 UR - https://mental.jmir.org/2023/1/e43780 UR - http://dx.doi.org/10.2196/43780 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195747 ID - info:doi/10.2196/43780 ER - TY - JOUR AU - Braund, A. Taylor AU - O?Dea, Bridianne AU - Bal, Debopriyo AU - Maston, Kate AU - Larsen, Mark AU - Werner-Seidler, Aliza AU - Tillman, Gabriel AU - Christensen, Helen PY - 2023/5/15 TI - Associations Between Smartphone Keystroke Metadata and Mental Health Symptoms in Adolescents: Findings From the Future Proofing Study JO - JMIR Ment Health SP - e44986 VL - 10 KW - adolescents KW - anxiety KW - depression KW - digital phenotype KW - keystroke dynamics KW - keystroke metadata KW - smartphone KW - students N2 - Background: Mental disorders are prevalent during adolescence. Among the digital phenotypes currently being developed to monitor mental health symptoms, typing behavior is one promising candidate. However, few studies have directly assessed associations between typing behavior and mental health symptom severity, and whether these relationships differs between genders. Objective: In a cross-sectional analysis of a large cohort, we tested whether various features of typing behavior derived from keystroke metadata were associated with mental health symptoms and whether these relationships differed between genders. Methods: A total of 934 adolescents from the Future Proofing study undertook 2 typing tasks on their smartphones through the Future Proofing app. Common keystroke timing and frequency features were extracted across tasks. Mental health symptoms were assessed using the Patient Health Questionnaire-Adolescent version, the Children?s Anxiety Scale-Short Form, the Distress Questionnaire 5, and the Insomnia Severity Index. Bivariate correlations were used to test whether keystroke features were associated with mental health symptoms. The false discovery rates of P values were adjusted to q values. Machine learning models were trained and tested using independent samples (ie, 80% train 20% test) to identify whether keystroke features could be combined to predict mental health symptoms. Results: Keystroke timing features showed a weak negative association with mental health symptoms across participants. When split by gender, females showed weak negative relationships between keystroke timing features and mental health symptoms, and weak positive relationships between keystroke frequency features and mental health symptoms. The opposite relationships were found for males (except for dwell). Machine learning models using keystroke features alone did not predict mental health symptoms. Conclusions: Increased mental health symptoms are weakly associated with faster typing, with important gender differences. Keystroke metadata should be collected longitudinally and combined with other digital phenotypes to enhance their clinical relevance. Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true UR - https://mental.jmir.org/2023/1/e44986 UR - http://dx.doi.org/10.2196/44986 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184904 ID - info:doi/10.2196/44986 ER - TY - JOUR AU - Huffman, Goodgame Landry AU - Lawrence-Sidebottom, Darian AU - Huberty, Jennifer AU - Roots, Monika AU - Roots, Kurt AU - Parikh, Amit AU - Guerra, Rachael AU - Weiser, Jaclyn PY - 2023/4/20 TI - Using Digital Measurement?Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data JO - JMIR Pediatr Parent SP - e46154 VL - 6 KW - digital mental health intervention KW - anxiety KW - depression KW - child KW - adolescent KW - collaborative care KW - mental health KW - caregiver KW - pediatric KW - youth KW - demographic KW - health outcome KW - retrospective KW - treatment KW - e-mental health KW - symptoms N2 - Background: A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. Objective: This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Methods: Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children?s symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Results: Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members? depressive symptom T-scores remained largely stable throughout their involvement. Conclusions: As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc. UR - https://pediatrics.jmir.org/2023/1/e46154 UR - http://dx.doi.org/10.2196/46154 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079366 ID - info:doi/10.2196/46154 ER - TY - JOUR AU - Berry, R. Katie AU - Gliske, Kate AU - Schmidt, Clare AU - Ballard, Jaime AU - Killian, Michael AU - Fenkel, Caroline PY - 2023/4/20 TI - The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis JO - JMIR Form Res SP - e45305 VL - 7 KW - adolescents KW - family therapy KW - intensive outpatient KW - mental health KW - treatment engagement KW - young adults N2 - Background:  Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. Objective:  We aimed to examine whether family members? participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient?s treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Methods:  Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample?s baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Results:  Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ?1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). Conclusions:  Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families. UR - https://formative.jmir.org/2023/1/e45305 UR - http://dx.doi.org/10.2196/45305 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079372 ID - info:doi/10.2196/45305 ER - TY - JOUR AU - Rifkin-Zybutz, Raphael AU - Turner, Nicholas AU - Derges, Jane AU - Bould, Helen AU - Sedgewick, Felicity AU - Gooberman-Hill, Rachael AU - Linton, Myles-Jay AU - Moran, Paul AU - Biddle, Lucy PY - 2023/4/17 TI - Digital Technology Use and Mental Health Consultations: Survey of the Views and Experiences of Clinicians and Young People JO - JMIR Ment Health SP - e44064 VL - 10 KW - internet KW - adolescent KW - child KW - mental health KW - anxiety KW - patient-physician relationship N2 - Background: Digital technologies play an increasingly important role in the lives of young people and have important effects on their mental health. Objective: We aimed to explore 3 key areas of the intersection between digital technology and mental health: the views and experiences of young people and clinicians about digital technology and mental health; implementation and barriers to the UK national guidance recommendation?that the discussion of digital technology use should form a core part of mental health assessment; and how digital technology might be used to support existing consultations. Methods: Two cross-sectional web-based surveys were conducted in 2020 between June and December, with mental health clinicians (n=99) and young people (n=320). Descriptive statistics were used to summarize the proportions. Multilinear regression was used to explore how the answers varied by gender, sexuality, and age. Thematic analysis was used to explore the contents of the extended free-text answers. Anxiety was measured using the Generalized Anxiety Disorder Questionnaire-7 (GAD-7). Results: Digital technology use was ubiquitous among young people, with positive and negative aspects acknowledged by both clinicians and young people. Negative experiences were common (131/284, 46.1%) and were associated with increased anxiety levels among young people (GAD-7 3.29; 95% CI 1.97-4.61; P<.001). Although the discussion of digital technology use was regarded as important by clinicians and acceptable by young people, less than half of clinicians (42/85, 49.4%) routinely asked about the use of digital technology and over a third of young people (48/121, 39.6%) who had received mental health care had never been asked about their digital technology use. The conversations were often experienced as unhelpful. Helpful conversations were characterized by greater depth and exploration of how an individual?s digital technology use related to mental health. Despite most clinicians (59/83, 71.1%) wanting training, very few (21/86, 24.4%) reported receiving training. Clinicians were open to viewing mental health data from apps or social media to help with consultations. Although young people were generally, in theory, comfortable sharing such data with health professionals, when presented with a binary choice, most reported not wanting to share social media (84/117, 71.8%) or app data (67/118, 56.8%) during consultations. Conclusions: Digital technology use was common, and negative experiences were frequent and associated with anxiety. Over a third of young people were not asked about their digital technology use during mental health consultations, and potentially valuable information about relevant negative experiences on the web was not being captured during consultations. Clinicians would benefit from having access to training to support these discussions with young people. Although young people recognized that app data could be helpful to clinicians, they appeared hesitant to share their own data. This finding suggests that data sharing has barriers that need to be further explored. UR - https://mental.jmir.org/2023/1/e44064 UR - http://dx.doi.org/10.2196/44064 UR - http://www.ncbi.nlm.nih.gov/pubmed/37067869 ID - info:doi/10.2196/44064 ER - TY - JOUR AU - Evans-Chase, Michelle AU - Solomon, Phyllis AU - Peralta, Bethany AU - Kornmann, Rachel AU - Fenkel, Caroline PY - 2023/4/11 TI - Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment JO - JMIR Form Res SP - e44756 VL - 7 KW - depression KW - IOP KW - LGBTQ+ KW - mental health KW - telehealth KW - youth KW - young adult N2 - Background: Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. Objective: The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. Methods: Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. Results: Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference ?6.06) were seen in depression between intake and discharge (t967=?24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). Conclusions: Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth. UR - https://formative.jmir.org/2023/1/e44756 UR - http://dx.doi.org/10.2196/44756 UR - http://www.ncbi.nlm.nih.gov/pubmed/37040155 ID - info:doi/10.2196/44756 ER - TY - JOUR AU - Derges, Jane AU - Bould, Helen AU - Gooberman-Hill, Rachael AU - Moran, Paul AU - Linton, Myles-Jay AU - Rifkin-Zybutz, Raphael AU - Biddle, Lucy PY - 2023/4/7 TI - Mental Health Practitioners? and Young People?s Experiences of Talking About Social Media During Mental Health Consultations: Qualitative Focus Group and Interview Study JO - JMIR Form Res SP - e43115 VL - 7 KW - young people KW - digital technology and social media KW - mental health consultations KW - clinician and young people?s experiences N2 - Background: Increasing concerns among mental health care professionals have focused on the impact of young people?s use of digital technology and social media on their mental well-being. It has been recommended that the use of digital technology and social media be routinely explored during mental health clinical consultations with young people. Whether these conversations occur and how they are experienced by both clinicians and young people are currently unknown. Objective: This study aimed to explore mental health practitioners? and young people?s experiences of talking about young people?s web-based activities related to their mental health during clinical consultations. Web-based activities include use of social media, websites, and messaging. Our aim was to identify barriers to effective communication and examples of good practice. In particular, we wanted to obtain the views of young people, who are underrepresented in studies, on their social media and digital technology use related to mental health. Methods: A qualitative study was conducted using focus groups (11 participants across 3 groups) with young people aged 16 to 24 years and interviews (n=8) and focus groups (7 participants across 2 groups) with mental health practitioners in the United Kingdom. Young people had experience of mental health problems and support provided by statutory mental health services or third-sector organizations. Practitioners worked in children and young people?s mental health services, statutory services, or third-sector organizations such as a university counseling service. Thematic analysis was used to analyze the data. Results: Practitioners and young people agreed that talking about young people?s web-based activities and their impact on mental health is important. Mental health practitioners varied in their confidence in doing this and were keen to have more guidance. Young people said that practitioners seldom asked about their web-based activities, but when asked, they often felt judged or misunderstood. This stopped them from disclosing difficult web-based experiences and precluded useful conversations about web-based safety and how to access appropriate web-based support. Young people supported the idea of guidance or training for practitioners and were enthusiastic about sharing their experiences and being involved in the training or guidance provided to practitioners. Conclusions: Practitioners would benefit from structured guidance and professional development to enable them to support young people in feeling more willing to disclose and talk about their web-based experiences and their impact on their mental health. This is reflected in practitioners? desire for guidance to improve their confidence and skills to safely support young people in navigating the challenges of the web-based world. Young people want to feel comfortable discussing their web-based activities during their consultations with mental health practitioners, both in tackling the challenges and using the opportunity to discuss their experiences, gain support, and develop coping strategies related to web-based safety. UR - https://formative.jmir.org/2023/1/e43115 UR - http://dx.doi.org/10.2196/43115 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027182 ID - info:doi/10.2196/43115 ER - TY - JOUR AU - McGillivray, Lauren AU - Keng-Meng Hui, Nicholas AU - Wong, J. Quincy J. AU - Han, Jin AU - Qian, Jiahui AU - Torok, Michelle PY - 2023/3/30 TI - The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness JO - JMIR Ment Health SP - e44862 VL - 10 KW - loneliness KW - suicidal ideation KW - suicide prevention KW - digital therapeutics KW - smartphone intervention KW - apps N2 - Background: Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. Objective: This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). Methods: A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy?based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Results: Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI ?0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI ?1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI ?0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI ?0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI ?0.17 to 0.18; P=.98) or depression (B=?0.08, 95% CI ?0.19 to 0.03; P=.14). Conclusions: Loneliness was not found to affect young adults? engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8 International Registered Report Identifier (IRRID): RR2-10.2196/23655 UR - https://mental.jmir.org/2023/1/e44862 UR - http://dx.doi.org/10.2196/44862 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995752 ID - info:doi/10.2196/44862 ER - TY - JOUR AU - Palmer, Abigail AU - Johns, Gemma AU - Ahuja, Alka AU - Gartner, Daniel PY - 2023/3/28 TI - Optimizing an Adolescent Hybrid Telemedical Mental Health Service Through Staff Scheduling Using Mathematical Programming: Model Development Study JO - JMIR Form Res SP - e43222 VL - 7 KW - linear Programming KW - telemedicine KW - remote consultation KW - mental health KW - teen KW - adolescent KW - mental disorder KW - disorder KW - disease KW - youth KW - decision KW - support KW - tool KW - model N2 - Background: According to the World Health Organization, globally, one in seven 10- to 19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. Half of all mental illnesses begin by the age of 14 years and some teenagers with severe presentations must be admitted to the hospital and assessed by highly skilled mental health care practitioners. Digital telehealth solutions can be useful for the assessment of young individuals remotely. Ultimately, this technology can save travel costs for the health service rather than assessing adolescents in person at the corresponding hospital. Especially in rural regions, where travel times can be high, this innovative approach can make a difference to patients by providing quicker assessments. Objective: The aim of this study is to share insights on how we developed a decision support tool to assign staff to days and locations where adolescent mental health patients are assessed face to face. Where possible, patients are seen through video consultation. The model not only seeks to reduce travel times and consequently carbon emissions but also can be used to find a minimum number of staff to run the service. Methods: To model the problem, we used integer linear programming, a technique that is used in mathematical modeling. The model features 2 objectives: first, we aim to find a minimum coverage of staff to provide the service and second, to reduce travel time. The constraints that are formulated algebraically are used to ensure the feasibility of the schedule. The model is implemented using an open-source solver backend. Results: In our case study, we focus on real-world demand coming from different hospital sites in the UK National Health Service (NHS). We incorporate our model into a decision support tool and solve a realistic test instance. Our results reveal that the tool is not only capable of solving this problem efficiently but also shows the benefits of using mathematical modeling in health services. Conclusions: Our approach can be used by NHS managers to better match capacity and location-dependent demands within an increasing need for hybrid telemedical services, and the aims to reduce traveling and the carbon footprint within health care organizations. UR - https://formative.jmir.org/2023/1/e43222 UR - http://dx.doi.org/10.2196/43222 UR - http://www.ncbi.nlm.nih.gov/pubmed/36976622 ID - info:doi/10.2196/43222 ER - TY - JOUR AU - Plackett, Ruth AU - Sheringham, Jessica AU - Dykxhoorn, Jennifer PY - 2023/3/24 TI - The Longitudinal Impact of Social Media Use on UK Adolescents' Mental Health: Longitudinal Observational Study JO - J Med Internet Res SP - e43213 VL - 25 KW - social media KW - mental health KW - depression KW - depressive KW - anxiety KW - adolescent KW - adolescence KW - mediation analysis KW - cohort study KW - youth KW - young people KW - self-esteem KW - national survey KW - household survey KW - computer use KW - technology use KW - screen time N2 - Background: Cross-sectional studies have found a relationship between social media use and depression and anxiety in young people. However, few longitudinal studies using representative data and mediation analysis have been conducted to understand the causal pathways of this relationship. Objective: This study aims to examine the longitudinal relationship between social media use and young people?s mental health and the role of self-esteem and social connectedness as potential mediators. Methods: The sample included 3228 participants who were 10- to 15-year-olds from Understanding Society (2009-2019), a UK longitudinal household survey. The number of hours spent on social media was measured on a 5-point scale from ?none? to ?7 or more hours? at the ages of 12-13 years. Self-esteem and social connectedness (number of friends and happiness with friendships) were measured at the ages of 13-14 years. Mental health problems measured by the Strengths and Difficulties Questionnaire were assessed at the ages of 14-15 years. Covariates included demographic and household variables. Unadjusted and adjusted multilevel linear regression models were used to estimate the association between social media use and mental health. We used path analysis with structural equation modeling to investigate the mediation pathways. Results: In adjusted analysis, there was a nonsignificant linear trend showing that more time spent on social media was related to poorer mental health 2 years later (n=2603, ?=.21, 95% CI ?0.43 to 0.84; P=.52). In an unadjusted path analysis, 68% of the effect of social media use on mental health was mediated by self-esteem (indirect effect, n=2569, ?=.70, 95% CI 0.15-1.30; P=.02). This effect was attenuated in the adjusted analysis, and it was found that self-esteem was no longer a significant mediator (indirect effect, n=2316, ?=.24, 95% CI ?0.12 to 0.66; P=.22). We did not find evidence that the association between social media and mental health was mediated by social connectedness. Similar results were found in imputed data. Conclusions: There was little evidence to suggest that more time spent on social media was associated with later mental health problems in UK adolescents. This study shows the importance of longitudinal studies to examine this relationship and suggests that prevention strategies and interventions to improve mental health associated with social media use could consider the role of factors like self-esteem. UR - https://www.jmir.org/2023/1/e43213 UR - http://dx.doi.org/10.2196/43213 UR - http://www.ncbi.nlm.nih.gov/pubmed/36961482 ID - info:doi/10.2196/43213 ER - TY - JOUR AU - Elledge, K. Daniel AU - Lee, Craddock Simon AU - Stewart, M. Sunita AU - Pop, Radu AU - Trivedi, H. Madhukar AU - Hughes, L. Jennifer PY - 2023/3/22 TI - Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study JO - JMIR Form Res SP - e38042 VL - 7 KW - youth KW - prevention KW - resilience KW - mental health app KW - mobile phone N2 - Background: Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes. Objective: This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience. Methods: In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use. Results: Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback. Conclusions: Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research. UR - https://formative.jmir.org/2023/1/e38042 UR - http://dx.doi.org/10.2196/38042 UR - http://www.ncbi.nlm.nih.gov/pubmed/36947113 ID - info:doi/10.2196/38042 ER - TY - JOUR AU - Salamanca-Sanabria, Alicia AU - Jabir, Ishqi Ahmad AU - Lin, Xiaowen AU - Alattas, Aishah AU - Kocaballi, Baki A. AU - Lee, Jimmy AU - Kowatsch, Tobias AU - Tudor Car, Lorainne PY - 2023/3/20 TI - Exploring the Perceptions of mHealth Interventions for the Prevention of Common Mental Disorders in University Students in Singapore: Qualitative Study JO - J Med Internet Res SP - e44542 VL - 25 KW - interventions KW - students KW - mobile health KW - mHealth KW - mental health KW - mental disorders KW - university KW - common mental disorders KW - anxiety KW - depression N2 - Background: Mental health interventions delivered through mobile health (mHealth) technologies can increase the access to mental health services, especially among university students. The development of mHealth intervention is complex and needs to be context sensitive. There is currently limited evidence on the perceptions, needs, and barriers related to these interventions in the Southeast Asian context. Objective: This qualitative study aimed to explore the perception of university students and mental health supporters in Singapore about mental health services, campaigns, and mHealth interventions with a focus on conversational agent interventions for the prevention of common mental disorders such as anxiety and depression. Methods: We conducted 6 web-based focus group discussions with 30 university students and one-to-one web-based interviews with 11 mental health supporters consisting of faculty members tasked with student pastoral care, a mental health first aider, counselors, psychologists, a clinical psychologist, and a psychiatrist. The qualitative analysis followed a reflexive thematic analysis framework. Results: The following 6 main themes were identified: a healthy lifestyle as students, access to mental health services, the role of mental health promotion campaigns, preferred mHealth engagement features, factors that influence the adoption of mHealth interventions, and cultural relevance of mHealth interventions. The interpretation of our findings shows that students were reluctant to use mental health services because of the fear of stigma and a possible lack of confidentiality. Conclusions: Study participants viewed mHealth interventions for mental health as part of a blended intervention. They also felt that future mental health mHealth interventions should be more personalized and capable of managing adverse events such as suicidal ideation. UR - https://www.jmir.org/2023/1/e44542 UR - http://dx.doi.org/10.2196/44542 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939808 ID - info:doi/10.2196/44542 ER - TY - JOUR AU - Bohr, Yvonne AU - Litwin, Leah AU - Hankey, Ryan Jeffrey AU - McCague, Hugh AU - Singoorie, Chelsea AU - Lucassen, G. Mathijs F. AU - Shepherd, Matthew AU - Barnhardt, Jenna PY - 2023/3/9 TI - Evaluating the Utility of a Psychoeducational Serious Game (SPARX) in Protecting Inuit Youth From Depression: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e38493 VL - 11 KW - psychoeducation KW - cognitive behavioral therapy KW - Inuit youth KW - Nunavut KW - depression KW - suicide KW - resilience KW - serious game KW - youth KW - mental health KW - teen KW - adolescent KW - pilot study KW - community N2 - Background: Inuit youth in Northern Canada show considerable resilience in the face of extreme adversities. However, they also experience significant mental health needs and some of the highest adolescent suicide rates in the world. Disproportionate rates of truancy, depression, and suicide among Inuit adolescents have captured the attention of all levels of government and the country. Inuit communities have expressed an urgent imperative to create, or adapt, and then evaluate prevention and intervention tools for mental health. These tools should build upon existing strengths, be culturally appropriate for Inuit communities, and be accessible and sustainable in Northern contexts, where mental health resources are often scarce. Objective: This pilot study assesses the utility, for Inuit youth in Canada, of a psychoeducational e-intervention designed to teach cognitive behavioral therapy strategies and techniques. This serious game, SPARX, had previously demonstrated effectiveness in addressing depression with M?ori youth in New Zealand. Methods: The Nunavut Territorial Department of Health sponsored this study, and a team of Nunavut-based community mental health staff facilitated youth?s participation in an entirely remotely administered pilot trial using a modified randomized control approach with 24 youths aged 13-18 across 11 communities in Nunavut. These youth had been identified by the community facilitators as exhibiting low mood, negative affect, depressive presentations, or significant levels of stress. Entire communities, instead of individual youth, were randomly assigned to an intervention group or a waitlist control group. Results: Mixed models (multilevel regression) revealed that participating youth felt less hopeless (P=.02) and engaged in less self-blame (P=.03), rumination (P=.04), and catastrophizing (P=.03) following the SPARX intervention. However, participants did not show a decrease in depressive symptoms or an increase in formal resilience indicators. Conclusions: Preliminary results suggest that SPARX may be a good first step for supporting Inuit youth with skill development to regulate their emotions, challenge maladaptive thoughts, and provide behavioral management techniques such as deep breathing. However, it will be imperative to work with youth and communities to design, develop, and test an Inuit version of the SPARX program, tailored to fit the interests of Inuit youth and Elders in Canada and to increase engagement and effectiveness of the program. Trial Registration: ClinicalTrials.gov NCT05702086; https://www.clinicaltrials.gov/ct2/show/NCT05702086 UR - https://games.jmir.org/2023/1/e38493 UR - http://dx.doi.org/10.2196/38493 UR - http://www.ncbi.nlm.nih.gov/pubmed/36892940 ID - info:doi/10.2196/38493 ER - TY - JOUR AU - Chiauzzi, Emil AU - Robinson, Athena AU - Martin, Kate AU - Petersen, Carl AU - Wells, Nicole AU - Williams, Andre AU - Gleason, Margaret Mary PY - 2023/3/3 TI - A Relational Agent Intervention for Adolescents Seeking Mental Health Treatment: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e44940 VL - 12 KW - adolescent KW - digital health KW - cognitive behavioral therapy KW - CBT KW - chatbot KW - feasibility KW - therapeutic alliance KW - depression KW - anxiety KW - relational agent KW - mental health care KW - intervention KW - agent KW - youth KW - teenager KW - mental health KW - treatment KW - protocol KW - randomized controlled trial KW - acceptability KW - telehealth KW - outcome KW - utility N2 - Background: Unmet pediatric mental health (MH) needs are growing as rates of pediatric depression and anxiety dramatically increase. Access to care is limited by multiple factors, including a shortage of clinicians trained in developmentally specific, evidence-based services. Novel approaches to MH care delivery, including technology-leveraged and readily accessible options, need to be evaluated in service of expanding evidence-based services to youths and their families. Preliminary evidence supports the use of Woebot, a relational agent that digitally delivers guided cognitive behavioral therapy (CBT) through a mobile app, for adults with MH concerns. However, no studies have evaluated the feasibility and acceptability of such app-delivered relational agents specifically for adolescents with depression and/or anxiety within an outpatient MH clinic, nor compared them to other MH support services. Objective: This paper describes the protocol for a randomized controlled trial evaluating the feasibility and acceptability of an investigational device, Woebot for Adolescents (W-GenZD), within an outpatient MH clinic for youths presenting with depression and/or anxiety. The study?s secondary aim will compare the clinical outcomes of self-reported depressive symptoms with W-GenZD and a telehealth-delivered CBT-based skills group (CBT-group). Tertiary aims will evaluate additional clinical outcomes and therapeutic alliance between adolescents in W-GenZD and the CBT-group. Methods: Participants include youths aged 13-17 years with depression and/or anxiety seeking care from an outpatient MH clinic at a children?s hospital. Eligible youths will have no recent safety concerns or complex comorbid clinical diagnoses; have no concurrent individual therapy; and, if on medications, are on stable doses, based on clinical screening and as well as study-specific criteria. Results: Recruitment began in May 2022. As of December 8, 2022, we have randomized 133 participants. Conclusions: Establishing the feasibility and acceptability of W-GenZD within an outpatient MH clinical setting will add to the field?s current understanding of the utility and implementation considerations of this MH care service modality. The study will also evaluate the noninferiority of W-GenZD against the CBT-group. Findings may also have implications for patients, families, and providers looking for additional MH support options for adolescents seeking help for their depression and/or anxiety. Such options expand the menu of supports for youths with lower-intensity needs as well as possibly reduce waitlists and optimize clinician deployment toward more severe cases. Trial Registration: ClinicalTrials.gov NCT05372913; https://clinicaltrials.gov/ct2/show/NCT05372913 International Registered Report Identifier (IRRID): DERR1-10.2196/44940 UR - https://www.researchprotocols.org/2023/1/e44940 UR - http://dx.doi.org/10.2196/44940 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867455 ID - info:doi/10.2196/44940 ER - TY - JOUR AU - Liang, Elisa AU - Kutok, R. Emily AU - Rosen, K. Rochelle AU - Burke, A. Taylor AU - Ranney, L. Megan PY - 2023/2/23 TI - Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents JO - JMIR Ment Health SP - e37711 VL - 10 KW - social media KW - adolescents KW - COVID-19 KW - emotions KW - connectivity N2 - Background: The COVID-19 pandemic provided a unique opportunity to examine social media and technology use during a time in which technology served as adolescents? primary form of socialization. The literature is mixed regarding how increased screen time during this period affected adolescent mental health and well-being. The mechanisms by which screen time use affected adolescent psychosocial outcomes are also unknown. Objective: We aimed to deepen our understanding of how social media and technology use, social connectivity, and emotional well-being intersected during pandemic-related school closures. Methods: English-speaking adolescents aged 13 to 17 years were recruited on Instagram for a brief screening survey; 39 participants were purposefully selected to complete a semistructured interview regarding their social media and technology use during the pandemic. Interview summaries were abstracted from recordings, and deductive codes were created for the primary question stems. These codes were subsequently reviewed for the main themes. Results: The main themes were as follows: adolescent social media and technology use during school closures usually allowed for more and easier social connectivity, but the amount and relative ease of connectivity differed according to purpose and type of use. Emotions, particularly those of stress and happiness, were connected to whether adolescents actively or passively engaged with social media and technology. Conclusions: Our results suggest a nuanced relationship among social media and technology use, adolescent social support, and emotional well-being, including during the pandemic. Specifically, how adolescents use or engage with web-based platforms greatly influences their ability to connect with others and their feelings of stress and happiness. In the context of the COVID-19 pandemic and as technology in general remains at the core of the adolescent experience, future research should continue to examine how adolescents navigate and use web-based spaces in beneficial and harmful ways. This will inform education and interventions that foster healthy social media and technological habits. UR - https://mental.jmir.org/2023/1/e37711 UR - http://dx.doi.org/10.2196/37711 UR - http://www.ncbi.nlm.nih.gov/pubmed/36054613 ID - info:doi/10.2196/37711 ER - TY - JOUR AU - Shroff, Akash AU - Roulston, Chantelle AU - Fassler, Julia AU - Dierschke, A. Nicole AU - Todd, Pedro Jennifer San AU - Ríos-Herrera, Ámbar AU - Plastino, A. Kristen AU - Schleider, Lee Jessica PY - 2023/2/14 TI - A Digital Single-Session Intervention Platform for Youth Mental Health: Cultural Adaptation, Evaluation, and Dissemination JO - JMIR Ment Health SP - e43062 VL - 10 KW - single-session intervention KW - cultural adaptation KW - web-based intervention KW - adolescents KW - mobile phone N2 - Background: Despite the proliferation of evidence-based digital mental health programs for young people, their low uptake and inconsistent implementation preclude them from benefiting youths at scale. Identifying effective implementation strategies for evidence-based supports is especially critical in regions where treatment access is lowest owing to mental health provider shortages. Objective: The goal of this academic-community partnership, funded by the City of San Antonio Metropolitan Health District, was to culturally adapt, disseminate, and gauge the acceptability and utility of an evidence-based digital mental health platform?Project Youth Empowerment and Support (YES)?among English- and Spanish-speaking youths living in south Texas. Methods: Project YES is an open-access, anonymous platform containing 3 evidence-based, self-guided interventions for youth mental health. Project YES was culturally adapted via focus groups and co-design sessions with San Antonio youths with lived experience of depression and anxiety; translated into Spanish; and disseminated throughout San Antonio, Texas, via community and school partnerships. Results: During the project period (April 2021 to December 2021), 1801 San Antonio youths began and 894 (49.64%) of them completed a 30-minute, single-session intervention within Project YES (aged 11-17 years; n=718, 39.87% male; n=961, 53.36% female; and n=3, 0.17% intersex; n=1477, 82.01% Hispanic; n=77, 4.28% non-Hispanic White; n=113, 6.27% Black; n=28, 1.55% Asian; and n=93, 5.16% other). This completion rate (49.64%) surpassed those previously observed for Project YES (eg, 34% when disseminated via social media). San Antonio youths rated Project YES as highly acceptable across all metrics, both in English and Spanish. In addition, the youths who completed Project YES?ENGLISH reported significant improvements in hopelessness (Cohen d=0.33; P<001), self-hate (Cohen d=0.27; P<001), and perceived agency (Cohen d=0.25; P<001) from before to after the intervention, and the youths who completed Project YES?SPANISH reported significant improvements in self-hate (Cohen d=0.37; P=.049) from before to after the intervention. Conclusions: The results indicate that Project YES?an open-access, free, and anonymous web-based single-session intervention platform?is an acceptable, accessible, and applicable mental health support for English- and Spanish-speaking San Antonio youths. UR - https://mental.jmir.org/2023/1/e43062 UR - http://dx.doi.org/10.2196/43062 UR - http://www.ncbi.nlm.nih.gov/pubmed/36787180 ID - info:doi/10.2196/43062 ER - TY - JOUR AU - Gómez-Restrepo, Carlos AU - Romero, Rumbo Jose Alejandro AU - Rodriguez, Martha AU - Ospina-Pinillos, Laura AU - Stanislaus Sureshkumar, Diliniya AU - Priebe, Stefan AU - Bird, Victoria PY - 2023/2/8 TI - Effectiveness of a Patient-Centered Assessment With a Solution-Focused Approach (DIALOG-A) in the Routine Care of Colombian Adolescents With Depression and Anxiety: Protocol for a Multicenter Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e43401 VL - 12 KW - randomised controlled trial KW - adolescent KW - mental health KW - depression KW - anxiety KW - telemedicine KW - primary health care KW - Colombia N2 - Background: Colombia is a middle-income country in South America, which has historically had high rates of mental health problems, coupled with a scarcity of mental health care. There is growing concern for the mental health of the adolescent population within this region. There is a significant treatment gap for young people, especially those living in the most vulnerable areas. DIALOG+ is a low-cost patient-centered intervention that can potentially improve the delivery of care and quality of life for adolescents with mental health problems. Objective: This exploratory randomized controlled trial aims to evaluate the effectiveness, acceptability, and feasibility of an adapted version of the DIALOG+ intervention (DIALOG-A) in the community treatment of Colombian adolescents with depression and anxiety. Methods: In total, 18 clinicians and 108 adolescents will be recruited from primary health care services in Bogota and Duitama, Colombia. Clinicians will be randomized 2:1 to either the intervention (12 clinicians:72 adolescents) or control group (6 clinicians:36 adolescents). In the intervention arm, clinicians will use DIALOG-A with adolescents once per month over 6 months. The control arm will continue to receive routine care. Outcomes will be measured at baseline, 6 months, and 9 months following randomization. Semistructured interviews with all clinicians and a subset of adolescents in the intervention arm will be conducted at the end of the intervention period. Quantitative and qualitative analysis of the data will be conducted. Results: Trial recruitment was completed toward the end of October 2022, and follow-up is anticipated to last through to October 2023. Conclusions: This is the first study to test an adapted resource-orientated intervention (DIALOG-A) in the treatment of adolescents with depression and anxiety attending primary care services. If the results are positive, DIALOG-A can be implemented in the routine care of adolescents with these mental health problems and provide valuable insight to other middle-income countries. Trial Registration: ISRCTN Registry ISRCTN13980767; https://www.isrctn.com/ISRCTN13980767?q=ISRCTN13980767 International Registered Report Identifier (IRRID): DERR1-10.2196/43401 UR - https://www.researchprotocols.org/2023/1/e43401 UR - http://dx.doi.org/10.2196/43401 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753329 ID - info:doi/10.2196/43401 ER - TY - JOUR AU - Winstone, Lizzy AU - Mars, Becky AU - Ferrar, Jennifer AU - Moran, Paul AU - Penton-Voak, Ian AU - Grace, Lydia AU - Biddle, Lucy PY - 2023/1/31 TI - Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study JO - JMIR Ment Health SP - e43840 VL - 10 KW - self-harm KW - lived experience stories KW - web-based support KW - self-help KW - recovery KW - focus groups N2 - Background: The positive and negative effects of interacting with web-based content on mental health, and especially self-harm, are well documented. Lived experience stories are one such type of static web-based content, frequently published on health care or third-sector organization websites, as well as social media and blogs, as a form of support for those seeking help via the web. Objective: This study aimed to increase understanding about how people who self-harm engage with and evaluate web-based lived experience stories. Methods: Overall, 4 web-based focus groups were conducted with 13 people with recent self-harm experience (aged 16-40 years). In total, 3 example lived experience stories were read aloud to participants, who were then asked to share their reactions to the stories. Participants were also encouraged to reflect on stories previously encountered on the web. Data were analyzed thematically. Results: Overall, 5 themes were generated: stories of recovery from self-harm and their emotional impact, impact on self-help and help-seeking behaviors, identifying with the narrator, authenticity, and language and stereotyping. Conclusions: Lived experience stories published on the web can provide a valuable form of support for those experiencing self-harm. They can be motivating and empowering for the reader, and they have the potential to distract readers from urges to self-harm. However, these effects may be moderated by age, and narratives of recovery may demoralize older readers. Our findings have implications for organizations publishing lived experience content and for community guidelines and moderators of web-based forums in which users share their stories. These include the need to consider the narrator?s age and the relatability and authenticity of their journey and the need to avoid using stigmatizing language. UR - https://mental.jmir.org/2023/1/e43840 UR - http://dx.doi.org/10.2196/43840 UR - http://www.ncbi.nlm.nih.gov/pubmed/36719729 ID - info:doi/10.2196/43840 ER - TY - JOUR AU - Perakslis, Eric AU - Quintana, Yuri PY - 2023/1/26 TI - Social Media is Addictive and Influences Behavior: Should it Be Regulated as a Digital Therapeutic? JO - J Med Internet Res SP - e43174 VL - 25 KW - social media KW - mental health KW - suicide KW - health policy KW - addictions KW - youth mental health KW - FDA KW - Food and Drug Administration KW - Canada KW - United Kingdom KW - United States KW - European Union KW - privacy KW - security KW - adverse event UR - https://www.jmir.org/2023/1/e43174 UR - http://dx.doi.org/10.2196/43174 UR - http://www.ncbi.nlm.nih.gov/pubmed/36701180 ID - info:doi/10.2196/43174 ER - TY - JOUR AU - Dysthe, Kristoffer Kim AU - Røssberg, Ivar Jan AU - Brandtzaeg, Bae Petter AU - Skjuve, Marita AU - Haavet, Rikard Ole AU - Følstad, Asbjørn AU - Klovning, Atle PY - 2023/1/24 TI - Analyzing User-Generated Web-Based Posts of Adolescents? Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis JO - J Med Internet Res SP - e37289 VL - 25 KW - adolescent KW - depression KW - internet KW - education KW - preventive psychiatry KW - early medical intervention KW - health literacy KW - cognitive behavioral therapy N2 - Background: Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking. Objective: This study aimed to fill this knowledge gap through a new understanding of adolescents? cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice. Methods: The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression. Results: Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts. Conclusions: These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action. UR - https://www.jmir.org/2023/1/e37289 UR - http://dx.doi.org/10.2196/37289 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692944 ID - info:doi/10.2196/37289 ER - TY - JOUR AU - Kaiser, Sabine AU - Rye, Marte AU - Jakobsen, Reidar AU - Martinussen, Monica AU - Høgsdal, Helene AU - Kyrrestad, Henriette PY - 2023/1/11 TI - A Universal Mental Health?Promoting Mobile App for Adolescents: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e42119 VL - 12 KW - mental health promotion KW - mobile app KW - mobile phone KW - adolescents KW - Opp KW - teens KW - application KW - effectiveness KW - intervention KW - effect KW - health KW - health promotion N2 - Background: In times of increasing mental health problems among young people, strengthening efforts to improve mental health through mental health promotion and prevention becomes increasingly important. Effective measures that support young people in coping with negative thoughts, feelings, and stress are essential, not just for the individual but also for society. Objective: The aim of this paper is to provide a description of a cluster randomized controlled trial that will be conducted to examine the effectiveness of Opp, a universal mental health?promoting mobile app for adolescents aged 13 to 19 years that provides information and exercises to better cope with stress, negative thoughts, and negative feelings. The protocol was developed in accordance with the SPIRIT checklist. Methods: An effectiveness study will be conducted with 3 measurement points: preintervention (T1), 2 weeks after the intervention (T2), and about 1 month after the intervention (T3). Adolescents will be recruited from middle and high schools in Norway and randomly assigned to the intervention or control groups. Randomization will be conducted on the school level. Opp can be downloaded from the Google Play or App Store but is password protected with a 4-digit code, which will be removed after study completion. Participants in the intervention group will receive a text message with the code to unlock the app. The participants in the intervention group can use Opp without limits on length or time of use. Objective data on how long or how often the participants use the app will not be collected. However, the second and third questionnaires for the intervention group contain app-specific questions on, for example, the use of the app. Results: Recruitment and data collection started in August and September 2022. So far, 381 adolescents have answered the first questionnaire. Data collection was expected to end in December 2022 but has had to be prolonged to approximately June 2023. The results of the study will be available in 2023 at the earliest. Conclusions: This project will contribute unique knowledge to the field, as there are few studies that have examined the effects of universal health-promoting mobile apps for adolescents. However, several limitations have to be taken into account when interpreting the results, such as randomization on the school level, the short time frame in which the study was conducted, and the lack of objective data to monitor the use of the app. Trial Registration: ClinicalTrials.gov NCT05211713; https://www.clinicaltrials.gov/ct2/show/NCT05211713 International Registered Report Identifier (IRRID): PRR1-10.2196/42119 UR - https://www.researchprotocols.org/2023/1/e42119 UR - http://dx.doi.org/10.2196/42119 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630167 ID - info:doi/10.2196/42119 ER - TY - JOUR AU - Høgsdal, Helene AU - Kaiser, Sabine AU - Kyrrestad, Henriette PY - 2023/1/6 TI - Adolescents? Assessment of Two Mental Health?Promoting Mobile Apps: Results of Two User Surveys JO - JMIR Form Res SP - e40773 VL - 7 KW - mental health app KW - mobile app KW - mental health KW - mental health promotion KW - cyberbullying KW - adolescents KW - user satisfaction KW - system usability KW - app quality KW - mental health intervention KW - health promotion KW - app usability KW - user experience N2 - Background: The importance of mental health promotion is irrevocable and is especially important at a young age. More mental health-promoting mobile apps have been developed in the last few years. However, their usability and quality have been rarely assessed. Objective: The aim of this study is to investigate how adolescents assess the usability, quality, and potential goal achievement of Opp and NettOpp. Opp is a universal mental health?promoting mobile app aimed at 13- to 19-year-olds, and NettOpp is a mobile app for children and adolescents between 11 to 16 years of age that have experienced negative incidents online. Methods: A total of 45 adolescents tested either Opp (n=30) or NettOpp (n=15) for a period of 3 weeks and answered a questionnaire. The System Usability Scale (SUS) was used to measure the usability of the apps. A SUS score above 70 indicates acceptable usability. Items from the Mobile Application Rating Scale were adapted for study purposes and used to measure the quality and perceived goal achievement that Opp and NettOpp might have on adolescents? knowledge, attitudes, and intention to change behavior. Furthermore, adolescents could answer an open comment question. Results: Opp had a mean SUS score of 80.37 (SD 9.27), and NettOpp?s mean SUS score was 80.33 (SD 10.30). In the overall evaluation, Opp and NettOpp were given a mean score of 3.78 (SD 0.42) and 4.20 (SD 0.56), respectively, on a 5-point scale, where 5 was best. Most adolescents who evaluated Opp rated that the app would increase knowledge about mental health and help young people deal with stress and difficult emotions or situations. Most adolescents who evaluated NettOpp agreed that the app would increase awareness and knowledge about cyberbullying, change attitudes toward cyberbullying, and motivate them to address cyberbullying. Some adolescents stated that Opp was difficult to navigate and consisted of too much text. Some of the adolescents that tested NettOpp stated that the app had crashed and that the design was a bit childish. Conclusions: All in all, this study indicates that Opp and NettOpp have good usability and that adolescents are satisfied with both apps. It also indicates that the potential goal achievement of the apps, for example, increasing knowledge about mental health (Opp) or cyberbullying (NettOpp) is promising. While there are some comments from the users that are more difficult to solve (eg, Opp is too text-based), some comments helped improve the apps (eg, that the app crashed). Overall, the user evaluation provided valuable knowledge about how adolescents assess Opp and NettOpp. However, more extensive effectiveness studies are necessary to measure their actual goal achievement. UR - https://formative.jmir.org/2023/1/e40773 UR - http://dx.doi.org/10.2196/40773 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607734 ID - info:doi/10.2196/40773 ER - TY - JOUR AU - Adeane, Emily AU - Gibson, Kerry PY - 2023/1/4 TI - Using Web-Based Content to Connect Young People With Real-life Mental Health Support: Qualitative Interview Study JO - JMIR Form Res SP - e38296 VL - 7 KW - young people KW - mental health KW - online help seeking KW - internet KW - mental health services KW - digital interviews N2 - Background: Young people experience high rates of mental health problems but make insufficient use of the formal services available to them. As young people are heavy users of the internet, there may be an untapped potential to use web-based content to encourage this hard-to-reach population to make better use of face-to-face mental health services. However, owing to the vast range of content available and the complexities in how young people engage with it, it is difficult to know what web-based content is most likely to resonate with this age group