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 - Llanes, D. Karla AU - Amastae, Jon AU - Amrhein, C. Paul AU - Lisha, Nadra AU - Arteaga, Katherina AU - Lopez, Eugene AU - Moran, A. Roberto AU - Cohn, D. Lawrence PY - 2025/4/25 TI - Impact of Computer-Mediated Versus Face-to-Face Motivational-Type Interviews on Participants? Language and Subsequent Cannabis Use: Randomized Controlled Trial JO - J Med Internet Res SP - e59085 VL - 27 KW - motivational interviews KW - computer-mediated KW - commitment language KW - change talk KW - sustain talk KW - marijuana use KW - cannabis use KW - behavior change KW - randomized study KW - young adults KW - marijuana users KW - substance use N2 - Background: Motivational interviewing (MI) is frequently used to facilitate behavior change. The use of change talk during motivational interviews can predict subsequent behavior change. However, no studies have compared the information obtained from traditional face-to-face motivational interviews and computer-mediated motivational interviews or resulted in the same amount of behavior change. Objective: This study aimed to investigate if face-to-face motivational-type interviews (MTIs) and computer-mediated MTIs elicit the same amount of ?change talk? and behavior change when young adults discuss their ambivalence about using marijuana. Methods: A total of 150 users, including frequent marijuana users, occasional marijuana users, and non?marijuana users, participated in the study. All participants reported being at least moderately ambivalent about their current level of marijuana use. Participants were randomly assigned to complete a brief MTI using either the standard face-to-face format or a computer-mediated format. Amrhein?s manual for assessing the presence of ?change talk? and ?sustain talk? was used to code the language produced by respondents in each interview format. A reduction in marijuana use was assessed at a 2-month follow-up. Results: The word count was significantly higher in face-to-face MTIs compared with computer-mediated MTIs (P<.001). After controlling for verbosity, face-to-face MTIs, and computer-mediated MTIs did not differ statistically in the overall amount of change talk (P=.47) and sustain talk (P=.05). Face-to-face MTIs elicited significantly more reasons for reducing future marijuana use (ie, change talk; P=.02) and readiness toward not using marijuana (ie, change talk; P=.009), even after controlling for verbosity. However, these differences were not statistically significant after using a conservative Bonferroni correction (P<.004). After controlling for marijuana use at Time 1, the relationship between the strength of commitment language at Time 1 and marijuana use at Time 2 was not statistically significant (semipartial correlation r=0.03, P=.57). The association between Time 1 change talk and Time 2 marijuana use depended on the type of motivational interview that participants experienced: face-to-face MTI versus computer-mediated MTI (B=0.45, P=.01). A negative binomial regression with a log link function was used to probe this relationship after controlling for 2 covariates: gender and Time 1 (baseline assessment) marijuana use. Among participants in the face-to-face MTI condition, Time 2 (follow-up) marijuana use decreased as the strength of Time 1 change talk increased, although this finding was not significant (B=?0.21, P=.08). However, among participants in the computer-mediated MTI condition, Time 2 marijuana use was not significantly related to the strength of Time 1 change talk (B=0.13, P=.16). Conclusions: Computer-mediated MTIs and face-to-face MTIs elicit both change talk and sustain talk, which suggests that motivational interviews could potentially be adapted for delivery via text-based computer platforms. However, further research is needed to enhance the predictive validity of the type of language obtained via computer-delivered MI. Trial Registration: ClinicalTrials.gov NCT06945471; https://clinicaltrials.gov/study/NCT06945471 UR - https://www.jmir.org/2025/1/e59085 UR - http://dx.doi.org/10.2196/59085 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59085 ER - TY - JOUR AU - Blalock, Kyla AU - Pistorello, Jacqueline AU - Rizvi, L. Shireen AU - Seeley, R. John AU - Kassing, Francesca AU - Sinclair, James AU - Oshin, A. Linda AU - Gallop, J. Robert AU - Fry, M. Cassidy AU - Snyderman, Ted AU - Jobes, A. David AU - Crumlish, Jennifer AU - Krall, R. Hannah AU - Stadelman, Susan AU - Gözenman-Sapin, Filiz AU - Davies, Kate AU - Steele, David AU - Goldston, B. David AU - Compton, N. Scott PY - 2025/4/22 TI - The Comprehensive Adaptive Multisite Prevention of University Student Suicide Trial: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e68441 VL - 14 KW - suicide KW - adaptive treatment strategies KW - Collaborative Assessment and Management of Suicidality KW - CAMS KW - dialectical behavior therapy KW - DBT KW - university students N2 - Background: Suicidal ideation is increasing among university students. Despite