and facilitate their engagement with professional support. Objective: This study aimed to identify the types of web-based content young people identified as more likely to prompt youth engagement with mental health services. Methods: This study used a qualitative design conducted within a social constructionist epistemology that recognized the importance of youth empowerment in mental health. Digital interviews using WhatsApp instant messenger were conducted with 37 young people aged 16-23 years who participated as ?expert informants? on the priorities and practices of youth in web-based spaces. The data were analyzed using reflexive thematic analysis to identify the types of web-based content that participants believed would encourage young people to reach out to a face-to-face mental health service for support. Results: The analysis generated 3 main themes related to the research question. First, participants noted that a lack of information about available services and how they worked prevented young people from engaging with face-to-face mental health services. They proposed web-based content that provided clear information about relevant mental health services and how to access them. They also suggested the use of both text and video to provide young people with greater insight into how face-to-face counseling might work. Second, participants recommended content dedicated to combating misconceptions about mental health and negative portrayals of mental health services and professionals that are prevalent in their web-based spaces. They suggested content that challenged the stigma surrounding mental health and help seeking and highlighted the value of mental health services. Finally, participants suggested that young people would be more likely to respond to ?relatable? digital stories of using mental health services, recounted in the context of a personal connection with someone they trusted. Conclusions: This study offers recommendations for professionals and service providers on how to better engage young people with real-life mental health support using web-based content. Web-based content can be used to challenge some of the barriers that continue to prevent young people from accessing face-to-face mental health services and underlines the importance of including young people?s voices in the design of web-based mental health content. UR - https://formative.jmir.org/2023/1/e38296 UR - http://dx.doi.org/10.2196/38296 UR - http://www.ncbi.nlm.nih.gov/pubmed/36598810 ID - info:doi/10.2196/38296 ER - TY - JOUR AU - Xiao, Wen AU - Wu, Jinlong AU - Yip, Joanne AU - Shi, Qiuqiong AU - Peng, Li AU - Lei, Emma Qiwen AU - Ren, Zhanbing PY - 2022/12/14 TI - The Relationship Between Physical Activity and Mobile Phone Addiction Among Adolescents and Young Adults: Systematic Review and Meta-analysis of Observational Studies JO - JMIR Public Health Surveill SP - e41606 VL - 8 IS - 12 KW - mobile phone addiction KW - physical activity KW - adolescents KW - young adults KW - systematic review KW - phone addiction KW - association KW - correlation KW - phone use N2 - Background: Previous studies have reported a potential negative correlation between physical activity (PA) and mobile phone addiction (MPA) among adolescents and young adults. To date, the strength of this correlation has not been well characterized. Objective: This review and meta-analysis aimed to synthesize available empirical studies to examine the correlations between PA and MPA among adolescents and young adults. We also explored several potential moderators, including time of data collection, country or region, and type of population, associated with the relationship between PA and MPA. Methods: Four electronic databases (PubMed, Scopus, PsycINFO, and Web of Science) were searched from database inception to March 2022 to identify relevant studies. The pooled Pearson correlation coefficients and their corresponding 95% CIs for the relationship between PA and MPA were calculated using the inverse variance method. The methodological quality of the included cross-sectional studies was determined based on the Joanna Briggs Institute appraisal checklist. The study conformed to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) guidelines. Results: In total, 892 relevant articles were identified, of which 22 were selected based on the inclusion and exclusion criteria. The final meta-analysis included 17 of the 22 studies. Results of random effects modeling revealed a moderate correlation between PA and MPA among adolescents and young adults (summary r=?0.243, P<.001). Sensitivity and publication bias analyses further demonstrated the robustness of our results. All the included studies were scored as high quality with a low risk of bias. Subgroup analysis further indicated that none of the hypothesized moderators (time of data collection, country or region, and type of population) significantly affected the relationship between PA and MPA, as confirmed by the mixed effects analysis. In addition, in the data collection subgroups, medium effect sizes were obtained for data collected before COVID-19 (r=?0.333, P<.001) and data collected during COVID-19 (r=?0.207, P<.001). In subgroup analyses for country or region, the correlation coefficient for China and other developing regions showed a similarly moderate effect size (r=?0.201, P<.001 and r= ?0.217, P<.001, respectively). However, the effect sizes for developed regions were not significant (r=?0.446, P=.39). In a subgroup analysis based on the type of population, we found that the effect size for young adults was moderate (r=?0.250, P<.001). However, that of adolescents was not significant (r=?0.129, P=.24). Conclusions: Our results demonstrate a moderately negative relationship between PA and MPA among young adults. The strength of this relationship was not influenced by the time of data collection, country or region, or type of population. UR - https://publichealth.jmir.org/2022/12/e41606 UR - http://dx.doi.org/10.2196/41606 UR - http://www.ncbi.nlm.nih.gov/pubmed/36515994 ID - info:doi/10.2196/41606 ER - TY - JOUR AU - Isiwele, Anthony AU - Rivas, Carol AU - Stokes, Gillian PY - 2022/12/9 TI - Nigerian and Ghanaian Young People?s Experiences of Care for Common Mental Disorders in Inner London: Protocol for a Multimethod Investigation JO - JMIR Res Protoc SP - e42575 VL - 11 IS - 12 KW - Nigerian KW - Ghanaian KW - lived experience KW - common mental disorder KW - mental health KW - London KW - mental healthcare KW - mental disorder KW - ethnic KW - minority KW - racial KW - preference KW - perspective KW - patient need KW - qualitative KW - experience KW - content analysis KW - mental illness KW - phenomenological KW - phenomenology KW - policy analysis KW - United Kingdom KW - Great Britain KW - youth KW - pediatric KW - adolescent KW - adolescence KW - young person KW - young people N2 - Background: The Care Quality Commission published a review in 2018 in England titled ?Are We Listening,? which revealed that child and adolescent mental health services are not responsive to the specific needs of young Black people and other ethnic minorities even in areas with ethnically diverse populations. It found that commissioners and service planners failed to engage with these young people and their families to understand their needs and expectations. Objective: The purpose of this study is to engage Nigerian and Ghanaian young people (NAGYP) with experiences of care for common mental disorders (CMDs) in London, to increase understanding of their needs, and to give voice to their views and preferences. Their parents?, caregivers?, and practitioners? views will also be sought for service improvement. Methods: Three combined contemporary complementary methodologies?thematic analysis, interpretative phenomenological analysis (IPA), and intersectionality-based policy analysis (IBPA)?will be used across 3 comprehensive phases. First, a scoping review where relevant themes will be critically analyzed will inform further phases of this study. Detailed mapping of community and mental health care services in 13 inner London boroughs to investigate what professionals actually do rather than what they say they do. Second, IBPA will be used to scrutinize improving access to psychological therapies and other legislations and policies relevant to NAGYP to undertake an intersectional multileveled analysis of power, models, and constraints. Third, IPA will ?give voice? and ?make sense? of NAGYP lived experiences of CMDs via a representative sample of NAGYP participants? (n=30) aged 16-25 years, parents or caregivers? (n=20), and practitioners? (n=20) perspectives will be captured. Results: The study has been approved by the UCL Institute of Education Research Ethics Committee (Z6364106/2022/02/28; health research) and University College London (Z6364106/2022/10/24; social research). Recruitment has begun in 13 inner boroughs of London. Data collection through observation, semistructured interviews, and focus groups are expected to be finalized by early 2024, and the study will be published by early 2025. Conclusions: Combining multiple qualitative methodologies and methods will enable rigorous investigation into NAGYP?s lived experiences of care received for CMDs in London. Findings from this study should enable a reduction in the negative connotations and harmful superstitions associated with mental health?related issues in this group, inform evidence-based interventions, and facilitate preventive or early access to interventions. There may also be an indirect impact on problems resulting from mental illness such as school dropout, antisocial behaviors, knife crimes, juvenile detention centers, and even death. International Registered Report Identifier (IRRID): PRR1-10.2196/42575 UR - https://www.researchprotocols.org/2022/12/e42575 UR - http://dx.doi.org/10.2196/42575 UR - http://www.ncbi.nlm.nih.gov/pubmed/36485025 ID - info:doi/10.2196/42575 ER - TY - JOUR AU - Logie, H. Carmen AU - Okumu, Moses AU - Kortenaar, Jean-Luc AU - Gittings, Lesley AU - Khan, Naimul AU - Hakiza, Robert AU - Kibuuka Musoke, Daniel AU - Nakitende, Aidah AU - Katisi, Brenda AU - Kyambadde, Peter AU - Khan, Torsum AU - Lester, Richard AU - Mbuagbaw, Lawrence PY - 2022/12/8 TI - Mobile Health?Supported Virtual Reality and Group Problem Management Plus: Protocol for a Cluster Randomized Trial Among Urban Refugee and Displaced Youth in Kampala, Uganda (Tushirikiane4MH, Supporting Each Other for Mental Health) JO - JMIR Res Protoc SP - e42342 VL - 11 IS - 12 KW - adolescents and youth KW - mental health KW - refugee KW - implementation research KW - virtual reality KW - mobile health KW - Uganda KW - urban N2 - Background: Although mental health challenges disproportionately affect people in humanitarian contexts, most refugee youth do not receive the mental health support needed. Uganda is the largest refugee-hosting nation in Africa, hosting over 1.58 million refugees in 2022, with more than 111,000 living in the city of Kampala. There is limited information about effective and feasible interventions to improve mental health outcomes and mental health literacy, and to reduce mental health stigma among urban refugee adolescents and youth in low- and middle-income countries (LMICs). Virtual reality (VR) is a promising approach to reduce stigma and improve mental health and coping, yet such interventions have not yet been tested in LMICs where most forcibly displaced people reside. Group Problem Management Plus (GPM+) is a scalable brief psychological transdiagnostic intervention for people experiencing a range of adversities, but has not been tested with adolescents and youth to date. Further, mobile health (mHealth) strategies have demonstrated promise in promoting mental health literacy. Objective: The aim of this study is to evaluate the feasibility and effectiveness of two youth-tailored mental health interventions (VR alone and VR combined with GMP+) in comparison with the standard of care in improving mental health outcomes among refugee and displaced youth aged 16-24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomized in a 1:1:1 design. Approximately 330 adolescents (110 per cluster) are enrolled and will be followed for approximately 16 weeks. Data will be collected at three time points: baseline enrollment, 8 weeks following enrollment, and 16 weeks after enrollment. Primary (depression) and secondary outcomes (mental health literacy, attitudes toward mental help?seeking, adaptive coping, mental health stigma, mental well-being, level of functioning) will be evaluated. Results: The study will be conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (#40965; May 12, 2021), Mildmay Uganda Research Ethics Committee (MUREC-2021-41; June 24, 2021), and Uganda National Council for Science & Technology (SS1021ES; January 1, 2022). A qualitative formative phase was conducted using focus groups and in-depth, semistructured key informant interviews to understand contextual factors influencing mental well-being among urban refugee and displaced youth. Qualitative findings will inform the VR intervention, SMS text check-in messages, and the adaptation of GPM+. Intervention development was conducted in collaboration with refugee youth peer navigators. The trial launched in June 2022 and the final follow-up survey will be conducted in November 2022. Conclusions: This study will contribute to the knowledge of youth-tailored mental health intervention strategies for urban refugee and displaced youth living in informal settlements in LMIC contexts. Findings will be shared in peer-reviewed publications, conference presentations, and with community dissemination. Trial Registration: ClinicalTrials.gov NCT05187689; https://clinicaltrials.gov/ct2/show/NCT05187689 International Registered Report Identifier (IRRID): DERR1-10.2196/42342 UR - https://www.researchprotocols.org/2022/12/e42342 UR - http://dx.doi.org/10.2196/42342 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480274 ID - info:doi/10.2196/42342 ER - TY - JOUR AU - Blattert, Lisa AU - Armbruster, Christoph AU - Buehler, Eva AU - Heiberger, Andrea AU - Augstein, Patrick AU - Kaufmann, Sarina AU - Reime, Birgit AU - PY - 2022/11/23 TI - Health Needs for Suicide Prevention and Acceptance of e-Mental Health Interventions in Adolescents and Young Adults: Qualitative Study JO - JMIR Ment Health SP - e39079 VL - 9 IS - 11 KW - suicide prevention KW - e-mental health KW - peer support KW - adolescents and young adults KW - health needs KW - acceptance KW - qualitative data analysis KW - suicide KW - mental health KW - teens KW - adolescent KW - young adult KW - vulnerable KW - behavior KW - Germany KW - rural KW - intervention KW - formative KW - digital KW - online N2 - Background: Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy. Objective: The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions. Methods: This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016). Results: Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness. Conclusions: The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account. UR - https://mental.jmir.org/2022/11/e39079 UR - http://dx.doi.org/10.2196/39079 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416884 ID - info:doi/10.2196/39079 ER - TY - JOUR AU - Nicol, Ginger AU - Wang, Ruoyun AU - Graham, Sharon AU - Dodd, Sherry AU - Garbutt, Jane PY - 2022/11/22 TI - Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study JO - JMIR Form Res SP - e40242 VL - 6 IS - 11 KW - COVID-19 KW - adolescent depression KW - mobile health KW - cognitive behavioral therapy KW - chatbot KW - relational conversational agent KW - depression KW - anxiety KW - suicide KW - self-harm KW - pandemic KW - pediatric KW - youth KW - adolescent KW - adolescence KW - psychiatry KW - conversational agent KW - CBT KW - clinic KW - data KW - acceptability KW - feasibility KW - usability KW - primary care KW - intervention KW - mental health KW - digital health KW - technology mediated KW - computer mediated N2 - Background: Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. Objective: In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. Methods: This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. Results: The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. Conclusions: In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053 UR - https://formative.jmir.org/2022/11/e40242 UR - http://dx.doi.org/10.2196/40242 UR - http://www.ncbi.nlm.nih.gov/pubmed/36413390 ID - info:doi/10.2196/40242 ER - TY - JOUR AU - Skripkauskaite, Simona AU - Fazel, Mina AU - PY - 2022/11/18 TI - Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis JO - JMIR Pediatr Parent SP - e41480 VL - 5 IS - 4 KW - gaming KW - adolescents KW - latent profile analysis KW - mobile phone KW - well-being KW - mental ill-health KW - mental health KW - digital technology N2 - Background: The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern. Objective: This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk. Methods: We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences. Results: In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81). Conclusions: A substantial number of adolescents are spending ?3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers. UR - https://pediatrics.jmir.org/2022/4/e41480 UR - http://dx.doi.org/10.2196/41480 UR - http://www.ncbi.nlm.nih.gov/pubmed/36399378 ID - info:doi/10.2196/41480 ER - TY - JOUR AU - Gómez-Restrepo, Carlos AU - Sarmiento-Suárez, José María AU - Alba-Saavedra, Magda AU - Bird, Jane Victoria AU - Priebe, Stefan AU - van Loggerenberg, Francois PY - 2022/11/9 TI - Adapting DIALOG+ in a School Setting?A Tool to Support Well-being and Resilience in Adolescents Living in Postconflict Areas During the COVID-19 Pandemic: Protocol for a Cluster Randomized Exploratory Study JO - JMIR Res Protoc SP - e40286 VL - 11 IS - 11 KW - mental health KW - mental disorder KW - eHealth KW - digital health KW - digital intervention KW - psychosocial intervention KW - resilience KW - psychological support KW - psychosocial well-being KW - mental well-being KW - resource-oriented approach KW - computer-mediated intervention KW - armed conflict KW - post-conflict KW - adolescent health KW - adolescent KW - adolescence KW - child KW - youth KW - school KW - teacher KW - student KW - acceptability KW - feasibility KW - vulnerable N2 - Background: Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population. Objective: Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders? (teachers? and students?) perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being. Methods: We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents? data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability. Results: Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022. Conclusions: This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. Trial Registration: ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374 International Registered Report Identifier (IRRID): DERR1-10.2196/40286 UR - https://www.researchprotocols.org/2022/11/e40286 UR - http://dx.doi.org/10.2196/40286 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350703 ID - info:doi/10.2196/40286 ER - TY - JOUR AU - She, Rui AU - Zhang, Youmin AU - Yang, Xue PY - 2022/11/8 TI - Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study JO - JMIR Serious Games SP - e33806 VL - 10 IS - 4 KW - internet gaming disorder KW - adolescents KW - parental factors KW - longitudinal study KW - parenting KW - gaming KW - gaming disorder KW - health intervention KW - treatment KW - mental health N2 - Background: Parents play central roles in adolescents? socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. Objective: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. Methods: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. Results: Of all the participants, 12.4% (148/1200) and 11.7% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support (?=?.06, P=.02) and parental abuse (?=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control (?=.03, P=.25) and a positive relationship with parents (?=?.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. Conclusions: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD. UR - https://games.jmir.org/2022/4/e33806 UR - http://dx.doi.org/10.2196/33806 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346660 ID - info:doi/10.2196/33806 ER - TY - JOUR AU - Clemmensen, Harder Line Katrine AU - Lønfeldt, Nadine Nicole AU - Das, Sneha AU - Lund, Leander Nicklas AU - Uhre, Funch Valdemar AU - Mora-Jensen, Cecilie Anna-Rosa AU - Pretzmann, Linea AU - Uhre, Funch Camilla AU - Ritter, Melanie AU - Korsbjerg, Jepsen Nicoline Løcke AU - Hagstrøm, Julie AU - Thoustrup, Lykke Christine AU - Clemmesen, Thiemer Iben AU - Plessen, Jessica Kersten AU - Pagsberg, Katrine Anne PY - 2022/10/28 TI - Associations Between the Severity of Obsessive-Compulsive Disorder and Vocal Features in Children and Adolescents: Protocol for a Statistical and Machine Learning Analysis JO - JMIR Res Protoc SP - e39613 VL - 11 IS - 10 KW - machine learning KW - obsessive-compulsive disorder KW - vocal features KW - speech signals KW - children KW - teens KW - adolescents KW - OCD KW - AI KW - artificial intelligence KW - tool KW - mental health KW - care KW - speech KW - data KW - clinical trial KW - validity KW - results N2 - Background: Artificial intelligence tools have the potential to objectively identify youth in need of mental health care. Speech signals have shown promise as a source for predicting various psychiatric conditions and transdiagnostic symptoms. Objective: We designed a study testing the association between obsessive-compulsive disorder (OCD) diagnosis and symptom severity on vocal features in children and adolescents. Here, we present an analysis plan and statistical report for the study to document our a priori hypotheses and increase the robustness of the findings of our planned study. Methods: Audio recordings of clinical interviews of 47 children and adolescents with OCD and 17 children and adolescents without a psychiatric diagnosis will be analyzed. Youths were between 8 and 17 years old. We will test the effect of OCD diagnosis on computationally derived scores of vocal activation using ANOVA. To test the effect of OCD severity classifications on the same computationally derived vocal scores, we will perform a logistic regression. Finally, we will attempt to create an improved indicator of OCD severity by refining the model with more relevant labels. Models will be adjusted for age and gender. Model validation strategies are outlined. Results: Simulated results are presented. The actual results using real data will be presented in future publications. Conclusions: A major strength of this study is that we will include age and gender in our models to increase classification accuracy. A major challenge is the suboptimal quality of the audio recordings, which are representative of in-the-wild data and a large body of recordings collected during other clinical trials. This preregistered analysis plan and statistical report will increase the validity of the interpretations of the upcoming results. International Registered Report Identifier (IRRID): DERR1-10.2196/39613 UR - https://www.researchprotocols.org/2022/10/e39613 UR - http://dx.doi.org/10.2196/39613 UR - http://www.ncbi.nlm.nih.gov/pubmed/36306153 ID - info:doi/10.2196/39613 ER - TY - JOUR AU - Ravaccia, Gaia Giulia AU - Johnson, Laura Sophie AU - Morgan, Nicholas AU - Lereya, Tanya Suzet AU - Edbrooke-Childs, Julian PY - 2022/10/20 TI - Experiences of Using the Digital Support Tool MeeToo: Mixed Methods Study JO - JMIR Pediatr Parent SP - e37424 VL - 5 IS - 4 KW - mHealth KW - mental health KW - peer support KW - COVID-19 KW - well-being KW - young people N2 - Background: Digital peer support is an increasingly used form of mental health support for young people. However, there is a need for more research on the impact of digital peer support and why it has an impact. Objective: The aim of this research is to examine young people?s experiences of using a digital peer support tool: MeeToo. After the time of writing, MeeToo has changed their name to Tellmi. MeeToo is an anonymous, fully moderated peer support tool for young people aged 11-25 years. There were two research questions: (1) What impacts did using MeeToo have on young people? (2) Why did using MeeToo have these impacts on young people? Methods: A mixed methods study was conducted. It involved secondary analysis of routinely collected feedback questionnaires, which were completed at two time points (T1 and T2) 2-3 months apart. Questionnaires asked about young people?s (N=876) experience of using MeeToo, mental health empowerment, and well-being. Primary data were collected from semistructured interviews with 10 young people. Results: Overall, 398 (45.4%) of 876 young people completed the T1 questionnaire, 559 (63.8%) completed the T2 questionnaire, and 81 (9.2%) completed both. Descriptive statistics from the cross-sectional analysis of the questionnaires identified a range of positive impacts of using MeeToo, which included making it easier to talk about difficult things, being part of a supportive community, providing new ways to help oneself, feeling better, and feeling less alone. Subgroup analysis (paired-sample t test) of 58 young females who had completed both T1 and T2 questionnaires showed a small but statistically significant increase in levels of patient activation, one of the subscales of the mental health empowerment scale: time 1 mean=1.83 (95% CI 1.72-1.95), time 2 mean=2.00 (95% CI 1.89-2.11), t59=2.15, and P=.04. Anonymity and the MeeToo sense of community were identified from interviews as possible reasons for why using MeeToo had these impacts. Anonymity helped to create a safe space in which users could express their feelings, thoughts, and experiences freely without the fear of being judged by others. The MeeToo sense of community was described as a valuable form of social connectedness, which in turn had a positive impact on young people?s mental health and made them feel less isolated and alone. Conclusions: The findings of this research showed a range of positive impacts and possible processes for young people using MeeToo. Future research is needed to examine how these impacts and processes can be sustained. UR - https://pediatrics.jmir.org/2022/4/e37424 UR - http://dx.doi.org/10.2196/37424 UR - http://www.ncbi.nlm.nih.gov/pubmed/36264619 ID - info:doi/10.2196/37424 ER - TY - JOUR AU - Agapie, Elena AU - Chang, Katherine AU - Patrachari, Sneha AU - Neary, Martha AU - Schueller, M. Stephen PY - 2022/10/18 TI - Understanding Mental Health Apps for Youth: Focus Group Study With Latinx Youth JO - JMIR Form Res SP - e40726 VL - 6 IS - 10 KW - mental health KW - mental health apps KW - youth KW - child KW - teenager KW - focus group KW - human-centered design KW - mobile health KW - mHealth KW - health app KW - cognitive behavioral therapy KW - CBT KW - perspective KW - qualitative KW - mindfulness KW - digital health tool KW - Latino KW - Latinx KW - mobile phone N2 - Background: An increasing number of mental health apps (MHapps) are being developed for youth. In addition, youth are high users of both technologies and MHapps. However, little is known about their perspectives on MHapps. MHapps might be particularly well suited to reach the youth underserved by traditional mental health resources, and incorporating their perspectives is especially critical to ensure such tools are useful to them. Objective: The goal of this study was to develop and pilot a process for eliciting youth perspectives on MHapps in a structured and collaborative way. We also sought to generate learnings on the perspectives of Latinx youth on MHapps and their use in ways that might facilitate discovery, activation, or engagement in MHapps, especially in Latinx populations. Methods: We created a series of focus groups consisting of 5 sessions. The groups introduced different categories of MHapps (cognitive behavioral therapy apps, mindfulness apps, and miscellaneous apps). Within each category, we selected 4 MHapps that participants chose to use for a week and provided feedback through both between-session and in-session activities. We recruited 5 youths ranging in age from 15 to 21 (mean 18, SD 2.2) years. All the participants identified as Hispanic or Latinx. After completing all 5 focus groups, the participants completed a brief questionnaire to gather their impressions of the apps they had used. Results: Our focus group methodology collected detailed and diverse information about youth perspectives on MHapps. However, we did identify some aspects of our methods that were less successful at engaging the youth, such as our between-session activities. The Latinx youth in our study wanted apps that were accessible, relatable, youth centric, and simple and could be integrated with their offline lives. We also found that the mindfulness apps were viewed most favorably but that the miscellaneous and cognitive behavioral therapy apps were viewed as more impactful. Conclusions: Eliciting youth feedback on MHapps is critical if these apps are going to serve a role in supporting their mental health and well-being. We refined a process for collecting feedback from the youth and identified factors that were important to a set of Latinx youth. Future work could be broader, that is, recruit larger samples of more diverse youth, or deeper, that is, collect more information from each youth around interests, needs, barriers, or facilitators or better understand the various impacts of MHapps by using qualitative and quantitative measures. Nevertheless, this study advances the formative understanding of how the youth, particularly Latinx youth, might be viewing these tools. UR - https://formative.jmir.org/2022/10/e40726 UR - http://dx.doi.org/10.2196/40726 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256835 ID - info:doi/10.2196/40726 ER - TY - JOUR AU - Radovic, Ana AU - Li, Yaming AU - Landsittel, Doug AU - Odenthal, R. Kayla AU - Stein, D. Bradley AU - Miller, Elizabeth PY - 2022/10/7 TI - A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents With Depression or Anxiety: Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e35313 VL - 9 IS - 10 KW - adolescent KW - adolescent health services KW - technology KW - depression KW - anxiety N2 - Background: Adolescents with depression or anxiety initiate mental health treatment in low numbers. Supporting Our Valued Adolescents (SOVA) is a peer support website intervention for adolescents seen in primary care settings and their parents with the goal of increasing treatment uptake through changing negative health beliefs, enhancing knowledge, offering peer emotional support, and increasing parent-adolescent communication about mental health. Objective: This pilot study aimed to refine recruitment and retention strategies, refine document intervention fidelity, and explore changes in study outcomes (the primary outcome being treatment uptake). Methods: We conducted a 2-group, single-blind, pilot randomized controlled trial in a single adolescent medicine clinic. Participants were aged 12 to 19 years with clinician-identified symptoms of depression or anxiety for which a health care provider recommended treatment. The patient and parent, if interested, were randomized to receive the SOVA websites and enhanced usual care (EUC) compared with EUC alone. Baseline, 6-week, and 3-month measures were collected using a web-based self-report survey and blinded electronic health record review. The main pilot outcomes assessed were the feasibility of recruitment and retention strategies. Implementation outcomes, intervention fidelity, missingness, and adequacy of safety protocols were documented. Descriptive statistics were used to summarize mental health service use and target measures with 2-sample t tests to compare differences between arms. Results: Less than half of the adolescents who were offered patient education material (195/461, 42.2%) were referred by their clinician to the study. Of 146 adolescents meeting the inclusion criteria, 38 completed the baseline survey, qualifying them for randomization, and 25 (66%, 95% CI 51%-81%) completed the 6-week measures. There was limited engagement in the treatment arm, with 45% (5/11) of adolescents who completed 6-week measures reporting accessing SOVA, and most of those who did not access cited forgetting as the reason. Changes were found in target factors at 6 weeks but not in per-protocol analyses. At 12 weeks, 83% (15/18) of adolescents randomized to SOVA received mental health treatment as compared with 50% (10/20) of adolescents randomized to EUC (P=.03). Conclusions: In this pilot trial of a peer support website intervention for adolescents with depression or anxiety, we found lower-than-expected study enrollment after recruitment. Although generalizability may be enhanced by not requiring parental permission for adolescent participation in the trials of mental health interventions, this may limit study recruitment and retention. We found that implementing education introducing the study into provider workflow was feasible and acceptable, resulting in almost 500 study referrals. Finally, although not the primary outcome, we found a signal for greater uptake of mental health treatment in the arm using the SOVA intervention than in the usual care arm. Trial Registration: ClinicalTrials.gov NCT03318666; https://clinicaltrials.gov/ct2/show/NCT03318666 International Registered Report Identifier (IRRID): RR2-10.2196/12117 UR - https://mental.jmir.org/2022/10/e35313 UR - http://dx.doi.org/10.2196/35313 UR - http://www.ncbi.nlm.nih.gov/pubmed/36206044 ID - info:doi/10.2196/35313 ER - TY - JOUR AU - Horita, Hideki AU - Seki, Yoichi AU - Shimizu, Eiji PY - 2022/10/5 TI - Parents? Perspectives on Their Relationship With Their Adolescent Children With Internet Addiction: Survey Study JO - JMIR Pediatr Parent SP - e35466 VL - 5 IS - 4 KW - internet addiction KW - mental health KW - parent-child relationship N2 - Background: Parents of adolescents with internet addiction are confronted with their children?s internet problems on a daily basis. Parents may notice that adolescents with addiction may also have emotional and behavioral problems, including impulsivity and violence. Parenting styles have been found to be related to internet addiction. Objective: The purpose of this study is to investigate parents? perspectives on their parenting style, relationship with their child, and the degree of internet addiction and emotional and behavioral problems of their child. Methods: A web survey was conducted with 600 parents of children between the ages of 12 and 17 years, from October 14 to 18, 2021, across Japan. Respondents were recruited by an internet research company and were asked to complete an anonymous online questionnaire. The survey was divided into two groups: 300 parents who answered ?yes? to the question ?Do you think your child is dependent on the internet?? and 300 parents who answered ?no? to that question. Questionnaires were collected until each group had 300 participants. The questionnaire included (1) the Parent-Child Internet Addiction Test (PCIAT), (2) the daily time spent using the internet, (3) the Strengths and Difficulties Questionnaire (SDQ), (4) the Parenting Style and Dimensions Questionnaire (PSDQ), and (5) the Relationship Questionnaire (RQ) measuring self-report attachment style prototypes. Results: Mean scores of the PCIAT and the daily time spent using the internet for the groupwith probable internet addiction were significantly higher than those of the group without probable internet addiction (50%; P<.001). The total difficulties score from the SDQ for the group with probable internet addiction (mean 10.87, SD 5.9) was significantly higher than that for the group without probable internet addiction (mean 8.23, SD 5.64; P<.001). The mean score for authoritarian parenting from the PSDQ for the group with probable internet addiction (mean 2.1, SD 0.58) was significantly higher than that for the group without probable internet addiction (mean 2.1, SD 0.58; P<.001). Regarding the RQ, there were no significant differences between the two groups. Conclusions: Our findings suggest that parents who think their child is addicted to the internet may recognize emotional and behavioral problems of the child and have an authoritarian parenting style. UR - https://pediatrics.jmir.org/2022/4/e35466 UR - http://dx.doi.org/10.2196/35466 UR - http://www.ncbi.nlm.nih.gov/pubmed/36197716 ID - info:doi/10.2196/35466 ER - TY - JOUR AU - You, Yueyue AU - Yang-Huang, Junwen AU - Raat, Hein AU - Van Grieken, Amy PY - 2022/10/4 TI - Social Media Use and Health-Related Quality of Life Among Adolescents: Cross-sectional Study JO - JMIR Ment Health SP - e39710 VL - 9 IS - 10 KW - adolescents KW - social media platforms KW - social media KW - health-related quality of life KW - EuroQol 5-dimension questionnaire, youth version N2 - Background: Using social media is a time-consuming activity of children and adolescents. Health authorities have warned that excessive use of social media can negatively affect adolescent social, physical, and psychological health. However, scientific findings regarding associations between time spent on social media and adolescent health-related quality of life (HRQoL) are not consistent. Adolescents typically use multiple social media platforms. Whether the use of multiple social media platforms impacts adolescent health is unclear. Objective: The aim of this study was to examine the relationship between social media use, including the number of social media platforms used and time spent on social media, and adolescent HRQoL. Methods: We analyzed the data of 3397 children (mean age 13.5, SD 0.4 years) from the Generation R Study, a population-based cohort study in the Netherlands. Children reported the number of social media platforms used and time spent on social media during weekdays and weekends separately. Children?s HRQoL was self-reported with the EuroQol 5-dimension questionnaire?youth version. Data on social media use and HRQoL were collected from 2015 to 2019. Multiple logistic and linear regressions were applied. Results: In this study, 72.6% (2466/3397) of the children used 3 or more social media platforms, and 37.7% (1234/3276) and 58.3% (1911/3277) of the children used social media at least 2 hours per day during weekdays and weekends, respectively. Children using more social media platforms (7 or more platforms) had a higher odds of reporting having some or a lot of problems on ?having pain or discomfort? (OR 1.55, 95% CI 1.20 to 1.99) and ?feeling worried, sad or unhappy? (OR 1.99, 95% CI 1.52 to 2.60) dimensions and reported lower self-rated health (? ?3.81, 95% CI ?5.54 to ?2.09) compared with children who used 0 to 2 social media platforms. Both on weekdays and weekends, children spent more time on social media were more likely to report having some or a lot of problems on ?doing usual activities,? ?having pain or discomfort,? ?feeling worried, sad or unhappy,? and report lower self-rated health (all P<.001). Conclusions: Our findings indicate that using more social media platforms and spending more time on social media were significantly related to lower HRQoL. We recommend future research to study the pathway between social media use and HRQoL among adolescents. UR - https://mental.jmir.org/2022/10/e39710 UR - http://dx.doi.org/10.2196/39710 UR - http://www.ncbi.nlm.nih.gov/pubmed/36194460 ID - info:doi/10.2196/39710 ER - TY - JOUR AU - Setia, Sajita AU - Furtner, Daniel AU - Bendahmane, Mounir AU - Tichy, Michelle PY - 2022/9/14 TI - Success4life Youth Empowerment for Promoting Well-being and Boosting Mental Health: Protocol for an Experimental Study JO - JMIR Res Protoc SP - e38463 VL - 11 IS - 9 KW - learned optimism KW - mind power tool KW - mental health KW - success4life, positive psychology-based interventions, well-being KW - youth empowerment N2 - Background: There is an increasingly alarming worsening of mental health among the youth. There remain significant unmet needs for developing innovative, evidence-based technology?enhanced, positive psychology interventions (PPIs) all-inclusive in targeting psychological distress and risk factors related to high-risk behavior commonly encountered in adolescents. Objective: We aim to assess the effectiveness of a hybrid (incorporating both synchronous and asynchronous learning) and holistic (targeting social and emotional learning and tackling risk factors unique for this age group) PPI, ?success4life youth empowerment,? in improving well-being in the youth. Methods: Students? well-being will be assessed by the 5-item World Health Organization Well-Being Index, and hope will be assessed by the 6-item Children?s Hope Scale at week 0, week 8, and week 10, month 6, and month 12. Any improvement in well-being and hope will be measured, estimating the difference in postintervention (week 8 and week 10) and preintervention (week 0) scores by determining the P value and effect size using appropriate statistical tests. Results: This study includes 2 phases: pilot phase 1, delivered by the creators of the succcess4life youth empowerment modules and platform, and phase 2, which will consist of the estimation of scalability through the recruitment of trainers. We hope to start student recruitment by 2022 and aim to complete the results for phase 1 pilot testing by 2023. Conclusions: We anticipate that a primarily web-based, 10-week holistic PPI can support improvement in the mental wellness of the youth and has the potential for effective scalability. International Registered Report Identifier (IRRID): PRR1-10.2196/38463 UR - https://www.researchprotocols.org/2022/9/e38463 UR - http://dx.doi.org/10.2196/38463 UR - http://www.ncbi.nlm.nih.gov/pubmed/36041997 ID - info:doi/10.2196/38463 ER - TY - JOUR AU - Qasrawi, Radwan AU - Vicuna Polo, Paola Stephanny AU - Abu Al-Halawa, Diala AU - Hallaq, Sameh AU - Abdeen, Ziad PY - 2022/8/31 TI - Assessment and Prediction of Depression and Anxiety Risk Factors in Schoolchildren: Machine Learning Techniques Performance Analysis JO - JMIR Form Res SP - e32736 VL - 6 IS - 8 KW - machine learning KW - depression KW - anxiety KW - schoolchildren KW - school-age children KW - children KW - youth KW - young adult KW - transition-aged youth KW - early childhood education KW - prediction KW - random forest N2 - Background: Depression and anxiety symptoms in early childhood have a major effect on children?s mental health growth and cognitive development. The effect of mental health problems on cognitive development has been studied by researchers for the last 2 decades. Objective: In this paper, we sought to use machine learning techniques to predict the risk factors associated with schoolchildren?s depression and anxiety. Methods: The study sample consisted of 3984 students in fifth to ninth grades, aged 10-15 years, studying at public and refugee schools in the West Bank. The data were collected using the health behaviors schoolchildren questionnaire in the 2013-2014 academic year and analyzed using machine learning to predict the risk factors associated with student mental health symptoms. We used 5 machine learning techniques (random forest [RF], neural network, decision tree, support vector machine [SVM], and naive Bayes) for prediction. Results: The results indicated that the SVM and RF models had the highest accuracy levels for depression (SVM: 92.5%; RF: 76.4%) and anxiety (SVM: 92.4%; RF: 78.6%). Thus, the SVM and RF models had the best performance in classifying and predicting the students? depression and anxiety. The results showed that school violence and bullying, home violence, academic performance, and family income were the most important factors affecting the depression and anxiety scales. Conclusions: Overall, machine learning proved to be an efficient tool for identifying and predicting the associated factors that influence student depression and anxiety. The machine learning techniques seem to be a good model for predicting abnormal depression and anxiety symptoms among schoolchildren, so the deployment of machine learning within the school information systems might facilitate the development of health prevention and intervention programs that will enhance students? mental health and cognitive development. UR - https://formative.jmir.org/2022/8/e32736 UR - http://dx.doi.org/10.2196/32736 UR - http://www.ncbi.nlm.nih.gov/pubmed/35665695 ID - info:doi/10.2196/32736 ER - TY - JOUR AU - Babbage, M. Camilla AU - Jackson, M. Georgina AU - Davies, Bethan E. AU - Nixon, Elena PY - 2022/8/26 TI - Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review JO - JMIR Ment Health SP - e25716 VL - 9 IS - 8 KW - digital health interventions KW - psychological well-being KW - mental well-being KW - mental disorders KW - mental health KW - children and young people KW - self-help KW - systematic review N2 - Background: Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective: The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods: A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results: Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions: The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration: PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz UR - https://mental.jmir.org/2022/8/e25716 UR - http://dx.doi.org/10.2196/25716 UR - http://www.ncbi.nlm.nih.gov/pubmed/36018675 ID - info:doi/10.2196/25716 ER - TY - JOUR AU - Reynard, Sally AU - Dias, Joao AU - Mitic, Marija AU - Schrank, Beate AU - Woodcock, Anne Kate PY - 2022/8/19 TI - Digital Interventions for Emotion Regulation in Children and Early Adolescents: Systematic Review and Meta-analysis JO - JMIR Serious Games SP - e31456 VL - 10 IS - 3 KW - emotion regulation KW - digital interventions KW - youth KW - systematic review KW - meta-analysis KW - children KW - early adolescents KW - serious games KW - training KW - biofeedback KW - mobile phone N2 - Background: Difficulties in emotion regulation are common in adolescence and are associated with poor social and mental health outcomes. However, psychological therapies that promote adaptive emotion regulation may be inaccessible and unattractive to youth. Digital interventions may help address this need. Objective: The aim of this systematic review and meta-analysis was to synthesize evidence on the efficacy, feasibility, and acceptability of emotion regulation digital interventions in children and early adolescents aged 8 to 14 years. Methods: Systematic searches of Web of Science, MEDLINE, PsycINFO, EMBASE, Education Resources Information Centre, ACM Digital Library, and IEEE Xplore up to July 2020 identified 39 studies, of which 11 (28%) were included in the meta-analyses (n=2476 participants). A bespoke tool was used to assess risk of bias. Results: The studies evaluated digital games (27/39, 69%), biofeedback (4/39, 10%), virtual or augmented reality (4/39, 10%), and program or multimedia (4/39, 10%) digital interventions in samples classified as diagnosed, at risk, healthy, and universal. The most consistent evidence came from digital games, which reduced negative emotional experience with a small significant effect, largely in youth at risk of anxiety (Hedges g=?0.19, 95% CI ?0.34 to ?0.04). In general, digital interventions tended to improve emotion regulation, but this effect was not significant (Hedges g=0.19, 95% CI ?0.16 to 0.54). Conclusions: Most feasibility issues were identified in diagnosed youth, and acceptability was generally high across intervention types and samples. Although there is cause to be optimistic about digital interventions supporting the difficulties that youth experience in emotion regulation, the predominance of early-stage development studies highlights the need for more work in this area. UR - https://games.jmir.org/2022/3/e31456 UR - http://dx.doi.org/10.2196/31456 UR - http://www.ncbi.nlm.nih.gov/pubmed/35984681 ID - info:doi/10.2196/31456 ER - TY - JOUR AU - Li, H. Sophie AU - Achilles, R. Melinda AU - Werner-Seidler, Aliza AU - Beames, R. Joanne AU - Subotic-Kerry, Mirjana AU - O'Dea, Bridianne PY - 2022/8/17 TI - Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review JO - JMIR Ment Health SP - e37640 VL - 9 IS - 8 KW - adherence KW - youth KW - digital KW - cognitive behavioral therapy KW - review KW - mobile phone N2 - Background: Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. Objective: This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. Methods: A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. Results: There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. Conclusions: Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. Trial Registration: PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram UR - https://mental.jmir.org/2022/8/e37640 UR - http://dx.doi.org/10.2196/37640 UR - http://www.ncbi.nlm.nih.gov/pubmed/35976180 ID - info:doi/10.2196/37640 ER - TY - JOUR AU - Tuijnman, Anouk AU - Kleinjan, Marloes AU - Olthof, Merlijn AU - Hoogendoorn, Evert AU - Granic, Isabela AU - Engels, CME Rutger PY - 2022/8/17 TI - A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial JO - JMIR Ment Health SP - e26615 VL - 9 IS - 8 KW - depression KW - help-seeking behavior KW - helping behavior KW - health literacy KW - stigma KW - video games KW - adolescence KW - secondary schools KW - mental health KW - digital health N2 - Background: Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. Objective: The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. Methods: A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. Results: Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=?0.53, 95% CI ?1.02 to ?0.03; t179.16=?2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=?0.57, 95% CI ?1.11 to ?0.03; t174.39=?2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). Conclusions: The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. Trial Registration: Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033 International Registered Report Identifier (IRRID): RR2-10.2196/11255 UR - https://mental.jmir.org/2022/8/e26615 UR - http://dx.doi.org/10.2196/26615 UR - http://www.ncbi.nlm.nih.gov/pubmed/35976200 ID - info:doi/10.2196/26615 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Buller, K. Mary PY - 2022/8/3 TI - Posttraining Outcomes, Acceptability, and Technology-Based Delivery of the STAC Bystander Bullying Intervention Teacher Module: Mixed Methods Study JO - JMIR Form Res SP - e40022 VL - 6 IS - 8 KW - teacher bullying interventions KW - technology-based bullying intervention KW - STAC KW - middle school N2 - Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers? attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation. UR - https://formative.jmir.org/2022/8/e40022 UR - http://dx.doi.org/10.2196/40022 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921129 ID - info:doi/10.2196/40022 ER - TY - JOUR AU - Jerrott, Susan AU - Clark, Sharon AU - Chorney, Jill AU - Coulombe, Aimee AU - Wozney, Lori PY - 2022/8/2 TI - Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study JO - JMIR Form Res SP - e35685 VL - 6 IS - 8 KW - text messaging KW - youth KW - mental health KW - waiting list KW - informatics KW - health behavior KW - self-care KW - mental health literacy KW - caregivers KW - transdiagnostic N2 - Background: Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. Objective: To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. Methods: A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. Results: A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% (22/41) and 44%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73%) and would recommend them to others (16/22, 73%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. Conclusions: Results are preliminary but show that brief, core skill?focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention. UR - https://formative.jmir.org/2022/8/e35685 UR - http://dx.doi.org/10.2196/35685 UR - http://www.ncbi.nlm.nih.gov/pubmed/35738559 ID - info:doi/10.2196/35685 ER - TY - JOUR AU - Conley, S. Colleen AU - Raposa, B. Elizabeth AU - Bartolotta, Kate AU - Broner, E. Sarah AU - Hareli, Maya AU - Forbes, Nicola AU - Christensen, M. Kirsten AU - Assink, Mark PY - 2022/7/29 TI - The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis JO - JMIR Ment Health SP - e34254 VL - 9 IS - 7 KW - meta-analysis KW - mental health KW - well-being KW - intervention KW - treatment KW - youth KW - technology KW - smartphone KW - mobile phone KW - app KW - mobile health N2 - Background: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. Conclusions: Overall, this study?s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings. UR - https://mental.jmir.org/2022/7/e34254 UR - http://dx.doi.org/10.2196/34254 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904845 ID - info:doi/10.2196/34254 ER - TY - JOUR AU - Jones, B. Laura AU - Judkowicz, Carolina AU - Hudec, L. Kristen AU - Munthali, J. Richard AU - Prescivalli, Paula Ana AU - Wang, Y. Angel AU - Munro, Lonna AU - Xie, Hui AU - Pendakur, Krishna AU - Rush, Brian AU - Gillett, James AU - Young, Marisa AU - Singh, Diana AU - Todorova, A. Antoaneta AU - Auerbach, P. Randy AU - Bruffaerts, Ronny AU - Gildea, M. Sarah AU - McKechnie, Irene AU - Gadermann, Anne AU - Richardson, G. Chris AU - Sampson, A. Nancy AU - Kessler, C. Ronald AU - Vigo, V. Daniel PY - 2022/7/29 TI - The World Mental Health International College Student Survey in Canada: Protocol for a Mental Health and Substance Use Trend Study JO - JMIR Res Protoc SP - e35168 VL - 11 IS - 7 KW - mental health KW - substance use KW - student health KW - World Mental Health International College Student Initiative KW - Canada KW - Canadian KW - online survey KW - survey KW - questionnaire KW - screen KW - epidemiology KW - depression KW - anxiety KW - trend N2 - Background: The World Health Organization World Mental Health International College Student (WMH-ICS) initiative aims to screen for mental health and substance use problems among postsecondary students on a global scale as well as to develop and evaluate evidence-based preventive and ameliorative interventions for this population. This protocol paper presents the Canadian version of the WMH-ICS survey, detailing the adapted survey instrument, the unique weekly cross-sectional administration, the multitiered recruitment strategy, and the associated risk mitigation protocols. Objective: This paper aims to provide a methodological resource for researchers conducting cross-national comparisons of WMH-ICS data, as well as to serve as a useful guide for those interested in replicating the outlined cross-sectional methodology to better understand how mental health and substance use vary over time among university students. Methods: The online survey is based on the WMH-ICS survey instrument, modified to the Canadian context by the addition of questions pertaining to Canadian-based guidelines and the translation of the survey to Canadian French. The survey is administered through the Qualtrics survey platform and is sent to an independent stratified random sample of 350 students per site weekly, followed by two reminder emails. Upon survey closure every week, a random subsample of 70 nonresponders are followed up with via phone or through a personal email in an effort to decrease nonresponder bias. The survey is accompanied by an extensive risk mitigation protocol that stratifies respondents by the level of need and provides tailored service recommendations, including a facilitated expedited appointment to student counseling services for those at increased risk of suicide. The anticipated sample size is approximately 5500 students per site per year. Results: In February 2020, the Canadian survey was deployed at the University of British Columbia. This was followed by deployment at Simon Fraser University (November 2020), McMaster University (January 2021), and the University of Toronto (January 2022). Data collection at all 4 sites is ongoing. As of May 6, 2022, 29,503 responses have been collected. Conclusions: Based on international collaboration, the Canadian version of the WMH-ICS survey incorporates a novel methodological approach centered on the weekly administration of a comprehensive cross-sectional survey to independent stratified random samples of university students. After 27 months of consecutive survey administration, we have developed and refined a survey protocol that has proven effective in engaging students at four Canadian institutions, allowing us to track how mental health and substance use vary over time using an internationally developed university student survey based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). International Registered Report Identifier (IRRID): RR1-10.2196/35168 UR - https://www.researchprotocols.org/2022/7/e35168 UR - http://dx.doi.org/10.2196/35168 UR - http://www.ncbi.nlm.nih.gov/pubmed/35696337 ID - info:doi/10.2196/35168 ER - TY - JOUR AU - Jani, Payal AU - Song, Nuri AU - Artna, Erin AU - Lyeo, Joonsoo AU - Assam, Ashley AU - Maelzer, Faith AU - Murphy, Andriene AU - Grant, Angelo AU - Archie, Suzanne PY - 2022/6/20 TI - Online Knowledge Translation Program Involving Video Games and University Student?Led Tutorials About Cannabis and Psychosis for Black Youth: Mixed Method Feasibility Study JO - JMIR Form Res SP - e33693 VL - 6 IS - 6 KW - knowledge translation KW - Black youth KW - video game KW - psychosis KW - cannabis use KW - knowledge KW - young adult KW - race KW - demographic KW - minority KW - gaming KW - mental health KW - drug KW - cannabis KW - acceptability KW - feasibility KW - risk N2 - Background: We have piloted a new online knowledge translation (KT) program created to educate youth about cannabis effects, which uniquely focuses on mental health risks for Black youth. Youth are generally unaware of the research linking underage usage and the risk of psychosis. Youth from some Black racialized communities in Ontario may be disproportionately affected and in need of this knowledge. Objective: Because very little is known about the acceptability and feasibility of programs educating Black youth about cannabis and psychosis risk, we evaluated this KT program, which consists of tutorials facilitated by university students and video games. Methods: This mixed methods pilot study evaluates the transfer of knowledge about cannabis and psychosis risk before and after the online KT program and, at the same time, explores participant satisfaction with the program and views about underage use. Eligible participants were youth 16-19 years of age of Black African or Caribbean descent. Trained undergraduate students from McMaster University administered a quiz (psychosis and cannabis test; PCT) to evaluate knowledge before and after the KT program. After playing the psychoeducational video games, participants attended two tutorial group sessions led by undergraduate students. The undergraduate students facilitated the online tutorials about cannabis and psychosis. The tutorials augmented the educational content embedded within the gameplay: participants discussed what they learned from the video games and their understanding of psychosis and the effects of cannabis. In addition, undergraduate students qualitatively analyzed the tutorial discussions for themes, and the prequiz and postquiz scores were analyzed for significant differences in scores. Results: A total of 9 Black youth were recruited and completed this pilot study. The mean PCT scores were 5.67 (SD 1.7) and 7.78 (SD 1.8) before and after the KT program, respectively. There was a significant improvement in scores (P<.05) post-KT program. Thematic analysis of the facilitated tutorials revealed three major themes: video game satisfaction, marijuana and psychosis literacy, and help-seeking awareness. Overall, participants showed an increased awareness and understanding of the subject matter after the gameplay and tutorial intervention. Conclusions: When supplemented with tutorial sessions, the Back to Reality Series shows promise for addressing the gap in knowledge about cannabis and psychosis, and the results provide preliminary evidence that the games appeal to Black youth. UR - https://formative.jmir.org/2022/6/e33693 UR - http://dx.doi.org/10.2196/33693 UR - http://www.ncbi.nlm.nih.gov/pubmed/35315782 ID - info:doi/10.2196/33693 ER - TY - JOUR AU - Wagner, Birgit AU - Reuter, Laurence AU - van Noort, Maria Betteke PY - 2022/6/14 TI - Internet-Based Prevention Program of Victimization for Youth in Care and Care Leavers (EMPOWER YOUTH): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34706 VL - 11 IS - 6 KW - foster care KW - youth in care KW - victimization KW - prevention KW - online program N2 - Background: The global estimate of the number of children in institutional care is around 5 million, with around 1 million of these children living in Europe. In Germany, about 75,000 children and adolescents find themselves in the foster care system and about 93,000 additional children and adolescents are living in institutions. Traumatic experiences and neglect in childhood are highly prevalent among these youth in care and are related to severe long-term effects. Childhood maltreatment and abuse can increase the risk of future victimization experiences. Although youth in care are at risk of victimization or revictimization, no specific evidence-based prevention program has been designed to address these specific needs. Objective: This study aims to evaluate the efficacy of a newly developed 6-module internet-based prevention program of victimization for youth in care, named EMPOWER YOUTH. Methods: In a randomized controlled trial, the intervention group will be compared to a waiting-list control group with an unblinded 1:1 allocation ratio. Assessments will take place before randomization (baseline) and at follow-up 18 weeks after baseline (ie, 12 weeks after finishing the last module of the program). The primary endpoint is the number of victimization, and online and offline bullying experiences (composite score) at the 18-week follow-up. Secondary endpoints are risk-taking behavior, aggressive tendencies, empathy, prosocial behavior, depressiveness, and loneliness at follow-up. The expected outcome requires a sample size of 156 subjects to achieve a power of 80%. Assuming a 30% dropout rate at follow-up, we require 225 participants to be allocated to the trial. Participants are youth in care, that is, adolescents in foster care, adopted adolescents, or young care leavers aged 14 to 21 years. Results: Ethical approval was granted by the Ethics Committee of the Medical School Berlin in March 2021 (MSB-2021/55). Recruitment started in September 2021 and is planned until November 2022. The results are expected to be published in January 2023. Conclusions: Given the increased likelihood for future victimization experiences among youth in care, there is a strong need for a low-threshold intervention specifically for this high-risk age group. There are no existing nationwide mental health programs exclusively for youth in care in Germany. Trial Registration: German Clinical Trials Register DRKS00024749; https://tinyurl.com/tjaahayw International Registered Report Identifier (IRRID): DERR1-10.2196/34706 UR - https://www.researchprotocols.org/2022/6/e34706 UR - http://dx.doi.org/10.2196/34706 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700035 ID - info:doi/10.2196/34706 ER - TY - JOUR AU - Carney, E. Colleen AU - Carmona, E. Nicole PY - 2022/6/13 TI - Authors? Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on ?Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study? JO - JMIR Form Res SP - e39198 VL - 6 IS - 6 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone KW - smartphone KW - polysomnography UR - https://formative.jmir.org/2022/6/e39198 UR - http://dx.doi.org/10.2196/39198 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699990 ID - info:doi/10.2196/39198 ER - TY - JOUR AU - Tsai, Wan-Tong AU - Liu, Tzung-Liang PY - 2022/6/13 TI - Additional Measurement Approaches for Sleep Disturbances. Comment on ?A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study? JO - JMIR Form Res SP - e35959 VL - 6 IS - 6 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone KW - smartphone KW - polysomnography UR - https://formative.jmir.org/2022/6/e35959 UR - http://dx.doi.org/10.2196/35959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700003 ID - info:doi/10.2196/35959 ER - TY - JOUR AU - Eilert, Nora AU - Wogan, Rebecca AU - Leen, Aisling AU - Richards, Derek PY - 2022/5/12 TI - Internet-Delivered Interventions for Depression and Anxiety Symptoms in Children and Young People: Systematic Review and Meta-analysis JO - JMIR Pediatr Parent SP - e33551 VL - 5 IS - 2 KW - internet-delivered interventions KW - children and young people KW - depression KW - anxiety KW - digital health N2 - Background: Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP). Objective: In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP. Methods: Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol. Results: A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=?0.25, 95% CI ?0.38 to ?0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=?0.27, 95% CI ?0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=?0.01, 95% CI ?0.23 to 0.21; P=.94). Conclusions: The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP. Trial Registration: PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171 UR - https://pediatrics.jmir.org/2022/2/e33551 UR - http://dx.doi.org/10.2196/33551 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551071 ID - info:doi/10.2196/33551 ER - TY - JOUR AU - Zapolski, Tamika AU - Whitener, MacKenzie AU - Khazvand, Shirin AU - Crichlow, Queenisha AU - Revilla, Rebecca AU - Salgado, F. Eduardo AU - Aalsma, Matthew AU - Cyders, Melissa AU - Salyers, Michelle AU - Wu, Wei PY - 2022/5/12 TI - Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e32490 VL - 11 IS - 5 KW - dialectical behavioral therapy KW - adolescents KW - high school KW - intervention KW - teenagers KW - risk-taking behavior KW - impulsivity KW - emotion dysregulation KW - social and emotional learning KW - youth N2 - Background: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school?s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions. International Registered Report Identifier (IRRID): DERR1-10.2196/32490 UR - https://www.researchprotocols.org/2022/5/e32490 UR - http://dx.doi.org/10.2196/32490 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551054 ID - info:doi/10.2196/32490 ER - TY - JOUR AU - Bell, H. Imogen AU - Thompson, Andrew AU - Valentine, Lee AU - Adams, Sophie AU - Alvarez-Jimenez, Mario AU - Nicholas, Jennifer PY - 2022/5/11 TI - Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey JO - JMIR Ment Health SP - e30716 VL - 9 IS - 5 KW - adolescent KW - youth mental health KW - mental health KW - attitude KW - digital technology KW - internet-based interventions KW - digital mental health KW - mental health services KW - clinician KW - mobile phone N2 - Background: There is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies. Objective: This study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients? mental health. Methods: Youth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients. Results: A total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80%) and video chat (69/76, 91%) commonly in clinical practice and found them to be helpful. Approximately 50% (296/609) of the young people used mental health apps, which was significantly less than the clinicians (?23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy. Conclusions: Technology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health. UR - https://mental.jmir.org/2022/5/e30716 UR - http://dx.doi.org/10.2196/30716 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544295 ID - info:doi/10.2196/30716 ER - TY - JOUR AU - Douglass, H. Caitlin AU - Borthwick, Aidan AU - Lim, C. Megan S. AU - Erbas, Bircan AU - Eren, Senem AU - Higgs, Peter PY - 2022/5/10 TI - Social Media and Online Digital Technology Use Among Muslim Young People and Parents: Qualitative Focus Group Study JO - JMIR Pediatr Parent SP - e36858 VL - 5 IS - 2 KW - Muslim KW - social media KW - young adult KW - qualitative research KW - social connection KW - parenting KW - pediatrics KW - digital health KW - youth KW - adolescent KW - parent KW - digital technology KW - user experience KW - mental health KW - psychological effect KW - diverse population KW - COVID-19 N2 - Background: Digital technology and social media use are common among young people in Australia and worldwide. Research suggests that young people have both positive and negative experiences online, but we know little about the experiences of Muslim communities. Objective: This study aims to explore the positive and negative experiences of digital technology and social media use among young people and parents from Muslim backgrounds in Melbourne, Victoria, Australia. Methods: This study involved a partnership between researchers and a not-for-profit organization that work with culturally and linguistically diverse communities. We adopted a participatory and qualitative approach and designed the research in consultation with young people from Muslim backgrounds. Data were collected through in-person and online focus groups with 33 young people aged 16-22 years and 15 parents aged 40-57 years. Data were thematically analyzed. Results: We generated 3 themes: (1) maintaining local and global connections, (2) a paradoxical space: identity, belonging and discrimination, and (3) the digital divide between young Muslims and parents. Results highlighted that social media was an important extension of social and cultural connections, particularly during COVID-19, when people were unable to connect through school or places of worship. Young participants perceived social media as a space where they could establish their identity and feel a sense of belonging. However, participants were also at risk of being exposed to discrimination and unrealistic standards of beauty and success. Although parents and young people shared some similar concerns, there was a large digital divide in online experiences. Both groups implemented strategies to reduce social media use, with young people believing that having short technology-free breaks during prayer and quality family time was beneficial for their mental well-being. Conclusions: Programs that address technology-related harms must acknowledge the benefits of social media for young Muslims across identity, belonging, representation, and social connection. Further research is required to understand how parents and young people can create environments that foster technology-free breaks to support mental well-being. UR - https://pediatrics.jmir.org/2022/2/e36858 UR - http://dx.doi.org/10.2196/36858 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536616 ID - info:doi/10.2196/36858 ER - TY - JOUR AU - Moreno, A. Megan AU - Binger, Kole AU - Zhao, Qianqian AU - Eickhoff, Jens AU - Minich, Matt AU - Uhls, Tehranian Yalda PY - 2022/5/4 TI - Digital Technology and Media Use by Adolescents: Latent Class Analysis JO - JMIR Pediatr Parent SP - e35540 VL - 5 IS - 2 KW - digital technology KW - adolescents KW - latent class analysis KW - social media KW - mobile phone N2 - Background: Digital technology and media use is integral to adolescents? lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use. Objective: The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators. Methods: Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents? Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs. Results: Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3% (1842/3981) were female, 67.8% (2701/3981) were White, and 75% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators. Conclusions: Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support. UR - https://pediatrics.jmir.org/2022/2/e35540 UR - http://dx.doi.org/10.2196/35540 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507401 ID - info:doi/10.2196/35540 ER - TY - JOUR AU - Guemghar, Imane AU - Pires de Oliveira Padilha, Paula AU - Abdel-Baki, Amal AU - Jutras-Aswad, Didier AU - Paquette, Jesseca AU - Pomey, Marie-Pascale PY - 2022/4/19 TI - Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review JO - JMIR Ment Health SP - e36094 VL - 9 IS - 4 KW - social robots KW - socially assistive robots KW - SARs KW - mental health KW - mental health services KW - dementia KW - autism spectrum disorder KW - schizophrenia KW - depression KW - scoping review N2 - Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O?Malley?s framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. UR - https://mental.jmir.org/2022/4/e36094 UR - http://dx.doi.org/10.2196/36094 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438639 ID - info:doi/10.2196/36094 ER - TY - JOUR AU - Shannon, Holly AU - Bush, Katie AU - Villeneuve, J. Paul AU - Hellemans, GC Kim AU - Guimond, Synthia PY - 2022/4/14 TI - Problematic Social Media Use in Adolescents and Young Adults: Systematic Review and Meta-analysis JO - JMIR Ment Health SP - e33450 VL - 9 IS - 4 KW - problematic social media use KW - depression KW - anxiety KW - stress N2 - Background: Technology is ever evolving, with more and more diverse activities becoming possible on screen-based devices. However, participating in a heavy screen-based lifestyle may come at a cost. Our hypothesis was that problematic social media use increased the prevalence of mental health outcomes. Objective: This study seeks to systematically examine problematic social media use in youth and its association with symptoms of depression, anxiety, and stress. Methods: A systematic search was conducted to identify studies in adolescents and young adults, using the databases Engineering Village, Psycinfo, Pubmed, and Web of Science. A total of 18 studies were identified, with a total of 9269 participants in our review and included in the meta-analysis. Results: Our metaregression shows moderate but statistically significant correlations between problematic social media use and depression (r=0.273, P<.001), anxiety (r=0.348, P<.001), and stress (r=0.313, P<.001). We did not find evidence of heterogeneity of these summary correlations by age, gender, or year of publication. Conclusions: This study provides further evidence of the association between problematic social media use and negative mental health among adolescents and young adults and supports future research to focus on the underlying mechanisms of problematic use of social media. Trial Registration: PROSPERO CRD42021222309; https://tinyurl.com/2p9y4bjx UR - https://mental.jmir.org/2022/4/e33450 UR - http://dx.doi.org/10.2196/33450 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436240 ID - info:doi/10.2196/33450 ER - TY - JOUR AU - Silva, Wnurinham AU - Virtanen, Eeva AU - Kajantie, Eero AU - Sebert, Sylvain PY - 2022/4/14 TI - Cognitive Function, Mental Health, and Quality of Life in Siblings of Preterm Born Children: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e34987 VL - 11 IS - 4 KW - preterm birth KW - birth weight KW - siblings KW - cognitive KW - mental health KW - quality of life KW - family N2 - Background: Children and adults born preterm are at increased risk of cognitive impairments, mental health disorders, and poorer quality of life. Epidemiological studies have shown that the impact of preterm birth extends to the immediate family members; however, existing research have focused on parents, and little attention has been given to siblings. Objective: The aim of the systematic review described in this protocol is to synthesize currently available evidence on the impact of exposure to preterm birth (ie, having a sibling born preterm) on cognition, mental health, and quality of life of term born siblings (index child) of preterm born children, and to critically appraise the evidence. Methods: This protocol outlines a systematic review designed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist. We will include all studies that assess outcomes in siblings of children born preterm. Quantitative and qualitative studies will be eligible for the systematic review, and only studies in English will be included. Firstly, search will be conducted electronically on PubMed, Scopus, Embase, Mednar, and opengrey.eu databases and, secondly, manually in Google Scholar and reference lists. The search strategy will include keywords and synonyms, Boolean operators, and text words (ie, within title and abstract). The team of reviewers will screen the search results, extract data from eligible studies, and critically appraise the studies. Analysis will involve both descriptive and quantitative approaches. Meta-analysis will be conducted if appropriate. Results: This systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) on December 18, 2020, and it is currently in progress. The findings will be synthesized to determine the effect of preterm birth on full-term siblings and the quality of the available evidence. Conclusions: The evidence derived from this study will shed light on gaps and limitations in the field of preterm birth, more specifically, the effect of preterm birth on full-term siblings. In addition, we hope that understanding the impact of preterm birth on family members will inform targeted interventions and policies for those identified at high risk and how to mitigate health risks. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021222887; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222887 International Registered Report Identifier (IRRID): DERR1-10.2196/34987 UR - https://www.researchprotocols.org/2022/4/e34987 UR - http://dx.doi.org/10.2196/34987 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436229 ID - info:doi/10.2196/34987 ER - TY - JOUR AU - Korpilahti-Leino, Tarja AU - Luntamo, Terhi AU - Ristkari, Terja AU - Hinkka-Yli-Salomäki, Susanna AU - Pulkki-Råback, Laura AU - Waris, Otto AU - Matinolli, Hanna-Maria AU - Sinokki, Atte AU - Mori, Yuko AU - Fukaya, Mami AU - Yamada, Yuko AU - Sourander, Andre PY - 2022/4/13 TI - Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study JO - J Med Internet Res SP - e26438 VL - 24 IS - 4 KW - adolescent KW - anxiety KW - child KW - cognitive behavioral therapy KW - coping KW - COVID-19 KW - Internet KW - mental health KW - parents KW - web-based N2 - Background: The COVID-19 pandemic has had a major impact on families? daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children?s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let?s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program?s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children?s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. UR - https://www.jmir.org/2022/4/e26438 UR - http://dx.doi.org/10.2196/26438 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138265 ID - info:doi/10.2196/26438 ER - TY - JOUR AU - Wickersham, Alice AU - Barack, Tamara AU - Cross, Lauren AU - Downs, Johnny PY - 2022/4/11 TI - Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e29842 VL - 24 IS - 4 KW - adolescent KW - anxiety KW - depression KW - meta-analysis N2 - Background: Depression and anxiety are major public health concerns among adolescents. Computerized cognitive behavioral therapy (cCBT) has emerged as a potential intervention, but its efficacy in adolescents remains unestablished. Objective: This review aimed to systematically review and meta-analyze findings on the efficacy of cCBT for the treatment of adolescent depression and anxiety. Methods: Embase, PsycINFO, and Ovid MEDLINE were systematically searched for randomized controlled trials in English, which investigated the efficacy of cCBT for reducing self-reported depression or anxiety in adolescents aged 11 to 19 years. Titles, abstracts, and full texts were screened for eligibility by 2 independent researchers (TB and LC). A random-effects meta-analysis was conducted to pool the effects of cCBT on depression and anxiety symptom scores compared with the control groups. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool. Results: A total of 16 randomized controlled trials were eligible for inclusion in this review, of which 13 (81%) were included in the meta-analysis. The quality of the studies was mixed, with 5 (31%) studies rated as good overall, 2 (13%) rated as fair, and 9 (56%) rated as poor. Small but statistically significant effects of cCBT were detected, with cCBT conditions showing lower symptom scores at follow-up compared with control conditions for both anxiety (standardized mean difference ?0.21, 95% CI ?0.33 to ?0.09; I2=36.2%) and depression (standardized mean difference ?0.23, 95% CI ?0.39 to ?0.07; I2=59.5%). Secondary analyses suggested that cCBT may be comparable with alternative, active interventions (such as face-to-face therapy or treatment as usual). Conclusions: This meta-analysis reinforces the efficacy of cCBT for the treatment of anxiety and depression and is the first to examine this exclusively in adolescents. Future research could aim to identify the active components of these interventions toward optimizing their development and increasing the feasibility and acceptability of cCBT in this age group. Trial Registration: PROSPERO CRD42019141941; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941 UR - https://www.jmir.org/2022/4/e29842 UR - http://dx.doi.org/10.2196/29842 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404263 ID - info:doi/10.2196/29842 ER - TY - JOUR AU - O'Sullivan, Shaunagh AU - Schmaal, Lianne AU - D'Alfonso, Simon AU - Toenders, Jo Yara AU - Valentine, Lee AU - McEnery, Carla AU - Bendall, Sarah AU - Nelson, Barnaby AU - Gleeson, F. John AU - Alvarez-Jimenez, Mario PY - 2022/4/7 TI - Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis JO - JMIR Ment Health SP - e29211 VL - 9 IS - 4 KW - digital intervention KW - digital health KW - youth mental health KW - psychotic disorders KW - clustering KW - usage metrics KW - log data KW - social networking N2 - Background: Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in use makes it difficult to determine which components lead to improved treatment outcomes. Objective: This study aims to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention for first-episode psychosis that incorporates therapeutic content and social networking, along with clinical, vocational, and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective is to compare each user profile with young people receiving treatment as usual (TAU). Methods: Participants comprised 82 young people (aged 16-27 years) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. In addition, 6-month use data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression, and anxiety were assessed at baseline and 6-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes and between each user profile with TAU. Results: A total of 3 user profiles were identified based on the following system use metrics: low use, maintained use of social components, and maintained use of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F2,51=3.58; P=.04), negative symptoms (F2,51=4.45; P=.02), and overall psychiatric symptom severity (F2,50=3.23; P=.048) compared with the other user profiles. This group also showed improvements in social functioning (F1,62=4.68; P=.03), negative symptoms (F1,62=14.61; P<.001), and overall psychiatric symptom severity (F1,63=5.66; P=.02) compared with the TAU group. Conversely, the maintained social group showed increases in anxiety compared with the TAU group (F1,57=7.65; P=.008). No differences were found between the low use group and the TAU group on treatment outcomes. Conclusions: Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social use and low use outcomes were broadly comparable with TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits. UR - https://mental.jmir.org/2022/4/e29211 UR - http://dx.doi.org/10.2196/29211 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389351 ID - info:doi/10.2196/29211 ER - TY - JOUR AU - Thabrew, Hiran AU - Chubb, A. Laura AU - Kumar, Harshali AU - Fouché, Christa PY - 2022/3/25 TI - Immersive Reality Experience Technology for Reducing Social Isolation and Improving Social Connectedness and Well-being of Children and Young People Who Are Hospitalized: Open Trial JO - JMIR Pediatr Parent SP - e29164 VL - 5 IS - 1 KW - immersive reality experiences KW - social isolation KW - hospitalized children KW - well-being KW - social connectedness KW - immersive reality KW - virtual reality KW - serious games KW - pediatrics KW - mental health KW - isolation KW - hospitalized patients KW - adolescents N2 - Background: Children and young people who are hospitalized can feel disconnected from their peers and families, which can, in turn, predispose them to psychological problems, including anxiety and depression. Immersive reality experience technology, recently developed by the New Zealand Patience Project Charitable Trust, may help to overcome these issues. Immersive reality experience technology uses immersive 360° live streaming and a virtual reality headset to enable children and young people who are hospitalized to connect through cameras located in either their school or home environment and via SMS text messaging with a designated buddy. Objective: This trial aims to expand qualitative findings from a previous smaller proof of concept trial to ascertain the views of New Zealand children and young people who are hospitalized, their caregivers, and teachers regarding immersive reality experience technology and quantitatively evaluate the effectiveness of immersive reality experience technology in reducing social isolation and improving social connectedness and well-being using validated outcome measures. Methods: An open trial of immersive reality experience technology was conducted between December 2019 and December 2020 for which 19 New Zealand children and young people aged 13 to 18 years who had been hospitalized at Starship Hospital?a specialist pediatric hospital in Auckland?for at least 2 weeks were recruited. All young people completed the Short Warwick?Edinburgh Mental Well-Being Scale, an abbreviated version of the Social Connectedness Scale, and the Social Inclusion Scale at baseline. Of the 19 participants, 10 (53%) used immersive reality experience technology as often as they wished over a 6-week period and completed postintervention measures. Semistructured interviews with a subset of the 10 young people, 4 caregivers, and 6 teachers were conducted immediately after the intervention. Results: Participants reported improvements in social inclusion (mean change 3.9, SD 2.8; P=.06), social connectedness (mean change 14.2, SD 10.0; P=.002), and well-being (mean change 5.7, SD 4.0; P=.001). Key themes from interviews with participants, caregivers, and teachers were the importance of support for using immersive reality experience technology, connecting versus connectedness, choice and connection, and the value of setting it up and getting it right. Recommendations for improving connectedness via immersive reality experience and related technologies were also provided. Conclusions: Immersive reality experience technology can improve the social inclusion, social connectedness, and well-being of New Zealand children and young people who are hospitalized. With some technological modifications and simplified implementation, immersive reality experience and related technology could become part of standard care and support children and young people who are hospitalized in New Zealand and elsewhere to sustain family and peer cohesion, experience fewer psychological problems, and more easily return to normal life following the completion of treatment. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12619000252112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376837&isReview=true UR - https://pediatrics.jmir.org/2022/1/e29164 UR - http://dx.doi.org/10.2196/29164 UR - http://www.ncbi.nlm.nih.gov/pubmed/35333184 ID - info:doi/10.2196/29164 ER - TY - JOUR AU - Tatham, Iona AU - Clarke, Ellisiv AU - Grieve, Ann Kelly AU - Kaushal, Pulkit AU - Smeddinck, Jan AU - Millar, Barron Evelyn AU - Sharma, Narain Aditya PY - 2022/3/23 TI - Process and Outcome Evaluations of Smartphone Apps for Bipolar Disorder: Scoping Review JO - J Med Internet Res SP - e29114 VL - 24 IS - 3 KW - child and adolescent mental health KW - scoping review KW - bipolar disorder KW - mental health N2 - Background: Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated. Objective: This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies. Methods: A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD. Results: Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD. Conclusions: Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD. UR - https://www.jmir.org/2022/3/e29114 UR - http://dx.doi.org/10.2196/29114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319470 ID - info:doi/10.2196/29114 ER - TY - JOUR AU - Claesdotter-Knutsson, Emma AU - André, Frida AU - Fridh, Maria AU - Delfin, Carl AU - Håkansson, Anders AU - Lindström, Martin PY - 2022/3/17 TI - Gender Differences and Associated Factors Influencing Problem Gambling in Adolescents in Sweden: Cross-sectional Investigation JO - JMIR Pediatr Parent SP - e35207 VL - 5 IS - 1 KW - gambling KW - cross-sectional study KW - adolescents KW - sleep KW - alcohol KW - smoking KW - pediatrics KW - parenting KW - mental health KW - addiction KW - children N2 - Background: Although gambling disorder is traditionally considered an adult phenomenon, the behavior usually begins in childhood or adolescence. Objective: The aim of this study was to explore the frequency of problem gambling among Swedish adolescents and the suspected associated factors. Methods: This study was based on data collected through a public health survey distributed in 2016 to pupils in ninth grade of primary school and in second grade of secondary school in Sweden. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of the associated factors differed between those with and without problem gambling. Results: Approximately 11.7% (469/4002) of the boys in ninth grade of primary school and 13.9% (472/3407) of the boys in second grade of secondary school were classified as problem gamblers. For girls, the corresponding frequencies were 1.2% (48/4167) and 0.7% (27/3634), respectively. The overall response rate was 77% (9143/11,868) among ninth grade pupils and 73.4% (7949/10,832) among second grade pupils, resulting in a total of 17,092 responses. Problem gambling was associated with poor sleep and having tried smoking, alcohol, and other substances among both boys and girls in ninth grade of primary school and boys in second grade of secondary school. Problem gambling among girls in second grade of secondary school was associated with an increased prevalence of having tried smoking and other substances and an increased prevalence of poor sleep. Conclusions: Using a large representative sample of Swedish adolescents, we found that problem gambling was robustly associated with a substantially increased prevalence of poor sleep and having tried smoking, alcohol, and other substances among both boys and girls in ninth grade of primary school as well as among boys in second grade of secondary school. Our study adds important information for policy makers pointing at vulnerable groups to be considered in their work to prevent problem gambling. UR - https://pediatrics.jmir.org/2022/1/e35207 UR - http://dx.doi.org/10.2196/35207 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297770 ID - info:doi/10.2196/35207 ER - TY - JOUR AU - ?orgo, Andrej AU - Crnkovi?, Nu?a AU - Gabrovec, Branko AU - Cesar, Katarina AU - Selak, ?pela PY - 2022/3/15 TI - Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study JO - J Med Internet Res SP - e30778 VL - 24 IS - 3 KW - online study KW - stress KW - COVID-19 KW - postsecondary students KW - pandemic KW - epidemiology KW - educational institutions KW - online education KW - pedagogy KW - mental health N2 - Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students? mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study?related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students? negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. UR - https://www.jmir.org/2022/3/e30778 UR - http://dx.doi.org/10.2196/30778 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171098 ID - info:doi/10.2196/30778 ER - TY - JOUR AU - Dewa, H. Lindsay AU - Roberts, Lily AU - Lawrance, Emma AU - Ashrafian, Hutan PY - 2022/3/11 TI - Authors? Reply to: Toward a Better Understanding of Quality Social Connections. Comment on ?Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis? JO - J Med Internet Res SP - e37440 VL - 24 IS - 3 KW - mental health KW - digital interventions KW - young people KW - quality social connection KW - depression KW - anxiety KW - systematic review KW - meta-analysis KW - patient and public involvement KW - mobile phone UR - https://www.jmir.org/2022/3/e37440 UR - http://dx.doi.org/10.2196/37440 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275072 ID - info:doi/10.2196/37440 ER - TY - JOUR AU - Deng, Huachu AU - Qin, Xingan PY - 2022/3/11 TI - Toward a Better Understanding of Quality Social Connections. Comment on ?Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis? JO - J Med Internet Res SP - e36739 VL - 24 IS - 3 KW - mental health KW - digital interventions KW - young people KW - quality social connection KW - depression KW - anxiety KW - systematic review KW - meta-analysis KW - patient and public involvement KW - mobile phone UR - https://www.jmir.org/2022/3/e36739 UR - http://dx.doi.org/10.2196/36739 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275073 ID - info:doi/10.2196/36739 ER - TY - JOUR AU - Vaingankar, Ajit Janhavi AU - van Dam, M. Rob AU - Samari, Ellaisha AU - Chang, Sherilyn AU - Seow, Esmond AU - Chua, Chian Yi AU - Luo, Nan AU - Verma, Swapna AU - Subramaniam, Mythily PY - 2022/3/4 TI - Social Media?Driven Routes to Positive Mental Health Among Youth: Qualitative Enquiry and Concept Mapping Study JO - JMIR Pediatr Parent SP - e32758 VL - 5 IS - 1 KW - teens KW - young adults KW - concept mapping KW - mental well-being KW - digital media KW - social media KW - mental health KW - social support KW - mental health promotion KW - self-expression N2 - Background: Social media influence almost every aspect of our lives by facilitating instant many-to-many communication and self-expression. Recent research suggests strong negative and positive impacts of social media exposure on youth mental health; however, there has been more emphasis on harmful relationships. Objective: Given the limited research on the benefits of social media for mental health, this qualitative study explored the lived experiences of youth to understand how social media use can contribute to positive mental health among youth. Methods: Using an interpretivist epistemological approach, 25 semistructured interviews and 11 focus group discussions were conducted with male and female youth of different ethnicities (aged 15 to 24 years) residing in Singapore, who were recruited through purposive sampling from the community. We conducted inductive thematic analysis and concept mapping to address the research aims. Results: We found that youth engaged in a wide range of activities on social media from connecting with family and friends to participating in global movements, and these served as avenues for building positive mental health. Based on participants? narratives, our analysis suggested that positive mental health among youth could be influenced by 3 features of social media consumption (connection with friends and their global community, engagement with social media content, and the value of social media as an outlet for expression). Through these, pathways leading to the following 5 positive mental health components were identified: (1) positive relationships and social capital, (2) self-concept, (3) coping, (4) happiness, and (5) other relevant aspects of mental health (for example, positivity and personal growth). Conclusions: The study results highlight the integral role of social media in the lives of today?s youth and indicate that they can offer opportunities for positive influence, personal expression, and social support, thus contributing to positive mental health among youth. The findings of our research can be applied to optimize engagement with youth through social media and enhance the digital modes of mental health promotion. UR - https://pediatrics.jmir.org/2022/1/e32758 UR - http://dx.doi.org/10.2196/32758 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254285 ID - info:doi/10.2196/32758 ER - TY - JOUR AU - Schriger, H. Simone AU - Klein, R. Melanie AU - Last, S. Briana AU - Fernandez-Marcote, Sara AU - Dallard, Natalie AU - Jones, Bryanna AU - Beidas, S. Rinad PY - 2022/3/3 TI - Community Mental Health Clinicians? Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Pediatr Parent SP - e29250 VL - 5 IS - 1 KW - telehealth KW - COVID-19 KW - evidence-based practice KW - community mental health KW - trauma-focused cognitive behavioral therapy KW - implementation science KW - youth mental health N2 - Background: In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians? experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective: We examined community mental health clinicians? perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods: We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists? responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results: Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions: First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services. UR - https://pediatrics.jmir.org/2022/1/e29250 UR - http://dx.doi.org/10.2196/29250 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023839 ID - info:doi/10.2196/29250 ER - TY - JOUR AU - Cena, Loredana AU - Rota, Matteo AU - Trainini, Alice AU - Zecca, Sara AU - Bonetti Zappa, Sofia AU - Tralli, Nella AU - Stefana, Alberto PY - 2022/2/25 TI - Investigating Adolescents? Video Gaming and Gambling Activities, and Their Relationship With Behavioral, Emotional, and Social Difficulties: Protocol for a Multi-Informant Study JO - JMIR Res Protoc SP - e33376 VL - 11 IS - 2 KW - adolescents KW - gaming disorder KW - gambling disorder KW - pathological video gaming KW - pathological gambling N2 - Background: Growing empirical evidence suggests that adolescents have a relatively greater propensity to develop problematic video gaming or gambling habits. Objective: The main objectives of this study are to estimate the prevalence of potential pathological gambling and video game use among adolescent students and to evaluate their risk factors. Methods: This is a cross-sectional multi-informant study based on an online survey. It will include a sample of adolescents attending secondary schools located in Brescia, northern Italy, their schoolteachers, and parents. The survey includes extensive data on adolescents? (1) demographic, social, economic, and environmental characteristics; (2) behavioral, emotional, and social problems and adaptive functioning; (3) emotional and social loneliness; (4) perception of the reasons to use social networks; (5) video game habits and pathological use of video gaming; and (6) gambling behaviors. Results: This protocol was approved by the Institutional Ethics Board of the Spedali Civili of Brescia (Italy). We expect to collect data from 793 or more adolescent students, as determined by our sample size calculation. Conclusions: This multisite project will make a substantial contribution to (1) the implementation of a system for identifying pathological gambling and pathological video game use among adolescents, allowing for interventions aimed at improving adolescents? financial, emotional, and social well-being; and (2) the identification of distinct profiles of gamblers and pathological video gamers that will contribute to setting up effective targeted prevention measures. Understanding the causes and impact of gambling and pathological video gaming on adolescents is a public health issue. International Registered Report Identifier (IRRID): DERR1-10.2196/33376 UR - https://www.researchprotocols.org/2022/2/e33376 UR - http://dx.doi.org/10.2196/33376 UR - http://www.ncbi.nlm.nih.gov/pubmed/35212638 ID - info:doi/10.2196/33376 ER - TY - JOUR AU - Sun, Zeyuan AU - Zhou, Yue AU - Zhang, Yinan AU - Gui, Bing AU - Liu, Zhenmi PY - 2022/2/21 TI - Exploring Deeper Causes Linking Adolescents? Mental Disorders to Mobile Phone Use Problems: Grounded Theory Approach JO - JMIR Form Res SP - e31089 VL - 6 IS - 2 KW - mobile phone use KW - adolescent health KW - mental disorder N2 - Background: Evidence from a variety of studies link mobile phone use with an increase in mental health problems, with the situation being particularly prevalent in China and exacerbated by the COVID-19 quarantine. Objective: This study aims to reveal underlying connections between mobile phone use and mental disorders of adolescents, and to develop a theory to help parents and counseling psychologists better understand and intervene in future cases. Methods: A total of 37 teenagers having both mental health and mobile phone use problems, along with their parents, were included for individual interviews. These interviews were transcribed, coded, and analyzed using qualitative methods of grounded theory. Results: The grades-ranking-first mentality is one of the main factors causing problems such as defective family bonding and peer influences, pushing teenagers with mental disorders to seek comfort in the virtual world through their cellphones. Conclusions: The idea proposed in this study is not only inspiring for psychological counseling and therapy on adolescents with mental problems but also beneficial for school educators and parents to better understand the adolescents. The findings of the study are also particularly noteworthy in the postpandemic age, where parents whose work locations and schedules are substantially affected due to any emergencies should try to build a relaxing and cozy atmosphere at home to avoid possible conflicts with adolescents. UR - https://formative.jmir.org/2022/2/e31089 UR - http://dx.doi.org/10.2196/31089 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188470 ID - info:doi/10.2196/31089 ER - TY - JOUR AU - Macam, Reyes Samantha AU - Mack, Wendy AU - Palinkas, Lawrence AU - Kipke, Michele AU - Javier, Rivera Joyce PY - 2022/2/17 TI - Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e21867 VL - 11 IS - 2 KW - Filipino KW - mental health KW - prevention KW - parenting practices KW - community health N2 - Background: Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. Objective: The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. Methods: This study uses a randomized controlled 2-arm individually randomized group treatment pretest?posttest design for 180 parent?child dyads. Individuals are eligible if they are ?18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics? Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. Results: Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. Conclusions: Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. Trial Registration: ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170 International Registered Report Identifier (IRRID): DERR1-10.2196/21867 UR - https://www.researchprotocols.org/2022/2/e21867 UR - http://dx.doi.org/10.2196/21867 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175200 ID - info:doi/10.2196/21867 ER - TY - JOUR AU - Freebairn, Louise AU - Occhipinti, Jo-An AU - Song, C. Yun Ju AU - Skinner, Adam AU - Lawson, Kenny AU - Lee, Yeeun Grace AU - Hockey, J. Samuel AU - Huntley, Samantha AU - Hickie, B. Ian PY - 2022/2/7 TI - Participatory Methods for Systems Modeling of Youth Mental Health: Implementation Protocol JO - JMIR Res Protoc SP - e32988 VL - 11 IS - 2 KW - participatory system modeling KW - youth mental health KW - co-design KW - public health systems research KW - mental health services N2 - Background: Despite significant investment, mental health issues remain a leading cause of death among young people globally. Sophisticated decision analysis methods are needed to better understand the dynamic and multisector drivers of youth mental health. System modeling can help explore complex issues such as youth mental health and inform strategies to effectively respond to local needs and achieve lasting improvements. The advantages of engaging stakeholders in model development processes have long been recognized; however, the methods for doing so are often not well-described. Objective: This paper aims to describe the participatory procedures that will be used to support systems modeling for national multisite implementation. The Right Care, First Time, Where You Live research program will focus on regional youth mental health applications of systems modeling in 8 different sites across Australia. Methods: The participatory model development approach involves an iterative process of engaging with a range of participants, including people with lived experience of mental health issues. Their knowledge of the local systems, pathways, and drivers is combined with the academic literature and data to populate the models and validate their structure. The process centers around 3 workshops where participants interact and actively engage in group model-building activities to define, refine, and validate the systems models. This paper provides a detailed blueprint for the implementation of this process for mental health applications. Results: The participatory modeling methods described in this paper will be implemented at 2 sites per year from 2022 to 2025. The 8 selected sites have been chosen to capture variations in important factors, including determinants of mental health issues and access to services. Site engagement commenced in August 2021, and the first modeling workshops are scheduled to commence in February 2022. Conclusions: Mental health system decision makers require tools to help navigate complex environments and leverage interdisciplinary problem-solving. Systems modeling can mobilize data from diverse sources to explore a range of scenarios, including the impact of interventions in different combinations and contexts. Involving stakeholders in the model development process ensures that the model findings are context-relevant and fit-for-purpose to inform decision-making. International Registered Report Identifier (IRRID): PRR1-10.2196/32988 UR - https://www.researchprotocols.org/2022/2/e32988 UR - http://dx.doi.org/10.2196/32988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129446 ID - info:doi/10.2196/32988 ER - TY - JOUR AU - Lucassen, G. Mathijs F. AU - Samra, Rajvinder AU - Rimes, A. Katharine AU - Brown, E. Katherine AU - Wallace, M. Louise PY - 2022/2/1 TI - Promoting Resilience and Well-being Through Co-design (The PRIDE Project): Protocol for the Development and Preliminary Evaluation of a Prototype Resilience-Based Intervention for Sexual and Gender Minority Youth JO - JMIR Res Protoc SP - e31036 VL - 11 IS - 2 KW - LGBT KW - e-therapy KW - depression KW - adolescent KW - youth KW - online KW - sexuality KW - gender KW - resilience KW - public health N2 - Background: Sexual and gender minority youth (SGMY) are at an increased risk of a range of mental health problems. However, few evidence-informed interventions have been developed specifically to support their mental well-being. Interventions that are evidence-informed for the general population and are fine-tuned specifically with SGMY in mind proffer considerable potential. A particular opportunity lies in the delivery of engaging interventions on the web, where the focus is on enhancing the coping skills and building the resilience of SGMY, in a way that is directly relevant to their experiences. On the basis of earlier work related to an intervention called Rainbow SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), we seek to create a new resource, especially for SGMY in the United Kingdom. Objective: This project has 3 main objectives. First, together with SGMY as well as key adult experts, we aim to co-design a media-rich evidence-informed web-based SGMY well-being prototype toolkit aimed at those aged between 13 and 19 years. Second, we will explore how the web-based toolkit can be used within public health systems in the United Kingdom by SGMY and potentially other relevant stakeholders. Third, we aim to conduct a preliminary evaluation of the toolkit, which will inform the design of a future effectiveness study. Methods: The first objective will be met by conducting the following: approximately 10 interviews with SGMY and 15 interviews with adult experts, a scoping review of studies focused on psychosocial coping strategies for SGMY, and co-design workshops with approximately 20 SGMY, which will inform the creation of the prototype toolkit. The second objective will be met by carrying out interviews with approximately 5 selected adult experts and 10 SGMY to explore how the toolkit can be best used and to determine the parameters and user-generated standards for a future effectiveness trial. The final objective will be met with a small-scale process evaluation, using the think out loud methodology, conducted with approximately 10 SGMY. Results: The study commenced on September 1, 2021, and data gathering for phase 1 began in October 2021. Conclusions: A considerable body of work has described the issues faced by the SGMY. However, there is a dearth of research seeking to develop interventions for SGMY so that they can thrive. This project aims to co-design such an intervention. Trial Registration: Research Registry Reference researchregistry6815; https://www.researchregistry.com/browse-the-registry#home/registrationdetails/609e81bda4a706001c94b63a/ International Registered Report Identifier (IRRID): PRR1-10.2196/31036 UR - https://www.researchprotocols.org/2022/2/e31036 UR - http://dx.doi.org/10.2196/31036 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103613 ID - info:doi/10.2196/31036 ER - TY - JOUR AU - Gansner, Meredith AU - Nisenson, Melanie AU - Lin, Vanessa AU - Pong, Sovannarath AU - Torous, John AU - Carson, Nicholas PY - 2022/1/28 TI - Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e33114 VL - 9 IS - 1 KW - COVID-19 KW - problematic internet use KW - ecological momentary assessment KW - internet KW - app KW - youth KW - young adult KW - teenager KW - outpatient KW - mental health KW - treatment KW - pilot KW - cohort KW - change N2 - Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many ?in-person? coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple?s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. UR - https://mental.jmir.org/2022/1/e33114 UR - http://dx.doi.org/10.2196/33114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089157 ID - info:doi/10.2196/33114 ER - TY - JOUR AU - Lockwood, Joanna AU - Williams, Laura AU - Martin, L. Jennifer AU - Rathee, Manjul AU - Hill, Claire PY - 2022/1/24 TI - Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivering Exposure-Based Cognitive Behavioral Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study JO - JMIR Ment Health SP - e29008 VL - 9 IS - 1 KW - anxiety KW - children KW - exposure therapy KW - cognitive behavioral therapy KW - immersive gaming KW - digital intervention KW - app KW - smartphone KW - mobile phone N2 - Background: Childhood anxiety disorders are a prevalent mental health problem that can be treated effectively with cognitive behavioral therapy, in which exposure is a key component; however, access to treatment is poor. Mobile-based apps on smartphones or tablets may facilitate the delivery of evidence-based therapy for child anxiety, thereby overcoming the access and engagement barriers of traditional treatment. Apps that deliver therapeutic content via immersive gaming technology could offer an effective, highly engaging, and flexible treatment proposition. Objective: In this paper, we aim to describe a preliminary multi-method evaluation of Lumi Nova, a mobile app intervention targeting mild to moderate anxiety problems in children aged 7-12 years using exposure therapy delivered via an immersive game. The primary objective is to evaluate the effectiveness, user engagement and experience, and safety of the beta version of Lumi Nova. Methods: Lumi Nova was co-designed with children, parents, teachers, clinicians, game industry experts, and academic partnerships. In total, 120 community-based children with mild to moderate anxiety and their guardians were enrolled to participate in an 8-week pilot study. The outcome measures captured the app?s effectiveness (anxiety symptoms, child-identified goal-based outcomes, and functional impairment), user engagement (game play data and ease-of-use ratings), and safety (mood ratings and adverse events). The outcome measures before and after the intervention were available for 30 children (age: mean 9.8, SD 1.7 years; girls: 18/30, 60%; White: 24/30, 80%). Additional game play data were automatically generated for 67 children (age: mean 9.6, SD 1.53 years; girls: 35/67, 52%; White: 42/67, 63%). Postintervention open-response data from 53% (16/30) of guardians relating to the primary objectives were also examined. Results: Playing Lumi Nova was effective in reducing anxiety symptom severity over the 8-week period of game play (t29=2.79; P=.009; Cohen d=0.35) and making progress toward treatment goals (z=2.43; P=.02), but there were no improvements in relation to functional impairment. Children found it easy to play the game and engaged safely with therapeutic content. However, the positive effects were small, and there were limitations to the game play data. Conclusions: This preliminary study provides initial evidence that an immersive mobile game app may safely benefit children experiencing mild to moderate anxiety. It also demonstrates the value of the rigorous evaluation of digital interventions during the development process to rapidly improve readiness for full market launch. UR - https://mental.jmir.org/2022/1/e29008 UR - http://dx.doi.org/10.2196/29008 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072644 ID - info:doi/10.2196/29008 ER - TY - JOUR AU - Paz Castro, Raquel AU - Haug, Severin AU - Debelak, Rudolf AU - Jakob, Robert AU - Kowatsch, Tobias AU - Schaub, P. Michael PY - 2022/1/19 TI - Engagement With a Mobile Phone?Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis JO - J Med Internet Res SP - e28638 VL - 24 IS - 1 KW - engagement KW - life skills KW - adolescents KW - mobile phone KW - machine learning KW - decision tree N2 - Background: Mobile phone?delivered life skills programs are an emerging and promising way to promote mental health and prevent substance use among adolescents, but little is known about how adolescents actually use them. Objective: The aim of this study is to determine engagement with a mobile phone?based life skills program and its different components, as well as the associations of engagement with adolescent characteristics and intended substance use and mental health outcomes. Methods: We performed secondary data analysis on data from the intervention group (n=750) from a study that compared a mobile phone?based life skills intervention for adolescents recruited in secondary and upper secondary school classes with an assessment-only control group. Throughout the 6-month intervention, participants received 1 SMS text message prompt per week that introduced a life skills topic or encouraged participation in a quiz or individual life skills training or stimulated sharing messages with other program participants through a friendly contest. Decision trees were used to identify predictors of engagement (use and subjective experience). The stability of these decision trees was assessed using a resampling method and by graphical representation. Finally, associations between engagement and intended substance use and mental health outcomes were examined using logistic and linear regression analyses. Results: The adolescents took part in half of the 50 interactions (mean 23.6, SD 15.9) prompted by the program, with SMS text messages being the most used and contests being the least used components. Adolescents who did not drink in a problematic manner and attended an upper secondary school were the ones to use the program the most. Regarding associations between engagement and intended outcomes, adolescents who used the contests more frequently were more likely to be nonsmokers at follow-up than those who did not (odds ratio 0.86, 95% CI 0.76-0.98; P=.02). In addition, adolescents who read the SMS text messages more attentively were less likely to drink in a problematic manner at follow-up (odds ratio 0.43, 95% CI 1.29-3.41; P=.003). Finally, participants who used the program the most and least were more likely to increase their well-being from baseline to 6-month follow-up compared with those with average engagement (?s=.39; t586=2.66; P=.008; R2=0.24). Conclusions: Most of the adolescents participating in a digital life skills program that aimed to prevent substance use and promote mental health engaged with the intervention. However, measures to increase engagement in problem drinkers should be considered. Furthermore, efforts must be made to ensure that interventions are engaging and powerful across different educational levels. First results indicate that higher engagement with digital life skills programs could be associated with intended outcomes. Future studies should apply further measures to improve the reach of lower-engaged participants at follow-up to establish such associations with certainty. UR - https://www.jmir.org/2022/1/e28638 UR - http://dx.doi.org/10.2196/28638 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044309 ID - info:doi/10.2196/28638 ER - TY - JOUR AU - Moltrecht, Bettina AU - Patalay, Praveetha AU - Bear, Alice Holly AU - Deighton, Jessica AU - Edbrooke-Childs, Julian PY - 2022/1/19 TI - A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned JO - JMIR Form Res SP - e28300 VL - 6 IS - 1 KW - mHealth KW - participatory design KW - emotion regulation KW - interdisciplinary development KW - child mental health N2 - Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient?clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children?s mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. UR - https://formative.jmir.org/2022/1/e28300 UR - http://dx.doi.org/10.2196/28300 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044312 ID - info:doi/10.2196/28300 ER - TY - JOUR AU - Poon, Kean PY - 2022/1/17 TI - Effects of Aerobic Exercise and High-Intensity Interval Training on the Mental Health of Adolescents Living in Poverty: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34915 VL - 11 IS - 1 KW - adolescents KW - mental health KW - exercise KW - socioeconomic status KW - intervention N2 - Background: The increasing rate of mental health issues among adolescents has recently been a considerable concern in Hong Kong. In particular, adolescents with low socioeconomic status (SES) are likely to experience poor mental health, including low self-esteem and high levels of anxiety, anger, and depression. Previous research has found that physical activities have a positive impact on improving mental health outcomes among adolescents. However, approximately 96% of adolescents in Hong Kong do not engage in regular exercise, which potentially increases the risk of poor mental health. Objective: In this study, we aim to examine whether changes in the 3 indicators (reduced ill-being, enhanced well-being, and cognitive functions) of mental health among adolescents with low SES are evident before and after exercise. In addition, this study compares the effectiveness of aerobic exercise and high-intensity interval training on these indicators among adolescents with low SES. Methods: A total of 78 participants from low-income families aged between 12 and 15 years from 3 to 4 secondary schools will be recruited for this study. They will be randomly assigned to either an aerobic exercise group (26/78, 33%), a high-intensity interval training group (26/78, 33%), or a control group (26/78, 33%). Participants in the first 2 groups will take part in a 10-week training program period. Participants in the control group will participate in other physical activities during the same intervention period. The training sessions will be conducted 3 times per week on nonconsecutive days. A range of neuropsychological tests and psychometric scales will be used to measure the executive functions and indicators of psychological well-being and ill-being, including enjoyment, self-efficacy, mood, depression, anxiety, and stress at pretest, posttest, and follow-up assessments. Results: The project was funded in 2021 by the Research Matching Grant Scheme, through the University Grants Committee of the Hong Kong Special Administrative Region Government. Ethical approval has been obtained from the author?s institution. Participant recruitment will begin in January 2022 and continue through to April 2022. Data collection and follow-up are expected to be completed by the end of 2022. The results are expected to be submitted for publication in 2023. Conclusions: The findings will help inform policy makers and practitioners in promoting the importance of physical exercise to enhance mental health. Trial Registration: ClinicalTrials.gov NCT050293888; https://clinicaltrials.gov/ct2/show/record/NCT05029388 International Registered Report Identifier (IRRID): PRR1-10.2196/34915 UR - https://www.researchprotocols.org/2022/1/e34915 UR - http://dx.doi.org/10.2196/34915 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037892 ID - info:doi/10.2196/34915 ER - TY - JOUR AU - Burn, Anne-Marie AU - Ford, J. Tamsin AU - Stochl, Jan AU - Jones, B. Peter AU - Perez, Jesus AU - Anderson, K. Joanna PY - 2022/1/10 TI - Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study JO - JMIR Form Res SP - e30565 VL - 6 IS - 1 KW - mental health KW - assessment KW - young people KW - youth KW - schools KW - computerized adaptive testing KW - mobile apps KW - user-centered design KW - coproduction KW - qualitative study N2 - Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles?an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. UR - https://formative.jmir.org/2022/1/e30565 UR - http://dx.doi.org/10.2196/30565 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006079 ID - info:doi/10.2196/30565 ER - TY - JOUR AU - Kang-Yi, D. Christina AU - Page, Amy PY - 2022/1/5 TI - Purpose Formulation, Coalition Building, and Evidence Use in Public?Academic Partnerships: Web-Based Survey Study JO - JMIR Hum Factors SP - e29288 VL - 9 IS - 1 KW - use of research evidence KW - public care policy KW - public?academic partnership KW - partnership purpose formulation KW - partnership coalition building KW - youth mental health and well-being N2 - Background: Partnerships between academic institutions and public care agencies (public?academic partnerships [PAPs]) can promote effective policy making and care delivery. Public care agencies are often engaged in PAPs for evidence-informed policy making in health care. Previous research has reported essential partnership contextual factors and mechanisms that promote evidence-based policy making and practice in health care. However, the studies have not yet informed whether public care agency leaders? and academic researchers? perceptions of partnership purpose formulation and coalition building evolve through the PAP life cycle and whether public care agency leaders? use of research evidence differs through life cycle stages. Objective: This exploratory study aims to focus on PAPs designed to improve youth mental health and well-being outcomes. This study also aims to identify public care agency leaders? and academic researchers? perceptions of PAP purpose formulation (structure, goals, primary function, and agenda-setting process) and coalition building (mutual benefits, trust, convener?s role, member role clarity, and conflict management) by PAP life cycle stage and examine whether public care agency leaders? use of research evidence differs according to the perception of PAP purpose formulation and coalition building through the PAP life cycle. Methods: A web-based survey of PAP experience was conducted by recruiting academic researchers (n=40) and public care agency leaders (n=26) who were engaged in PAPs for the past 10 years. Public care agency leaders additionally participated in the survey of the Structured Interview for Evidence Use scale (n=48). Results: Most public care agency leaders and academic researchers in PAPs formed, matured, and sustained perceived their PAP as having purpose formulation context well aligned with their organizational purpose formulation context, pursuing mutual benefits, having leadership representation and role clarity, having a higher level of trust, and knowing how to handle conflicts. Most PAPs across all life cycle stages crystallized another issue to focus, but not all PAPs with issue crystallization had purpose reformulation. Public care agency leaders who trusted academic researchers in their PAP had greater use of research evidence. Public care agency leaders in PAPs that had gone through new issue crystallization also showed greater use of research evidence compared with those that had not. Conclusions: To promote public care agency leaders? use of research evidence, focusing on developing trusting partnerships and continuously crystallizing PAP issues are important. International Registered Report Identifier (IRRID): RR2-10.2196/14382 UR - https://humanfactors.jmir.org/2022/1/e29288 UR - http://dx.doi.org/10.2196/29288 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989678 ID - info:doi/10.2196/29288 ER - TY - JOUR AU - Adams, Zachary AU - Grant, Miyah AU - Hupp, Samantha AU - Scott, Taylor AU - Feagans, Amanda AU - Phillips, Lois Meredith AU - Bixler, Kristina AU - Nallam, Teja Phani AU - La Putt, Dorothy PY - 2021/12/24 TI - Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design JO - JMIR Form Res SP - e30268 VL - 5 IS - 12 KW - mobile health KW - user-centered design KW - adolescents KW - substance use disorders KW - mental health KW - mHealth KW - cognitive behavioral therapy KW - homework KW - technology acceptance model KW - trauma KW - mobile phone N2 - Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. UR - https://formative.jmir.org/2021/12/e30268 UR - http://dx.doi.org/10.2196/30268 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951593 ID - info:doi/10.2196/30268 ER - TY - JOUR AU - Dewa, H. Lindsay AU - Lawrance, Emma AU - Roberts, Lily AU - Brooks-Hall, Ellie AU - Ashrafian, Hutan AU - Fontana, Gianluca AU - Aylin, Paul PY - 2021/12/17 TI - Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis JO - J Med Internet Res SP - e26584 VL - 23 IS - 12 KW - mental health KW - digital interventions KW - young people KW - quality social connection KW - depression KW - anxiety KW - systematic review KW - meta-analysis KW - patient and public involvement KW - mobile phone N2 - Background: Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. Objective: The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. Methods: A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. Results: Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (?25.6%, 95% CI ?0.352 to ?0.160; P<.001) and anxiety (?15.1%, 95% CI ?0.251 to ?0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. Conclusions: D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations. UR - https://www.jmir.org/2021/12/e26584 UR - http://dx.doi.org/10.2196/26584 UR - http://www.ncbi.nlm.nih.gov/pubmed/34927592 ID - info:doi/10.2196/26584 ER - TY - JOUR AU - Martinez, Kim AU - Menéndez-Menéndez, Isabel Maria AU - Bustillo, Andres PY - 2021/12/16 TI - Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review JO - JMIR Serious Games SP - e30482 VL - 9 IS - 4 KW - serious games KW - depression KW - anxiety KW - children KW - adolescents KW - virtual reality KW - mental health KW - detection KW - awareness KW - prevention KW - therapy N2 - Background: Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. Objective: This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. Methods: The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. Results: A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. Conclusions: The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology. UR - https://games.jmir.org/2021/4/e30482 UR - http://dx.doi.org/10.2196/30482 UR - http://www.ncbi.nlm.nih.gov/pubmed/34927589 ID - info:doi/10.2196/30482 ER - TY - JOUR AU - Davies, M. Sian AU - Jardine, Jenni AU - Gutridge, Kerry AU - Bernard, Zara AU - Park, Stephen AU - Dawson, Tom AU - Abel, M. Kathryn AU - Whelan, Pauline PY - 2021/12/13 TI - Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study JO - JMIR Form Res SP - e30668 VL - 5 IS - 12 KW - digital mental health KW - acceptability KW - feasibility KW - child and adolescent mental health and well-being KW - school-based mental health care KW - prevention KW - digital assessment and monitoring KW - reading screening or ability N2 - Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (?1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. UR - https://formative.jmir.org/2021/12/e30668 UR - http://dx.doi.org/10.2196/30668 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898446 ID - info:doi/10.2196/30668 ER - TY - JOUR AU - Mcgeough, Julienne AU - Gallagher-Mitchell, Thomas AU - Clark, Andrew Dan Philip AU - Harrison, Neil PY - 2021/12/7 TI - Reliability and Confirmatory Factor Analysis (CFA) of a Paper- Versus App-Administered Resilience Scale in Scottish Youths: Comparative Study JO - JMIR Mhealth Uhealth SP - e11055 VL - 9 IS - 12 KW - resilience KW - psychometrics KW - app administration KW - cyberpsychology N2 - Background: Adequately measuring resilience is important to support young people and children who may need to access resources through social work or educational settings. A widely accepted measure of youth resilience has been developed previously and has been shown to be suitable for vulnerable youth. While the measure is completed by the young person on paper, it has been designed to be worked through with a teacher or social worker in case further clarification is required. However, this method is time consuming and, when faced with large groups of pupils who need assessment, can be overwhelming for schools and practitioners. This study assesses app software with a built-in avatar that can guide young persons through the assessment and its interpretation. Objective: Our primary objective is to compare the reliability and psychometric properties of a mobile software app to a paper version of the Child and Youth Resilience measure (CYRM-28). Second, this study assesses the use of the CYRM-28 in a Scottish youth population (aged 11-18 years). Methods: Following focus groups and discussion with teachers, social workers, and young people, an avatar was developed by a software company and integrated into an android smartphone app designed to ask questions via the device?s inbuilt text-to-voice engine. In total, 714 students from 2 schools in North East Scotland completed either a paper version or app version of the CYRM-28. A cross-sectional design was used, and students completed their allocated version twice, with a 2-week period in between each testing. All participants could request clarification either from a guidance teacher (paper version) or from the in-built software glossary (app version). Results: Test and retest correlations showed that the app version performed better than the paper version of the questionnaire (paper version: r303=0.81; P<.001; 95% CI 0.77-0.85; app version: r413=0.84; P<.001; 95% CI 0.79-0.89). Fisher r to z transformation revealed a significant difference in the correlations (Z=?2.97, P<.01). Similarly, Cronbach ? in both conditions was very high (app version: ?=.92; paper version: ?=.87), suggesting item redundancy. Ordinarily, this would lead to a possible removal of highly correlated items; however, our primary objective was to compare app delivery methods over a pen-and-paper mode and was hence beyond the scope of the study. Fisher r to z transformation revealed a significant difference in the correlations (Z=?3.69, P<.01). A confirmatory factor analysis supported the 3-factor solution (individual, relational, and contextual) and reported a good model fit (?215=27.6 [n=541], P=.24). Conclusions: ALEX, an avatar with an integrated voice guide, had higher reliability when measuring resilience than a paper version with teacher assistance. The CFA reports similar structure using the avatar when compared against the original validation. UR - https://mhealth.jmir.org/2021/12/e11055 UR - http://dx.doi.org/10.2196/11055 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878995 ID - info:doi/10.2196/11055 ER - TY - JOUR AU - Lal, Shalini AU - Gleeson, F. John AU - D'Alfonso, Simon AU - Etienne, Geraldine AU - Joober, Ridha AU - Lepage, Martin AU - Lee, Hajin AU - Alvarez-Jimenez, Mario PY - 2021/12/7 TI - A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2) JO - JMIR Res Protoc SP - e28141 VL - 10 IS - 12 KW - psychotic disorders KW - mental health KW - telemedicine KW - young adult KW - mental health services KW - e?mental health KW - virtual care KW - schizophrenia KW - eHealth KW - social support KW - therapy KW - psychiatry KW - psychology N2 - Background: Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. Objective: In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). Methods: This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. Results: This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. Conclusions: This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. Trial Registration: ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105 International Registered Report Identifier (IRRID): RR1-10.2196/28141 UR - https://www.researchprotocols.org/2021/12/e28141 UR - http://dx.doi.org/10.2196/28141 UR - http://www.ncbi.nlm.nih.gov/pubmed/34879000 ID - info:doi/10.2196/28141 ER - TY - JOUR AU - Schick, Anita AU - Paetzold, Isabell AU - Rauschenberg, Christian AU - Hirjak, Dusan AU - Banaschewski, Tobias AU - Meyer-Lindenberg, Andreas AU - Boehnke, R. Jan AU - Boecking, Benjamin AU - Reininghaus, Ulrich PY - 2021/12/3 TI - Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e27462 VL - 10 IS - 12 KW - experience sampling methodology (ESM) KW - ecological momentary assessment (EMA) KW - mobile intervention KW - at-risk individuals KW - smartphone training KW - blended care KW - mental health KW - stress reactivity KW - mobile phone N2 - Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. Objective: This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth?EMIcompass. Methods: In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. Results: The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. Conclusions: This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial Registration: German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): DERR1-10.2196/27462 UR - https://www.researchprotocols.org/2021/12/e27462 UR - http://dx.doi.org/10.2196/27462 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870613 ID - info:doi/10.2196/27462 ER - TY - JOUR AU - Jolliff, Anna AU - Zhao, Qianqian AU - Eickhoff, Jens AU - Moreno, Megan PY - 2021/12/2 TI - Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Form Res SP - e30702 VL - 5 IS - 12 KW - COVID-19 KW - pandemic KW - adolescent KW - depression KW - anxiety KW - socioeconomic status KW - survey KW - mental health N2 - Background: The COVID-19 pandemic has resulted in significant changes to adolescents? daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. Objective: This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. Methods: Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants? age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. Results: The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. Conclusions: In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative. UR - https://formative.jmir.org/2021/12/e30702 UR - http://dx.doi.org/10.2196/30702 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609316 ID - info:doi/10.2196/30702 ER - TY - JOUR AU - Piqueras, A. Jose AU - Vidal-Arenas, Verónica AU - Falcó, Raquel AU - Moreno-Amador, Beatriz AU - Marzo, C. Juan AU - Holcomb, M. Juliana AU - Murphy, Michael PY - 2021/12/1 TI - Short Form of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y): Spanish Validation Study JO - J Med Internet Res SP - e31127 VL - 23 IS - 12 KW - PSC-17-Y KW - psychometric properties KW - screening KW - mental problems KW - adolescents KW - adolescent health KW - adolescent medicine KW - psychiatry KW - psychology KW - psychosocial issues N2 - Background: The short form, 17-item version of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y) is a validated measure that assesses psychosocial problems overall (OVR) and in 3 major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5-10 min to complete. Prior research has established sound psychometric properties of the PSC-17-Y for English speakers. Objective: This study extends psychometric evidence for the acceptability of the PSC-17-Y in a large sample of Spanish adolescents, providing proof of its reliability and structure, convergent and discriminant validity, and longitudinal and gender invariance. Methods: Data were collected on 5430 adolescents, aged 12-18 years, who filled out the PSC-17-Y twice during 2018-2019 (7-month interval). We calculated the Cronbach alpha and the McDonald omega coefficients to test reliability, the Pearson correlation for convergent (distress) and criterion validity (well-being, quality of life, and socioemotional skills), confirmatory factor analysis (CFA) for structure validity, and multigroup and longitudinal measurement invariance analysis for longitudinal and gender stability. Results: Within structural analysis for the PSC-17-Y, CFA supported a correlated 3-factor solution, which was also invariant longitudinally and across gender. All 3 subscales showed evidence of reliability, with coefficients near or above .70. Moreover, scores of PSC-17-Y subscales were positively related with convergent measures and negatively related with criterion measures. Normative data for the PSC-17-Y are presented in the form of percentiles (75th and 90th). Conclusions: This work provides the first evidence of the reliability and validity of the Spanish version of the PSC-17-Y administered over the internet to assess mental health problems among adolescents, maintaining the same domains as the long version. UR - https://www.jmir.org/2021/12/e31127 UR - http://dx.doi.org/10.2196/31127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855614 ID - info:doi/10.2196/31127 ER - TY - JOUR AU - Domhardt, Matthias AU - Engler, Sophie AU - Nowak, Hannah AU - Lutsch, Arne AU - Baumel, Amit AU - Baumeister, Harald PY - 2021/11/26 TI - Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review JO - J Med Internet Res SP - e29742 VL - 23 IS - 11 KW - children and adolescents KW - mental disorders KW - mediator KW - mechanisms of change KW - digital health intervention KW - psychotherapy KW - mobile phone N2 - Background: Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective: This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods: A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results: A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions: The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future. UR - https://www.jmir.org/2021/11/e29742 UR - http://dx.doi.org/10.2196/29742 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842543 ID - info:doi/10.2196/29742 ER - TY - JOUR AU - Kiekens, Glenn AU - Robinson, Kealagh AU - Tatnell, Ruth AU - Kirtley, J. Olivia PY - 2021/11/19 TI - Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility JO - JMIR Ment Health SP - e30915 VL - 8 IS - 11 KW - real-time monitoring KW - nonsuicidal self-injury KW - NSSI KW - experience sampling KW - ecological momentary assessment KW - digital psychiatry UR - https://mental.jmir.org/2021/11/e30915 UR - http://dx.doi.org/10.2196/30915 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807835 ID - info:doi/10.2196/30915 ER - TY - JOUR AU - Martel, Rhiannon AU - Shepherd, Matthew AU - Goodyear-Smith, Felicity PY - 2021/11/19 TI - Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review JO - JMIR Ment Health SP - e30479 VL - 8 IS - 11 KW - adolescent KW - mental health KW - risk behavior KW - screening KW - primary care N2 - Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases?MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews?were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. UR - https://mental.jmir.org/2021/11/e30479 UR - http://dx.doi.org/10.2196/30479 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807833 ID - info:doi/10.2196/30479 ER - TY - JOUR AU - Suffoletto, Brian AU - Goldstein, Tina AU - Brent, David PY - 2021/11/9 TI - A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial JO - JMIR Form Res SP - e30580 VL - 5 IS - 11 KW - adolescent KW - depression KW - help seeking KW - text message KW - intervention N2 - Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care. Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers. Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks. Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care. Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation. UR - https://formative.jmir.org/2021/11/e30580 UR - http://dx.doi.org/10.2196/30580 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751665 ID - info:doi/10.2196/30580 ER - TY - JOUR AU - Malamsha, Proches Maria AU - Sauli, Elingarami AU - Luhanga, Talina Edith PY - 2021/11/8 TI - Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study JO - JMIR Serious Games SP - e30350 VL - 9 IS - 4 KW - child sexual abuse KW - social cultural belief KW - ecological setting KW - prevention KW - parents KW - caretakers KW - child experts KW - mobile game N2 - Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa?where sexual education is still taboo?that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods:  HappyToto children?s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game?s interface, storylines, and options. To validate the application?s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. UR - https://games.jmir.org/2021/4/e30350 UR - http://dx.doi.org/10.2196/30350 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747703 ID - info:doi/10.2196/30350 ER - TY - JOUR AU - Wang, Jie AU - Wang, Xin AU - Wang, Lei AU - Peng, Yan PY - 2021/11/8 TI - Health Information Needs of Young Chinese People Based on an Online Health Community: Topic and Statistical Analysis JO - JMIR Med Inform SP - e30356 VL - 9 IS - 11 KW - information needs KW - young people KW - online health community KW - topic analysis N2 - Background: The internet has been widely accessible and well accepted by young people; however, there is a limited understanding of the internet usage patterns and characteristics on issues related to health problems. The contents posted on online health communities (OHCs) are valuable resources to learn about youth's health information needs. Objective: In this study, we concurrently exploited statistical analysis and topic analysis of online health information needs to explore the distribution, impact factors, and topics of interest relevant to Chinese young people. Methods: We collected 60,478 health-related data sets posted by young people from a well-known Chinese OHC named xywy.com. Descriptive statistical analysis and correlation analysis were applied to find the distribution and influence factors of the information needs of Chinese young people. Furthermore, a general 4-step topic mining strategy was presented for sparse short texts, which included sentence vectorization, dimension reduction, clustering, and keyword generation. Results: In the Chinese OHC, Chinese young people had a high demand for information in the areas of gynecology and obstetrics, internal medicine, dermatology, plastic surgery, and surgery, and they focused on topics such as treatment, symptoms, causes, pathology, and diet. Females accounted for 69.67% (42,136/60,478) and young adults accounted for 87.44% (52,882/60,478) of all data. Gender, age, and disease type all had a significant effect on young people's information needs and topic preferences (P<.001). Conclusions: We conducted comprehensive analyses to discover the online health information needs of Chinese young people. The research findings are of great practical value to carry out health education and health knowledge dissemination inside and outside of schools according to the interests of youth, enable the innovation of information services in OHCs, and improve the health literacy of young people. UR - https://medinform.jmir.org/2021/11/e30356 UR - http://dx.doi.org/10.2196/30356 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747707 ID - info:doi/10.2196/30356 ER - TY - JOUR AU - Kaiser, Sabine AU - Martinussen, Monica AU - Adolfsen, Frode AU - Breivik, Kyrre AU - Kyrrestad, Henriette PY - 2021/11/8 TI - An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31789 VL - 10 IS - 11 KW - cyberbullying KW - intervention KW - mobile app KW - adolescents KW - NettOpp KW - mental health KW - health care N2 - Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 UR - https://www.researchprotocols.org/2021/11/e31789 UR - http://dx.doi.org/10.2196/31789 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747704 ID - info:doi/10.2196/31789 ER - TY - JOUR AU - Calvo-Valderrama, Gabriela Maria AU - Marroquín-Rivera, Arturo AU - Burn, Erin AU - Ospina-Pinillos, Laura AU - Bird, Victoria AU - Gómez-Restrepo, Carlos PY - 2021/11/3 TI - Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study JO - JMIR Form Res SP - e30293 VL - 5 IS - 11 KW - pandemic KW - COVID-19 KW - online focus groups KW - qualitative research KW - technology KW - adolescents KW - public health N2 - Background: Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective: The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods: As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results: Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions: OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings. UR - https://formative.jmir.org/2021/11/e30293 UR - http://dx.doi.org/10.2196/30293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34637395 ID - info:doi/10.2196/30293 ER - TY - JOUR AU - Lilja, Lotten Josefine AU - Rupcic Ljustina, Mirna AU - Nissling, Linnea AU - Larsson, Caroline Anna AU - Weineland, Sandra PY - 2021/11/1 TI - Youths? and Parents? Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study JO - JMIR Pediatr Parent SP - e26842 VL - 4 IS - 4 KW - internet KW - CBT KW - cognitive behavioral therapy KW - adolescents KW - parents KW - anxiety KW - primary care KW - mixed methods KW - experiences KW - youths KW - digital health N2 - Background: Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people?s interest in internet treatment or the attitudes they and their parents have toward it. Objective: This study aims to investigate adolescents? and parents? attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects. Methods: The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment. Results: The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms (?22=8.333; P=.02) and that adolescents? motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths? need for autonomy while also engaging with them in the treatment work. Conclusions: Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist?s role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment. UR - https://pediatrics.jmir.org/2021/4/e26842 UR - http://dx.doi.org/10.2196/26842 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723830 ID - info:doi/10.2196/26842 ER - TY - JOUR AU - Carmona, E. Nicole AU - Usyatynsky, Aleksandra AU - Kutana, Samlau AU - Corkum, Penny AU - Henderson, Joanna AU - McShane, Kelly AU - Shapiro, Colin AU - Sidani, Souraya AU - Stinson, Jennifer AU - Carney, E. Colleen PY - 2021/11/1 TI - A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study JO - JMIR Form Res SP - e25392 VL - 5 IS - 11 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone N2 - Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz?s with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode?4) on the items ?easy to use,? ?easy to understand,? ?time commitment,? and ?overall satisfaction? and was rated as credible (mode?4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 UR - https://formative.jmir.org/2021/11/e25392 UR - http://dx.doi.org/10.2196/25392 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723820 ID - info:doi/10.2196/25392 ER - TY - JOUR AU - MacLeod, Lucy AU - Suruliraj, Banuchitra AU - Gall, Dominik AU - Bessenyei, Kitti AU - Hamm, Sara AU - Romkey, Isaac AU - Bagnell, Alexa AU - Mattheisen, Manuel AU - Muthukumaraswamy, Viswanath AU - Orji, Rita AU - Meier, Sandra PY - 2021/10/26 TI - A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study JO - JMIR Mhealth Uhealth SP - e20638 VL - 9 IS - 10 KW - mobile sensing KW - youth KW - psychiatry KW - feasibility KW - mobile phone N2 - Background: Internalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier. Objective: This study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada. Methods: In this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants. Results: More severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=?0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=?0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit. Conclusions: Passively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on. UR - https://mhealth.jmir.org/2021/10/e20638 UR - http://dx.doi.org/10.2196/20638 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698650 ID - info:doi/10.2196/20638 ER - TY - JOUR AU - Moon, C. Khatiya AU - Van Meter, R. Anna AU - Kirschenbaum, A. Michael AU - Ali, Asra AU - Kane, M. John AU - Birnbaum, L. Michael PY - 2021/10/22 TI - Internet Search Activity of Young People With Mood Disorders Who Are Hospitalized for Suicidal Thoughts and Behaviors: Qualitative Study of Google Search Activity JO - JMIR Ment Health SP - e28262 VL - 8 IS - 10 KW - suicide KW - mood disorders KW - depression KW - internet KW - search engine KW - Google search KW - digital health KW - mobile health KW - adolescent KW - young adult N2 - Background: Little is known about the internet search activity of people with suicidal thoughts and behaviors (STBs). This data source has the potential to inform both clinical and public health efforts, such as suicide risk assessment and prevention. Objective: We aimed to evaluate the internet search activity of suicidal young people to find evidence of suicidal ideation and behavioral health?related content. Methods: Individuals aged between 15 and 30 years (N=43) with mood disorders who were hospitalized for STBs provided access to their internet search history. Searches that were conducted in the 3-month period prior to hospitalization were extracted and manually evaluated for search themes related to suicide and behavioral health. Results: A majority (27/43, 63%) of participants conducted suicide-related searches. Participants searched for information that exactly matched their planned or chosen method of attempting suicide in 21% (9/43) of cases. Suicide-related search queries also included unusual suicide methods and references to suicide in popular culture. A majority of participants (33/43, 77%) had queries related to help-seeking themes, including how to find inpatient and outpatient behavioral health care. Queries related to mood and anxiety symptoms were found among 44% (19/43) of participants and included references to panic disorder, the inability to focus, feelings of loneliness, and despair. Queries related to substance use were found among 44% (19/43) of participants. Queries related to traumatic experiences were present among 33% (14/43) of participants. Few participants conducted searches for crisis hotlines (n=3). Conclusions: Individuals search the internet for information related to suicide prior to hospitalization for STBs. The improved understanding of the search activity of suicidal people could inform outreach, assessment, and intervention strategies for people at risk. Access to search data may also benefit the ongoing care of suicidal patients. UR - https://mental.jmir.org/2021/10/e28262 UR - http://dx.doi.org/10.2196/28262 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677139 ID - info:doi/10.2196/28262 ER - TY - JOUR AU - Parker, L. Belinda AU - Anderson, Melissa AU - Batterham, J. Philip AU - Gayed, Aimee AU - Subotic-Kerry, Mirjana AU - Achilles, R. Melinda AU - Chakouch, Cassandra AU - Werner-Seidler, Aliza AU - Whitton, E. Alexis AU - O?Dea, Bridianne PY - 2021/10/22 TI - Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators? Skills in Adolescent Mental Health) Program JO - JMIR Ment Health SP - e29989 VL - 8 IS - 10 KW - mental health KW - training KW - high school teachers KW - youth KW - mental health programs KW - secondary schools N2 - Background: Secondary schools are increasingly supporting adolescents? mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators? skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers? knowledge and confidence in caring for students? mental health. Objective: This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers. Methods: A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants? perceptions of program effectiveness. Results: A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness. Conclusions: Findings indicated that a web-based training program may be beneficial for improving secondary school teachers? abilities to care for students? mental health; however, program modifications are required to increase training completions. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529 UR - https://mental.jmir.org/2021/10/e29989 UR - http://dx.doi.org/10.2196/29989 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677134 ID - info:doi/10.2196/29989 ER - TY - JOUR AU - Livanou, Maria AU - Lane, Rebecca PY - 2021/10/22 TI - Assessing the Feasibility of a Multicenter Transition Intervention Model Across Adolescent Secure Services in England (MOVING FORWARD): Protocol for a Feasibility Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e29273 VL - 10 IS - 10 KW - transition KW - intervention KW - young people KW - feasibility cluster randomized trial KW - cluster randomized controlled trial KW - secure hospitals KW - outcomes KW - adolescents KW - patients N2 - Background: Young people moving from adolescent secure inpatient units to adult care in the United Kingdom have multiple and complex needs and are more likely to experience poor transition outcomes. Poorly managed transitions can lead to enduring use and dependency on mental health services. However, there is a lack of knowledge about the feasibility of transitional care models. Objective: This paper presents the protocol for a study that aims to test a feasibility cluster randomized controlled trial for young people transitioning from adolescent secure services to adult-oriented settings. The overarching aim of the MOVING FORWARD study is to provide a preliminary estimate of the effectiveness and cost-effectiveness of a new transition intervention model and to inform a future full-scale cluster randomized controlled trial. Methods: The design of the study is a 3-arm feasibility cluster randomized controlled trial comparing the MOVING FORWARD intervention against standard transition preparation conducted at 6 adolescent secure services, of which 4 units will receive the intervention and 2 will serve as controls. Eligible young people between 17-19 years, their parents/carers, and key workers will be invited to participate. Young people and parents/carers will be allocated to two conditions (young people alone and young people with a parent/carer) and will receive 4 transition preparation workshops across 6 months. Six adolescent secure hospitals will be randomly allocated, stratified by area and service type. Data will be collected at 3 time points: baseline (T0), 6-12 months postintervention (T1), and 18-24 months postbaseline (T2). Primary and secondary outcomes will be based on assessment measures and interviews conducted at T1 and T2. Results: A total of 13 young people and 17 staff members have contributed to the intervention design through online advisory groups on the design of the study and important themes for transition. We have also consulted members of the public (a steering group) including 2 young people who have transitioned to the community and 2 parents/carers. Common identified themes included appropriateness of module content and support during delayed transitions. The content of the intervention will be finalized during the first 6 months of the study. Participants will be recruited over the course of 6 months. An intraclass correlation coefficient will be calculated to inform the power of the sample size for a further large-scale trial. With a sample size of 50, we will be able to estimate a dropout rate of 80% (95% CI ?11% to 11%). Conclusions: This research will provide practitioners and policy makers with an evidence-based framework of how training and familiarization with the prospective transitions can yield positive outcomes. This study will test whether a psychosocial intervention can be implemented in adolescent secure hospitals. The results will identify barriers and facilitators to the proposed intervention and will enable services to reflect on the quality of transitional care delivery. International Registered Report Identifier (IRRID): PRR1-10.2196/29273 UR - https://www.researchprotocols.org/2021/10/e29273 UR - http://dx.doi.org/10.2196/29273 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677140 ID - info:doi/10.2196/29273 ER - TY - JOUR AU - Kemp, Jessica AU - Chorney, Jill AU - Kassam, Iman AU - MacDonald, Julie AU - MacDonald, Tara AU - Wozney, Lori AU - Strudwick, Gillian PY - 2021/10/19 TI - Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study JO - J Med Internet Res SP - e30491 VL - 23 IS - 10 KW - youth mental health KW - digital mental health KW - COVID-19 KW - digital mental health interventions KW - e-mental health N2 - Background: The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. Objective: A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. Methods: The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content. Results: A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care. Conclusions: As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth. UR - https://www.jmir.org/2021/10/e30491 UR - http://dx.doi.org/10.2196/30491 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665141 ID - info:doi/10.2196/30491 ER - TY - JOUR AU - Mansell, Holly AU - Quinn, Declan AU - Kelly, E. Lauren AU - Szafron, Michael AU - Alcorn, Jane PY - 2021/10/18 TI - Pharmacokinetics and Perceptions of Children and Young Adults Using Cannabis for Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder: Protocol for a Mixed Methods Proof-of-Concept Study JO - JMIR Res Protoc SP - e31281 VL - 10 IS - 10 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - oppositional defiant disorder KW - cannabis KW - cannabidiol KW - young adults KW - youths KW - pharmacokinetics KW - marijuana N2 - Background: Despite the lack of evidence on the use of cannabis for the treatment of attention-deficit/hyperactivity disorder (ADHD), the growing perception that cannabis is safe has led more patients and caregivers to self-medicate. Some psychiatrists now authorize medicinal cannabis for patients with ADHD with features of oppositional defiant disorder (ODD) to curtail the unregulated (ie, self-medicated) use of recreational cannabis or to offer a therapeutic option to those who continue to experience symptoms after exhausting all other treatment options. Objective: This protocol aims to explore the perceived effectiveness and pharmacokinetics of cannabis in youth and young adults, who are currently taking it as part of their treatment plan for ADHD with features of ODD, under the supervision of a psychiatrist. Methods: Patients between the ages of 12 and 25 years with a diagnosis of ADHD and features of ODD, who are currently taking cannabis herbal extract (at a ?9-tetrahydrocannabinol [THC]:cannabidiol [CBD] ratio of 1:20) as a treatment adjunct to stimulant pharmacotherapy will be recruited. A sample size of 10-20 individuals is estimated. The study interview will consist of (1) validated symptom rating scales (Swanson, Nolan, and Pelham-IV Questionnaire [SNAP-IV], 90-item; Patient Health Questionnaire, 9-item [PHQ-9]; and Screen for Child Anxiety Related Emotional Disorders [SCARED] tool to measure symptoms of ADHD and ODD, depression, and anxiety, respectively); (2) a semistructured interview to probe the experiences of using cannabis; and (3) a cannabis side effects survey. A cannabis product sample as well as 2 blood samples (a trough level and 2-hour postdose level) will be collected to measure plasma concentrations of cannabinoids and relevant metabolites (THC, CBD, 11-hydroxy-THC, 7-hydroxy-CBD, cannabichromene, and 11-nor-9-carboxy-THB) using liquid chromatography?tandem mass spectrometry (LC?MS/MS). Self-report rating scales (SNAP-IV, SCARED, and PHQ-9) will be scored in accordance with standard protocols and compared to retrospective scores obtained from the participant?s chart. Demographic variables (age, weight, and race), symptom scores, and blood levels (peaks and troughs) of THC, CBD, cannabichromene (CBC), and metabolites will be summarized using descriptive statistics. Relationships between plasma concentrations and symptom scores will be determined using analysis of variance, and multiple regression analysis will be performed to determine associations between plasma concentrations and demographic variables (age, weight, and ethnicity). The qualitative data will be audio-recorded and transcribed and organized into themes. Results: The protocol was approved by the Biomedical Research Ethics Board at the University of Saskatchewan (protocol #1726), and recruitment began in May 2021. Conclusions: This proof-of-concept study will explore the potential treatment effectiveness of medical cannabis in participants with ADHD and ODD through a mixed methods approach to inform future research in this area. International Registered Report Identifier (IRRID): DERR1-10.2196/31281 UR - https://www.researchprotocols.org/2021/10/e31281 UR - http://dx.doi.org/10.2196/31281 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661540 ID - info:doi/10.2196/31281 ER - TY - JOUR AU - Gonsalves, P. Pattie AU - Sharma, Rhea AU - Hodgson, Eleanor AU - Bhat, Bhargav AU - Jambhale, Abhijeet AU - Weiss, A. Helen AU - Fairburn, G. Christopher AU - Cavanagh, Kate AU - Cuijpers, Pim AU - Michelson, Daniel AU - Patel, Vikram PY - 2021/10/6 TI - A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e30339 VL - 10 IS - 10 KW - randomized controlled trial KW - internet-based intervention KW - smartphone KW - adolescent KW - schools KW - mental health KW - COVID-19 KW - app KW - protocol KW - problem-solving KW - intervention KW - teenager KW - young adult KW - India KW - feasibility KW - effective N2 - Background: ?POD Adventures? is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 UR - https://www.researchprotocols.org/2021/10/e30339 UR - http://dx.doi.org/10.2196/30339 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586075 ID - info:doi/10.2196/30339 ER - TY - JOUR AU - Dysthe, K. Kim AU - Haavet, R. Ole AU - Røssberg, I. Jan AU - Brandtzaeg, B. Petter AU - Følstad, Asbjørn AU - Klovning, Atle PY - 2021/9/30 TI - Finding Relevant Psychoeducation Content for Adolescents Experiencing Symptoms of Depression: Content Analysis of User-Generated Online Texts JO - J Med Internet Res SP - e28765 VL - 23 IS - 9 KW - adolescent KW - depression KW - internet KW - education KW - preventive psychiatry KW - early medical intervention KW - self-report KW - psychoeducation KW - information content KW - online KW - digital health KW - e-health N2 - Background: Symptoms of depression are frequent in youth and may develop into more severe mood disorders, suggesting interventions should take place during adolescence. However, young people tend not to share mental problems with friends, family, caregivers, or professionals. Many receive misleading information when searching the internet. Among several attempts to create mental health services for adolescents, technological information platforms based on psychoeducation show promising results. Such development rests on established theories and therapeutic models. To fulfill the therapeutic potential of psychoeducation in health technologies, we lack data-driven research on young peoples? demand for information about depression. Objective: Our objective is to gain knowledge about what information is relevant to adolescents with symptoms of depression. From this knowledge, we can develop a population-specific psychoeducation for use in different technology platforms. Methods: We conducted a qualitative, constructivist-oriented content analysis of questions submitted by adolescents aged 16-20 years to an online public information service. A sample of 100 posts containing questions on depression were randomly selected from a total of 870. For analysis, we developed an a priori codebook from the main information topics of existing psychoeducational programs on youth depression. The distribution of topic prevalence in the total volume of posts containing questions on depression was calculated. Results: With a 95% confidence level and a ±9.2% margin of error, the distribution analysis revealed the following categories to be the most prevalent among adolescents seeking advice about depression: self-management (33%, 61/180), etiology (20%, 36/180), and therapy (20%, 36/180). Self-management concerned subcategories on coping in general and how to open to friends, family, and caregivers. The therapy topic concerned therapy options, prognosis, where to seek help, and how to open up to a professional. We also found young people dichotomizing therapy and self-management as opposite entities. The etiology topic concerned stressors and risk factors. The diagnosis category was less frequently referred to (9%, 17/180). Conclusions: Self-management, etiology, and therapy are the most prevalent categories among adolescents seeking advice about depression. Young people also dichotomize therapy and self-management as opposite entities. Future research should focus on measures to promote self-management, measures to stimulate expectations of self-efficacy, information about etiology, and information about diagnosis to improve self-monitoring skills, enhancing relapse prevention. UR - https://www.jmir.org/2021/9/e28765 UR - http://dx.doi.org/10.2196/28765 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591021 ID - info:doi/10.2196/28765 ER - TY - JOUR AU - Thabrew, Hiran AU - Stasiak, Karolina AU - Kumar, Harshali AU - Naseem, Tarique AU - Frampton, Christopher AU - Merry, Sally PY - 2021/9/24 TI - A Cognitive Behavioral Therapy?, Biofeedback-, and Game-Based eHealth Intervention to Treat Anxiety in Children and Young People With Long-Term Physical Conditions (Starship Rescue): Co-design and Open Trial JO - JMIR Serious Games SP - e26084 VL - 9 IS - 3 KW - long-term physical conditions KW - chronic illness KW - anxiety KW - eHealth KW - gaming KW - young people KW - treatment KW - cognitive behavioral therapy KW - biofeedback N2 - Background: Approximately 10%-12% of New Zealand children and young people have long-term physical conditions (chronic illnesses) and are more likely to develop psychological problems, particularly anxiety and depression. Delayed treatment leads to worse health care and poorer long-term outcomes. Recently, eHealth interventions, especially those based on principles of cognitive behavioral therapy and biofeedback, have been shown to be moderately effective in reducing anxiety. However, these modalities have rarely been combined. Young people have expressed a preference for well-designed and technology-based support to deal with psychological issues. Objective: This study aims to co-design and evaluate the acceptability and usability of a cognitive behavioral therapy and biofeedback-based, 5-module eHealth game called Starship Rescue and to provide preliminary evidence regarding its effectiveness in addressing anxiety and quality of life in young people with long-term physical conditions. Methods: Starship Rescue was co-designed with 15 children and young people from a tertiary hospital in New Zealand. Following this, 24 others aged 10-17 years participated in an open trial of the game, accessing it over an 8-week period. The acceptability of the game to all participants was assessed using a brief, open-ended questionnaire. More detailed feedback was obtained from a subset of 10 participants via semistructured interviews. Usability was evaluated via device-recorded frequency and duration of access on completion of the game and the System Usability Scale. Anxiety levels were measured at baseline, completion, and 3 months after completion of the game using the Generalized Anxiety Disorder 7-item scale and Spence Child Anxiety Scale, and at the start of each module and on completion using an embedded Likert visual analog scale. Quality of life was measured at baseline, completion, and 3 months after completion using the Pediatric Quality of Life Inventory scale. Results: Users gave Starship Rescue an overall rating of 5.9 out of 10 (range 3-10) and a mean score of 71 out of 100 (SD 11.7; minimum 47.5; maximum 90) on the System Usability Scale. The mean period for the use of the game was just over 11 weeks (78.8 days, 13.5 hours, 40 minutes). Significant reductions in anxiety were noted between the start and end of the game on the Generalized Anxiety Disorder 7-item scale (?4.6; P<.001), Spence Child Anxiety Scale (?9.6; P=.005), and the Likert visual analog scales (?2.4; P=.001). Quality of life also improved on the Pediatric Quality of Life Inventory scale (+4.3; P=.04). All changes were sustained at the 3-month follow-up. Conclusions: This study provides preliminary evidence for Starship Rescue as an acceptable, usable, and effective eHealth intervention for treating anxiety in young people with long-term physical conditions. Further evaluation is planned via a randomized controlled trial. Trial Registration: Australian New Zealand Clinical Trials Network Registry (ANZCTR) ACTRN12616001253493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371443 UR - https://games.jmir.org/2021/3/e26084 UR - http://dx.doi.org/10.2196/26084 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559053 ID - info:doi/10.2196/26084 ER - TY - JOUR AU - Exner-Cortens, Deinera AU - Baker, Elizabeth AU - Gray, Shawna AU - Fernandez Conde, Cristina AU - Rivera, Ramirez Rocio AU - Van Bavel, Marisa AU - Vezina, Elisabeth AU - Ambrose, Aleta AU - Pawluk, Chris AU - Schwartz, D. Kelly AU - Arnold, D. Paul PY - 2021/9/21 TI - School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review JO - JMIR Ment Health SP - e29454 VL - 8 IS - 9 KW - suicide KW - risk assessment KW - youth KW - eHealth KW - school mental health KW - mobile phone N2 - Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature?consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former?s focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. UR - https://mental.jmir.org/2021/9/e29454 UR - http://dx.doi.org/10.2196/29454 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546178 ID - info:doi/10.2196/29454 ER - TY - JOUR AU - Burbach, R. Frank AU - Stiles, M. Katie PY - 2021/9/17 TI - Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation JO - JMIR Form Res SP - e29845 VL - 5 IS - 9 KW - telehealth KW - young people KW - adolescents KW - online psychological therapy KW - online neurodevelopmental assessments KW - digital services KW - realist evaluation KW - multiple case study KW - CBT KW - autism N2 - Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case?study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services. UR - https://formative.jmir.org/2021/9/e29845 UR - http://dx.doi.org/10.2196/29845 UR - http://www.ncbi.nlm.nih.gov/pubmed/34369382 ID - info:doi/10.2196/29845 ER - TY - JOUR AU - Hamilton, Leigh Jessica AU - Lee, Woanjun PY - 2021/9/15 TI - Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample JO - JMIR Ment Health SP - e26273 VL - 8 IS - 9 KW - adolescents KW - social media KW - daytime sleepiness KW - parenting KW - bedtime KW - mental health KW - mobile phone N2 - Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents? mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45% (1929/4153) identified as female, and 67.93% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=?0.34, SE 0.09; P<.001) and importance (B=?0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth?s perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. UR - https://mental.jmir.org/2021/9/e26273 UR - http://dx.doi.org/10.2196/26273 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524967 ID - info:doi/10.2196/26273 ER - TY - JOUR AU - Bushman, Maggie AU - Godishala, Shreya AU - Hyzer, Reese AU - Jerisha, Joshua AU - Jolliff, Anna AU - Kaji, Ethan AU - Kerr, Bradley AU - Mathur, Anjali AU - Tsao, Owen PY - 2021/9/15 TI - Adolescent Health on Social Media and the Mentorship of Youth Investigators: Five Content Analysis Studies Conducted by Youth Investigators JO - JMIR Ment Health SP - e29318 VL - 8 IS - 9 KW - social media KW - anxiety KW - depression KW - self-esteem KW - Instagram KW - Reddit KW - Twitter KW - YouTube KW - content analysis KW - adolescent UR - https://mental.jmir.org/2021/9/e29318 UR - http://dx.doi.org/10.2196/29318 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524099 ID - info:doi/10.2196/29318 ER - TY - JOUR AU - Evans, Yolanda AU - Hutchinson, Jeffrey AU - Ameenuddin, Nusheen PY - 2021/9/15 TI - Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning JO - JMIR Ment Health SP - e26484 VL - 8 IS - 9 KW - pandemic KW - technology KW - media KW - bullying KW - mental health KW - distance learning UR - https://mental.jmir.org/2021/9/e26484 UR - http://dx.doi.org/10.2196/26484 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524094 ID - info:doi/10.2196/26484 ER - TY - JOUR AU - Charmaraman, Linda AU - Hodes, Rachel AU - Richer, M. Amanda PY - 2021/9/15 TI - Young Sexual Minority Adolescent Experiences of Self-expression and Isolation on Social Media: Cross-sectional Survey Study JO - JMIR Ment Health SP - e26207 VL - 8 IS - 9 KW - social media KW - social networking sites KW - sexual minorities KW - cyberbullying KW - depression KW - loneliness KW - self-harm KW - social support KW - adolescents N2 - Background: Early adolescent years are marked by pervasive self- and peer-regulation regarding gender and sexuality norms, which can affect the mental well-being of sexual minority youth. During this developmental period, social media use is also emerging as a dominant mode of communication with peers, allowing for both risk and resilient behaviors that can impact well-being. Objective: This exploratory study aims to examine how sexual minorities in middle school use social media, who they are connected to and for what purposes, and the associations between these behaviors and mental well-being compared with their heterosexual peers. Methods: In our cross-sectional survey study of 1033 early adolescents aged between 10 and 16 years (average age 12.7, SD 1.21 years) from 4 middle school sites in the Northeastern United States, we conducted an exploratory study comparing sexual minorities (212/873, 24.3% of sample with known sexual orientation) with their heterosexual peers (n=661), obtaining an 84.46% (1033/1223; total possible) response rate. Results: Sexual minorities reported having smaller networks on their favorite social media website (?=?.57; P<.001), less often responded positively when friends shared good news (?=?.35; P=.002), and less often tried to make friends feel better when they shared bad news (?=?.30; P=.01). However, sexual minorities more often reported joining a group or web-based community to make themselves feel less alone (?=.28; P=.003), unlike heterosexual youth. Sexual minorities had higher averages of loneliness and social isolation (?=.19; P<.001) than heterosexual students. Sexual minorities were also twice as likely to have tried to harm themselves in the past (?=.81; odds ratio [OR] 2.24, 95% CI 1.64-3.06; P<.001) and were more likely to have symptoms that reached the Center for Epidemiological Studies-Depression definition of depression (?=.15; OR 1.16, 95% CI 1.08-1.25; P<.001). About 39.1% (83/212) of sexual minorities had no one to talk to about their sexual orientation. Sexual minorities were 1.5 times more likely to have joined a social media website their parents would disapprove (?=.41; OR 1.50, 95% CI 1.14-1.97; P=.004) and more likely to report seeing videos related to self-harm (?=.33; OR 1.39, 95% CI 1.06-1.83; P=.02) on the web than heterosexual youth. Conclusions: Given previous reports of supportive and safe web-based spaces for sexual minority youth, our findings demonstrated that sexual minority youth prefer to maintain small, close-knit web-based communities (apart from their families) to express themselves, particularly when reaching out to web-based communities to reduce loneliness. Future longitudinal studies could determine any bidirectional influences of mental well-being and social media use in sexual minorities during this difficult developmental period. UR - https://mental.jmir.org/2021/9/e26207 UR - http://dx.doi.org/10.2196/26207 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524107 ID - info:doi/10.2196/26207 ER - TY - JOUR AU - Hwang, Juwon AU - Toma, L. Catalina PY - 2021/9/15 TI - The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents? Problematic Internet Use: Moderation Analysis JO - JMIR Ment Health SP - e26203 VL - 8 IS - 9 KW - problematic internet use KW - PIU KW - subjective mental well-being KW - perceived parental supportiveness KW - adolescents KW - well-being KW - young adult KW - internet KW - mental health KW - support KW - parent KW - engagement KW - social media N2 - Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents? subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents? engagement in PIU. Objective: This paper aimed to examine the role played by adolescents? perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology & Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4% (2130/4592) female and 66.9% (3370/4592) White. Findings revealed that, controlling for adolescents? demographics and social media use, higher levels of perceived parental supportiveness (?=?.285, P<.001) and higher levels of subjective mental well-being (?=?.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being (?=?.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents? mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents? mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. UR - https://mental.jmir.org/2021/9/e26203 UR - http://dx.doi.org/10.2196/26203 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524093 ID - info:doi/10.2196/26203 ER - TY - JOUR AU - Bickham, S. David AU - Moukalled, Summer AU - Inyart, K. Heather AU - Zlokower, Rona PY - 2021/9/15 TI - Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study JO - JMIR Ment Health SP - e26197 VL - 8 IS - 9 KW - digital citizenship KW - cyberbullying KW - evaluation KW - media literacy KW - middle school KW - conflict resolution KW - internet safety KW - mobile phone N2 - Background: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people?s mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. Objective: This study aims to determine the effectiveness of the Screenshots program in increasing participants? knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males? and females? conflict and bullying resolution strategies. Methods: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. Results: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52% (33/63) to 84% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. Conclusions: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students? increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students? high ratings of the relevance of Screenshots? content reinforce the need for this type of intervention. UR - https://mental.jmir.org/2021/9/e26197 UR - http://dx.doi.org/10.2196/26197 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524098 ID - info:doi/10.2196/26197 ER - TY - JOUR AU - Gewali, Anupa AU - Lopez, Alana AU - Dachelet, Kristin AU - Healy, Elise AU - Jean-Baptiste, Marimirca AU - Harridan, Holly AU - Evans, Yolanda AU - Unger, A. Jennifer AU - Bhat, Amritha AU - Tandon, Darius AU - Ronen, Keshet PY - 2021/9/15 TI - A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design JO - JMIR Ment Health SP - e26188 VL - 8 IS - 9 KW - depression KW - mental health KW - perinatal KW - pregnancy KW - postpartum KW - adolescent KW - youth KW - social media KW - group KW - mobile phone N2 - Background: Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective: We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths? mental health needs and document how they informed IMAGINE design. Methods: We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results: Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions: Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group. UR - https://mental.jmir.org/2021/9/e26188 UR - http://dx.doi.org/10.2196/26188 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524086 ID - info:doi/10.2196/26188 ER - TY - JOUR AU - Campos-Castillo, Celeste AU - Thomas, Jason Brian AU - Reyes, Felipe AU - Laestadius, Irina Linnea PY - 2021/9/15 TI - Seeking Help From Trusted Adults in Response to Peers? Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents JO - JMIR Ment Health SP - e26176 VL - 8 IS - 9 KW - adolescents KW - confidants KW - ethnicity KW - gender KW - network resources KW - privacy KW - race KW - social media KW - social support KW - tie activation KW - trust N2 - Background: Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being. Objective: This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide. Methods: We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents? request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide. Results: Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults. Conclusions: To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support. UR - https://mental.jmir.org/2021/9/e26176 UR - http://dx.doi.org/10.2196/26176 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524088 ID - info:doi/10.2196/26176 ER - TY - JOUR AU - Craig Rushing, Stephanie AU - Kelley, Allyson AU - Bull, Sheana AU - Stephens, David AU - Wrobel, Julia AU - Silvasstar, Joshva AU - Peterson, Roger AU - Begay, Corey AU - Ghost Dog, Thomas AU - McCray, Celena AU - Love Brown, Danica AU - Thomas, Morgan AU - Caughlan, Colbie AU - Singer, Michelle AU - Smith, Paige AU - Sumbundu, Kanku PY - 2021/9/15 TI - Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial JO - JMIR Ment Health SP - e26158 VL - 8 IS - 9 KW - American Indian KW - Alaska Native KW - adolescent KW - mental health KW - help-seeking skills, text messaging KW - mHealth, behavioral intervention KW - Indian health KW - mobile phone N2 - Background: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. Conclusions: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 UR - https://mental.jmir.org/2021/9/e26158 UR - http://dx.doi.org/10.2196/26158 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524092 ID - info:doi/10.2196/26158 ER - TY - JOUR AU - Fadiran, Babayosimi AU - Lee, Jessica AU - Lemminger, Jared AU - Jolliff, Anna PY - 2021/9/15 TI - How Our Technology Use Changed in 2020: Perspectives From Three Youths JO - JMIR Ment Health SP - e26154 VL - 8 IS - 9 KW - mental health KW - social media KW - digital technology KW - youth KW - adolescent KW - commentary KW - technology KW - wellness UR - https://mental.jmir.org/2021/9/e26154 UR - http://dx.doi.org/10.2196/26154 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524108 ID - info:doi/10.2196/26154 ER - TY - JOUR AU - Rutter, A. Lauren AU - Thompson, M. Holly AU - Howard, Jacqueline AU - Riley, N. Tennisha AU - De Jesús-Romero, Robinson AU - Lorenzo-Luaces, Lorenzo PY - 2021/9/15 TI - Social Media Use, Physical Activity, and Internalizing Symptoms in Adolescence: Cross-sectional Analysis JO - JMIR Ment Health SP - e26134 VL - 8 IS - 9 KW - social media KW - depression KW - anxiety KW - physical activity KW - adolescence KW - mobile phone N2 - Background: Most American adolescents have access to smartphones, and recent estimates suggest that they spend considerable time on social media compared with other physical and leisure activities. A large body of literature has established that social media use is related to poor mental health, but the complicated relationship between social media and symptoms of depression and anxiety in adolescents is yet to be fully understood. Objective: We aim to investigate the relationship between social media use and depression and anxiety symptoms in adolescents by exploring physical activity as a mediator. Methods: A Qualtrics survey manager recruited adult panel participants between February and March 2019, who indicated that they had adolescent children who spoke English. A total of 4592 adolescent-parent dyads completed the survey that took approximately 39 minutes. The survey entailed completing web-based questionnaires assessing various aspects of social media use, psychological symptoms, and psychosocial factors. The average age of the adolescent participants was 14.62 (SD 1.68; range 12-17) years, and the majority of the adolescent sample was male (2392/4592, 52.09%). Results: Total social media use was associated with more depressive symptoms (multiple R2=0.12; F3,4480=207.1; P<.001), anxiety (multiple R2=0.09; F3,4477=145.6; P<.001), and loneliness (multiple R2=0.06; F3,4512=98.06; P<.001), controlling for age and gender. Physical activity was associated with decreased depression and anxiety symptoms after controlling for other extracurricular activities and social media use (multiple R2=0.24; F5,4290=266.0; P<.001). There were significant differences in symptoms based on gender: female adolescents reported higher rates of social media use and males reported higher rates of depression. Nonbinary and transgender adolescents had higher rates of depression, anxiety, and loneliness than the female and male adolescents in the sample. Conclusions: In a nationally representative sample of adolescents, more social media use was associated with more severe symptoms of depression, anxiety, and loneliness. Increased physical activity was associated with decreased depression and anxiety symptoms. Physical activity partially mediated the relationship between social media use and depression and anxiety. As this was a cross-sectional study, we cannot conclude that social media use causes internalizing symptoms or that physical activity leads to decreased internalizing symptoms?there may be additional confounding variables producing the relationships we observed. Physical activity may protect against the potentially harmful effect of social media on some adolescents. The effect sizes were small to medium, and the results should be interpreted with caution. Other limitations of this study include our reliance on self-reporting. Future work should examine social media use beyond how much time adolescents spend using social media and instead focus on the nature of social media activity. UR - https://mental.jmir.org/2021/9/e26134 UR - http://dx.doi.org/10.2196/26134 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524096 ID - info:doi/10.2196/26134 ER - TY - JOUR AU - Radovic, Ana AU - Anderson, Nathan AU - Hamm, Megan AU - George-Milford, Brandie AU - Fascetti, Carrie AU - Engster, Stacey AU - Lindhiem, Oliver PY - 2021/9/15 TI - Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study JO - JMIR Ment Health SP - e26035 VL - 8 IS - 9 KW - depression KW - adolescent KW - suicidality KW - screening N2 - Background: Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents? and parents? reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. Objective: This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. Methods: We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. Results: We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. Conclusions: We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW. UR - https://mental.jmir.org/2021/9/e26035 UR - http://dx.doi.org/10.2196/26035 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524090 ID - info:doi/10.2196/26035 ER - TY - JOUR AU - Biernesser, Candice AU - Zelazny, Jamie AU - Brent, David AU - Bear, Todd AU - Mair, Christina AU - Trauth, Jeanette PY - 2021/9/15 TI - Automated Monitoring of Suicidal Adolescents? Digital Media Use: Qualitative Study Exploring Acceptability Within Clinical Care JO - JMIR Ment Health SP - e26031 VL - 8 IS - 9 KW - adolescents KW - parents KW - digital media KW - social media KW - technology KW - monitoring KW - suicide prevention KW - implementation in clinical care KW - natural language processing KW - qualitative N2 - Background: Monitoring linguistic cues from adolescents? digital media use (DMU; ie, digital content transmitted on the web, such as through text messages or social media) that could denote suicidal risk offers a unique opportunity to protect adolescents vulnerable to suicide, the second leading cause of death among youth. Adolescents communicate through digital media in high volumes and frequently express emotionality. In fact, web-based disclosures of suicidality are more common than in-person disclosures. The use of automated methods of digital media monitoring triggered by a natural language processing algorithm offers the potential to detect suicidal risk from subtle linguistic units (eg, negatively valanced words, phrases, or emoticons known to be associated with suicidality) present within adolescents? digital media content and to use this information to respond to alerts of suicidal risk. Critical to the implementation of such an approach is the consideration of its acceptability in the clinical care of adolescents at high risk of suicide. Objective: Through data collection among recently suicidal adolescents, parents, and clinicians, this study examines the current context of digital media monitoring for suicidal adolescents seeking clinical care to inform the need for automated monitoring and the factors that influence the acceptance of automated monitoring of suicidal adolescents? DMU within clinical care. Methods: A total of 15 recently suicidal adolescents (aged 13-17 years), 12 parents, and 10 clinicians participated in focus groups, qualitative interviews, and a group discussion, respectively. Data were recorded, transcribed, and analyzed using thematic analysis. Results: Participants described important challenges to the current strategies for monitoring the DMU of suicidal youth. They felt that automated monitoring would have advantages over current monitoring approaches, namely, by protecting web-based environments and aiding adolescent disclosure and support seeking about web-based suicidal risk communication, which may otherwise go unnoticed. However, they identified barriers that could impede implementation within clinical care, namely, adolescents? and parents? concerns about unintended consequences of automated monitoring, that is, the potential for loss of privacy or false alerts, and clinicians? concerns about liability to respond to alerts of suicidal risk. On the basis of the needs and preferences of adolescents, parents, and clinicians, a model for automated digital media monitoring is presented that aims to optimize acceptability within clinical care for suicidal youth. Conclusions: Automated digital media monitoring offers a promising means to augment detection and response to suicidal risk within the clinical care of suicidal youth when strategies that address the preferences of adolescents, parents, and clinicians are in place. UR - https://mental.jmir.org/2021/9/e26031 UR - http://dx.doi.org/10.2196/26031 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524104 ID - info:doi/10.2196/26031 ER - TY - JOUR AU - Kutok, R. Emily AU - Dunsiger, Shira AU - Patena, V. John AU - Nugent, R. Nicole AU - Riese, Alison AU - Rosen, K. Rochelle AU - Ranney, L. Megan PY - 2021/9/15 TI - A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e26029 VL - 8 IS - 9 KW - cyberbullying KW - adolescents KW - mobile application KW - messaging KW - brief interventions KW - social media KW - recruitment KW - mobile phone N2 - Background: Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant?led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (?=1.17, SE 0.87, P=.02 at 8 weeks and ?=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (?=?.66, SE 0.08, P=.04 at 8 weeks and ?=?.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (?=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. UR - https://mental.jmir.org/2021/9/e26029 UR - http://dx.doi.org/10.2196/26029 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524103 ID - info:doi/10.2196/26029 ER - TY - JOUR AU - Uhls, T. Yalda AU - Felt, Laurel AU - Wartella, Ellen AU - Sanders, Andrew PY - 2021/9/15 TI - Investigating Viewership of Season 3 of ?13 Reasons Why? and the Mental Wellness of Adolescents: Partially Randomized Preference Trial JO - JMIR Ment Health SP - e25782 VL - 8 IS - 9 KW - media KW - adolescence KW - mental health KW - narrative KW - 13 Reasons Why KW - conversation KW - television KW - depression KW - sexual assault N2 - Background: A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents? mental wellness. Objective: This study aims to investigate adolescents? viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. Methods: A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. Results: Our sample (N=157) was 52.2% (n=82) female and 54.8% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices?having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. Conclusions: Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3?s stories drove conversations?and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships?potential wellness implications for television shows featuring social and mental health issues are considerable. UR - https://mental.jmir.org/2021/9/e25782 UR - http://dx.doi.org/10.2196/25782 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524097 ID - info:doi/10.2196/25782 ER - TY - JOUR AU - Borghouts, Judith AU - Eikey, V. Elizabeth AU - Mark, Gloria AU - De Leon, Cinthia AU - Schueller, M. Stephen AU - Schneider, Margaret AU - Stadnick, Nicole AU - Zheng, Kai AU - Mukamel, B. Dana AU - Sorkin, H. Dara PY - 2021/9/14 TI - Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study JO - J Med Internet Res SP - e27745 VL - 23 IS - 9 KW - mHealth KW - mental health KW - community college KW - students KW - structural equation modeling KW - mobile apps KW - services KW - mental health services KW - stress KW - privacy N2 - Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. UR - https://www.jmir.org/2021/9/e27745 UR - http://dx.doi.org/10.2196/27745 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519668 ID - info:doi/10.2196/27745 ER - TY - JOUR AU - Beames, R. Joanne AU - Johnston, Lara AU - O'Dea, Bridianne AU - Torok, Michelle AU - Christensen, Helen AU - Boydell, M. Katherine AU - Werner-Seidler, Aliza PY - 2021/8/27 TI - Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study JO - J Med Internet Res SP - e26223 VL - 23 IS - 8 KW - secondary school KW - depression KW - prevention KW - digital KW - barrier KW - facilitator KW - teacher KW - counselor KW - principal KW - student N2 - Background: Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective: The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods: This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results: A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students? mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions: The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types. UR - https://www.jmir.org/2021/8/e26223 UR - http://dx.doi.org/10.2196/26223 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448701 ID - info:doi/10.2196/26223 ER - TY - JOUR AU - Lau, Nancy AU - Colt, F. Susannah AU - Waldbaum, Shayna AU - O'Daffer, Alison AU - Fladeboe, Kaitlyn AU - Yi-Frazier, P. Joyce AU - McCauley, Elizabeth AU - Rosenberg, R. Abby PY - 2021/8/27 TI - Telemental Health For Youth With Chronic Illnesses: Systematic Review JO - JMIR Ment Health SP - e30098 VL - 8 IS - 8 KW - telehealth care KW - mental health KW - psychosocial issues KW - psychiatry KW - psychology KW - child KW - chronic disease N2 - Background: Children, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap. Objective: In this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ?25 years with chronic illnesses. Methods: PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ?25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals. Results: We screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis. Conclusions: The state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic. UR - https://mental.jmir.org/2021/8/e30098 UR - http://dx.doi.org/10.2196/30098 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448724 ID - info:doi/10.2196/30098 ER - TY - JOUR AU - Ribanszki, Robert AU - Saez Fonseca, Andres Jose AU - Barnby, Matthew Joseph AU - Jano, Kimberly AU - Osmani, Fatima AU - Almasi, Soma AU - Tsakanikos, Elias PY - 2021/8/27 TI - Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study JO - JMIR Form Res SP - e14004 VL - 5 IS - 8 KW - qualitative KW - adolescents KW - mental health KW - digital smartphone app KW - digital mental health KW - mobile phone N2 - Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. UR - https://formative.jmir.org/2021/8/e14004 UR - http://dx.doi.org/10.2196/14004 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128814 ID - info:doi/10.2196/14004 ER - TY - JOUR AU - Knapp, A. Ashley AU - Cohen, Katherine AU - Nicholas, Jennifer AU - Mohr, C. David AU - Carlo, D. Andrew AU - Skerl, J. Joshua AU - Lattie, G. Emily PY - 2021/8/19 TI - Integration of Digital Tools Into Community Mental Health Care Settings That Serve Young People: Focus Group Study JO - JMIR Ment Health SP - e27379 VL - 8 IS - 8 KW - digital mental health KW - treatment KW - young people KW - children KW - adolescents KW - community mental health care KW - mobile phone N2 - Background: Digital mental health tools have substantial potential to be easily integrated into people?s lives and fundamentally impact public health. Such tools can extend the reach and maximize the impact of mental health interventions. Before implementing digital tools in new settings, it is critical to understand what is important to organizations and individuals who will implement and use these tools. Given that young people are highly familiar with technology and many mental health concerns emerge in childhood and adolescence, it is especially crucial to understand how digital tools can be integrated into settings that serve young people. Objective: This study aims to learn about considerations and perspectives of community behavioral health care providers on incorporating digital tools into their clinical care for children and adolescents. Methods: Data were analyzed from 5 focus groups conducted with clinicians (n=37) who work with young people at a large community service organization in the United States. This organization provides care to more than 27,000 people annually, most of whom are of low socioeconomic status. The transcripts were coded using thematic analysis. Results: Clinicians first provided insight into the digital tools they were currently using in their treatment sessions with young people, such as web-based videos and mood-tracking apps. They explained that their main goals in using these tools were to help young people build skills, facilitate learning, and monitor symptoms. Benefits were expressed, such as engagement of adolescents in treatment, along with potential challenges (eg, accessibility and limited content) and developmental considerations (eg, digital devices getting taken away as punishment). Clinicians discussed their desire for a centralized digital platform that securely connects the clinician, young person, and caregivers. Finally, they offered several considerations for integrating digital tools into mental health care, such as setting up expectations with clients and the importance of human support. Conclusions: Young people have unique considerations related to complex accessibility patterns and technology expectations that may not be observed when adults are the intended users of mental health technologies. Therefore, these findings provide critical insights to inform the development of future tools, specifically regarding connectivity, conditional restraints (eg, devices taken away as punishment and school restrictions), expectations of users from different generations, and the blended nature in which digital tools can support young people. UR - https://mental.jmir.org/2021/8/e27379 UR - http://dx.doi.org/10.2196/27379 UR - http://www.ncbi.nlm.nih.gov/pubmed/34420928 ID - info:doi/10.2196/27379 ER - TY - JOUR AU - Stevens, R. Hannah AU - Acic, Irena AU - Rhea, Sofia PY - 2021/8/17 TI - Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit JO - JMIR Public Health Surveill SP - e29029 VL - 7 IS - 8 KW - COVID-19 KW - natural language processing KW - LGBTQ+ KW - mental health KW - anxiety KW - emotion KW - coronavirus KW - outbreak N2 - Background: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. Objective: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. Methods: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. Results: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. Conclusions: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens? anonymous discussions can inform future mental health interventions in LGBTQ+ youth. UR - https://publichealth.jmir.org/2021/8/e29029 UR - http://dx.doi.org/10.2196/29029 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402803 ID - info:doi/10.2196/29029 ER - TY - JOUR AU - Allen, J. Brittany AU - Stratman, E. Zoe AU - Kerr, R. Bradley AU - Zhao, Qianqian AU - Moreno, A. Megan PY - 2021/8/13 TI - Associations Between Psychosocial Measures and Digital Media Use Among Transgender Youth: Cross-sectional Study JO - JMIR Pediatr Parent SP - e25801 VL - 4 IS - 3 KW - transgender person KW - internet KW - sex and gender minorities KW - well-being KW - adolescent KW - mobile phone N2 - Background: Transgender, nonbinary, and gender-diverse (TNG) youth encounter barriers to psychosocial wellness and also describe exploring identities and communities on the web. Studies of cisgender youth connect increased digital technology use with lower well-being, parent relationships, and body image scores as well as increased loneliness and fear of missing out (FOMO). However, little is known about the psychosocial factors associated with digital technology use among TNG compared with cisgender youth. Objective: This study aims to examine the associations between psychosocial measures and digital technology use and its importance for cisgender and TNG youth. Methods: We surveyed a nationally representative sample of adolescents (aged 13-18 years) about psychosocial wellness and digital technology use. Psychosocial measures included assessment of well-being, parental relationships, body image, loneliness, and FOMO. Digital media use assessments included the short Problematic and Risky Internet Use Screening Scale-3 and the Adolescent Digital Technology Interactions and Importance (ADTI) scale and subscales. We compared psychosocial measures between gender identity groups. We also compared stratified correlations for psychosocial measures (well-being, parent relationships, body image, loneliness, and FOMO) with ADTI and Problematic and Risky Internet Use Screening Scale-3 scores between gender identity groups. All comparisons were adjusted for age, race, and ethnicity. Results: Among 4575 adolescents, 53 (1.16%) self-identified as TNG youth. TNG youth had lower scores for well-being (23.76 vs 26.47; P<.001), parent relationships (19.29 vs 23.32; P<.001), and body image (13.50 vs 17.12; P<.001), and higher scores for loneliness (9.28 vs 6.55; P<.001) and FOMO (27.93 vs 23.89; P=.004), compared with cisgender peers. In a pattern different from that of their cisgender peers, better well-being scores and body image for TNG youth predicted higher problematic internet use (PIU) scores (correlation coefficients of 0.32 vs ?0.07; P=.004 and 0.26 vs ?0.21; P=.002, respectively). FOMO was a stronger positive predictor of higher ADTI total and subscale scores for cisgender youth compared with TNG youth. Conclusions: Overall, this study supports previously demonstrated disparities in the psychosocial wellness of TNG youth and adds that these disparities include loneliness and FOMO. This study shows prediction of PIU by both higher well-being and better body image, indicating that PIU may not be unilaterally driven by problematic factors among TNG youth. We suggest that this may be because of the specific digital media functions that TNG youth engage with as a disenfranchised population. UR - https://pediatrics.jmir.org/2021/3/e25801 UR - http://dx.doi.org/10.2196/25801 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398792 ID - info:doi/10.2196/25801 ER - TY - JOUR AU - Manabe, Masae AU - Liew, Kongmeng AU - Yada, Shuntaro AU - Wakamiya, Shoko AU - Aramaki, Eiji PY - 2021/8/12 TI - Estimation of Psychological Distress in Japanese Youth Through Narrative Writing: Text-Based Stylometric and Sentiment Analyses JO - JMIR Form Res SP - e29500 VL - 5 IS - 8 KW - psychological distress KW - youth KW - narratives KW - natural language processing KW - Japan KW - mental health KW - stress KW - distress KW - young adult KW - teenager KW - sentiment N2 - Background: Internalizing mental illnesses associated with psychological distress are often underdetected. Text-based detection using natural language processing (NLP) methods is increasingly being used to complement conventional detection efforts. However, these approaches often rely on self-disclosure through autobiographical narratives that may not always be possible, especially in the context of the collectivistic Japanese culture. Objective: We propose the use of narrative writing as an alternative resource for mental illness detection in youth. Accordingly, in this study, we investigated the textual characteristics of narratives written by youth with psychological distress; our research focuses on the detection of psychopathological tendencies in written imaginative narratives. Methods: Using NLP tools such as stylometric measures and lexicon-based sentiment analysis, we examined short narratives from 52 Japanese youth (mean age 19.8 years, SD 3.1) obtained through crowdsourcing. Participants wrote a short narrative introduction to an imagined story before completing a questionnaire to quantify their tendencies toward psychological distress. Based on this score, participants were categorized into higher distress and lower distress groups. The written narratives were then analyzed using NLP tools and examined for between-group differences. Although outside the scope of this study, we also carried out a supplementary analysis of narratives written by adults using the same procedure. Results: Youth demonstrating higher tendencies toward psychological distress used significantly more positive (happiness-related) words, revealing differences in valence of the narrative content. No other significant differences were observed between the high and low distress groups. Conclusions: Youth with tendencies toward mental illness were found to write more positive stories that contained more happiness-related terms. These results may potentially have widespread implications on psychological distress screening on online platforms, particularly in cultures such as Japan that are not accustomed to self-disclosure. Although the mechanisms that we propose in explaining our results are speculative, we believe that this interpretation paves the way for future research in online surveillance and detection efforts. UR - https://formative.jmir.org/2021/8/e29500 UR - http://dx.doi.org/10.2196/29500 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387556 ID - info:doi/10.2196/29500 ER - TY - JOUR AU - Pine, Russell AU - Mbinta, James AU - Te Morenga, Lisa AU - Fleming, Theresa PY - 2021/8/12 TI - A Casual Video Game With Psychological Well-being Concepts for Young Adolescents: Protocol for an Acceptability and Feasibility Study JO - JMIR Res Protoc SP - e31588 VL - 10 IS - 8 KW - digital mental health tools KW - casual video games KW - young people N2 - Background: Many face-to-face and digital therapeutic supports are designed for adolescents experiencing high levels of psychological distress. However, promoting psychological well-being among adolescents is often neglected despite significant short-term and long-term benefits. Objective: This research has 3 main objectives: (1) to assess the acceptability of Match Emoji, a casual video game with psychological well-being concepts among 13-15-year-old students in a New Zealand secondary school; (2) to identify the feasibility of the research process; and (3) to explore the preliminary well-being and therapeutic potential of Match Emoji. Methods: Approximately 40 participants aged 13-15 years from a local secondary college in Wellington, New Zealand, will be invited to download and play Match Emoji 3-4 times a week for 5-15 minutes over a 2-week period. Participants will complete 4 assessments at baseline, postintervention, and 3 weeks later to assess