growing demand for services, university counseling centers (UCCs) face limited resources to meet the complex needs of students who are suicidal. Objective: The Comprehensive Adaptive Multisite Prevention of University Student Suicide (CAMPUS) Trial evaluates 4 treatment sequences within UCCs to develop evidence-based treatment guidelines. Methods: The CAMPUS Trial consists of a feasibility study followed by a sequential multiple-assignment randomized trial (SMART). The original CAMPUS protocol was modified during the COVID-19 pandemic to accommodate new UCC tele?mental health services, including remote treatment, assessments, and monitoring. A smaller-scale feasibility study was conducted to (1) evaluate implementation of hybrid telehealth and in-person interventions and (2) fine-tune online procedures. Following the feasibility study, university students (aged 18-25 years) seeking UCC services with moderate to severe suicidal ideation will enroll in the CAMPUS Trial. Student participants are randomly assigned to 1 of 4 treatment sequences with 2 stages of intervention. In stage 1, students receive 4 to 6 weeks of either (1) a suicide-focused treatment?Collaborative Assessment and Management of Suicidality?or (2) enhanced treatment as usual. Treatment responders enter the maintenance phase. In stage 2, nonresponders are rerandomized for an additional 1 to 8 weeks of (1) Collaborative Assessment and Management of Suicidality or (2) an intensive skills-based treatment?dialectical behavior therapy for UCC settings. UCC counselors will enroll in the CAMPUS Trial to complete measures about their experience working with students who are suicidal. CAMPUS Trial administration includes representation from all sites to facilitate cross-site coordination and an advisory board of stakeholders from all UCCs to facilitate treatment implementation. Results: Student participant recruitment began on October 25, 2022, and ended on May 16, 2024. As of November 2024, data collection for the SMART was ongoing with active study participants. Data collection was completed in November 2024, and as of April 2025, data analysis is underway. Full results will be available in 2025. Conclusions: The CAMPUS Trial offers a model for future SMARTs for the treatment of suicidal thoughts or behaviors (or both) across various settings. The results will inform treatment guidelines for students presenting with suicidality at UCCs. Trial Registration: ClinicalTrials.gov NCT04707066; http://clinicaltrials.gov/ct2/show/NCT04707066 International Registered Report Identifier (IRRID): DERR1-10.2196/68441 UR - https://www.researchprotocols.org/2025/1/e68441 UR - http://dx.doi.org/10.2196/68441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68441 ER - TY - JOUR AU - Chernick, Rachel AU - Sy, Amanda AU - Dauber, Sarah AU - Vuolo, Lindsey AU - Allen, Bennett AU - Muench, Fred PY - 2025/4/14 TI - Demographics and Use of an Addiction Helpline for Concerned Significant Others: Observational Study JO - J Med Internet Res SP - e55621 VL - 27 KW - family KW - hotline KW - helpline KW - warmline KW - crisis continuum KW - substance abuse KW - addiction KW - youth KW - concerned significant other KW - digital behavioral health KW - parents KW - substance use disorders KW - well-being KW - public health intervention KW - cannabis KW - treatment KW - opioids KW - men KW - women KW - assessments N2 - Background: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction?s helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO?s substance use. Objective: The article analyzes the demographics and use patterns of the Partnership to End Addiction?s helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models. Methods: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO?s ?use state,? that is, their location on the continuum of substance use. Results: CSOs primarily comprised women (13,980/18,373, 76.1%) seeking support for their children (1062/1542, 68.9%). LOs were mostly male (1090/1738, 62.7%), aged 18-25 years (2380/7208, 33%), with primary substance concerns being cannabis (5266/12,817, 40.9%), opioids (2445/12,817, 19%), and stimulants (1563/12,817, 12.1%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2%), while the rest (3182/17,920, 17.8%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7% vs n=4026, 38.6%) and stimulants (n=304, 16.9% vs n=1185, 11.3%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3% vs n=94, 5.2%; P<.001). Conclusions: The study illuminates the helpline?s pioneering role in aiding CSOs grappling with an LO?s substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO?s social network. Spanish-speaking individuals? significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline?s crucial role in aiding CSOs with tailored, accessible support services. UR - https://www.jmir.org/2025/1/e55621 UR - http://dx.doi.org/10.2196/55621 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55621 ER - TY - JOUR AU - Kola, Lola AU - Fatodu, Tobi AU - Kola, Manasseh AU - Olayemi, A. Bisola AU - Adefolarin, O. Adeyinka AU - Dania, Simpa AU - Kumar, Manasi AU - Ben-Zeev, Dror PY - 2025/4/9 TI - Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study JO - JMIR Form Res SP - e42406 VL - 9 KW - adolescent perinatal depression KW - primary care KW - mHealth app KW - user centered design KW - smartphone KW - human-centered design KW - HCD KW - depression KW - postpartum KW - perinatal KW - postnatal KW - teenage KW - adolescent KW - youth KW - low-middle-income countries KW - LMIC KW - middle income KW - adoption KW - acceptability KW - mobile health KW - mHealth KW - mobile app KW - women?s health KW - mental health KW - depressive N2 - Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants? knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients? relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. UR - https://formative.jmir.org/2025/1/e42406 UR - http://dx.doi.org/10.2196/42406 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/42406 ER - TY - JOUR AU - Murphy, M. Karly AU - Glock, Rachel AU - Victorson, David AU - Reddy, Madhu AU - Birken, A. Sarah AU - Salsman, M. John PY - 2025/3/24 TI - Co-Design of a Depression Self-Management Tool for Adolescent and Young Adult Cancer Survivors: User-Centered Design Approach JO - JMIR Form Res SP - e67175 VL - 9 KW - adolescent and young adult KW - cancer survivorship KW - depressive symptoms KW - self-management KW - co-design workshops KW - user-centered design KW - thematic analysis KW - intervention tailoring KW - digital mental health KW - evidence-based intervention KW - digital tools KW - psychosocial support N2 - Background: Adolescent and young adult (AYA) cancer survivors are more likely to experience elevated depressive symptoms than older survivors and healthy age-matched peers. Despite the elevated risk of depressive symptoms in AYA cancer survivors and the existence of evidence-based interventions to address depression, it is unclear whether AYA cancer survivors can access support services. Digital tools are a potential solution to overcoming barriers to AYA cancer survivors? unmet needs for psychosocial support, but they have not been tailored to the needs and preferences of this unique population. Objective: This study engaged AYA cancer survivors and their providers in the concept generation and ideation step of the user-centered design process through online co-design workshops. The goal was to generate concepts and ideas for a digital depression self-management tool tailored to AYA cancer survivors. Methods: We conducted 5 co-design workshops?4 with AYA cancer survivors and 1 with providers who serve them. Participants were asked to provide feedback on an existing digital mindfulness course using an ?I like, I wish, I wonder? framework. Then, participants were asked ?How might we...? questions focused on brainstorming ideas for how the digital tool might work. Participants brainstormed responses independently and then worked as a group to categorize and expand on their ideas. Co-design workshops were autotranscribed using Webex (Cisco) software. Transcripts underwent thematic analysis with additional context provided by the products created during the workshop. Results: Eight AYA cancer survivors (aged 15-37 years) and 4 providers (2 oncologists and 2 social workers) participated in co-design workshops. We identified 6 themes: barriers to engagement, desired content, preferences for content delivery, preferences for interface, features, and aspects to avoid. Each theme had 2-7 subthemes that we relied upon when making design decisions for the prototype. Conclusions: Co-design workshops provided critical insights that informed the prototype development of a digital depression self-management tool tailored to AYA cancer survivors. Key takeaways that were integrated into prototype design include (1) using stories from other AYA cancer survivors to demonstrate concepts; (2) delivering content in brief lessons; and (3) using encouraging notifications, organizational tools, and reward systems to keep AYA cancer survivors engaged with the tool. Some of the themes identified in this study (eg, desired content and features) are consistent with known strategies for promoting user engagement and co-design work in other cancer survivors. However, this study extended previous research by identifying uniquely relevant strategies for tailoring to AYA cancer survivors, such as delivering content in brief sessions to overcome the time constraints AYA cancer survivors experience, providing opportunities for private expression, and maintaining an encouraging tone throughout the tool. These data were used to inform the prototype development of a digital depression self-management tool tailored to AYA cancer survivors. UR - https://formative.jmir.org/2025/1/e67175 UR - http://dx.doi.org/10.2196/67175 UR - http://www.ncbi.nlm.nih.gov/pubmed/40126551 ID - info:doi/10.2196/67175 ER - TY - JOUR AU - Alexander, D. Jordan AU - Duffy, A. Kelly AU - Freis, M. Samantha AU - Chow, Sy-Miin AU - Friedman, P. Naomi AU - Vrieze, I. Scott PY - 2025/3/17 TI - Investigating the Magnitude and Persistence of COVID-19?Related Impacts on Affect and GPS-Derived Daily Mobility Patterns in Adolescence and Emerging Adulthood: Insights From a Smartphone-Based Intensive Longitudinal Study of Colorado-Based Youths From June 2016 to April 2022 JO - J Med Internet Res SP - e64965 VL - 27 KW - adolescence KW - emerging adulthood KW - intensive longitudinal assessment KW - COVID-19 KW - affect KW - GPS KW - mobility patterns KW - smartphone data KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - adolescents KW - teens KW - teenagers KW - mobility KW - apps KW - smartphones KW - intensive longitudinal panel studies KW - emotional well-being KW - well-being KW - daily routines KW - affect survey N2 - Background: The onset of the COVID-19 pandemic in early 2020 introduced unprecedented disruptions impacting the emotional well-being and daily routines of US youths. However, the patterns and persistence of these impacts over the pandemic?s multiyear course remain less well understood. Objective: This study examined longitudinal changes in affect and daily mobility patterns observed in adolescence and young adulthood from June 2016 to April 2022. The study aimed to quantify changes in youths? mood and daily routines following the pandemic?s onset and in response to local COVID-19 case rates as well as the persistence of these effects over the pandemic?s multiyear course. Methods: Colorado-based adolescent and young adult twins (N=887; n=479, 54% female; meanage 19.2, SDage 1.5 years on January 01, 2020) participating in the CoTwins study between June 2016 and April 2022 were followed via a smartphone app, which recorded persistent GPS location data and, beginning in February 2019, administered an abbreviated Positive and Negative Affect Schedule every 2 weeks. Nonlinear trajectories in affect and daily mobility over time and in response to local COVID-19 counts were modeled via generalized additive mixed models, while the magnitude and persistence of pandemic-related changes were quantified via linear mixed effects regressions. Results: Between January and April 2020, participants experienced a 28.6% decline in daily locations visited (from 3.5 to 2.5; SD 0.9) and a 60% reduction in daily travel distance (from 20.0 to 8.0 km; SD 9.4). Mean positive affect similarly declined by 0.3 SD (from 3.0 to 2.79; SD 0.6), while, correspondingly, mean negative affect increased by 0.3 SD (from 1.85 to 2.10; SD 0.6). Though mobility levels partially recovered beginning in the summer of 2020, daily locations visited remained slightly below 2019 levels through the study?s conclusion in April 2022 (standardized ?=?0.10; P<.001). Average positive affect similarly remained slightly below (standardized ?=?0.20; P<.001) and negative affect slightly above (standardized ?=0.14; P=.04) 2019 levels through April 2022. Weekly county-level COVID-19 transmission rates were negatively associated with mobility and positive affect and positively with negative affect, though these effects were greatly weakened later in the pandemic (eg, early 2022) or when transmission rates were high (eg, >200 new cases per 100,000 people per week). Conclusions: Findings demonstrate large initial declines in daily mobility, a moderate decline in positive affect, and a moderate increase in negative affect following the pandemic?s onset in 2020. Though most effects attenuated over time, affect and mobility levels had not recovered to prepandemic levels by April 2022. Findings support theories of hedonic adaptation and resiliency while also identifying lingering emotional and behavioral consequences. The study highlights both youth?s resiliency in adapting to major stressors while also underscoring the need for continued support for youth mental health and psychosocial functioning in the pandemic?s aftermath. UR - https://www.jmir.org/2025/1/e64965 UR - http://dx.doi.org/10.2196/64965 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64965 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 - Chen, Shu-Cheng AU - Lo, Kwai-Ching AU - Li, Han AU - Wong, Pong-Ming AU - Pang, Lok-Yi AU - Qin, Jing AU - Yeung, Wing-Fai PY - 2025/1/30 TI - Parental Experiences of Administering Pediatric Tuina for Sleep and Appetite in Early School-Aged Children With Attention-Deficit/Hyperactivity Disorder: Qualitative Study in Hong Kong JO - JMIR Pediatr Parent SP - e65471 VL - 8 KW - pediatric massage KW - child KW - traditional Chinese medicine KW - TCM KW - ADHD KW - qualitative study KW - complementary medicine KW - attention deficit KW - hyperactivity KW - massage KW - tuina KW - tui na KW - mental health KW - sleep KW - appetite KW - parent KW - parenting KW - interview KW - focus group KW - anmo KW - attention-deficit/hyperactivity disorder N2 - Background: Previous research suggested that parent-administered pediatric tuina could improve symptoms of attention-deficit/hyperactivity disorder (ADHD), such