psychological well-being and therapeutic changes. Statistical analysis will be used to synthesize data from interviews and triangulated with assessment changes and game analytics. This synthesis will help to assess the acceptability and feasibility of the Match Emoji. Results: The key outputs from the project will include the acceptability, feasibility, and therapeutic potential of Match Emoji. It is anticipated that participants will have finished playing the recommended game play regimen by August 2021 with analysis of results completed by October 2021. Conclusions: Data from the study are expected to inform future research on Match Emoji including a randomized controlled trial and further adjustments to the design and development of the game. International Registered Report Identifier (IRRID): PRR1-10.2196/31588 UR - https://www.researchprotocols.org/2021/8/e31588 UR - http://dx.doi.org/10.2196/31588 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387558 ID - info:doi/10.2196/31588 ER - TY - JOUR AU - Laestadius, I. Linnea AU - Craig, A. Katherine AU - Campos-Castillo, Celeste PY - 2021/8/10 TI - Perceptions of Alerts Issued by Social Media Platforms in Response to Self-injury Posts Among Latinx Adolescents: Qualitative Analysis JO - J Med Internet Res SP - e28931 VL - 23 IS - 8 KW - adolescents KW - social media KW - mental health KW - NSSI KW - race and ethnicity KW - mobile phone N2 - Background: There is growing interest in using social media data to detect and address nonsuicidal self-injury (NSSI) among adolescents. Adolescents often do not seek clinical help for NSSI and may adopt strategies to obscure detection; therefore, social media platforms may be able to facilitate early detection and treatment by using machine learning models to screen posts for harmful content and subsequently alert adults. However, such efforts have raised privacy and ethical concerns among health researchers. Little is currently known about how adolescents perceive these efforts. Objective: The aim of this study is to examine perceptions of automated alerts for NSSI posts on social media among Latinx adolescents, who are at risk for NSSI yet are underrepresented in both NSSI and health informatics research. In addition, we considered their perspectives on preferred recipients of automated alerts. Methods: We conducted semistructured, qualitative interviews with 42 Latinx adolescents between the ages of 13 and 17 years who were recruited from a nonprofit organization serving the Latinx community in Milwaukee, Wisconsin. The Latinx population in Milwaukee is largely of Mexican descent. All interviews were conducted between June and July 2019. Transcripts were analyzed using framework analysis to discern their perceptions of automated alerts sent by social media platforms and potential alert recipients. Results: Participants felt that automated alerts would make adolescents safer and expedite aid before the situation escalated. However, some worried that hyperbolic statements would generate false alerts and instigate conflicts. Interviews revealed strong opinions about ideal alert recipients. Parents were most commonly endorsed, but support was conditional on perceptions that the parent would respond appropriately. Emergency services were judged as safer but inappropriate for situations considered lower risk. Alerts sent to school staff generated the strongest privacy concerns. Altogether, the preferred alert recipients varied by individual adolescents and perceived risks in the situation. None raised ethical concerns about the collection, analysis, or storage of personal information regarding their mental health status. Conclusions: Overall, Latinx adolescents expressed broad support for automated alerts for NSSI on social media, which indicates opportunities to address NSSI. However, these efforts should be co-constructed with adolescents to ensure that preferences and needs are met, as well as embedded within broader approaches for addressing structural and cultural barriers to care. UR - https://www.jmir.org/2021/8/e28931 UR - http://dx.doi.org/10.2196/28931 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383683 ID - info:doi/10.2196/28931 ER - TY - JOUR AU - Rauschenberg, Christian AU - Boecking, Benjamin AU - Paetzold, Isabell AU - Schruers, Koen AU - Schick, Anita AU - van Amelsvoort, Thérèse AU - Reininghaus, Ulrich PY - 2021/8/5 TI - A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study JO - JMIR Ment Health SP - e25650 VL - 8 IS - 8 KW - mental health KW - adolescent psychopathology KW - digital interventions KW - mobile health KW - self-compassion KW - ecological momentary assessment KW - mobile phone N2 - Background: Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective: This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods: In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results: In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions: Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. UR - https://mental.jmir.org/2021/8/e25650 UR - http://dx.doi.org/10.2196/25650 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383687 ID - info:doi/10.2196/25650 ER - TY - JOUR AU - Birrell, Louise AU - Furneaux-Bate, Ainsley AU - Chapman, Cath AU - Newton, C. Nicola PY - 2021/7/30 TI - A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study) JO - JMIR Res Protoc SP - e26796 VL - 10 IS - 7 KW - prevention KW - mental health KW - substance use KW - peer support KW - depression KW - anxiety KW - help-seeking KW - mobile phone N2 - Background: Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories. Objective: This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents. Methods: Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data. Results: The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022. Conclusions: The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/26796 UR - https://www.researchprotocols.org/2021/7/e26796 UR - http://dx.doi.org/10.2196/26796 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328426 ID - info:doi/10.2196/26796 ER - TY - JOUR AU - Simonsson, Olivia AU - Engberg, Hedvig AU - Bjureberg, Johan AU - Ljótsson, Brjánn AU - Stensils, Julia AU - Sahlin, Hanna AU - Hellner, Clara PY - 2021/7/23 TI - Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study JO - JMIR Form Res SP - e17910 VL - 5 IS - 7 KW - nonsuicidal self-injury KW - self-injurious behavior KW - online treatment KW - internet KW - digital health KW - emotion regulation KW - emotion regulation individual therapy for adolescents KW - adolescent KW - qualitative KW - experience N2 - Background: Nonsuicidal self-injury (NSSI) is common in adolescence and is associated with several adverse outcomes. Despite this, few established treatment options exist. Online treatment seems promising for several conditions; however, knowledge on NSSI is scarce. It is important to explore how online treatment for NSSI is experienced to improve such interventions and learn more about factors that are important in the treatment of adolescents with NSSI. Objective: This study aims to explore the experiences of a novel online treatment for adolescents with NSSI and their caregivers. Methods: A qualitative study using thematic analysis was conducted through semistructured interviews with 9 adolescents and 11 caregivers at treatment termination or at the 6-month follow-up of the online emotion regulation individual therapy for adolescents. Results: A total of 3 overarching themes were identified. The theme support can come in different shapes showed how support could be attained through both interaction with the therapist as well as through the format itself (such as through the fictional characters in the material and the mobile app). Caregivers found it helpful to have their own online course, and adolescents accepted their involvement. The theme self-responsibility can be empowering as well as distressing showed that self-responsibility was highly appreciated (such as deciding when and how to engage in treatment) but also challenging; it caused occasional distress for some. The theme acquiring new skills and treatment effects showed the advantages and challenges of learning several different emotion regulation skills and that decreased emotion regulation difficulties were important treatment outcomes for adolescents. In addition, several different skills seemed to facilitate emotion regulation, and having access to such skills could hinder NSSI. Conclusions: Online emotion regulation individual therapy for adolescents seems to offer an accepted way to deliver family interventions for this target group; facilitate skills training with several means of support, including support from both the mobile app and the therapist; contribute to decreasing emotion regulation difficulties and teaching skills that could hinder NSSI; and cause (in some individuals) distress because of the self-responsibility that is inherent to online formats, which needs to be addressed. UR - https://formative.jmir.org/2021/7/e17910 UR - http://dx.doi.org/10.2196/17910 UR - http://www.ncbi.nlm.nih.gov/pubmed/34297001 ID - info:doi/10.2196/17910 ER - TY - JOUR AU - Moltrecht, Bettina AU - Patalay, Praveetha AU - Deighton, Jessica AU - Edbrooke-Childs, Julian PY - 2021/7/14 TI - A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial JO - JMIR Mhealth Uhealth SP - e21837 VL - 9 IS - 7 KW - emotion regulation KW - digital mental health KW - mhealth KW - school intervention KW - child mental health KW - mobile phone N2 - Background: Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. Objective: This study investigates the use of a new app-based intervention designed to support children?s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. Methods: As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). Results: The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention?s usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children?s emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. Conclusions: We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children?s emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys. UR - https://mhealth.jmir.org/2021/7/e21837 UR - http://dx.doi.org/10.2196/21837 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259642 ID - info:doi/10.2196/21837 ER - TY - JOUR AU - Bhattacharya, Arpita AU - Nagar, Ria AU - Jenness, Jessica AU - Munson, A. Sean AU - Kientz, A. Julie PY - 2021/7/13 TI - Designing Asynchronous Remote Support for Behavioral Activation in Teenagers With Depression: Formative Study JO - JMIR Form Res SP - e20969 VL - 5 IS - 7 KW - teens KW - mental health KW - behavioral activation KW - asynchronous remote communities N2 - Background: Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based on behavioral activation (BA) help teens understand the relationship between mood and activity, help them practice goal-directed behaviors to improve mood, and may be particularly well-suited to delivery via internet-based platforms. Objective: This study aims to understand the needs and challenges that teens and mental health clinicians face in depression management and involve them in the design process of a remote intervention that uses asynchronous remote communities. Our goal is to understand the benefits and challenges of adapting BA to an internet-based platform that supports the asynchronous remote community approach as a delivery tool for teen depression management. Methods: We enrolled mental health clinicians (n=10) and teens (n=8) in separate, private, internet-based groups on Slack (Slack Technologies Inc). They participated in 20-minute design activities for 10 weeks and were then invited to interviews about their experiences in the study. Results: Both teen and clinician participants wanted internet-based support for BA as a supplement to in-person therapy. Although participants perceived the asynchronous format as conducive to supporting accessible care, teens and clinicians raised concerns about safety, privacy, and the moderating of the internet-based group. Design decisions that address these concerns need to be balanced with the potential benefits of learning coping skills, increasing access to mental health care, and promoting asynchronous human connection to support teens. Conclusions: We discuss considerations for balancing tensions in privacy and safety while designing and selecting internet-based platforms to support remote care and integrating evidence-based support when designing digital technologies for the treatment of teens with depression. UR - https://formative.jmir.org/2021/7/e20969 UR - http://dx.doi.org/10.2196/20969 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255665 ID - info:doi/10.2196/20969 ER - TY - JOUR AU - Sung, Y. Jenna AU - Mumper, Emma AU - Schleider, Lee Jessica PY - 2021/7/6 TI - Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation JO - JMIR Ment Health SP - e29538 VL - 8 IS - 7 KW - acceptability KW - adolescent mental health KW - adolescent KW - anxiety KW - avoidance KW - behavior KW - child mental health KW - children KW - digital mental health KW - intervention KW - mental health KW - parent KW - prevention KW - young adult N2 - Background: A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions?particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children?for instance, by mitigating known anxiety risk factors?remains unexplored. Objective: This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods: In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results: Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions: Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration: ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9 UR - https://mental.jmir.org/2021/7/e29538 UR - http://dx.doi.org/10.2196/29538 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255718 ID - info:doi/10.2196/29538 ER - TY - JOUR AU - Kwon, Lois AU - Medina, Daniela AU - Ghattas, Fady AU - Reyes, Lilia PY - 2021/6/24 TI - Trends in Positive, Negative, and Neutral Themes of Popular Music From 1998 to 2018: Observational Study JO - JMIR Pediatr Parent SP - e26475 VL - 4 IS - 2 KW - music KW - adolescent KW - themes KW - trends KW - primary care provider KW - social media KW - mental health KW - depression KW - anxiety KW - pop culture N2 - Background: Across the United States, the incidence of adolescent depression and suicide cases has risen in the past 10 years. Despite the risk factors and causes being multifactorial, the influence of popular culture on society and adolescents in this media-driven generation cannot be mitigated. Although the impact of social media and its effect on shaping self-identity in adolescents have been observed, the impact of music and its potential for subliminal negative messages to adolescents remains unclear. Objective: This study analyzes the lyrics and music videos of the most popular music of multiple genres to quantify the frequencies of varying music theme trends. Methods: The frequencies of themes of 1052 total American and Latin songs were collected from the Nielsen Music and Billboard?s top 100 chart performance from 1998 to 2018 for hip hop/rhythm and blues (R&B), pop, Latin, country, and rock/metal genres. Themes from songs were identified, quantified, and categorized with a rubric into negative, neutral, and positive themes by 3 different reviewers. Analysis was performed using 2-tailed t tests and a generalized linear model. Results: Popular songs were reviewed for positive, negative, and neutral themes in the following 3-year intervals for ease of analysis purposes: 1998 to 2000 (n=148), 2001 to 2003 (n=150), 2004 to 2006 (n=148), 2007 to 2009 (n=156), 2010 to 2012 (n= 150), 2013 to 2015 (n=150), and 2016 to 2018 (n=150). There was a significant 180% increase in the percentage of songs with negative themes between all the interval years and across all genres (P<.001), while there was no significant difference in the frequency of songs with positive (P=.54) or neutral (P=.26) themes by year. There were significant differences in the number of negative themes found across genres (P<.001), with hip hop/R&B having the highest frequency of 130 out of 208 (62.5%) of the negative themes when compared to each of the individual genres (P<.001). Conclusions: This study shows there is an increase in the frequency of negative themes over the span of 20 years across all genres, with hip hop/R&B having the highest frequency among the genres. These findings point to the potential impact that music may have in popular culture and on society. Furthermore, these results can help shape discussions between caregivers and their adolescent dependents and between primary care providers and their adolescent patients. UR - https://pediatrics.jmir.org/2021/2/e26475/ UR - http://dx.doi.org/10.2196/26475 UR - http://www.ncbi.nlm.nih.gov/pubmed/34184999 ID - info:doi/10.2196/26475 ER - TY - JOUR AU - March, Sonja AU - Batterham, J. Philip AU - Rowe, Arlen AU - Donovan, Caroline AU - Calear, L. Alison AU - Spence, H. Susan PY - 2021/6/18 TI - Trajectories of Change in an Open-access Internet-Based Cognitive Behavior Program for Childhood and Adolescent Anxiety: Open Trial JO - JMIR Ment Health SP - e27981 VL - 8 IS - 6 KW - iCBT KW - child KW - adolescent KW - anxiety KW - online KW - trajectories of change N2 - Background: Although evidence bolstering the efficacy of internet-based cognitive behavioral therapy (iCBT) for treating childhood anxiety has been growing continuously, there is scant empirical research investigating the timing of benefits made in iCBT programs (eg, early or delayed). Objective: This study aims to examine the patterns of symptom trajectories (changes in anxiety) across an iCBT program for anxiety (BRAVE Self-Help). Methods: This study?s participants included 10,366 Australian youth aged 7 to 17 years (4140 children aged 7-12 years; 6226 adolescents aged 12-17 years) with elevated anxiety who registered for the BRAVE Self-Help program. Participants self-reported their anxiety symptoms at baseline or session 1 and then at the commencement of each subsequent session. Results: The results show that young people completing the BRAVE Self-Help program tend to fall into two trajectory classes that can be reliably identified in terms of high versus moderate baseline levels of anxiety and subsequent reduction in symptoms. Both high and moderate anxiety severity trajectory classes showed significant reductions in anxiety, with the greatest level of change being achieved within the first six sessions for both classes. However, those in the moderate anxiety severity class tended to show reductions in anxiety symptoms to levels below the elevated range, whereas those in the high symptom group tended to remain in the elevated range despite improvements. Conclusions: These findings suggest that those in the high severity group who do not respond well to iCBT on a self-help basis may benefit from the additional support provided alongside the program or a stepped-care approach where progress is monitored and support can be provided as necessary. UR - https://mental.jmir.org/2021/6/e27981 UR - http://dx.doi.org/10.2196/27981 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142971 ID - info:doi/10.2196/27981 ER - TY - JOUR AU - Cheng, Qijin AU - Lui, Carrie AU - Ip, Lam Flora Wai AU - Yip, Fai Paul Siu PY - 2021/6/18 TI - Typology and Impact of YouTube Videos Posted in Response to a Student Suicide Crisis: Social Media Metrics and Content Analyses JO - JMIR Ment Health SP - e15551 VL - 8 IS - 6 KW - suicide KW - suicide prevention KW - social media KW - infodemiology KW - internet KW - digital health KW - YouTube KW - impact evaluation KW - network visualization N2 - Background: Videos relating to suicide are available on YouTube, but their characteristics and impacts have seldom been examined. Objective: This study aimed to examine YouTube videos posted in response to a sudden spate of student suicides in Hong Kong during the 2015-2016 school year and evaluate the impacts of those videos. Methods: Keyword search was performed on YouTube, and relevant videos were identified. Video typology was examined through content analysis, specifically grouping the videos by who uploaded the videos, what presentation formats were used in the videos, whether the videos were originally created by the uploaders, and whether the videos disclosed the uploaders? personal experiences with suicide. Impacts of the videos were assessed in terms of reach (measured by view count), engagement (measured by comment count), and insights (measured as to what extent the comments to each video could reveal personal suicide risk and attitude toward help-seeking). Statistical analysis was conducted to compare the impacts of different types of videos. The 7 most impactful videos that were originally created by the YouTubers were selected for further analysis. They were compared with 7 videos uploaded by the same YouTubers right before the student suicide videos and 7 right after the student suicide videos. The comparison focused on their impacts and the network structure of the comments to those videos. Results: A total of 162 relevant YouTube videos were identified. They were uploaded by 7 types of stakeholders, and the most common format was one person talking to the camera. A total of 87.0% (141/162) of the videos were originally created by the uploaders and only 8.0% (13/162) of the videos disclosed uploader personal experiences with suicide. The uploader profiles being popular or top YouTubers and the video containing disclosure of the uploader?s personal experiences were found to be significantly correlated with greater impacts (P<.001). Focusing on the 7 most impactful original videos, it is found that those videos generated more engagement, especially more interactions between the viewers, and more insights than regular videos uploaded by the same YouTubers. Conclusions: When responding to a youth suicide crisis, videos made by key opinion leaders on YouTube sharing their own experiences of overcoming suicide risks could generate significant positive impacts. These types of videos offer a precious opportunity to craft online campaigns and activities to raise suicide prevention awareness and engage vulnerable youth. UR - https://mental.jmir.org/2021/6/e15551/ UR - http://dx.doi.org/10.2196/15551 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/15551 ER - TY - JOUR AU - Liverpool, Shaun AU - Edbrooke-Childs, Julian PY - 2021/6/15 TI - A Caregiver Digital Intervention to Support Shared Decision Making in Child and Adolescent Mental Health Services: Development Process and Stakeholder Involvement Analysis JO - JMIR Form Res SP - e24896 VL - 5 IS - 6 KW - digital health intervention KW - caregivers KW - parents KW - child mental health N2 - Background: Parents and caregivers are generally recognized by literature and the law as key to child and adolescent mental health decisions. Digital interventions are increasingly being used to support care and treatment in child and adolescent mental health services (CAMHS). However, evidence of the design and development process is generally not made available. Objective: In light of calls for more transparency, this paper aims to describe the development of an evidence-based, theoretically informed digital decision support intervention for parents and caregivers of young people accessing CAMHS. Methods: The intervention was developed in line with the UK Medical Research Council framework for developing complex interventions. The process incorporated the steps for developing patient decision aids, as follows: assessing need, assessing feasibility; defining objectives; identifying the framework of decision support; and selecting the methods, designs, and dissemination approach. We synthesized theory, research, international guidelines, and input from relevant stakeholders using an iterative design approach. Results: The development steps resulted in Power Up for Parents, a decision support intervention, with five key features (ie, decisions, goals, journey, support, and resources). The intervention aims to encourage discussion, allow parents to ask questions during sessions or seek further information between sessions, and allow service providers to tailor the shared decision-making process to accommodate the needs of the parent and child. Conclusions: We confirmed that it is possible to use input from end users?integrated with theory and evidence?to create digital interventions to be used in CAMHS. Key lessons with implications for practice, policy, and implementation science, along with preliminary findings, are presented. International Registered Report Identifier (IRRID): RR2-10.2196/14571 UR - https://formative.jmir.org/2021/6/e24896 UR - http://dx.doi.org/10.2196/24896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128821 ID - info:doi/10.2196/24896 ER - TY - JOUR AU - Dohnt, C. Henriette AU - Dowling, J. Mitchell AU - Davenport, A. Tracey AU - Lee, Grace AU - Cross, P. Shane AU - Scott, M. Elizabeth AU - Song, C. Yun Ju AU - Hamilton, Blake AU - Hockey, J. Samuel AU - Rohleder, Cathrin AU - LaMonica, M. Haley AU - Hickie, B. Ian PY - 2021/6/14 TI - Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study JO - JMIR Res Protoc SP - e24697 VL - 10 IS - 6 KW - mental health service delivery KW - youth mental health KW - model of care coordination KW - transdiagnostic KW - health information technology KW - education KW - training KW - adoption into clinical practice KW - Kirkpatrick evaluation N2 - Background: Australia?s mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney?s Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC?s Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. Objective: This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. Methods: The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. Results: This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District?s Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. Conclusions: The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. International Registered Report Identifier (IRRID): PRR1-10.2196/24697 UR - https://www.researchprotocols.org/2021/6/e24697 UR - http://dx.doi.org/10.2196/24697 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125074 ID - info:doi/10.2196/24697 ER - TY - JOUR AU - Nicolaidou, Iolie AU - Stavrou, Evi AU - Leonidou, Georgia PY - 2021/6/9 TI - Building Primary-School Children?s Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study JO - JMIR Pediatr Parent SP - e27958 VL - 4 IS - 2 KW - COVID-19 KW - interactive learning environment KW - internet-based cognitive behavioral therapy KW - parents KW - prevention intervention KW - primary school children KW - psychological resilience KW - teachers N2 - Background: Resilience is a person?s mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children?s resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program ?Friends,? to overcome accessibility issues associated with delivering cognitive behavioral therapy?based interventions in formal and informal education settings. Objective: This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment?s usability. Methods: A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children?s anxiety symptoms, namely the Greek translation of the original Spence Children?s Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. Results: In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students? reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=?6.99; P<.001), identification of somatic symptoms of stress (t19=?7.31; P<.001), and identification of stress management techniques (t19=?6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. Conclusions: This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access. UR - https://pediatrics.jmir.org/2021/2/e27958 UR - http://dx.doi.org/10.2196/27958 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106080 ID - info:doi/10.2196/27958 ER - TY - JOUR AU - Moreno, A. Megan AU - Gaus, Quintin AU - Wilt, Megan AU - Arseniev-Koehler, Alina AU - Ton, Adrienne AU - Adrian, Molly AU - VanderStoep, Ann PY - 2021/5/31 TI - Displayed Depression Symptoms on Facebook at Two Time Points: Content Analysis JO - JMIR Form Res SP - e20179 VL - 5 IS - 5 KW - adolescents KW - content analysis KW - depression KW - Facebook KW - social media N2 - Background: Depression is a prevalent and problematic mental disorder that often has an onset in adolescence. Previous studies have illustrated that depression disclosures on social media are common and may be linked to an individual?s experiences of depression. However, most studies have examined depression displays on social media at a single time point. Objective: This study aims to investigate displayed depression symptoms on Facebook at 2 developmental time points based on symptom type and gender. Methods: Participants were recruited from an ongoing longitudinal cohort study. The content analysis of text-based Facebook data over 1 year was conducted at 2 time points: time 1 (adolescence; age 17-18 years) and time 2 (young adulthood; ages 20-22 years). Diagnostic criteria for depression were applied to each post to identify the displayed depression symptoms. Data were extracted verbatim. The analysis included nonparametric tests for comparisons. Results: A total of 78 participants? Facebook profiles were examined, of which 40 (51%) were male. At time 1, 62% (48/78) of the adolescents had a Facebook profile, and 54% (26/78) displayed depression symptom references with an average of 9.4 (SD 3.1) references and 3.3 (SD 2.3) symptom types. Of the 78 participants, 15 (19%) females and 12 (15%) males displayed depression symptom references; these prevalence estimates were not significantly different by gender (P=.59). At time 2, 35 young adults displayed symptoms of depression with an average of 4.6 (SD 2.3) references and 2.4 (SD 1.3) symptom types. There were no differences in the prevalence of symptoms of depression displayed between males (n=19) and females (n=16; P=.63). Conclusions: This content analysis study within an ongoing cohort study illustrates the differences in depression displays on Facebook by developmental stage and symptom. This study contributes to a growing body of literature by showing that using social media to observe and understand depression during the emerging adult developmental period may be a valuable approach. UR - https://formative.jmir.org/2021/5/e20179 UR - http://dx.doi.org/10.2196/20179 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057422 ID - info:doi/10.2196/20179 ER - TY - JOUR AU - Opara, Ijeoma AU - R Leonard, Noelle AU - Thorpe, Daneele AU - Kershaw, Trace PY - 2021/5/28 TI - Understanding Neighborhoods? Impact on Youth Substance Use and Mental Health Outcomes in Paterson, New Jersey: Protocol for a Community-Based Participatory Research Study JO - JMIR Res Protoc SP - e29427 VL - 10 IS - 5 KW - protocol KW - substance use KW - mental health KW - venue-based sampling KW - community N2 - Background: Substance use among youth is a major public health concern. Of note, substance use among youth is increasing in prevalence, and the incidence of substance use at earlier ages is rising. Given the long-term consequences of early substance use, it is important to identify factors that increase youth vulnerability to drug use, as they may be important targets for future interventions. Objective: This study aims to use innovative methods, such as venue-based sampling, to recruit youth who are disconnected from school and use community-based participatory research to gain a better understanding of the prevalence of substance use and important correlates among youth aged between 13 and 21 years in Paterson, New Jersey, a low-income, urban community. The study will use a convergent, mixed methods design involving multiple data collection components and the analysis of a ministrative data source, designed with the strengths of complex intervention frameworks in mind. The overall aims of the study are to identify the prevalence of substance use among youth who are engaged in school and not engaged in school; to understand important antecedents and correlates of substance use; and to use this information to inform social, environmental, and culturally appropriate interventions to address substance use and its correlates among youths in a lower-resourced urban community. Methods: This study will use both qualitative and quantitative methods to address important questions. Specifically, semistructured interviews using focus group and interview methodologies will be used to assess youths? lived experiences and will account for specific details that quantitative methods may not be able to attain. In addition, quantitative methods will be used to examine direct and multilevel associations between neighborhood factors and youth substance use and mental health outcomes. Results: A previous analysis from a substance use initiative in Paterson, New Jersey found that youth who use substances such as marijuana and alcohol are more likely to have higher rates of depression and anxiety. On the basis of the research questions, this study will examine the association between neighborhood characteristics, substance use, and mental health symptoms among youth in Paterson by using quantitative and qualitative methods and will use these findings to inform the adaptation of a community- and evidence-based substance use prevention intervention for these youths. Conclusions: The findings of this study will provide an important contribution to understanding the role of socioecological factors in predicting substance use and mental health outcomes among youth in a lower-resourced, urban community. Furthermore, these findings will serve as evidence for the development of a culturally informed, community-based prevention program to address substance use disparities for youth, including those who are truant in Paterson, New Jersey. International Registered Report Identifier (IRRID): PRR1-10.2196/29427 UR - https://www.researchprotocols.org/2021/5/e29427 UR - http://dx.doi.org/10.2196/29427 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047712 ID - info:doi/10.2196/29427 ER - TY - JOUR AU - Vogel, A. Erin AU - Ramo, E. Danielle AU - Prochaska, J. Judith AU - Meacham, C. Meredith AU - Layton, F. John AU - Humfleet, L. Gary PY - 2021/5/28 TI - Problematic Social Media Use in Sexual and Gender Minority Young Adults: Observational Study JO - JMIR Ment Health SP - e23688 VL - 8 IS - 5 KW - sexual and gender minorities KW - social media KW - Facebook KW - internet KW - social stigma KW - mobile phone N2 - Background: Sexual and gender minority (SGM) individuals experience minority stress, especially when they lack social support. SGM young adults may turn to social media in search of a supportive community; however, social media use can become problematic when it interferes with functioning. Problematic social media use may be associated with experiences of minority stress among SGM young adults. Objective: The objective of this study is to examine the associations among social media use, SGM-related internalized stigma, emotional social support, and depressive symptoms in SGM young adults. Methods: Participants were SGM young adults who were regular (?4 days per week) social media users (N=302) and had enrolled in Facebook smoking cessation interventions. As part of a baseline assessment, participants self-reported problematic social media use (characterized by salience, tolerance, and withdrawal-like experiences; adapted from the Facebook Addiction Scale), hours of social media use per week, internalized SGM stigma, perceived emotional social support, and depressive symptoms. Pearson correlations tested bivariate associations among problematic social media use, hours of social media use, internalized SGM stigma, perceived emotional social support, and depressive symptoms. Multiple linear regression examined the associations between the aforementioned variables and problematic social media use and was adjusted for gender identity. Results: A total of 302 SGM young adults were included in the analyses (assigned female at birth: 218/302, 72.2%; non-Hispanic White: 188/302, 62.3%; age: mean 21.9 years, SD 2.2 years). The sexual identity composition of the sample was 59.3% (179/302) bisexual and/or pansexual, 17.2% (52/302) gay, 16.9% (51/302) lesbian, and 6.6% (20/302) other. The gender identity composition of the sample was 61.3% (185/302) cisgender; 24.2% (73/302) genderqueer, fluid, nonbinary, or other; and 14.6% (44/302) transgender. Problematic social media use averaged 2.53 (SD 0.94) on a 5-point scale, with a median of 17 hours of social media use per week (approximately 2.5 h per day). Participants with greater problematic social media use had greater internalized SGM stigma (r=0.22; P<.001) and depressive symptoms (r=0.22; P<.001) and lower perceived emotional social support (r=?0.15; P=.007). Greater internalized SGM stigma remained was significantly associated with greater problematic social media use after accounting for the time spent on social media and other correlates (P<.001). In addition, participants with greater depressive symptoms had marginally greater problematic social media use (P=.05). In sum, signs of problematic social media use were more likely to occur among SGM young adults who had internalized SGM stigma and depressive symptoms. Conclusions: Taken together, problematic social media use among SGM young adults was associated with negative psychological experiences, including internalized stigma, low social support, and depressive symptoms. SGM young adults experiencing minority stress may be at risk for problematic social media use. UR - https://mental.jmir.org/2021/5/e23688 UR - http://dx.doi.org/10.2196/23688 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047276 ID - info:doi/10.2196/23688 ER - TY - JOUR AU - Cohen, Mara AU - Karrington, Baer AU - Trachtman, Howard AU - Salas-Humara, Caroline PY - 2021/5/19 TI - Allostatic Stress and Inflammatory Biomarkers in Transgender and Gender Expansive Youth: Protocol for a Pilot Cohort Study JO - JMIR Res Protoc SP - e24100 VL - 10 IS - 5 KW - transgender KW - gender diverse KW - adolescence KW - allostatic load KW - stress biomarkers KW - participatory action research KW - stress KW - biomarkers KW - participatory KW - gender N2 - Background: A growing number of adolescents are coming out as transgender and gender expansive (TGE). These teenagers have been shown to have significantly worse health outcomes than their cisgender peers. Hypotheses to explain this discrepancy are based on increased stress levels surrounding the societal acceptance of gender identity. In this context, elevated allostatic load (AL), which describes the wear and tear sustained by the body in response to repeated exposure to stress, has been associated with adverse long-term health outcomes. Objective: This protocol aims to measure AL among TGE adolescents compared with their cisgender peers and assess how AL varies depending on psychological stress and perceived societal acceptance. Methods: This is an observational proof-of-concept pilot study in which AL will be measured by assaying an array of inflammatory cytokines and cortisol in urine, saliva, and hair samples of TGE youth, and these parameters will be compared with those of age-matched control participants. A questionnaire will assess 4 aspects of psychosocial well-being: presence and management of depression and anxiety, gender identity support by family members, gender minority stress, and degree of perceived safety in the surrounding community. Samples and surveys will be collected at 3 visits (baseline, 6 months, and 12 months). This study will incorporate TGE coinvestigators to inform all aspects of design, data collection, and analysis and ensure that practices are carried out in a respectful and sensitive manner. Results: As of May 2021, the start of data collection for this project has continued to be postponed as a result of the COVID-19 pandemic, which has both impacted the functioning of the clinic and funding requests. We hope to begin participant recruitment and interviews with coinvestigators soon. Conclusions: We hypothesize that AL will be primarily influenced by psychological well-being and perceived support and that it will be similar in TGE adolescents and in age-matched cisgender control participants when acceptance and perceived support are high. The results of this study have the potential to increase our understanding of the health challenges faced by TGE individuals during adolescence as well as to show that low levels of acceptance may have detrimental health outcomes secondary to elevated ALs; this may lead to the development of a biomarker profile to assess allostatic stress in TGE patients that can be used to guide management. International Registered Report Identifier (IRRID): PRR1-10.2196/24100 UR - https://www.researchprotocols.org/2021/5/e24100 UR - http://dx.doi.org/10.2196/24100 UR - http://www.ncbi.nlm.nih.gov/pubmed/34009131 ID - info:doi/10.2196/24100 ER - TY - JOUR AU - Bowling, B. April AU - Slavet, James AU - Hendrick, Chelsea AU - Beyl, Robbie AU - Nauta, Phillip AU - Augustyn, Marilyn AU - Mbamalu, Mediatrix AU - Curtin, Carol AU - Bandini, Linda AU - Must, Aviva AU - Staiano, E. Amanda PY - 2021/5/14 TI - The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study JO - JMIR Form Res SP - e24566 VL - 5 IS - 5 KW - exercise KW - diet KW - sleep KW - mental health KW - children KW - adolescent KW - health promotion KW - telehealth KW - exergaming N2 - Background: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. Objective: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. Methods: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. Results: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (?58.8 min; P=.04) but not for the intervention group (?5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. Conclusions: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. Trial Registration: ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415. UR - https://formative.jmir.org/2021/5/e24566 UR - http://dx.doi.org/10.2196/24566 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988508 ID - info:doi/10.2196/24566 ER - TY - JOUR AU - Lehtimaki, Susanna AU - Martic, Jana AU - Wahl, Brian AU - Foster, T. Katherine AU - Schwalbe, Nina PY - 2021/4/29 TI - Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview JO - JMIR Ment Health SP - e25847 VL - 8 IS - 4 KW - digital health KW - adolescent health KW - young people KW - mental health KW - digital technologies N2 - Background: An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective: This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods: We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results: In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions: Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care. UR - https://mental.jmir.org/2021/4/e25847 UR - http://dx.doi.org/10.2196/25847 UR - http://www.ncbi.nlm.nih.gov/pubmed/33913817 ID - info:doi/10.2196/25847 ER - TY - JOUR AU - Zainel, Abdullatif Abduljaleel AU - Qotba, Hamda AU - Al-Maadeed, Alyaa AU - Al-Kohji, Sadriya AU - Al Mujalli, Hanan AU - Ali, Atif AU - Al Mannai, Lolwa AU - Aladab, Aisha AU - AlSaadi, Hamda AU - AlKarbi, Ali Khalid AU - Al-Baghdadi, Tholfakhar PY - 2021/4/27 TI - Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e24760 VL - 5 IS - 4 KW - COVID-19 KW - coronavirus KW - pandemic KW - psychological KW - coping strategies KW - children KW - adolescents KW - Qatar N2 - Background: In December 2019, a novel coronavirus called SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread due to human-to-human transmission, resulting in a global pandemic. Nearly every country, including Qatar, has established guidelines and regulations to limit the spread of the virus and to preserve public health. However, these procedures have been associated with negative effects on the psychological and intellectual well-being of individuals, including children and adolescents. Objective: The objective of this study was to determine the psychological influence of home isolation and social distancing on children and adolescents during the COVID-19 pandemic in Qatar, and the strategies used to cope with these measures. Methods: This cross-sectional study was undertaken using an online questionnaire administered through SMS text messaging. All home-isolated children and adolescents registered at the Primary Health Care Corporation aged 7-18 years were invited to participate in the study. Children and adolescents with intellectual disadvantages were excluded. A P value of .05 (two-tailed) was considered statistically significant. Results: Data were collected from 6608 participants from June 23 to July 18, 2020. Nearly all participants adhered to the official regulations during the period of home isolation and social distancing; however, 69.1% (n=4568) of parents believed their children were vulnerable to the virus compared to 25% (n=1652) who expressed they were not vulnerable at all. Higher levels of anger, depression, and general anxiety were prevalent among 1.3% (n=84), 3.9% (n=260), and 1.6% (n=104) of participants, respectively. The mean score for the emotional constructs anger and depression decreased with increased compliance with regulations (P=.04 and P=.11, respectively). The differences in mean score for all psychological and coping strategies used among participants across the 3 levels of vulnerability to SARS-CoV-2 were statistically significant. The mean score varied little with increasing reported vulnerability to the virus. This mild variation can make a difference when the sample size is large, as is the case in this study. Conclusions: Screening for psychological and social disruptions is important for the development of strategies by schools and health care providers to assess and monitor behavioral changes and negative psychological impact during post?COVID-19 reintegration. Participants experiencing higher levels of anxiety should be given more attention during reintegration and transitional phases in schools. Although electronic devices and social media platforms may have lowered anxiety levels in some cases, it is important to address how they are used and how content is tailored to children and adolescents. It is also important to maintain an active lifestyle for children and young persons, and encourage them not to neglect their physical health, as this promotes a better psychological state of mind. UR - https://formative.jmir.org/2021/4/e24760 UR - http://dx.doi.org/10.2196/24760 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851577 ID - info:doi/10.2196/24760 ER - TY - JOUR AU - Albritton, Tashuna AU - Ford, Lynett Kelsey AU - Elsbernd, Kira AU - Santodomingo, Melodie AU - Juzang, Ivan AU - Weddington, Pam AU - Bull, Sheana PY - 2021/4/23 TI - Implementing a Peer Advocate Mental Health Digital Intervention Program for Ohio Youth: Descriptive Pilot Study JO - JMIR Ment Health SP - e24605 VL - 8 IS - 4 KW - mental health KW - adolescent KW - digital health KW - suicide prevention KW - social support KW - youth N2 - Background: In the United States, millions of adolescents report poor mental health, where 1 in 5 teenagers considers suicide. Reducing stigma and fostering peer support remains critical for positive mental health interventions and programs. Increasingly, digital mental health tools have emerged with great promise, leveraging social networks. Despite the potential, limited understanding of such comprehensive programs and their implementation exist. Objective: The objective of this study investigates a piloted digital mental health training program (Be Present) for youth, specifically describing the impact on youth behavioral outcomes and user engagement and identifying high-risk youth in the early phases of prevention. Methods: Eligibility included Ohio residents (aged 14 to 22 years) to be enrolled as either a Friend or a Peer Advocate. From May 1 to June 1, 2019, participants completed the Advocate training course, taking pretest and posttest surveys. Single-arm descriptive analyses measured youth outcomes (self-efficacy, intentions, behaviors, social support, knowledge, and sources of strength) and engagement and assessed risk based on survey responses. Results: A total of 65 adolescents participated, with 54 completing both pretest and posttest surveys. The majority of participants included non-Hispanic White females. Findings illustrated a significant increase in self-report of referrals for mental health services as well as in perceptions that youth had of experiencing social support; however, no significant differences were found for measures of self-efficacy, knowledge, and sources of strength between pretest and posttest surveys. Roughly two-thirds of the participants completed all of the Advocate training modules, and we observed a gradual decline in engagement. Most respondents who received escalated high-risk response messages identified as female. Conclusions: The pilot presented promise for implementing a digital mental health program focused on peer support, specifically observing reported youth behavioral outcomes and user engagement and identifying high-risk youth. Various limitations exist given the small nonrepresentative sample and lack of control group. All findings should be considered preliminary to a larger trial and underscore the feasibility of delivering online training programs to bolster adolescent mental health. Such formative evaluation proved critical for future implementation and research, offering opportunity for substantial improvements for real-world digital mental health programs. UR - https://mental.jmir.org/2021/4/e24605 UR - http://dx.doi.org/10.2196/24605 UR - http://www.ncbi.nlm.nih.gov/pubmed/33890868 ID - info:doi/10.2196/24605 ER - TY - JOUR AU - Armstrong, C. Courtney AU - Odukoya, J. Erica AU - Sundaramurthy, Keerthi AU - Darrow, M. Sabrina PY - 2021/4/22 TI - Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis JO - JMIR Ment Health SP - e24482 VL - 8 IS - 4 KW - qualitative KW - mHealth KW - mobile phone KW - behavior monitoring KW - youth N2 - Background: Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. Objective: The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. Methods: Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. Results: During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. Conclusions: Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers. UR - https://mental.jmir.org/2021/4/e24482 UR - http://dx.doi.org/10.2196/24482 UR - http://www.ncbi.nlm.nih.gov/pubmed/33885364 ID - info:doi/10.2196/24482 ER - TY - JOUR AU - Stoyanov, R. Stoyan AU - Zelenko, Oksana AU - Staneva, Aleksandra AU - Kavanagh, J. David AU - Smith, Calvin AU - Sade, Gavin AU - Cheers, Jessica AU - Hides, Leanne PY - 2021/4/20 TI - Development of the Niggle App for Supporting Young People on Their Dynamic Journey to Well-being: Co-design and Qualitative Research Study JO - JMIR Mhealth Uhealth SP - e21085 VL - 9 IS - 4 KW - mHealth KW - adolescence KW - youth KW - young people KW - well-being KW - co-design KW - participatory design KW - qualitative research KW - thematic analysis KW - recovery KW - visual methods N2 - Background: Adolescence is a life stage characterized by intense development and increased vulnerability. Yet, young people rarely seek help for mental health, often due to stigma and embarrassment. Alarmingly, even those who do seek help may not be able to receive it. Interventions focused on well-being offer a protective factor against adversity. Highly effective, innovative, theoretically sound, accessible, and engaging mobile health (mHealth) interventions that can be used to look beyond mental ill-health and toward mental well-being are urgently needed. Objective: We aimed to explore how young Australians conceptualize and construct recovery journeys from feeling unwell to being well in order to inform the conceptual design of a youth-led information-, resource-, and support-focused mHealth intervention. Methods: A sample of young people, grouped by age (12-15 years, 16-19 years, and 20-25 years), took part in 3 in-person participatory design workshops (per group). Young people?s understanding and representation of well-being, feeling unwell, and the recovery journey were investigated using visual and linguistic data collection methods: photo elicitation and journey mapping. A social constructionist perspective was used for thematic analysis to produce a conceptual model of the recovery journey. A mobile app was co-designed and all app functions were mapped through iterative development and testing by young people and a team of psychology, research, design and information technology experts. Results: Young people (n=25) described a 6-stage journey with specific barriers and coping strategies. The findings, when situated within the personal recovery framework in mental health, emphasize the cyclic and iterative model of change. Through co-design, the new app?Niggle?was conceptualized as a visual representation of an amorphous problem, which can be addressed through app functions corresponding to the most helpful strategies that young people used to progress through the stages of their recovery journey. Conclusions: Niggle is available to offer support to young people for a range of problems and provides a hot link to counseling services in Australia. This paper elaborates on the process of in-depth qualitative data collection through visual, linguistic, and co-design methods. The findings of this study give insight into young people?s understanding of well-being and recovery. This paper could aid the development of high-quality personalized mHealth interventions and support resources. UR - https://mhealth.jmir.org/2021/4/e21085 UR - http://dx.doi.org/10.2196/21085 UR - http://www.ncbi.nlm.nih.gov/pubmed/33877050 ID - info:doi/10.2196/21085 ER - TY - JOUR AU - Boucher, M. Eliane AU - Ward, E. Haley AU - Stafford, L. Julia AU - Parks, C. Acacia PY - 2021/4/19 TI - Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e25545 VL - 10 IS - 4 KW - digital intervention KW - adolescents KW - stress management KW - mental health KW - mobile phone N2 - Background: Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress. Objective: The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination. Methods: This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions. Results: Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021. Conclusions: Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally. Trial Registration: ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888 International Registered Report Identifier (IRRID): PRR1-10.2196/25545 UR - https://www.researchprotocols.org/2021/4/e25545 UR - http://dx.doi.org/10.2196/25545 UR - http://www.ncbi.nlm.nih.gov/pubmed/33871377 ID - info:doi/10.2196/25545 ER - TY - JOUR AU - Tindall, Lucy AU - Toner, Paul AU - Mikocka-Walus, Antonina AU - Wright, Barry PY - 2021/4/13 TI - Perceptions of and Opinions on a Computerized Behavioral Activation Program for the Treatment of Depression in Young People: Thematic Analysis JO - J Med Internet Res SP - e19743 VL - 23 IS - 4 KW - depression KW - qualitative KW - thematic analysis KW - young people KW - health care professionals KW - computerized therapies N2 - Background: Depression is one of the leading causes of illness and disability in young people, with approximately 20% having experienced a depressive episode by the age of 18 years. Behavioral activation (BA), a National Institute for Health and Care Excellence?recommended treatment for adults with depression, has shown preliminary support for its use with young people. BA may have the potential to be adapted and delivered in a computerized format to address the barriers often associated with young people accessing support. Despite the benefits of adopting computerized therapy delivery, the limited effectiveness of some programs has been attributed to a failure to tailor interventions to patients and practices. Therefore, while developing new treatments, it is important that target users be involved in the intervention design. Objective: This qualitative study aims to explore the views and preferences of young people and health care professionals regarding the development of a new computerized BA therapy for young people with low mood or depression, to ensure that the therapy was suitable for the target user. Methods: Semistructured focus groups and individual interviews were conducted with young people (those with experience in accessing support and those without) and health care professionals regarding the development of a new computerized BA therapy for young people with low mood or depression. The data were analyzed using thematic analysis. Results: A total of 27 individuals, comprising both health care professionals and young people, participated in this study. Vital information pertaining to the important components of a new therapy, including its presentation, delivery, and content, was collected. Conclusions: Variations in perspectives highlighted the need to adopt a systemic approach in therapy development by considering the opinions of young people with and without experience in accessing mental health support and health care professionals. UR - https://www.jmir.org/2021/4/e19743 UR - http://dx.doi.org/10.2196/19743 UR - http://www.ncbi.nlm.nih.gov/pubmed/33847594 ID - info:doi/10.2196/19743 ER - TY - JOUR AU - Bailey, Eleanor AU - Robinson, Jo AU - Alvarez-Jimenez, Mario AU - Nedeljkovic, Maja AU - Valentine, Lee AU - Bendall, Sarah AU - D'Alfonso, Simon AU - Gilbertson, Tamsyn AU - McKechnie, Ben AU - Rice, Simon PY - 2021/4/5 TI - Moderated Online Social Therapy for Young People With Active Suicidal Ideation: Qualitative Study JO - J Med Internet Res SP - e24260 VL - 23 IS - 4 KW - suicide KW - youth KW - social media KW - internet-based intervention N2 - Background: Web-based interventions are a promising approach to support youth at risk of suicide, and those incorporating peer-to-peer social networking may have the added potential to target interpersonal states of perceived burdensomeness and thwarted belongingness. Owing to feasibility and safety concerns, including fear of contagion, this had not been tested until recently. In 2018, we conducted a pilot evaluation to test the feasibility, safety, and acceptability of a Moderated Online Social Therapy intervention, called Affinity, with a sample of young people with active suicidal ideation. Objective: The aim of this study is to report qualitative data collected from study participants regarding their experience of the web-based social network and the consequent safety features. Methods: Affinity is a closed website incorporating 3 key components: therapeutic content delivered via comics, peer-to-peer social networking, and moderation by peers and clinicians. Semistructured interviews were conducted with 17 young people who participated in the pilot study after 8 weeks of exposure to the intervention. Interview data from 2 young people who did not use Affinity were excluded from the analysis. The interviews were analyzed using thematic analysis, with the frequency of responses characterized using the consensual qualitative research method. The results are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Results: A total of 4 overarching themes were identified: a safe and supportive environment, the importance of mutual experiences, difficulty engaging and connecting, and the pros and cons of banning discussions about suicide. Interestingly, although Affinity was perceived to be safe and free of judgment, concerns about negative evaluation and triggering others were significant barriers to posting on the social network. Participants generally supported the banning of conversations about suicide, although for some this was perceived to reinforce stigma or was associated with frustration and distress. Conclusions: The results not only support the safety and potential therapeutic benefit of the social networking aspect of Affinity but also highlight several implementation challenges. There is a need to carefully balance the need for stringent safety and design features while ensuring that the potential for therapeutic benefit is maximized. UR - https://www.jmir.org/2021/4/e24260 UR - http://dx.doi.org/10.2196/24260 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818392 ID - info:doi/10.2196/24260 ER - TY - JOUR AU - Wong, W. Howard AU - Lo, Brian AU - Shi, Jenny AU - Hollenberg, Elisa AU - Abi-Jaoude, Alexxa AU - Johnson, Andrew AU - Chaim, Gloria AU - Cleverley, Kristin AU - Henderson, Joanna AU - Levinson, Andrea AU - Robb, Janine AU - Voineskos, Aristotle AU - Wiljer, David PY - 2021/4/2 TI - Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience JO - JMIR Ment Health SP - e23447 VL - 8 IS - 4 KW - transition-aged youth KW - qualitative study KW - user experience KW - help-seeking KW - mental health KW - postsecondary KW - mobile apps KW - adolescent N2 - Background: There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students. Objective: This study focuses on understanding postsecondary students? attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience. Methods: Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants? overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts. Results: User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time. Conclusions: Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 UR - https://mental.jmir.org/2021/4/e23447 UR - http://dx.doi.org/10.2196/23447 UR - http://www.ncbi.nlm.nih.gov/pubmed/33797395 ID - info:doi/10.2196/23447 ER - TY - JOUR AU - Li, H. Sophie AU - Graham, M. Bronwyn AU - Werner-Seidler, Aliza PY - 2021/3/23 TI - Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App?Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study JO - JMIR Form Res SP - e22498 VL - 5 IS - 3 KW - insomnia KW - gender differences KW - adolescents KW - sleep disturbance KW - sleep quality KW - sleep KW - gender KW - digital interventions N2 - Background: Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents. Objective: The purpose of this study was to examine gender differences in sleep symptom profiles and treatment response in adolescents. Methods: Digital cognitive behavioral therapy for insomnia (CBT-I) treatment responsiveness, as indexed by changes in Insomnia Severity Index (ISI) and Global Pittsburgh Sleep Quality Index (PSQI) scores, was compared in boys and girls (aged 12-16 years; N=49) who participated in a pilot evaluation of the Sleep Ninja smartphone app. Gender differences in self-reported baseline insomnia symptom severity (ISI), sleep quality (PSQI), and sleep characteristics derived from sleep diaries were also examined. Results: Compared with boys, we found that girls reported greater symptom severity (P=.04) and nighttime wakefulness (P=.01 and P=.04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), more nighttime awakenings (P=.16), or longer time to get to sleep (P=.21). However, gender differences in symptom severity and sleep duration were accounted for by boys being marginally younger in age. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity (P=.32); there was a trend showing gender differences in improvements in sleep quality, but this was not statistically significant (P=.07). Conclusions: These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents. UR - https://formative.jmir.org/2021/3/e22498 UR - http://dx.doi.org/10.2196/22498 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755029 ID - info:doi/10.2196/22498 ER - TY - JOUR AU - Hanley, Terry AU - Sefi, Aaron AU - Grauberg, Janet AU - Prescott, Julie AU - Etchebarne, Andre PY - 2021/3/22 TI - A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration JO - JMIR Pediatr Parent SP - e23193 VL - 4 IS - 1 KW - telepsychology KW - digital mental health KW - online therapy KW - young people KW - Kooth KW - Theory of Change KW - positive virtual ecosystems N2 - Background: Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging. Objective: This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. Methods: A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers). Results: A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations). Conclusions: Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers. UR - https://pediatrics.jmir.org/2021/1/e23193 UR - http://dx.doi.org/10.2196/23193 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749615 ID - info:doi/10.2196/23193 ER - TY - JOUR AU - Mariamo, Audrey AU - Temcheff, Elizabeth Caroline AU - Léger, Pierre-Majorique AU - Senecal, Sylvain AU - Lau, Alexandra Marianne PY - 2021/3/18 TI - Emotional Reactions and Likelihood of Response to Questions Designed for a Mental Health Chatbot Among Adolescents: Experimental Study JO - JMIR Hum Factors SP - e24343 VL - 8 IS - 1 KW - chatbots KW - conversational agents KW - mental health KW - well-being KW - adolescents KW - user experience KW - user preferences N2 - Background: Psychological distress increases across adolescence and has been associated with several important health outcomes with consequences that can extend into adulthood. One type of technological innovation that may serve as a unique intervention for youth experiencing psychological distress is the conversational agent, otherwise known as a chatbot. Further research is needed on the factors that may make mental health chatbots destined for adolescents more appealing and increase the likelihood that adolescents will use them. Objective: The aim of this study was to assess adolescents? emotional reactions and likelihood of responding to questions that could be posed by a mental health chatbot. Understanding adolescent preferences and factors that could increase adolescents? likelihood of responding to chatbot questions could assist in future mental health chatbot design destined for youth. Methods: We recruited 19 adolescents aged 14 to 17 years to participate in a study with a 2×2×3 within-subjects factorial design. Each participant was sequentially presented with 96 chatbot questions for a duration of 8 seconds per question. Following each presentation, participants were asked to indicate how likely they were to respond to the question, as well as their perceived affective reaction to the question. Demographic data were collected, and an informal debriefing was conducted with each participant. Results: Participants were an average of 15.3 years old (SD 1.00) and mostly female (11/19, 58%). Logistic regressions showed that the presence of GIFs predicted perceived emotional valence (?=?.40, P<.001), such that questions without GIFs were associated with a negative perceived emotional valence. Question type predicted emotional valence, such that yes/no questions (?=?.23, P=.03) and open-ended questions (?=?.26, P=.01) were associated with a negative perceived emotional valence compared to multiple response choice questions. Question type also predicted the likelihood of response, such that yes/no questions were associated with a lower likelihood of response compared to multiple response choice questions (?=?.24, P=.03) and a higher likelihood of response compared to open-ended questions (?=.54, P<.001). Conclusions: The findings of this study add to the rapidly growing field of teen-computer interaction and contribute to our understanding of adolescent user experience in their interactions with a mental health chatbot. The insights gained from this study may be of assistance to developers and designers of mental health chatbots. UR - https://humanfactors.jmir.org/2021/1/e24343 UR - http://dx.doi.org/10.2196/24343 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734089 ID - info:doi/10.2196/24343 ER - TY - JOUR AU - Ritvo, Paul AU - Knyahnytska, Yuliya AU - Pirbaglou, Meysam AU - Wang, Wei AU - Tomlinson, George AU - Zhao, Haoyu AU - Linklater, Renee AU - Bai, Shari AU - Kirk, Megan AU - Katz, Joel AU - Harber, Lillian AU - Daskalakis, Zafiris PY - 2021/3/10 TI - Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial JO - J Med Internet Res SP - e24380 VL - 23 IS - 3 KW - intervention study KW - telemedicine KW - electronic CBT KW - clinical trial KW - depression KW - cognitive behavioral therapy KW - CBT KW - online therapy KW - online intervention KW - youth KW - young adult N2 - Background: Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. Objective: We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. Methods: Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. Results: In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference ?8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference ?4.94, P=.001), Beck Anxiety Inventory score (difference ?11.29, P<.001), and Brief Pain Inventory score (difference ?1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire?Nonjudging subscale (difference ?2.68, P=.05). Conclusions: These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 UR - https://www.jmir.org/2021/3/e24380 UR - http://dx.doi.org/10.2196/24380 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688840 ID - info:doi/10.2196/24380 ER - TY - JOUR AU - Liverpool, Shaun AU - Edbrooke-Childs, Julian PY - 2021/3/2 TI - 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 JO - JMIR Form Res SP - e25235 VL - 5 IS - 3 KW - mental health KW - pilot projects KW - child KW - adolescent KW - parents KW - shared decision making N2 - 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 UR - https://formative.jmir.org/2021/3/e25235 UR - http://dx.doi.org/10.2196/25235 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650973 ID - info:doi/10.2196/25235 ER - TY - JOUR AU - Yu, Yanqiu AU - Li, Ji-Bin AU - Lau, F. Joseph T. PY - 2021/2/24 TI - Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China JO - J Med Internet Res SP - e22393 VL - 23 IS - 2 KW - gaming disorder KW - ICD-11 KW - high-risk subgroups KW - disease awareness KW - medicalization KW - internet gaming KW - awareness KW - impact KW - adolescent KW - young adult KW - China KW - game KW - disorder KW - ICD N2 - 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. UR - https://www.jmir.org/2021/2/e22393 UR - http://dx.doi.org/10.2196/22393 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625362 ID - info:doi/10.2196/22393 ER - TY - JOUR AU - Parker, L. Belinda AU - Chakouch, Cassandra AU - Subotic-Kerry, Mirjana AU - Batterham, J. Philip AU - Mackinnon, Andrew AU - Newby, M. Jill AU - Whitton, E. Alexis AU - McGoldrick, Janey AU - Cockayne, Nicole AU - O'Dea, Bridianne PY - 2021/2/24 TI - The Building Educators? Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e25870 VL - 10 IS - 2 KW - mental health training KW - schools KW - teachers KW - educators KW - mental health KW - student mental health KW - secondary school N2 - 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 UR - https://www.researchprotocols.org/2021/2/e25870 UR - http://dx.doi.org/10.2196/25870 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625374 ID - info:doi/10.2196/25870 ER - TY - JOUR AU - Egilsson, Erlendur AU - Bjarnason, Ragnar AU - Njardvik, Urdur PY - 2021/2/17 TI - Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e21432 VL - 5 IS - 2 KW - mHealth KW - intervention KW - adolescent KW - attrition KW - self-efficacy KW - mental health KW - physical activity KW - young adult KW - behavior N2 - 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 ? 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. UR - http://formative.jmir.org/2021/2/e21432/ UR - http://dx.doi.org/10.2196/21432 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481750 ID - info:doi/10.2196/21432 ER - TY - JOUR AU - Zheng, Katherine AU - George, Maureen AU - Roehlkepartain, Eugene AU - Santelli, John AU - Bruzzese, Jean-Marie AU - Smaldone, Arlene PY - 2021/2/16 TI - Developmental Assets of Adolescents and Young Adults With Chronic Illness and Comorbid Depression: Qualitative Study Using YouTube JO - JMIR Ment Health SP - e23960 VL - 8 IS - 2 KW - adolescent development KW - chronic disease KW - depression KW - developmental assets KW - positive youth development KW - YouTube N2 - 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. UR - http://mental.jmir.org/2021/2/e23960/ UR - http://dx.doi.org/10.2196/23960 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591288 ID - info:doi/10.2196/23960 ER - TY - JOUR AU - Liu, Guihua AU - Wang, Shuo AU - Liao, Jinhua AU - Ou, Ping AU - Huang, Longsheng AU - Xie, Namei AU - He, Yingshuang AU - Lin, Jinling AU - He, Hong-Gu AU - Hu, Rongfang PY - 2021/2/10 TI - 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 JO - JMIR Ment Health SP - e23917 VL - 8 IS - 2 KW - coronavirus disease 2019 KW - autism spectrum disorder KW - parenting training KW - psychological well-being KW - social media KW - WeChat KW - COVID-19 KW - autism KW - parenting KW - mental health KW - well-being KW - anxiety KW - depression KW - stress N2 - 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 UR - https://mental.jmir.org/2021/2/e23917 UR - http://dx.doi.org/10.2196/23917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481751 ID - info:doi/10.2196/23917 ER - TY - JOUR AU - Cheng, Sze Vanessa Wan AU - Piper, E. Sarah AU - Ottavio, Antonia AU - Davenport, A. Tracey AU - Hickie, B. Ian PY - 2021/2/10 TI - Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis JO - J Med Internet Res SP - e23502 VL - 23 IS - 2 KW - mental health KW - health information technologies KW - self-determination theory KW - eHealth KW - internet KW - digital health KW - adolescent KW - mental health services KW - young adult KW - LGBTQ persons KW - mobile phone KW - rural health N2 - 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. UR - https://www.jmir.org/2021/2/e23502 UR - http://dx.doi.org/10.2196/23502 UR - http://www.ncbi.nlm.nih.gov/pubmed/33565985 ID - info:doi/10.2196/23502 ER - TY - JOUR AU - Rickwood, Debra AU - Kennedy, Vanessa AU - Miyazaki, Koki AU - Telford, Nic AU - Carbone, Stephen AU - Hewitt, Ella AU - Watts, Carolyn PY - 2021/2/9 TI - An Online Platform to Provide Work and Study Support for Young People With Mental Health Challenges: Observational and Survey Study JO - JMIR Ment Health SP - e21872 VL - 8 IS - 2 KW - youth KW - mental health KW - unemployment KW - work KW - study KW - online support N2 - 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. UR - https://mental.jmir.org/2021/2/e21872 UR - http://dx.doi.org/10.2196/21872 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560238 ID - info:doi/10.2196/21872 ER - TY - JOUR AU - Coughlan, Helen AU - Quin, David AU - O'Brien, Kevin AU - Healy, Colm AU - Deacon, Jack AU - Kavanagh, Naoise AU - Humphries, Niamh AU - Clarke, C. Mary AU - Cannon, Mary PY - 2021/2/9 TI - Online Mental Health Animations for Young People: Qualitative Empirical Thematic Analysis and Knowledge Transfer JO - J Med Internet Res SP - e21338 VL - 23 IS - 2 KW - mental health KW - public health KW - mental health literacy KW - social media KW - youth KW - qualitative KW - knowledge translation KW - anxiety KW - bullying KW - depression KW - loneliness KW - internet N2 - 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. UR - http://www.jmir.org/2021/2/e21338/ UR - http://dx.doi.org/10.2196/21338 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560231 ID - info:doi/10.2196/21338 ER - TY - JOUR AU - Kuriyan, Aparajita AU - Kinkler, Grace AU - Cidav, Zuleyha AU - Kang-Yi, Christina AU - Eiraldi, Ricardo AU - Salas, Eduardo AU - Wolk, Benjamin Courtney PY - 2021/2/8 TI - 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 JO - JMIR Res Protoc SP - e26567 VL - 10 IS - 2 KW - teams KW - Team Strategies and Tools to Enhance Performance and Patient Safety KW - school mental health KW - school health N2 - 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 UR - https://www.researchprotocols.org/2021/2/e26567 UR - http://dx.doi.org/10.2196/26567 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555258 ID - info:doi/10.2196/26567 ER - TY - JOUR AU - Buttazzoni, Adrian AU - Brar, Keshbir AU - Minaker, Leia PY - 2021/1/11 TI - Smartphone-Based Interventions and Internalizing Disorders in Youth: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e16490 VL - 23 IS - 1 KW - mental health KW - meta-analysis KW - mobile phone KW - smartphone KW - systematic review KW - youth N2 - 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 (?=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. UR - http://www.jmir.org/2021/1/e16490/ UR - http://dx.doi.org/10.2196/16490 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427682 ID - info:doi/10.2196/16490 ER - TY - JOUR AU - MacDougall, Sarah AU - Jerrott, Susan AU - Clark, Sharon AU - Campbell, Anne Leslie AU - Murphy, Andrea AU - Wozney, Lori PY - 2021/1/8 TI - Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review JO - JMIR Ment Health SP - e16508 VL - 8 IS - 1 KW - adolescent KW - mental health KW - eHealth KW - text messaging KW - SMS KW - information science KW - cell phone KW - implementation KW - review N2 - 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. UR - https://mental.jmir.org/2021/1/e16508 UR - http://dx.doi.org/10.2196/16508 UR - http://www.ncbi.nlm.nih.gov/pubmed/33416504 ID - info:doi/10.2196/16508 ER - TY - JOUR AU - Agley, Jon AU - Jun, Mikyoung AU - Eldridge, Lori AU - Agley, L. Daniel AU - Xiao, Yunyu AU - Sussman, Steve AU - Golzarri-Arroyo, Lilian AU - Dickinson, L. Stephanie AU - Jayawardene, Wasantha AU - Gassman, Ruth PY - 2021/1/6 TI - Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial JO - JMIR Ment Health SP - e25860 VL - 8 IS - 1 KW - cyberbullying KW - bullying KW - social-emotional learning KW - SEL KW - social-emotional competence KW - RCT KW - randomized controlled trial KW - outcome KW - emotion KW - bully KW - prevention KW - school KW - intervention KW - assessment KW - effectiveness KW - implementation KW - fidelity KW - reception KW - children KW - young adults KW - adolescents N2 - 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 UR - http://mental.jmir.org/2021/1/e25860/ UR - http://dx.doi.org/10.2196/25860 UR - http://www.ncbi.nlm.nih.gov/pubmed/33338986 ID - info:doi/10.2196/25860 ER - TY - JOUR AU - MacIsaac, Angela AU - Mushquash, R. Aislin AU - Mohammed, Shakira AU - Grassia, Elizabeth AU - Smith, Savanah AU - Wekerle, Christine PY - 2021/1/4 TI - Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study JO - JMIR Mhealth Uhealth SP - e25087 VL - 9 IS - 1 KW - adverse childhood experiences KW - resilience KW - emotion regulation KW - smartphone KW - app KW - childhood KW - emotion KW - mental health KW - transition KW - innovation KW - intervention N2 - 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 (?21=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 (?21=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. UR - http://mhealth.jmir.org/2021/1/e25087/ UR - http://dx.doi.org/10.2196/25087 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393908 ID - info:doi/10.2196/25087 ER - TY - JOUR AU - Davenport, A. Tracey AU - Cheng, Sze Vanessa Wan AU - Iorfino, Frank AU - Hamilton, Blake AU - Castaldi, Eva AU - Burton, Amy AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2020/12/15 TI - Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond JO - JMIR Ment Health SP - e24578 VL - 7 IS - 12 KW - health information technologies KW - clinical staging KW - youth KW - mental health KW - transdiagnostic KW - eHealth KW - routine outcome monitoring KW - adolescent KW - mental health services KW - health services KW - telemedicine KW - monitoring KW - outcome KW - young adult KW - COVID-19 UR - http://mental.jmir.org/2020/12/e24578/ UR - http://dx.doi.org/10.2196/24578 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206051 ID - info:doi/10.2196/24578 ER - TY - JOUR AU - Newton, Amanda AU - Bagnell, Alexa AU - Rosychuk, Rhonda AU - Duguay, Janelle AU - Wozney, Lori AU - Huguet, Anna AU - Henderson, Joanna AU - Curran, Janet PY - 2020/12/8 TI - A Mobile Phone?Based App for Use During Cognitive Behavioral Therapy for Adolescents With Anxiety (MindClimb): User-Centered Design and Usability Study JO - JMIR Mhealth Uhealth SP - e18439 VL - 8 IS - 12 KW - anxiety disorders KW - mobile apps KW - adolescents KW - usability testing KW - development KW - design KW - anxiety N2 - 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. UR - https://mhealth.jmir.org/2020/12/e18439 UR - http://dx.doi.org/10.2196/18439 UR - http://www.ncbi.nlm.nih.gov/pubmed/33289671 ID - info:doi/10.2196/18439 ER - TY - JOUR AU - Gilbey, Dylan AU - Morgan, Helen AU - Lin, Ashleigh AU - Perry, Yael PY - 2020/12/3 TI - Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review JO - J Med Internet Res SP - e20158 VL - 22 IS - 12 KW - systematic review KW - mental health KW - physical health KW - sexual health KW - youth KW - sexuality KW - gender KW - mobile phones N2 - 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 UR - https://www.jmir.org/2020/12/e20158 UR - http://dx.doi.org/10.2196/20158 UR - http://www.ncbi.nlm.nih.gov/pubmed/33270039 ID - info:doi/10.2196/20158 ER - TY - JOUR AU - Størksen, Therese Hege AU - Haga, Marie Silje AU - Slinning, Kari AU - Drozd, Filip PY - 2020/11/18 TI - Health Personnel?s Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study JO - JMIR Ment Health SP - e15149 VL - 7 IS - 11 KW - internet KW - parent support KW - children KW - mental health KW - acceptability KW - health care services N2 - 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. UR - http://mental.jmir.org/2020/11/e15149/ UR - http://dx.doi.org/10.2196/15149 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206058 ID - info:doi/10.2196/15149 ER - TY - JOUR AU - Puzia, Megan AU - Laird, Breanne AU - Green, Jeni AU - Huberty, Jennifer PY - 2020/11/13 TI - Parents? Perceptions of Their Children?s Engagement in a Consumer-Based Meditation Mobile App: Cross-Sectional Survey Study JO - JMIR Pediatr Parent SP - e24536 VL - 3 IS - 2 KW - mindfulness KW - meditation KW - children KW - mental health KW - sleep KW - mHealth N2 - 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. UR - http://pediatrics.jmir.org/2020/2/e24536/ UR - http://dx.doi.org/10.2196/24536 UR - http://www.ncbi.nlm.nih.gov/pubmed/33185564 ID - info:doi/10.2196/24536 ER - TY - JOUR AU - Michel, Toni AU - Tachtler, Franziska AU - Slovak, Petr AU - Fitzpatrick, Geraldine PY - 2020/11/9 TI - Young People?s Attitude Toward Positive Psychology Interventions: Thematic Analysis JO - JMIR Hum Factors SP - e21145 VL - 7 IS - 4 KW - adolescent KW - mental health KW - health resources N2 - 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. UR - http://humanfactors.jmir.org/2020/4/e21145/ UR - http://dx.doi.org/10.2196/21145 UR - http://www.ncbi.nlm.nih.gov/pubmed/33164908 ID - info:doi/10.2196/21145 ER - TY - JOUR AU - Melbye, Sigurd AU - Kessing, Vedel Lars AU - Bardram, Eyvind Jakob AU - Faurholt-Jepsen, Maria PY - 2020/10/29 TI - Smartphone-Based Self-Monitoring, Treatment, and Automatically Generated Data in Children, Adolescents, and Young Adults With Psychiatric Disorders: Systematic Review JO - JMIR Ment Health SP - e17453 VL - 7 IS - 10 KW - mHealth KW - child and adolescent psychiatry KW - eHealth KW - systematic review KW - psychiatry KW - mobile phone N2 - 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. UR - http://mental.jmir.org/2020/10/e17453/ UR - http://dx.doi.org/10.2196/17453 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118950 ID - info:doi/10.2196/17453 ER - TY - JOUR AU - Van Voorhees, Benjamin AU - Gladstone, G. Tracy R. AU - Sobowale, Kunmi AU - Brown, Hendricks C. AU - Aaby, A. David AU - Terrizzi, A. Daniela AU - Canel, Jason AU - Ching, Eumene AU - Berry, D. Anita AU - Cantorna, James AU - Eder, Milton AU - Beardslee, William AU - Fitzgibbon, Marian AU - Marko-Holguin, Monika AU - Schiffer, Linda AU - Lee, Miae AU - de Forest, A. Sarah AU - Sykes, E. Emily AU - Suor, H. Jennifer AU - Crawford, J. Theodore AU - Burkhouse, L. Katie AU - Goodwin, C. Brady AU - Bell, Carl PY - 2020/10/28 TI - 24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial JO - J Med Internet Res SP - e16802 VL - 22 IS - 10 KW - adolescent KW - depression KW - prevention KW - scalable KW - eHealth N2 - 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. UR - https://www.jmir.org/2020/10/e16802 UR - http://dx.doi.org/10.2196/16802 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112254 ID - info:doi/10.2196/16802 ER - TY - JOUR AU - Thabrew, Hiran AU - Kumar, Harshali AU - Goldfinch, Mary AU - Cavadino, Alana AU - Goodyear-Smith, Felicity PY - 2020/10/26 TI - Repeated Psychosocial Screening of High School Students Using YouthCHAT: Cohort Study JO - JMIR Pediatr Parent SP - e20976 VL - 3 IS - 2 KW - mass screening KW - mental health KW - school health services KW - eHealth N2 - 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. UR - http://pediatrics.jmir.org/2020/2/e20976/ UR - http://dx.doi.org/10.2196/20976 UR - http://www.ncbi.nlm.nih.gov/pubmed/33104007 ID - info:doi/10.2196/20976 ER - TY - JOUR AU - Chamberlain, R. Liam AU - Hall, L. Charlotte AU - Andrén, Per AU - Davies, Bethan E. AU - Kilgariff, Joseph AU - Kouzoupi, Natalia AU - Murphy, Tara AU - Hollis, Chris PY - 2020/10/23 TI - Therapist-Supported Online Interventions for Children and Young People With Tic Disorders: Lessons Learned From a Randomized Controlled Trial and Considerations for Future Practice JO - JMIR Ment Health SP - e19600 VL - 7 IS - 10 KW - Tourette syndrome KW - tic disorders KW - internet-based cognitive behavioral therapy (iCBT) KW - remote therapy KW - therapist support UR - http://mental.jmir.org/2020/10/e19600/ UR - http://dx.doi.org/10.2196/19600 UR - http://www.ncbi.nlm.nih.gov/pubmed/33095180 ID - info:doi/10.2196/19600 ER - TY - JOUR AU - Kahl, Lorraine Bianca AU - Miller, May Hilary AU - Cairns, Kathryn AU - Giniunas, Hayley AU - Nicholas, Mariesa PY - 2020/10/15 TI - Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study JO - JMIR Ment Health SP - e21280 VL - 7 IS - 10 KW - digital mental health KW - digital intervention KW - youth KW - internet-based intervention KW - depression KW - anxiety KW - stress KW - suicide N2 - 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. UR - http://mental.jmir.org/2020/10/e21280/ UR - http://dx.doi.org/10.2196/21280 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055066 ID - info:doi/10.2196/21280 ER - TY - JOUR AU - Serlachius, Anna AU - Badawy, M. Sherif AU - Thabrew, Hiran PY - 2020/10/12 TI - Psychosocial Challenges and Opportunities for Youth With Chronic Health Conditions During the COVID-19 Pandemic JO - JMIR Pediatr Parent SP - e23057 VL - 3 IS - 2 KW - COVID-19 KW - coronavirus KW - pandemic KW - chronic illness KW - youth KW - adolescents KW - children KW - psychosocial KW - anxiety UR - http://pediatrics.jmir.org/2020/2/e23057/ UR - http://dx.doi.org/10.2196/23057 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001834 ID - info:doi/10.2196/23057 ER - TY - JOUR AU - Widnall, Emily AU - Grant, Ellen Claire AU - Wang, Tao AU - Cross, Lauren AU - Velupillai, Sumithra AU - Roberts, Angus AU - Stewart, Robert AU - Simonoff, Emily AU - Downs, Johnny PY - 2020/10/10 TI - User Perspectives of Mood-Monitoring Apps Available to Young People: Qualitative Content Analysis JO - JMIR Mhealth Uhealth SP - e18140 VL - 8 IS - 10 KW - mood monitoring KW - engagement KW - mobile applications KW - mHealth KW - mental health KW - smartphone KW - qualitative research KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2020/10/e18140/ UR - http://dx.doi.org/10.2196/18140 UR - http://www.ncbi.nlm.nih.gov/pubmed/33037875 ID - info:doi/10.2196/18140 ER - TY - JOUR AU - Stull, W. Samuel AU - McKnight, R. Erin AU - Bonny, E. Andrea PY - 2020/10/9 TI - Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? JO - JMIR Pediatr Parent SP - e23463 VL - 3 IS - 2 KW - adolescent KW - opioid use disorder KW - treatment KW - telehealth KW - drug KW - perspective KW - opioid KW - COVID-19 KW - young adult UR - http://pediatrics.jmir.org/2020/2/e23463/ UR - http://dx.doi.org/10.2196/23463 UR - http://www.ncbi.nlm.nih.gov/pubmed/33016885 ID - info:doi/10.2196/23463 ER - TY - JOUR AU - Szlyk, Hannah AU - Tan, Jia PY - 2020/10/9 TI - The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review JO - J Med Internet Res SP - e18672 VL - 22 IS - 10 KW - youth KW - suicide prevention KW - technology KW - continuum of care N2 - 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. UR - http://www.jmir.org/2020/10/e18672/ UR - http://dx.doi.org/10.2196/18672 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034568 ID - info:doi/10.2196/18672 ER - TY - JOUR AU - Stunden, Chelsea AU - Zasada, Julie AU - VanHeerwaarden, Nicole AU - Hollenberg, Elisa AU - Abi-Jaoudé, Alexxa AU - Chaim, Gloria AU - Cleverley, Kristin AU - Henderson, Joanna AU - Johnson, Andrew AU - Levinson, Andrea AU - Lo, Brian AU - Robb, Janine AU - Shi, Jenny AU - Voineskos, Aristotle AU - Wiljer, David PY - 2020/10/5 TI - Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study JO - J Med Internet Res SP - e18514 VL - 22 IS - 10 KW - mental health KW - students KW - adolescent KW - substance abuse KW - eHealth KW - mHealth KW - mobile apps KW - help-seeking behavior KW - social stigma KW - social support N2 - 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. UR - https://www.jmir.org/2020/10/e18514 UR - http://dx.doi.org/10.2196/18514 UR - http://www.ncbi.nlm.nih.gov/pubmed/33016882 ID - info:doi/10.2196/18514 ER - TY - JOUR AU - Christ, Carolien AU - Schouten, JE Maria AU - Blankers, Matthijs AU - van Schaik, JF Digna AU - Beekman, TF Aartjan AU - Wisman, A. Marike AU - Stikkelbroek, AJ Yvonne AU - Dekker, JM Jack PY - 2020/9/25 TI - Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Adolescents and Young Adults: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e17831 VL - 22 IS - 9 KW - cognitive behavior therapy KW - internet KW - anxiety KW - depression KW - youth KW - meta-analysis N2 - 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. UR - https://www.jmir.org/2020/9/e17831 UR - http://dx.doi.org/10.2196/17831 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673212 ID - info:doi/10.2196/17831 ER - TY - JOUR AU - Katapally, Reddy Tarun PY - 2020/9/25 TI - Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health JO - JMIR Pediatr Parent SP - e21155 VL - 3 IS - 2 KW - Indigenous youth KW - mental health KW - school policies KW - health policy KW - digital health interventions KW - mHealth KW - systems integration KW - land-based learning KW - physical activity UR - http://pediatrics.jmir.org/2020/2/e21155/ UR - http://dx.doi.org/10.2196/21155 UR - http://www.ncbi.nlm.nih.gov/pubmed/32975527 ID - info:doi/10.2196/21155 ER - TY - JOUR AU - Schuurmans, T. Angela A. AU - Nijhof, S. Karin AU - Scholte, Ron AU - Popma, Arne AU - Otten, Roy PY - 2020/9/23 TI - Game-Based Meditation Therapy to Improve Posttraumatic Stress and Neurobiological Stress Systems in Traumatized Adolescents: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e19881 VL - 9 IS - 9 KW - Adolescents KW - Autonomic nervous system KW - Cortisol KW - Meditation KW - Neurofeedback KW - Posttraumatic stress KW - Randomized controlled trial KW - Trauma N2 - 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 UR - http://www.researchprotocols.org/2020/9/e19881/ UR - http://dx.doi.org/10.2196/19881 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965226 ID - info:doi/10.2196/19881 ER - TY - JOUR AU - Croucher, Lauren AU - Mertan, Elif AU - Shafran, Roz AU - Bennett, D. Sophie PY - 2020/9/3 TI - The Use of Mumsnet by Parents of Young People With Mental Health Needs: Qualitative Investigation JO - JMIR Ment Health SP - e18271 VL - 7 IS - 9 KW - mental health KW - parenting KW - internet KW - evidence-based medicine N2 - 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. UR - https://mental.jmir.org/2020/9/e18271 UR - http://dx.doi.org/10.2196/18271 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880583 ID - info:doi/10.2196/18271 ER - TY - JOUR AU - Stiles-Shields, Colleen AU - Potthoff, M. Lauren AU - Bounds, T. Dawn AU - Burns, S. Maureen T. AU - Draxler, M. Janel AU - Otwell, H. Caitlin AU - Wolodiger, D. Emily AU - Westrick, Jennifer AU - Karnik, S. Niranjan PY - 2020/8/26 TI - Harnessing Phones to Target Pediatric Populations with Socially Complex Needs: Systematic Review JO - JMIR Pediatr Parent SP - e19269 VL - 3 IS - 2 KW - underserved youth KW - digital mental health KW - mHealth KW - telehealth KW - health disparities N2 - 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 UR - http://pediatrics.jmir.org/2020/2/e19269/ UR - http://dx.doi.org/10.2196/19269 UR - http://www.ncbi.nlm.nih.gov/pubmed/32845244 ID - info:doi/10.2196/19269 ER - TY - JOUR AU - Lynch, Jane Samantha AU - Sunderland, Matthew AU - Newton, Claire Nicola AU - Chapman, Cath PY - 2020/8/20 TI - Transdiagnostic Risk and Protective Factors for Psychopathology in Young People: Systematic Review Protocol JO - JMIR Res Protoc SP - e19779 VL - 9 IS - 8 KW - psychopathology KW - mental health KW - adolescent KW - young people KW - transdiagnostic KW - risk factors KW - protective factors KW - systematic review KW - protocol N2 - 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 UR - http://www.researchprotocols.org/2020/8/e19779/ UR - http://dx.doi.org/10.2196/19779 UR - http://www.ncbi.nlm.nih.gov/pubmed/32815821 ID - info:doi/10.2196/19779 ER - TY - JOUR AU - Jansen, Ronelle AU - Reid, Marianne PY - 2020/8/19 TI - Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review JO - JMIR Mhealth Uhealth SP - e13179 VL - 8 IS - 8 KW - caregiver KW - communication technology KW - adolescent KW - mental health issues KW - systematic review KW - self-efficacy, knowledge KW - parental skills KW - IMBP N2 - 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. UR - http://mhealth.jmir.org/2020/8/e13179/ UR - http://dx.doi.org/10.2196/13179 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663143 ID - info:doi/10.2196/13179 ER - TY - JOUR AU - Alvarez-Jimenez, Mario AU - Rice, Simon AU - D'Alfonso, Simon AU - Leicester, Steven AU - Bendall, Sarah AU - Pryor, Ingrid AU - Russon, Penni AU - McEnery, Carla AU - Santesteban-Echarri, Olga AU - Da Costa, Gustavo AU - Gilbertson, Tamsyn AU - Valentine, Lee AU - Solves, Laia AU - Ratheesh, Aswin AU - McGorry, D. Patrick AU - Gleeson, John PY - 2020/8/13 TI - 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 JO - J Med Internet Res SP - e17155 VL - 22 IS - 8 KW - mHealth KW - youth KW - social media KW - social networking KW - mobile phone KW - internet-based intervention N2 - 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. UR - https://www.jmir.org/2020/8/e17155 UR - http://dx.doi.org/10.2196/17155 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788151 ID - info:doi/10.2196/17155 ER - TY - JOUR AU - Brigden, Amberly AU - Anderson, Emma AU - Linney, Catherine AU - Morris, Richard AU - Parslow, Roxanne AU - Serafimova, Teona AU - Smith, Lucie AU - Briggs, Emily AU - Loades, Maria AU - Crawley, Esther PY - 2020/7/31 TI - Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review JO - J Med Internet Res SP - e16924 VL - 22 IS - 7 KW - mobile phone KW - mHealth KW - mobile health KW - eHealth KW - electronic health KW - digital health KW - behavior KW - pediatrics KW - chronic illness KW - systematic review N2 - 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. UR - http://www.jmir.org/2020/7/e16924/ UR - http://dx.doi.org/10.2196/16924 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735227 ID - info:doi/10.2196/16924 ER - TY - JOUR AU - O'Grady, Conor AU - Melia, Ruth AU - Bogue, John AU - O'Sullivan, Mary AU - Young, Karen AU - Duggan, Jim PY - 2020/7/30 TI - A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) JO - J Med Internet Res SP - e17481 VL - 22 IS - 7 KW - mobile apps KW - suicide KW - mHealth N2 - 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. UR - http://www.jmir.org/2020/7/e17481/ UR - http://dx.doi.org/10.2196/17481 UR - http://www.ncbi.nlm.nih.gov/pubmed/32729845 ID - info:doi/10.2196/17481 ER - TY - JOUR AU - Valentine, Lee AU - McEnery, Carla AU - Bell, Imogen AU - O'Sullivan, Shaunagh AU - Pryor, Ingrid AU - Gleeson, John AU - Bendall, Sarah AU - Alvarez-Jimenez, Mario PY - 2020/7/28 TI - Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study JO - JMIR Ment Health SP - e18990 VL - 7 IS - 7 KW - Blended Treatment KW - Psychotic Disorders KW - Digital Intervention KW - Adolescent KW - Young Adults KW - mHealth N2 - 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. UR - http://mental.jmir.org/2020/7/e18990/ UR - http://dx.doi.org/10.2196/18990 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720904 ID - info:doi/10.2196/18990 ER - TY - JOUR AU - Ye, Jiancheng PY - 2020/7/28 TI - Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19 JO - JMIR Pediatr Parent SP - e19867 VL - 3 IS - 2 KW - pediatrics KW - mental health KW - stay-at-home orders KW - health technology KW - digital interventions KW - social distancing KW - COVID-19 UR - http://pediatrics.jmir.org/2020/2/e19867/ UR - http://dx.doi.org/10.2196/19867 UR - http://www.ncbi.nlm.nih.gov/pubmed/32634105 ID - info:doi/10.2196/19867 ER - TY - JOUR AU - Edridge, Chloe AU - Wolpert, Miranda AU - Deighton, Jessica AU - Edbrooke-Childs, Julian PY - 2020/7/27 TI - An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial JO - J Med Internet Res SP - e14223 VL - 22 IS - 7 KW - cluster trial KW - behavioral difficulties KW - schools KW - mHealth KW - digital KW - mental health N2 - 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 UR - http://www.jmir.org/2020/7/e14223/ UR - http://dx.doi.org/10.2196/14223 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716299 ID - info:doi/10.2196/14223 ER - TY - JOUR AU - O'Connor, Kathleen AU - Bagnell, Alexa AU - McGrath, Patrick AU - Wozney, Lori AU - Radomski, Ashley AU - Rosychuk, J. Rhonda AU - Curtis, Sarah AU - Jabbour, Mona AU - Fitzpatrick, Eleanor AU - Johnson, W. David AU - Ohinmaa, Arto AU - Joyce, Anthony AU - Newton, Amanda PY - 2020/7/24 TI - An Internet-Based Cognitive Behavioral Program for Adolescents With Anxiety: Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e13356 VL - 7 IS - 7 KW - internet KW - cognitive behavioral therapy KW - adolescents KW - anxiety KW - randomized controlled trial KW - pilot N2 - 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. UR - https://mental.jmir.org/2020/7/e13356 UR - http://dx.doi.org/10.2196/13356 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706720 ID - info:doi/10.2196/13356 ER - TY - JOUR AU - Bevan Jones, Rhys AU - Thapar, Anita AU - Rice, Frances AU - Mars, Becky AU - Agha, Shameem Sharifah AU - Smith, Daniel AU - Merry, Sally AU - Stallard, Paul AU - Thapar, K. Ajay AU - Jones, Ian AU - Simpson, A. Sharon PY - 2020/7/17 TI - A Digital Intervention for Adolescent Depression (MoodHwb): Mixed Methods Feasibility Evaluation JO - JMIR Ment Health SP - e14536 VL - 7 IS - 7 KW - adolescent KW - depression KW - internet KW - education KW - early medical intervention KW - feasibility study N2 - 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. UR - https://mental.jmir.org/2020/7/e14536 UR - http://dx.doi.org/10.2196/14536 UR - http://www.ncbi.nlm.nih.gov/pubmed/32384053 ID - info:doi/10.2196/14536 ER - TY - JOUR AU - Müssener, Ulrika AU - Thomas, Kristin AU - Bendtsen, Preben AU - Bendtsen, Marcus PY - 2020/7/9 TI - High School Students? Preferences and Design Recommendations for a Mobile Phone?Based Intervention to Improve Psychological Well-Being: Mixed Methods Study JO - JMIR Pediatr Parent SP - e17044 VL - 3 IS - 2 KW - mental health KW - stress KW - high school students KW - intervention KW - mHealth N2 - 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. UR - https://pediatrics.jmir.org/2020/2/e17044 UR - http://dx.doi.org/10.2196/17044 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673268 ID - info:doi/10.2196/17044 ER - TY - JOUR AU - Schleider, Lee Jessica AU - Dobias, Mallory AU - Sung, Jenna AU - Mumper, Emma AU - Mullarkey, C. Michael PY - 2020/6/30 TI - Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health JO - JMIR Ment Health SP - e20513 VL - 7 IS - 6 KW - internet intervention KW - online interventions KW - youth KW - mental health KW - adolescent KW - depression KW - single-session intervention KW - intervention N2 - 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 UR - http://mental.jmir.org/2020/6/e20513/ UR - http://dx.doi.org/10.2196/20513 UR - http://www.ncbi.nlm.nih.gov/pubmed/32602846 ID - info:doi/10.2196/20513 ER - TY - JOUR AU - Valentine, Lee AU - McEnery, Carla AU - O?Sullivan, Shaunagh AU - Gleeson, John AU - Bendall, Sarah AU - Alvarez-Jimenez, Mario PY - 2020/6/26 TI - Young People?s Experience of a Long-Term Social Media?Based Intervention for First-Episode Psychosis: Qualitative Analysis JO - J Med Internet Res SP - e17570 VL - 22 IS - 6 KW - social media KW - social networking KW - youth KW - young adult KW - psychotic disorders KW - mHealth KW - qualitative research N2 - 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. UR - https://www.jmir.org/2020/6/e17570 UR - http://dx.doi.org/10.2196/17570 UR - http://www.ncbi.nlm.nih.gov/pubmed/32384056 ID - info:doi/10.2196/17570 ER - TY - JOUR AU - Lo, Brian AU - Shi, Jenny AU - Hollenberg, Elisa AU - Abi-Jaoudé, Alexxa AU - Johnson, Andrew AU - Wiljer, David PY - 2020/6/25 TI - Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review JO - JMIR Ment Health SP - e15942 VL - 7 IS - 6 KW - user engagement KW - mobile apps KW - mHealth KW - telemedicine KW - mental health KW - adolescent KW - data analytics N2 - 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. UR - https://mental.jmir.org/2020/6/e15942 UR - http://dx.doi.org/10.2196/15942 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348261 ID - info:doi/10.2196/15942 ER - TY - JOUR AU - Liverpool, Shaun AU - Mota, Pinheiro Catarina AU - Sales, D. Célia M. AU - ?u?, Anja AU - Carletto, Sara AU - Hancheva, Camellia AU - Sousa, Sónia AU - Cerón, Conejo Sonia AU - Moreno-Peral, Patricia AU - Pietrabissa, Giada AU - Moltrecht, Bettina AU - Ulberg, Randi AU - Ferreira, Nuno AU - Edbrooke-Childs, Julian PY - 2020/6/23 TI - Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers JO - J Med Internet Res SP - e16317 VL - 22 IS - 6 KW - mHealth KW - eHealth KW - technology KW - smartphone KW - children KW - adolescent mental health KW - mobile phone N2 - 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. UR - http://www.jmir.org/2020/6/e16317/ UR - http://dx.doi.org/10.2196/16317 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442160 ID - info:doi/10.2196/16317 ER - TY - JOUR AU - Duan, Suqian AU - Wang, Haoran AU - Wilson, Amanda AU - Qiu, Jiexi AU - Chen, Guanmei AU - He, Yuqiong AU - Wang, Yuanyuan AU - Ou, Jianjun AU - Chen, Runsen PY - 2020/6/11 TI - Developing a Text Messaging Intervention to Reduce Deliberate Self-Harm in Chinese Adolescents: Qualitative Study JO - JMIR Mhealth Uhealth SP - e16963 VL - 8 IS - 6 KW - text messaging KW - deliberate self-harm KW - adolescents KW - qualitative research KW - mental health N2 - 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. UR - https://mhealth.jmir.org/2020/6/e16963 UR - http://dx.doi.org/10.2196/16963 UR - http://www.ncbi.nlm.nih.gov/pubmed/32392173 ID - info:doi/10.2196/16963 ER - TY - JOUR AU - Khasawneh, Amro AU - Chalil Madathil, Kapil AU - Dixon, Emma AU - Wi?niewski, Pamela AU - Zinzow, Heidi AU - Roth, Rebecca PY - 2020/6/5 TI - Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study JO - JMIR Ment Health SP - e15973 VL - 7 IS - 6 KW - suicide KW - suicidal ideation KW - self-mutilation KW - mental health KW - self-injurious behavior KW - behavioral symptoms N2 - 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. UR - https://mental.jmir.org/2020/6/e15973 UR - http://dx.doi.org/10.2196/15973 UR - http://www.ncbi.nlm.nih.gov/pubmed/32515741 ID - info:doi/10.2196/15973 ER - TY - JOUR AU - Rivas, Ryan AU - Shahbazi, Moloud AU - Garett, Renee AU - Hristidis, Vagelis AU - Young, Sean PY - 2020/5/29 TI - Mental Health?Related Behaviors and Discussions Among Young Adults: Analysis and Classification JO - J Med Internet Res SP - e17224 VL - 22 IS - 5 KW - social media KW - data analysis KW - supervised machine learning KW - universities KW - students N2 - 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. UR - http://www.jmir.org/2020/5/e17224/ UR - http://dx.doi.org/10.2196/17224 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469317 ID - info:doi/10.2196/17224 ER - TY - JOUR AU - Czyz, K. Ewa AU - Arango, Alejandra AU - Healy, Nathaniel AU - King, A. Cheryl AU - Walton, Maureen PY - 2020/5/25 TI - Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study JO - JMIR Ment Health SP - e17345 VL - 7 IS - 5 KW - adolescents KW - suicide KW - text messaging KW - safety planning N2 - 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. UR - http://mental.jmir.org/2020/5/e17345/ UR - http://dx.doi.org/10.2196/17345 UR - http://www.ncbi.nlm.nih.gov/pubmed/32160150 ID - info:doi/10.2196/17345 ER - TY - JOUR AU - Thorn, Pinar AU - Hill, TM Nicole AU - Lamblin, Michelle AU - Teh, Zoe AU - Battersby-Coulter, Rikki AU - Rice, Simon AU - Bendall, Sarah AU - Gibson, L. Kerry AU - Finlay, May Summer AU - Blandon, Ryan AU - de Souza, Libby AU - West, Ashlee AU - Cooksey, Anita AU - Sciglitano, Joe AU - Goodrich, Simon AU - Robinson, Jo PY - 2020/5/11 TI - Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach JO - JMIR Ment Health SP - e17520 VL - 7 IS - 5 KW - suicide KW - social media KW - health promotion KW - co-design KW - adolescent KW - young adult KW - #chatsafe N2 - 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. UR - https://mental.jmir.org/2020/5/e17520 UR - http://dx.doi.org/10.2196/17520 UR - http://www.ncbi.nlm.nih.gov/pubmed/32391800 ID - info:doi/10.2196/17520 ER - TY - JOUR AU - Bossenbroek, Rineke AU - Wols, Aniek AU - Weerdmeester, Joanneke AU - Lichtwarck-Aschoff, Anna AU - Granic, Isabela AU - van Rooij, W. Marieke M. J. PY - 2020/3/24 TI - Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study JO - JMIR Ment Health SP - e16066 VL - 7 IS - 3 KW - anxiety KW - disruptive behavior KW - single-case study KW - applied game KW - serious games KW - special education KW - attention-deficit/hyperactivity disorder (ADHD) KW - autism spectrum disorder (ASD) KW - adolescents N2 - 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. UR - http://mental.jmir.org/2020/3/e16066/ UR - http://dx.doi.org/10.2196/16066 UR - http://www.ncbi.nlm.nih.gov/pubmed/32207697 ID - info:doi/10.2196/16066 ER - TY - JOUR AU - Lal, Shalini AU - Starcevic, Joanna Danielle AU - Fuhrer, Rebecca PY - 2020/3/24 TI - Youth Experiences With Referrals to Mental Health Services in Canada: Protocol for a Web-Based Cross-Sectional Survey Study JO - JMIR Res Protoc SP - e16945 VL - 9 IS - 3 KW - mental disorders KW - health care quality, access, and evaluation KW - mental health KW - psychology KW - telemedicine KW - young adult KW - health services accessibility KW - technology KW - referral and consultation N2 - 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 UR - http://www.researchprotocols.org/2020/3/e16945/ UR - http://dx.doi.org/10.2196/16945 UR - http://www.ncbi.nlm.nih.gov/pubmed/32207698 ID - info:doi/10.2196/16945 ER - TY - JOUR AU - Cliffe, Bethany AU - Croker, Abigail AU - Denne, Megan AU - Smith, Jacqueline AU - Stallard, Paul PY - 2020/3/3 TI - Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial JO - JMIR Ment Health SP - e14842 VL - 7 IS - 3 KW - insomnia KW - internet-based intervention KW - cognitive therapy KW - mental health N2 - 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 UR - https://mental.jmir.org/2020/3/e14842 UR - http://dx.doi.org/10.2196/14842 UR - http://www.ncbi.nlm.nih.gov/pubmed/32134720 ID - info:doi/10.2196/14842 ER - TY - JOUR AU - Gabrielli, Silvia AU - Rizzi, Silvia AU - Carbone, Sara AU - Donisi, Valeria PY - 2020/2/14 TI - A Chatbot-Based Coaching Intervention for Adolescents to Promote Life Skills: Pilot Study JO - JMIR Hum Factors SP - e16762 VL - 7 IS - 1 KW - life skills KW - chatbots KW - conversational agents KW - mental health KW - participatory design KW - adolescence KW - bullying KW - cyberbullying KW - well-being intervention N2 - 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. UR - http://humanfactors.jmir.org/2020/1/e16762/ UR - http://dx.doi.org/10.2196/16762 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130128 ID - info:doi/10.2196/16762 ER - TY - JOUR AU - Ospina-Pinillos, Laura AU - Davenport, A. Tracey AU - Navarro-Mancilla, Andres Alvaro AU - Cheng, Sze Vanessa Wan AU - Cardozo Alarcón, Camilo Andrés AU - Rangel, M. Andres AU - Rueda-Jaimes, Eduardo German AU - Gomez-Restrepo, Carlos AU - Hickie, B. Ian PY - 2020/2/6 TI - 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 JO - JMIR Ment Health SP - e15914 VL - 7 IS - 2 KW - Colombia KW - telemedicine KW - medical informatics KW - eHealth KW - mental health KW - cultural characteristics KW - cultural competency KW - ethnic groups KW - quality of health care KW - community-based participatory research KW - primary health care KW - patient participation KW - patient preference KW - patient satisfaction KW - consumer health information KW - methods KW - research design N2 - 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. UR - https://mental.jmir.org/2020/2/e15914 UR - http://dx.doi.org/10.2196/15914 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/15914 ER - TY - JOUR AU - Radomski, D. Ashley AU - Bagnell, Alexa AU - Curtis, Sarah AU - Hartling, Lisa AU - Newton, S. Amanda PY - 2020/2/5 TI - Examining the Usage, User Experience, and Perceived Impact of an Internet-Based Cognitive Behavioral Therapy Program for Adolescents With Anxiety: Randomized Controlled Trial JO - JMIR Ment Health SP - e15795 VL - 7 IS - 2 KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - anxiety KW - adolescents KW - clinical effectiveness KW - satisfaction KW - minimal clinically important difference KW - treatment adherence N2 - 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 UR - https://mental.jmir.org/2020/2/e15795 UR - http://dx.doi.org/10.2196/15795 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/15795 ER - TY - JOUR AU - Navarro, Pablo AU - Sheffield, Jeanie AU - Edirippulige, Sisira AU - Bambling, Matthew PY - 2020/1/29 TI - Exploring Mental Health Professionals? Perspectives of Text-Based Online Counseling Effectiveness With Young People: Mixed Methods Pilot Study JO - JMIR Ment Health SP - e15564 VL - 7 IS - 1 KW - mental health KW - child health KW - adolescent health KW - distance counseling KW - mHealth KW - applied psychology KW - psychological processes N2 - 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. UR - https://mental.jmir.org/2020/1/e15564 UR - http://dx.doi.org/10.2196/15564 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012097 ID - info:doi/10.2196/15564 ER - TY - JOUR AU - Cao, Jian AU - Truong, Lan Anh AU - Banu, Sophia AU - Shah, A. Asim AU - Sabharwal, Ashutosh AU - Moukaddam, Nidal PY - 2020/1/24 TI - Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study JO - JMIR Ment Health SP - e14045 VL - 7 IS - 1 KW - SOLVD-Teen and SOLVD-Parent App KW - adolescent depression KW - smartphone monitoring KW - self-evaluation KW - parental input KW - sensory data N2 - 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. UR - http://mental.jmir.org/2020/1/e14045/ UR - http://dx.doi.org/10.2196/14045 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012072 ID - info:doi/10.2196/14045 ER - TY - JOUR AU - Campbell, Andrew AU - Ridout, Brad AU - Amon, Krestina AU - Navarro, Pablo AU - Collyer, Brian AU - Dalgleish, John PY - 2019/12/20 TI - 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 JO - J Med Internet Res SP - e16176 VL - 21 IS - 12 KW - social media KW - social networking KW - online counseling KW - family discord KW - well-being N2 - 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 UR - http://www.jmir.org/2019/12/e16176/ UR - http://dx.doi.org/10.2196/16176 UR - http://www.ncbi.nlm.nih.gov/pubmed/31859671 ID - info:doi/10.2196/16176 ER - TY - JOUR AU - D'Alfonso, Simon AU - Phillips, Jessica AU - Valentine, Lee AU - Gleeson, John AU - Alvarez-Jimenez, Mario PY - 2019/12/4 TI - Moderated Online Social Therapy: Viewpoint on the Ethics and Design Principles of a Web-Based Therapy System JO - JMIR Ment Health SP - e14866 VL - 6 IS - 12 KW - Web-based intervention KW - social network KW - well-being KW - eudaimonia KW - persuasive technology KW - ethical design UR - https://mental.jmir.org/2019/12/e14866 UR - http://dx.doi.org/10.2196/14866 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799937 ID - info:doi/10.2196/14866 ER - TY - JOUR AU - Thabrew, Hiran AU - D'Silva, Simona AU - Darragh, Margot AU - Goldfinch, Mary AU - Meads, Jake AU - Goodyear-Smith, Felicity PY - 2019/12/3 TI - Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial JO - J Med Internet Res SP - e13911 VL - 21 IS - 12 KW - mass screening KW - adolescents KW - anxiety KW - depression KW - substance-related disorders KW - primary health care KW - school health services KW - eHealth N2 - 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 M?ori 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. UR - https://www.jmir.org/2019/12/e13911 UR - http://dx.doi.org/10.2196/13911 UR - http://www.ncbi.nlm.nih.gov/pubmed/31793890 ID - info:doi/10.2196/13911 ER - TY - JOUR AU - Pretorius, Claudette AU - Chambers, Derek AU - Coyle, David PY - 2019/11/19 TI - Young People?s Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review JO - J Med Internet Res SP - e13873 VL - 21 IS - 11 KW - internet KW - help-seeking behavior KW - youth KW - mental health KW - online behavior KW - self-determination theory KW - systematic review N2 - 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. UR - http://www.jmir.org/2019/11/e13873/ UR - http://dx.doi.org/10.2196/13873 UR - http://www.ncbi.nlm.nih.gov/pubmed/31742562 ID - info:doi/10.2196/13873 ER - TY - JOUR AU - McGar, Brook Ashley AU - Kindler, Christine AU - Marsac, Meghan PY - 2019/11/11 TI - Electronic Health Interventions for Preventing and Treating Negative Psychological Sequelae Resulting From Pediatric Medical Conditions: Systematic Review JO - JMIR Pediatr Parent SP - e12427 VL - 2 IS - 2 KW - telemedicine KW - children KW - caregivers KW - injury KW - chronic disease KW - wounds and injuries KW - depression KW - anxiety N2 - 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. UR - http://pediatrics.jmir.org/2019/2/e12427/ UR - http://dx.doi.org/10.2196/12427 UR - http://www.ncbi.nlm.nih.gov/pubmed/31710299 ID - info:doi/10.2196/12427 ER - TY - JOUR AU - Topooco, Naira AU - Byléhn, Sandra AU - Dahlström Nysäter, Ellen AU - Holmlund, Jenny AU - Lindegaard, Johanna AU - Johansson, Sanna AU - Åberg, Linnea AU - Bergman Nordgren, Lise AU - Zetterqvist, Maria AU - Andersson, Gerhard PY - 2019/11/1 TI - Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial JO - J Med Internet Res SP - e13393 VL - 21 IS - 11 KW - adolescent KW - depression KW - cognitive behavioral therapy KW - randomized controlled trial KW - internet KW - digital health KW - technology KW - mental health KW - text messaging KW - instant messaging N2 - 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 UR - https://www.jmir.org/2019/11/e13393 UR - http://dx.doi.org/10.2196/13393 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682572 ID - info:doi/10.2196/13393 ER - TY - JOUR AU - Radomski, D. Ashley AU - Wozney, Lori AU - McGrath, Patrick AU - Huguet, Anna AU - Hartling, Lisa AU - Dyson, P. Michele AU - Bennett, J. Kathryn AU - Newton, S. Amanda PY - 2019/10/23 TI - 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 JO - JMIR Ment Health SP - e13807 VL - 6 IS - 10 KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - persuasive communication KW - anxiety KW - children KW - adolescents KW - review KW - treatment effectiveness KW - clinical effectiveness KW - treatment efficacy KW - clinical N2 - 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. UR - https://mental.jmir.org/2019/10/e13807 UR - http://dx.doi.org/10.2196/13807 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647474 ID - info:doi/10.2196/13807 ER - TY - JOUR AU - Sanci, Lena AU - Kauer, Sylvia AU - Thuraisingam, Sharmala AU - Davidson, Sandra AU - Duncan, Ann-Maree AU - Chondros, Patty AU - Mihalopoulos, Cathrine AU - Buhagiar, Kerrie PY - 2019/10/17 TI - Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial JO - JMIR Ment Health SP - e13189 VL - 6 IS - 10 KW - adolescent KW - young adult KW - internet KW - web archives as topic KW - mental health KW - mental disorders KW - help-seeking behavior KW - mental health services KW - affect N2 - 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 UR - https://mental.jmir.org/2019/10/e13189 UR - http://dx.doi.org/10.2196/13189 UR - http://www.ncbi.nlm.nih.gov/pubmed/31625945 ID - info:doi/10.2196/13189 ER - TY - JOUR AU - Rasing, A. Sanne P. AU - Stikkelbroek, J. Yvonne A. AU - Riper, Heleen AU - Dekovic, Maja AU - Nauta, H. Maaike AU - Dirksen, D. Carmen AU - Creemers, M. Daan H. AU - Bodden, M. Denise H. PY - 2019/10/7 TI - Effectiveness and Cost-Effectiveness of Blended Cognitive Behavioral Therapy in Clinically Depressed Adolescents: Protocol for a Pragmatic Quasi-Experimental Controlled Trial JO - JMIR Res Protoc SP - e13434 VL - 8 IS - 10 KW - depression KW - major depressive disorder KW - cognitive behavioral therapy KW - blended KW - eHealth KW - online KW - adolescents KW - effectiveness KW - cost-effectiveness N2 - 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 UR - https://www.researchprotocols.org/2019/10/e13434 UR - http://dx.doi.org/10.2196/13434 UR - http://www.ncbi.nlm.nih.gov/pubmed/31593538 ID - info:doi/10.2196/13434 ER - TY - JOUR AU - Ryan-Pettes, R. Stacy AU - Lange, L. Lindsay AU - Magnuson, I. Katherine PY - 2019/9/26 TI - Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study JO - JMIR Mhealth Uhealth SP - e12407 VL - 7 IS - 9 KW - mobile phones KW - text messaging KW - substance use treatment KW - mhealth KW - parenting KW - aftercare N2 - 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. UR - https://mhealth.jmir.org/2019/9/e12407 UR - http://dx.doi.org/10.2196/12407 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573920 ID - info:doi/10.2196/12407 ER - TY - JOUR AU - Kleiman, Evan AU - Millner, J. Alexander AU - Joyce, W. Victoria AU - Nash, C. Carol AU - Buonopane, J. Ralph AU - Nock, K. Matthew PY - 2019/09/24 TI - Using Wearable Physiological Monitors With Suicidal Adolescent Inpatients: Feasibility and Acceptability Study JO - JMIR Mhealth Uhealth SP - e13725 VL - 7 IS - 9 KW - feasibility studies KW - wearable electronic devices KW - adolescent, hospitalized KW - self-injurious behavior KW - qualitative research N2 - 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. UR - http://mhealth.jmir.org/2019/9/e13725/ UR - http://dx.doi.org/10.2196/13725 UR - http://www.ncbi.nlm.nih.gov/pubmed/31586364 ID - info:doi/10.2196/13725 ER - TY - JOUR AU - Pretorius, Claudette AU - Chambers, Derek AU - Cowan, Benjamin AU - Coyle, David PY - 2019/08/26 TI - Young People Seeking Help Online for Mental Health: Cross-Sectional Survey Study JO - JMIR Ment Health SP - e13524 VL - 6 IS - 8 KW - mental health KW - eHealth KW - mHealth KW - Internet KW - help-seeking behavior KW - health literacy KW - young adults KW - survey and questionnaires N2 - 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. UR - http://mental.jmir.org/2019/8/e13524/ UR - http://dx.doi.org/10.2196/13524 UR - http://www.ncbi.nlm.nih.gov/pubmed/31452519 ID - info:doi/10.2196/13524 ER - TY - JOUR AU - Yap, Hui Marie Bee AU - Cardamone-Breen, C. Mairead AU - Rapee, M. Ronald AU - Lawrence, A. Katherine AU - Mackinnon, J. Andrew AU - Mahtani, Shireen AU - Jorm, F. Anthony PY - 2019/08/15 TI - 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 JO - J Med Internet Res SP - e13628 VL - 21 IS - 8 KW - family KW - parenting KW - mental health KW - depression KW - anxiety KW - adolescent KW - internet KW - randomized controlled trial KW - preventive health services N2 - 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). UR - http://www.jmir.org/2019/8/e13628/ UR - http://dx.doi.org/10.2196/13628 UR - http://www.ncbi.nlm.nih.gov/pubmed/31418422 ID - info:doi/10.2196/13628 ER - TY - JOUR AU - Theofanopoulou, Nikki AU - Isbister, Katherine AU - Edbrooke-Childs, Julian AU - Slovák, Petr PY - 2019/08/05 TI - A Smart Toy Intervention to Promote Emotion Regulation in Middle Childhood: Feasibility Study JO - JMIR Ment Health SP - e14029 VL - 6 IS - 8 KW - mental health KW - children KW - families KW - stress, psychological KW - emotional adjustment N2 - 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. UR - https://mental.jmir.org/2019/8/e14029/ UR - http://dx.doi.org/10.2196/14029 UR - http://www.ncbi.nlm.nih.gov/pubmed/31381502 ID - info:doi/10.2196/14029 ER - TY - JOUR AU - Ospina-Pinillos, Laura AU - Davenport, Tracey AU - Mendoza Diaz, Antonio AU - Navarro-Mancilla, Alvaro AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2019/08/02 TI - Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study JO - J Med Internet Res SP - e14127 VL - 21 IS - 8 KW - telemedicine KW - medical informatics KW - eHealth KW - mental health KW - cultural characteristics KW - cultural competency KW - ethnic groups KW - transients and migrants KW - quality of health care KW - international students KW - Hispanics KW - Latinos KW - community-based participatory research KW - primary health care KW - patient participation KW - patient preference KW - patient satisfaction KW - consumer health information N2 - 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. UR - https://www.jmir.org/2019/8/e14127/ UR - http://dx.doi.org/10.2196/14127 UR - http://www.ncbi.nlm.nih.gov/pubmed/31376271 ID - info:doi/10.2196/14127 ER - TY - JOUR AU - Ritvo, Paul AU - Daskalakis, J. Zafiris AU - Tomlinson, George AU - Ravindran, Arun AU - Linklater, Renee AU - Kirk Chang, Megan AU - Knyahnytska, Yuliya AU - Lee, Jonathan AU - Alavi, Nazanin AU - Bai, Shari AU - Harber, Lillian AU - Jain, Tania AU - Katz, Joel PY - 2019/07/29 TI - An Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth Diagnosed With Major Depressive Disorders: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e11591 VL - 8 IS - 7 KW - intervention study KW - telemedicine KW - mobile phone KW - mhealth KW - fitbit KW - depression KW - cognitive behavioral therapy N2 - 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 UR - http://www.researchprotocols.org/2019/7/e11591/ UR - http://dx.doi.org/10.2196/11591 UR - http://www.ncbi.nlm.nih.gov/pubmed/31359869 ID - info:doi/10.2196/11591 ER - TY - JOUR AU - Le, Khanh-Dao Long AU - Sanci, Lena AU - Chatterton, Lou Mary AU - Kauer, Sylvia AU - Buhagiar, Kerrie AU - Mihalopoulos, Cathrine PY - 2019/07/22 TI - The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial JO - J Med Internet Res SP - e13065 VL - 21 IS - 7 KW - economic evaluation KW - cost effectiveness KW - mental health KW - help-seeking KW - internet intervention N2 - 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 UR - http://www.jmir.org/2019/7/e13065/ UR - http://dx.doi.org/10.2196/13065 UR - http://www.ncbi.nlm.nih.gov/pubmed/31333199 ID - info:doi/10.2196/13065 ER - TY - JOUR AU - Toscos, Tammy AU - Drouin, Michelle AU - Flanagan, Mindy AU - Carpenter, Maria AU - Kerrigan, Connie AU - Carpenter, Colleen AU - Mere, Cameron AU - Haaff, Marcia PY - 2019/07/16 TI - Audience Response Systems and Missingness Trends: Using Interactive Polling Systems to Gather Sensitive Health Information From Youth JO - JMIR Form Res SP - e13798 VL - 3 IS - 3 KW - mental health KW - youth KW - surveys and questionnaires KW - health care KW - software N2 - 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. UR - https://formative.jmir.org/2019/3/e13798/ UR - http://dx.doi.org/10.2196/13798 UR - http://www.ncbi.nlm.nih.gov/pubmed/31313658 ID - info:doi/10.2196/13798 ER - TY - JOUR AU - Schleider, Lee Jessica AU - Mullarkey, C. Michael AU - Weisz, R. John PY - 2019/07/09 TI - Virtual Reality and Web-Based Growth Mindset Interventions for Adolescent Depression: Protocol for a Three-Arm Randomized Trial JO - JMIR Res Protoc SP - e13368 VL - 8 IS - 7 KW - mental health KW - depression KW - virtual reality KW - adolescence KW - ehealth N2 - 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 UR - https://www.researchprotocols.org/2019/7/e13368/ UR - http://dx.doi.org/10.2196/13368 UR - http://www.ncbi.nlm.nih.gov/pubmed/31290406 ID - info:doi/10.2196/13368 ER - TY - JOUR AU - Navarro, Pablo AU - Bambling, Matthew AU - Sheffield, Jeanie AU - Edirippulige, Sisira PY - 2019/07/03 TI - Exploring Young People?s Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study JO - JMIR Ment Health SP - e13152 VL - 6 IS - 7 KW - mental health KW - child health KW - adolescent health KW - distance counseling KW - mhealth KW - applied psychology KW - psychological processes N2 - 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. UR - https://mental.jmir.org/2019/7/e13152/ UR - http://dx.doi.org/10.2196/13152 UR - http://www.ncbi.nlm.nih.gov/pubmed/31271149 ID - info:doi/10.2196/13152 ER - TY - JOUR AU - Schueller, M. Stephen AU - Glover, C. Angela AU - Rufa, K. Anne AU - Dowdle, L. Claire AU - Gross, D. Gregory AU - Karnik, S. Niranjan AU - Zalta, K. Alyson PY - 2019/07/02 TI - A Mobile Phone?Based Intervention to Improve Mental Health Among Homeless Young Adults: Pilot Feasibility Trial JO - JMIR Mhealth Uhealth SP - e12347 VL - 7 IS - 7 KW - mental health KW - homelessness KW - telemedicine KW - treatment N2 - 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 UR - https://mhealth.jmir.org/2019/7/e12347/ UR - http://dx.doi.org/10.2196/12347 UR - http://www.ncbi.nlm.nih.gov/pubmed/31267980 ID - info:doi/10.2196/12347 ER - TY - JOUR AU - Neal-Barnett, Angela AU - Stadulis, Robert AU - Ellzey, Delilah AU - Jean, Elizabeth AU - Rowell, Tiffany AU - Somerville, Keaton AU - Petitti, Kallie AU - Siglow, Benjamin AU - Ruttan, Arden AU - Hogue, Mary PY - 2019/06/27 TI - Evaluation of the Effectiveness of a Musical Cognitive Restructuring App for Black Inner-City Girls: Survey, Usage, and Focus Group Evaluation JO - JMIR Mhealth Uhealth SP - e11310 VL - 7 IS - 6 KW - black girls KW - musical cognitive restructuring KW - mHealth KW - negative thinking N2 - 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. UR - http://mhealth.jmir.org/2019/6/e11310/ UR - http://dx.doi.org/10.2196/11310 UR - http://www.ncbi.nlm.nih.gov/pubmed/31188130 ID - info:doi/10.2196/11310 ER - TY - JOUR AU - Toscos, Tammy AU - Coupe, Amanda AU - Flanagan, Mindy AU - Drouin, Michelle AU - Carpenter, Maria AU - Reining, Lauren AU - Roebuck, Amelia AU - Mirro, J. Michael PY - 2019/6/21 TI - Teens Using Screens for Help: Impact of Suicidal Ideation, Anxiety, and Depression Levels on Youth Preferences for Telemental Health Resources JO - JMIR Ment Health SP - e13230 VL - 6 IS - 6 KW - adolescent KW - students KW - telemedicine KW - mental health KW - suicidal ideation KW - depression KW - anxiety KW - health resources KW - online social networking KW - mental health services KW - help-seeking behavior N2 - 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. UR - http://mental.jmir.org/2019/6/e13230/ UR - http://dx.doi.org/10.2196/13230 UR - http://www.ncbi.nlm.nih.gov/pubmed/31228179 ID - info:doi/10.2196/13230 ER - TY - JOUR AU - Craig, L. Shelley AU - McInroy, B. Lauren AU - Eaton, David Andrew AU - Iacono, Gio AU - Leung, WY Vivian AU - Austin, Ashley AU - Dobinson, Cheryl PY - 2019/06/06 TI - 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 JO - JMIR Res Protoc SP - e13462 VL - 8 IS - 6 KW - sexual and gender minorities KW - youth KW - coping behavior KW - pragmatic clinical trial KW - cognitive behavioral therapy KW - implementation science N2 - 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 UR - https://www.researchprotocols.org/2019/6/e13462/ UR - http://dx.doi.org/10.2196/13462 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172957 ID - info:doi/10.2196/13462 ER - TY - JOUR AU - Edbrooke-Childs, Julian AU - Edridge, Chloe AU - Averill, Phoebe AU - Delane, Louise AU - Hollis, Chris AU - Craven, P. Michael AU - Martin, Kate AU - Feltham, Amy AU - Jeremy, Grace AU - Deighton, Jessica AU - Wolpert, Miranda PY - 2019/06/04 TI - A Feasibility Trial of Power Up: Smartphone App to Support Patient Activation and Shared Decision Making for Mental Health in Young People JO - JMIR Mhealth Uhealth SP - e11677 VL - 7 IS - 6 KW - telemedicine KW - patient participation KW - mental health KW - adolescent N2 - 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) UR - https://mhealth.jmir.org/2019/6/e11677/ UR - http://dx.doi.org/10.2196/11677 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165709 ID - info:doi/10.2196/11677 ER - TY - JOUR AU - Brenas, Hael Jon AU - Shin, Kyong Eun AU - Shaban-Nejad, Arash PY - 2019/05/21 TI - Adverse Childhood Experiences Ontology for Mental Health Surveillance, Research, and Evaluation: Advanced Knowledge Representation and Semantic Web Techniques JO - JMIR Ment Health SP - e13498 VL - 6 IS - 5 KW - ontologies KW - mental health surveillance KW - adverse childhood experiences KW - semantics KW - computational psychiatry N2 - 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. UR - http://mental.jmir.org/2019/5/e13498/ UR - http://dx.doi.org/10.2196/13498 UR - http://www.ncbi.nlm.nih.gov/pubmed/31115344 ID - info:doi/10.2196/13498 ER - TY - JOUR AU - Smelror, Elle Runar AU - Bless, Johann Josef AU - Hugdahl, Kenneth AU - Agartz, Ingrid PY - 2019/05/14 TI - Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study JO - JMIR Form Res SP - e13882 VL - 3 IS - 2 KW - experience sampling method KW - ecological momentary assessment KW - schizophrenia KW - mHealth KW - health care technology N2 - 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. UR - http://formative.jmir.org/2019/2/e13882/ UR - http://dx.doi.org/10.2196/13882 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094321 ID - info:doi/10.2196/13882 ER - TY - JOUR AU - Fleming, Theresa AU - Merry, Sally AU - Stasiak, Karolina AU - Hopkins, Sarah AU - Patolo, Tony AU - Ruru, Stacey AU - Latu, Manusiu AU - Shepherd, Matthew AU - Christie, Grant AU - Goodyear-Smith, Felicity PY - 2019/05/08 TI - The Importance of User Segmentation for Designing Digital Therapy for Adolescent Mental Health: Findings From Scoping Processes JO - JMIR Ment Health SP - e12656 VL - 6 IS - 5 KW - gamification KW - computerized therapy KW - mental health KW - adolescent KW - mobile apps KW - internet N2 - Background: New Zealand youth, especially those of M?ori 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 wh?nau (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. UR - https://mental.jmir.org/2019/5/e12656/ UR - http://dx.doi.org/10.2196/12656 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066705 ID - info:doi/10.2196/12656 ER - TY - JOUR AU - Ong, G. Jeffrey AU - Lim-Ashworth, S. Nikki AU - Ooi, P. Yoon AU - Boon, S. Jillian AU - Ang, P. Rebecca AU - Goh, H. Dion AU - Ong, H. Say AU - Fung, S. Daniel PY - 2019/05/08 TI - An Interactive Mobile App Game to Address Aggression (RegnaTales): Pilot Quantitative Study JO - JMIR Serious Games SP - e13242 VL - 7 IS - 2 KW - video games KW - mental health KW - anger management KW - mobile app N2 - 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. UR - http://games.jmir.org/2019/2/e13242/ UR - http://dx.doi.org/10.2196/13242 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066682 ID - info:doi/10.2196/13242 ER - TY - JOUR AU - Edridge, Chloe AU - Deighton, Jessica AU - Wolpert, Miranda AU - Edbrooke-Childs, Julian PY - 2019/05/02 TI - The Implementation of an mHealth Intervention (ReZone) for the Self-Management of Overwhelming Feelings Among Young People JO - JMIR Form Res SP - e11958 VL - 3 IS - 2 KW - cluster trial KW - behavioural difficulties KW - schools KW - mHealth, digital KW - mental health KW - mobile phone N2 - 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 UR - http://formative.jmir.org/2019/2/e11958/ UR - http://dx.doi.org/10.2196/11958 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045499 ID - info:doi/10.2196/11958 ER - TY - JOUR AU - Milne, N. David AU - McCabe, L. Kathryn AU - Calvo, A. Rafael PY - 2019/04/26 TI - Improving Moderator Responsiveness in Online Peer Support Through Automated Triage JO - J Med Internet Res SP - e11410 VL - 21 IS - 4 KW - social support KW - triage KW - classification KW - natural language processing N2 - 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. UR - https://www.jmir.org/2019/4/e11410/ UR - http://dx.doi.org/10.2196/11410 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025945 ID - info:doi/10.2196/11410 ER - TY - JOUR AU - McCreary, Michael AU - Arevian, C. Armen AU - Brady, Madeline AU - Mosqueda Chichits, E. Ana AU - Zhang, Lily AU - Tang, Lingqi AU - Zima, Bonnie PY - 2019/04/23 TI - 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 JO - JMIR Ment Health SP - e12358 VL - 6 IS - 4 KW - integrated health care systems KW - data collection methods KW - community-based participatory research KW - community mental health services N2 - 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) UR - http://mental.jmir.org/2019/4/e12358/ UR - http://dx.doi.org/10.2196/12358 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012861 ID - info:doi/10.2196/12358 ER - TY - JOUR AU - Rickwood, Debra AU - Wallace, Alison AU - Kennedy, Vanessa AU - O?Sullivan, Shaunagh AU - Telford, Nic AU - Leicester, Steven PY - 2019/04/17 TI - Young People?s Satisfaction With the Online Mental Health Service eheadspace: Development and Implementation of a Service Satisfaction Measure JO - JMIR Ment Health SP - e12169 VL - 6 IS - 4 KW - mental health KW - adolescent KW - telemedicine KW - counseling KW - internet KW - satisfaction KW - feedback KW - telehealth KW - young people N2 - 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. UR - http://mental.jmir.org/2019/4/e12169/ UR - http://dx.doi.org/10.2196/12169 UR - http://www.ncbi.nlm.nih.gov/pubmed/30994470 ID - info:doi/10.2196/12169 ER - TY - JOUR AU - Tolou-Shams, Marina AU - Yonek, Juliet AU - Galbraith, Katharine AU - Bath, Eraka PY - 2019/04/05 TI - Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study JO - JMIR Mhealth Uhealth SP - e10904 VL - 7 IS - 4 KW - juvenile delinquency KW - treatment adherence and compliance KW - mental health KW - short message service text messaging N2 - 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. UR - https://mhealth.jmir.org/2019/4/e10904/ UR - http://dx.doi.org/10.2196/10904 UR - http://www.ncbi.nlm.nih.gov/pubmed/30950808 ID - info:doi/10.2196/10904 ER - TY - JOUR AU - Shum, KY Angie AU - Lai, SY Eliza AU - Leung, Gi Wing AU - Cheng, NS Mabel AU - Wong, Kit Ho AU - So, WK Sam AU - Law, Wa Yik AU - Yip, SF Paul PY - 2019/04/05 TI - A Digital Game and School-Based Intervention for Students in Hong Kong: Quasi-Experimental Design JO - J Med Internet Res SP - e12003 VL - 21 IS - 4 KW - digital game-based learning KW - school-based learning KW - mental health KW - schools KW - students KW - child welfare KW - health promotion KW - follow-up studies KW - internet access KW - public health KW - non-randomized controlled trials N2 - 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. UR - https://www.jmir.org/2019/4/e12003/ UR - http://dx.doi.org/10.2196/12003 UR - http://www.ncbi.nlm.nih.gov/pubmed/30950795 ID - info:doi/10.2196/12003 ER - TY - JOUR AU - Tuijnman, Anouk AU - Kleinjan, Marloes AU - Hoogendoorn, Evert AU - Granic, Isabela AU - Engels, CME Rutger PY - 2019/03/14 TI - A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e11255 VL - 8 IS - 3 KW - depression KW - help-seeking behavior KW - helping behavior KW - health literacy KW - stigma KW - video games KW - adolescence KW - secondary schools N2 - 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 UR - https://www.researchprotocols.org/2019/3/e11255/ UR - http://dx.doi.org/10.2196/11255 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869652 ID - info:doi/10.2196/11255 ER - TY - JOUR AU - Metsäranta, Kiki AU - Kurki, Marjo AU - Valimaki, Maritta AU - Anttila, Minna PY - 2019/02/20 TI - How Do Adolescents Use Electronic Diaries? A Mixed-Methods Study Among Adolescents With Depressive Symptoms JO - J Med Internet Res SP - e11711 VL - 21 IS - 2 KW - adolescent KW - depression KW - electronic diary KW - mental health KW - mobile phone KW - outpatient care N2 - 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. UR - http://www.jmir.org/2019/2/e11711/ UR - http://dx.doi.org/10.2196/11711 UR - http://www.ncbi.nlm.nih.gov/pubmed/30785408 ID - info:doi/10.2196/11711 ER - TY - JOUR AU - Radomski, D. Ashley AU - Wozney, Lori AU - McGrath, Patrick AU - Huguet, Anna AU - Hartling, Lisa AU - Dyson, P. Michele AU - Bennett, Kathryn AU - Newton, S. Amanda PY - 2019/02/05 TI - 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 JO - J Med Internet Res SP - e11128 VL - 21 IS - 2 KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - persuasive communication KW - anxiety KW - children KW - adolescents KW - review KW - adherence N2 - 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. UR - https://www.jmir.org/2019/2/e11128/ UR - http://dx.doi.org/10.2196/11128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30720436 ID - info:doi/10.2196/11128 ER - TY - JOUR AU - Goh, Leng Esther Chor AU - Chong, Har Wan AU - Mohanty, Jayashree AU - Law, Ning Evelyn Chung AU - Hsu, Stephen Chin-Ying AU - De Mol, Jan AU - Kuczynski, Leon PY - 2019/02/01 TI - Identifying Positive Adaptive Pathways in Low-Income Families in Singapore: Protocol for Sequential, Longitudinal Mixed-Methods Design JO - JMIR Res Protoc SP - e11629 VL - 8 IS - 2 KW - low-income families KW - family agency KW - adaptive pathways KW - trajectories N2 - 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 UR - http://www.researchprotocols.org/2019/2/e11629/ UR - http://dx.doi.org/10.2196/11629 UR - http://www.ncbi.nlm.nih.gov/pubmed/30707101 ID - info:doi/10.2196/11629 ER - TY - JOUR AU - Winsall, Megan AU - Orlowski, Simone AU - Vogl, Gillian AU - Blake, Victoria AU - Nicholas, Mariesa AU - Antezana, Gaston AU - Schrader, Geoffrey AU - Bidargaddi, Niranjan PY - 2019/01/30 TI - Designing Online Interventions in Consideration of Young People?s Concepts of Well-Being: Exploratory Qualitative Study JO - JMIR Hum Factors SP - e10106 VL - 6 IS - 1 KW - well-being KW - youth KW - online intervention KW - participatory design KW - technology N2 - 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. UR - http://humanfactors.jmir.org/2019/1/e10106/ UR - http://dx.doi.org/10.2196/10106 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698537 ID - info:doi/10.2196/10106 ER - TY - JOUR AU - Scholten, Hanneke AU - Granic, Isabela PY - 2019/01/14 TI - Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint JO - J Med Internet Res SP - e11528 VL - 21 IS - 1 KW - anxiety KW - depression KW - design thinking KW - e-mental health KW - youth UR - https://www.jmir.org/2019/1/e11528/ UR - http://dx.doi.org/10.2196/11528 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344671 ID - info:doi/10.2196/11528 ER - TY - JOUR AU - Lucassen, Mathijs AU - Samra, Rajvinder AU - Iacovides, Ioanna AU - Fleming, Theresa AU - Shepherd, Matthew AU - Stasiak, Karolina AU - Wallace, Louise PY - 2018/12/21 TI - How LGBT+ Young People Use the Internet in Relation to Their Mental Health and Envisage the Use of e-Therapy: Exploratory Study JO - JMIR Serious Games SP - e11249 VL - 6 IS - 4 KW - sexuality KW - LGBT KW - transgender KW - depression KW - adolescent KW - psychotherapy KW - mental health KW - computer games KW - computerized CBT KW - e-therapy N2 - 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. UR - http://games.jmir.org/2018/4/e11249/ UR - http://dx.doi.org/10.2196/11249 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578194 ID - info:doi/10.2196/11249 ER - TY - JOUR AU - Ridout, Brad AU - Campbell, Andrew PY - 2018/12/18 TI - The Use of Social Networking Sites in Mental Health Interventions for Young People: Systematic Review JO - J Med Internet Res SP - e12244 VL - 20 IS - 12 KW - social media KW - social networking KW - mental health KW - social support KW - support groups N2 - 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. UR - https://www.jmir.org/2018/12/e12244/ UR - http://dx.doi.org/10.2196/12244 UR - http://www.ncbi.nlm.nih.gov/pubmed/30563811 ID - info:doi/10.2196/12244 ER - TY - JOUR AU - Babbage, Camilla AU - Jackson, Margaret Georgina AU - Nixon, Elena PY - 2018/12/18 TI - Desired Features of a Digital Technology Tool for Self-Management of Well-Being in a Nonclinical Sample of Young People: Qualitative Study JO - JMIR Ment Health SP - e10067 VL - 5 IS - 4 KW - adolescence KW - young people KW - well-being KW - self-management KW - digital technology KW - E-health KW - coping strategies KW - mental health, help-seeking KW - qualitative N2 - 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. UR - http://mental.jmir.org/2018/4/e10067/ UR - http://dx.doi.org/10.2196/10067 UR - http://www.ncbi.nlm.nih.gov/pubmed/30563820 ID - info:doi/10.2196/10067 ER - TY - JOUR AU - Ospina-Pinillos, Laura AU - Davenport, Tracey AU - Iorfino, Frank AU - Tickell, Ashleigh AU - Cross, Shane AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2018/09/10 TI - Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study JO - J Med Internet Res SP - e259 VL - 20 IS - 9 KW - staging model KW - mental health KW - primary health care KW - telemedicine KW - symptom assessment health service reform N2 - 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. UR - http://www.jmir.org/2018/9/e259/ UR - http://dx.doi.org/10.2196/jmir.9966 UR - http://www.ncbi.nlm.nih.gov/pubmed/30201602 ID - info:doi/10.2196/jmir.9966 ER - TY - JOUR AU - Hullmann, E. Stephanie AU - Keller, A. Stacy AU - Lynch, O. Dustin AU - Jenkins, Kelli AU - Moore, Courtney AU - Cockrum, Brandon AU - Wiehe, E. Sarah AU - Carroll, E. Aaron AU - Bennett Jr, E. William PY - 2018/09/10 TI - 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 JO - J Participat Med SP - e10655 VL - 10 IS - 3 KW - qualitative research KW - patient-reported outcomes KW - depression KW - anxiety N2 - 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. UR - http://jopm.jmir.org/2018/3/e10655/ UR - http://dx.doi.org/10.2196/10655 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10655 ER - TY - JOUR AU - Shepherd, Matthew AU - Merry, Sally AU - Lambie, Ian AU - Thompson, Andrew PY - 2018/07/05 TI - Indigenous Adolescents? Perception of an eMental Health Program (SPARX): Exploratory Qualitative Assessment JO - JMIR Serious Games SP - e13 VL - 6 IS - 3 KW - M?ori youth KW - indigenous KW - depression KW - computerized CBT KW - consumer views KW - serious games KW - virtual worlds N2 - 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 (M?ori 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 M?ori. Objective: The aim was to conduct an exploratory qualitative study of M?ori 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 M?ori designs from the SPARX game were appropriate and useful, and the ability to customize the SPARX characters with M?ori 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 wh?nau (M?ori word for family) members with reported beneficial effect. Conclusions: Overall, this small group of M?ori 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. UR - http://games.jmir.org/2018/3/e13/ UR - http://dx.doi.org/10.2196/games.8752 UR - http://www.ncbi.nlm.nih.gov/pubmed/29980495 ID - info:doi/10.2196/games.8752 ER - TY - JOUR AU - March, Sonja AU - Spence, H. Susan AU - Donovan, L. Caroline AU - Kenardy, A. Justin PY - 2018/07/04 TI - Large-Scale Dissemination of Internet-Based Cognitive Behavioral Therapy for Youth Anxiety: Feasibility and Acceptability Study JO - J Med Internet Res SP - e234 VL - 20 IS - 7 KW - adolescent KW - child KW - anxiety disorders KW - cognitive behavioral therapy KW - eHealth KW - public health N2 - 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. UR - http://www.jmir.org/2018/7/e234/ UR - http://dx.doi.org/10.2196/jmir.9211 UR - http://www.ncbi.nlm.nih.gov/pubmed/29973338 ID - info:doi/10.2196/jmir.9211 ER - TY - JOUR AU - Wozney, Lori AU - McGrath, J. Patrick AU - Gehring, D. Nicole AU - Bennett, Kathryn AU - Huguet, Anna AU - Hartling, Lisa AU - Dyson, P. Michele AU - Soleimani, Amir AU - Newton, S. Amanda PY - 2018/06/26 TI - eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes JO - JMIR Ment Health SP - e48 VL - 5 IS - 2 KW - eHealth KW - mental health KW - implementation science KW - healthcare planning KW - organizational innovation KW - decision-making KW - healthcare organizations N2 - 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. UR - http://mental.jmir.org/2018/2/e48/ UR - http://dx.doi.org/10.2196/mental.9655 UR - http://www.ncbi.nlm.nih.gov/pubmed/29945858 ID - info:doi/10.2196/mental.9655 ER - TY - JOUR AU - Roggeveen, Suzanne AU - van Os, Jim AU - Bemelmans, Kelly AU - van Poll, Mikal AU - Lousberg, Richel PY - 2018/06/18 TI - Investigating Associations Between Changes in Mobile Phone Use and Emotions Using the Experience Sampling Method: Pilot Study JO - JMIR Formativ Res SP - e12 VL - 2 IS - 1 KW - mobile phone KW - experience sampling method KW - emotions KW - affect KW - concentration N2 - 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) UR - http://formative.jmir.org/2018/1/e12/ UR - http://dx.doi.org/10.2196/formative.8499 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684428 ID - info:doi/10.2196/formative.8499 ER - TY - JOUR AU - Pisani, R. Anthony AU - Wyman, A. Peter AU - Gurditta, Kunali AU - Schmeelk-Cone, Karen AU - Anderson, L. Carolyn AU - Judd, Emily PY - 2018/05/31 TI - Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test JO - JMIR Ment Health SP - e10425 VL - 5 IS - 2 KW - suicide prevention KW - school-based program KW - text messaging KW - school health services N2 - 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. UR - http://mental.jmir.org/2018/2/e10425/ UR - http://dx.doi.org/10.2196/10425 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10425 ER - TY - JOUR AU - Ospina-Pinillos, Laura AU - Davenport, A. Tracey AU - Ricci, S. Cristina AU - Milton, C. Alyssa AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2018/05/28 TI - Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies JO - J Med Internet Res SP - e188 VL - 20 IS - 5 KW - mental health KW - community-based participatory research KW - eHealth N2 - 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. UR - http://www.jmir.org/2018/5/e188/ UR - http://dx.doi.org/10.2196/jmir.9716 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9716 ER - TY - JOUR AU - Boendermaker, J. Wouter AU - Gladwin, E. Thomas AU - Peeters, Margot AU - Prins, M. Pier J. AU - Wiers, W. Reinout PY - 2018/05/23 TI - Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e10 VL - 6 IS - 2 KW - cognitive function KW - memory KW - video games KW - motivation N2 - 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. UR - http://games.jmir.org/2018/2/e10/ UR - http://dx.doi.org/10.2196/games.8364 UR - http://www.ncbi.nlm.nih.gov/pubmed/29792294 ID - info:doi/10.2196/games.8364 ER - TY - JOUR AU - Thom, Pauline Robyn AU - Bickham, S. David AU - Rich, Michael PY - 2018/05/22 TI - Internet Use, Depression, and Anxiety in a Healthy Adolescent Population: Prospective Cohort Study JO - JMIR Ment Health SP - e44 VL - 5 IS - 2 KW - mental health KW - psychiatric disorders KW - internet use KW - social networking sites N2 - 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. UR - http://mental.jmir.org/2018/2/e44/ UR - http://dx.doi.org/10.2196/mental.8471 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/mental.8471 ER - TY - JOUR AU - Tozzi, Federica AU - Nicolaidou, Iolie AU - Galani, Anastasia AU - Antoniades, Athos PY - 2018/05/10 TI - eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review JO - JMIR Pediatr Parent SP - e5 VL - 1 IS - 1 KW - child KW - adolescent KW - anxiety KW - anxiety disorders KW - telemedicine KW - eHealth KW - mobile applications KW - review N2 - 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. UR - http://pediatrics.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/pediatrics.7248 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518330 ID - info:doi/10.2196/pediatrics.7248 ER - TY - JOUR AU - Liu, Lin Lucia AU - Li, MH Tim AU - Teo, R. Alan AU - Kato, A. Takahiro AU - Wong, WC Paul PY - 2018/05/10 TI - Harnessing Social Media to Explore Youth Social Withdrawal in Three Major Cities in China: Cross-Sectional Web Survey JO - JMIR Ment Health SP - e34 VL - 5 IS - 2 KW - adolescent KW - social withdrawal KW - hikikomori KW - youth social issues KW - Web survey KW - China N2 - 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. UR - http://mental.jmir.org/2018/2/e34/ UR - http://dx.doi.org/10.2196/mental.8509 UR - http://www.ncbi.nlm.nih.gov/pubmed/29748164 ID - info:doi/10.2196/mental.8509 ER - TY - JOUR AU - Pramana, Gede AU - Parmanto, Bambang AU - Lomas, James AU - Lindhiem, Oliver AU - Kendall, C. Philip AU - Silk, Jennifer PY - 2018/05/10 TI - Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial JO - JMIR Serious Games SP - e9 VL - 6 IS - 2 KW - gamification KW - mobile health KW - ecological momentary intervention KW - cognitive behavioral therapy KW - child anxiety treatment KW - SmartCAT KW - childhood anxiety disorders N2 - 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. UR - http://games.jmir.org/2018/2/e9/ UR - http://dx.doi.org/10.2196/games.8902 UR - http://www.ncbi.nlm.nih.gov/pubmed/29748165 ID - info:doi/10.2196/games.8902 ER - TY - JOUR AU - March, Sonja AU - Day, Jamin AU - Zieschank, Kirsty AU - Ireland, Michael PY - 2018/04/19 TI - The Interactive Child Distress Screener: Development and Preliminary Feasibility Testing JO - JMIR Mhealth Uhealth SP - e90 VL - 6 IS - 4 KW - child KW - preschool KW - mental health KW - symptom assessment KW - self-assessment (psychology) N2 - 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. UR - http://mhealth.jmir.org/2018/4/e90/ UR - http://dx.doi.org/10.2196/mhealth.9456 UR - http://www.ncbi.nlm.nih.gov/pubmed/29674310 ID - info:doi/10.2196/mhealth.9456 ER - TY - JOUR AU - Booth, G. Richard AU - Allen, N. Britney AU - Bray Jenkyn, M. Krista AU - Li, Lihua AU - Shariff, Z. Salimah PY - 2018/04/06 TI - Youth Mental Health Services Utilization Rates After a Large-Scale Social Media Campaign: Population-Based Interrupted Time-Series Analysis JO - JMIR Ment Health SP - e27 VL - 5 IS - 2 KW - mental health KW - youth KW - adolescent KW - social media KW - population health KW - mass media N2 - 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. UR - http://mental.jmir.org/2018/2/e27/ UR - http://dx.doi.org/10.2196/mental.8808 UR - http://www.ncbi.nlm.nih.gov/pubmed/29625954 ID - info:doi/10.2196/mental.8808 ER - TY - JOUR AU - Subotic-Kerry, Mirjana AU - King, Catherine AU - O'Moore, Kathleen AU - Achilles, Melinda AU - O'Dea, Bridianne PY - 2018/03/23 TI - General Practitioners? Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery JO - JMIR Hum Factors SP - e12 VL - 5 IS - 1 KW - anxiety KW - depression KW - adolescent KW - general practitioners KW - internet N2 - 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. UR - http://humanfactors.jmir.org/2018/1/e12/ UR - http://dx.doi.org/10.2196/humanfactors.8913 UR - http://www.ncbi.nlm.nih.gov/pubmed/29572203 ID - info:doi/10.2196/humanfactors.8913 ER - TY - JOUR AU - VanHeerwaarden, Nicole AU - Ferguson, Genevieve AU - Abi-Jaoude, Alexxa AU - Johnson, Andrew AU - Hollenberg, Elisa AU - Chaim, Gloria AU - Cleverley, Kristin AU - Eysenbach, Gunther AU - Henderson, Joanna AU - Levinson, Andrea AU - Robb, Janine AU - Sharpe, Sarah AU - Voineskos, Aristotle AU - Wiljer, David PY - 2018/03/06 TI - The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research JO - J Med Internet Res SP - e79 VL - 20 IS - 3 KW - students KW - transition-aged youth KW - mental health KW - substance use KW - eHealth KW - mobile apps KW - participatory action research KW - help-seeking N2 - 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. UR - http://www.jmir.org/2018/3/e79/ UR - http://dx.doi.org/10.2196/jmir.8102 UR - http://www.ncbi.nlm.nih.gov/pubmed/29510970 ID - info:doi/10.2196/jmir.8102 ER - TY - JOUR AU - Radovic, Ana AU - Gmelin, Theresa AU - Hua, Jing AU - Long, Cassandra AU - Stein, D. Bradley AU - Miller, Elizabeth PY - 2018/02/26 TI - Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study JO - JMIR Ment Health SP - e17 VL - 5 IS - 1 KW - adolescent KW - adolescent health services KW - technology KW - depression KW - anxiety N2 - 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. UR - http://mental.jmir.org/2018/1/e17/ UR - http://dx.doi.org/10.2196/mental.9441 UR - http://www.ncbi.nlm.nih.gov/pubmed/29483067 ID - info:doi/10.2196/mental.9441 ER - TY - JOUR AU - Grist, Rebecca AU - Porter, Joanna AU - Stallard, Paul PY - 2018/02/23 TI - Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users? Experience JO - JMIR Ment Health SP - e16 VL - 5 IS - 1 KW - self-injurious behavior KW - mobile apps KW - adolescents KW - telemedicine KW - qualitative research KW - cognitive therapy KW - behavior therapy N2 - 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. UR - http://mental.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/mental.8779 UR - http://www.ncbi.nlm.nih.gov/pubmed/29475823 ID - info:doi/10.2196/mental.8779 ER - TY - JOUR AU - Rice, Simon AU - Gleeson, John AU - Leicester, Steven AU - Bendall, Sarah AU - D'Alfonso, Simon AU - Gilbertson, Tamsyn AU - Killackey, Eoin AU - Parker, Alexandra AU - Lederman, Reeva AU - Wadley, Greg AU - Santesteban-Echarri, Olga AU - Pryor, Ingrid AU - Mawren, Daveena AU - Ratheesh, Aswin AU - Alvarez-Jimenez, Mario PY - 2018/02/22 TI - 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 JO - JMIR Res Protoc SP - e48 VL - 7 IS - 2 KW - internet KW - social networking KW - young adult KW - adolescent KW - mental heath N2 - 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. UR - http://www.researchprotocols.org/2018/2/e48/ UR - http://dx.doi.org/10.2196/resprot.8813 UR - http://www.ncbi.nlm.nih.gov/pubmed/29472177 ID - info:doi/10.2196/resprot.8813 ER - TY - JOUR AU - Bevan Jones, Rhys AU - Thapar, Anita AU - Rice, Frances AU - Beeching, Harriet AU - Cichosz, Rachel AU - Mars, Becky AU - Smith, J. Daniel AU - Merry, Sally AU - Stallard, Paul AU - Jones, Ian AU - Thapar, K. Ajay AU - Simpson, A. Sharon PY - 2018/02/15 TI - A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb JO - JMIR Ment Health SP - e13 VL - 5 IS - 1 KW - adolescent KW - depression KW - internet KW - education KW - preventive psychiatry KW - early medical intervention N2 - 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. UR - http://mental.jmir.org/2018/1/e13/ UR - http://dx.doi.org/10.2196/mental.8894 UR - http://www.ncbi.nlm.nih.gov/pubmed/29449202 ID - info:doi/10.2196/mental.8894 ER - TY - JOUR AU - Martínez, Vania AU - Rojas, Graciela AU - Martínez, Pablo AU - Zitko, Pedro AU - Irarrázaval, Matías AU - Luttges, Carolina AU - Araya, Ricardo PY - 2018/01/31 TI - Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial JO - J Med Internet Res SP - e38 VL - 20 IS - 1 KW - primary health care KW - depression KW - adolescents KW - Internet KW - telemedicine KW - medically underserved area N2 - 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) UR - https://www.jmir.org/2018/1/e38/ UR - http://dx.doi.org/10.2196/jmir.8021 UR - http://www.ncbi.nlm.nih.gov/pubmed/29386172 ID - info:doi/10.2196/jmir.8021 ER - TY - JOUR AU - Stallard, Paul AU - Porter, Joanna AU - Grist, Rebecca PY - 2018/01/30 TI - A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial JO - JMIR Mhealth Uhealth SP - e32 VL - 6 IS - 1 KW - self-injury KW - smartphone KW - mobile apps KW - BlueIce KW - adolescents KW - cognitive behavioral therapy KW - mHealth N2 - 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. UR - http://mhealth.jmir.org/2018/1/e32/ UR - http://dx.doi.org/10.2196/mhealth.8917 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382632 ID - info:doi/10.2196/mhealth.8917 ER - TY - JOUR AU - Rowe, L. Sarah AU - Patel, Krisna AU - French, S. Rebecca AU - Henderson, Claire AU - Ougrin, Dennis AU - Slade, Mike AU - Moran, Paul PY - 2018/01/30 TI - Web-Based Decision Aid to Assist Help-Seeking Choices for Young People Who Self-Harm: Outcomes From a Randomized Controlled Feasibility Trial JO - JMIR Ment Health SP - e10 VL - 5 IS - 1 KW - adolescent KW - self-harm KW - decision aid KW - intervention KW - schools KW - feasibility KW - randomized controlled trials KW - ethics N2 - 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) UR - http://mental.jmir.org/2018/1/e10/ UR - http://dx.doi.org/10.2196/mental.8098 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382626 ID - info:doi/10.2196/mental.8098 ER - TY - JOUR AU - van Rosmalen-Nooijens, Karin AU - Lo Fo Wong, Sylvie AU - Prins, Judith AU - Lagro-Janssen, Toine PY - 2017/06/12 TI - 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 JO - J Med Internet Res SP - e204 VL - 19 IS - 6 KW - domestic violence KW - child abuse KW - exposure to violence KW - adolescent KW - young adult KW - telemedicine KW - peer group KW - peer influence KW - Internet KW - feasibility studies KW - randomized controlled trial KW - delivery of health care N2 - 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) UR - http://www.jmir.org/2017/6/e204/ UR - http://dx.doi.org/10.2196/jmir.6004 UR - http://www.ncbi.nlm.nih.gov/pubmed/28606893 ID - info:doi/10.2196/jmir.6004 ER -