as sleep quality and appetite. Objective: This study aimed to explore the experiences and perceptions of parents administering pediatric tuina to school-aged children with ADHD in Hong Kong. Methods: This qualitative study was embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for improving sleep and appetite in school-aged children diagnosed with ADHD. Purposive sampling was used to invite 12 parents who attended a pediatric tuina training program and delivered the intervention to their children at home for at least 8 weeks. Data were collected through semistructured focus group interviews and individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Two main themes emerged: (1) effects of parent-administered pediatric tuina and (2) parents? experience of administering pediatric tuina. Parents reported significant improvements in children?s sleep quality, appetite, behavior, mental state, and academic performance. Facilitators provided professional guidance and applied a user-friendly course design. Challenges included difficulties in mastering techniques, locating acupuncture points, and time management. Participants suggested the need for more traditional Chinese medicine pattern diagnostic sessions, real-time supervision methods, and extended follow-up to better observe long-term effects. Conclusions: Parent-administered pediatric tuina was perceived to improve children?s sleep quality and appetite significantly, along with other aspects of well-being. Professional guidance and a structured training program facilitated implementation, and challenges highlighted the need for more frequent diagnostic sessions, real-time supervision, and extended follow-up. Trial Registration: ClinicalTrials.gov NCT06007742; https://clinicaltrials.gov/study/NCT06007742 UR - https://pediatrics.jmir.org/2025/1/e65471 UR - http://dx.doi.org/10.2196/65471 ID - info:doi/10.2196/65471 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 - Leijse, L. Merel M. AU - van Dam, Levi AU - Jambroes, Tijs AU - Timmerman, Amber AU - Popma, Arne PY - 2024/12/30 TI - Using Active and Passive Smartphone Data to Enhance Adolescents? Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study JO - JMIR Form Res SP - e53613 VL - 8 KW - emotion regulation KW - emotion awareness KW - smartphone data KW - forensic outpatient youth care KW - treatment motivation KW - treatment alliance KW - emotion KW - behavioral KW - interview KW - mHealth KW - app KW - forensic KW - usability KW - feasibility KW - delinquent KW - pediatrics KW - youth KW - adolescent KW - teenager KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - acceptance KW - emoji KW - behavioral data KW - mobile phone N2 - Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents? limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee?s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. UR - https://formative.jmir.org/2024/1/e53613 UR - http://dx.doi.org/10.2196/53613 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53613 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 - 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 - 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 - Gollier-Briant, Fanny AU - Ollivier, Laurence AU - Joalland, Pierre-Hugues AU - Mouchabac, Stéphane AU - Leray, Philippe AU - Bonnot, Olivier PY - 2024/11/21 TI - Digital Homework Support Program for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e44553 VL - 13 KW - attention-deficit/hyperactivity disorder KW - mobile app KW - assisted homework session KW - digital mental health KW - e-health KW - smartphone KW - psychiatry KW - neurodeveloppemental disorders N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) affects 4% to 5% of the general population. Homework sessions are frequent conflictual moments characterized by increased anxiety in children and stress in their parents, contributing to a lower family quality of life. Children with ADHD experience more severe homework problems than typically developing peers. Poor academic performance in individuals with ADHD is partly attributed to challenging homework. Psychoeducational and school-based approaches are time-consuming and not fully accessible to professionals. Digital tools, such as smartphone and tablet apps, might offer an interesting alternative. We present our digital homework support program for children and adolescents, known as ?Programme d?Aide Numérique aux Devoirs pour Enfant avec TDA-H? (PANDAH), along with the study protocol of our ongoing randomized controlled trial. Objective: This study aims to test PANDAH?s efficacy in improving homework performance and family quality of life. Methods: Individuals aged 9-16 years with an ADHD diagnosis and no comorbid psychiatric disorders are included. This is a multicenter study involving 9 reference centers for ADHD in France. The study comprises (1) a 3-month period with a randomized controlled trial design, where participants are divided into 2 parallel groups (group 1: care as usual or waiting list; group 2: PANDAH app), followed by (2) an extension period of 3 months (months 3-6), during which all participants will have access to the app. This second phase serves as a crucial incentive for patients initially randomly assigned to group 1. Assessments will be conducted at baseline, month 3, and month 6 for each patient by trained psychologists. The primary end point will be the global Homework Performance Questionnaire (HPQ), Parent version score at 6 months. The main analysis will adhere to the ?intent-to-treat principle? (all patient data will be analyzed according to their initial group determined by randomization). We expect (1) HPQ score improvement in individuals using the app during the first 3-month period compared to individuals not using the app; (2) greater HPQ score improvement for individuals using the app for 6 months compared to those using the app for 3 months only; and (3) adherence to the PANDAH program, measured with in-app metrics. Results: Recruitment began in January 2024, and the trial is ongoing. Conclusions: This study contributes to the digital transformation of health care. The use of smartphone apps in self-care and self-management is a societal phenomenon, and its implementation in the field of psychiatry is of particular interest. The app might serve as both valuable support for patients and an opportunity for parents to distance themselves from conflict-laden homework sessions. Since the market for smartphone apps in the health care and well-being sector is primarily industry driven, it is crucial to have an academic conception and evaluation of such digital tools. Trial Registration: ClinicalTrials.gov NCT04857788; https://clinicaltrials.gov/ct2/show/NCT04857788 International Registered Report Identifier (IRRID): PRR1-10.2196/44553 UR - https://www.researchprotocols.org/2024/1/e44553 UR - http://dx.doi.org/10.2196/44553 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/44553 ER - TY - JOUR AU - Boege, Selina AU - Milne-Ives, Madison AU - Ananthakrishnan, Ananya AU - Cong, Cen AU - Sharma, Aditya AU - Anderson, David AU - Meinert, Edward PY - 2024/11/19 TI - Mental Health Monitoring for Young People Through Mood Apps: Protocol for a Scoping Review and Systematic Search in App Stores JO - JMIR Res Protoc SP - e56400 VL - 13 KW - digital health KW - mental health KW - mood apps KW - mobile apps KW - mobile phone N2 - Background: The researchers have used mobile phones to assist in monitoring, analyzing, and managing moods to acquire insight into mood patterns. There is a lack of evidence in their use as clinical tools and interventions, which necessitates a comprehensive review and quality assessment to understand barriers and facilitators for app implementation as an impactful clinical intervention. Objective: This review aims to (1) provide an overview of the recent evidence on mobile mood-monitoring apps that are intended for facilitating self-management and support of mental health in children, adolescents, and young people; and (2) investigate the quality of publicly available apps. Methods: The study will first involve a scoping review of the literature on mood-monitoring apps for children, adolescents, and young people followed by an evaluation of features of the apps available in the marketplace. The scoping review will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and search 6 databases? Embase, CINAHL, PubMed, ACM Digital Library, Scopus, and Springer LNCS?for relevant studies and reviews published in the last 3 years. The author will then screen the references, extract data from the included studies, and analyze them to synthesize the evidence on mood apps. Next, the Apple App Store and Google Play Store will be searched for mood apps. A total of 2 independent reviewers will screen the apps based on eligibility criteria, and disagreements will be resolved through consensus. The features of the selected apps will then be evaluated using the Mobile Health Index and Navigation framework, and descriptive analysis will be used to synthesize the findings. Results: Literature search and screening began soon after submission of the protocol and is expected to be completed by September 2024. The app evaluation will be completed by October 2024. Conclusions: Combined, the scoping literature review and app evaluation will provide an in-depth overview of the most recent scientific evidence related to mood apps and the quality of apps actually available for use. International Registered Report Identifier (IRRID): PRR1-10.2196/56400 UR - https://www.researchprotocols.org/2024/1/e56400 UR - http://dx.doi.org/10.2196/56400 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56400 ER - TY - JOUR AU - Yewale, Prasad AU - Rathi, Renu AU - Mate, Swapnali PY - 2024/11/11 TI - Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial JO - JMIR Res Protoc SP - e51833 VL - 13 KW - addiction KW - Ayurveda KW - gadget addiction KW - children KW - Kaumarbhritya KW - Medhya Rasayana KW - yoga KW - complementary and alternative medicine N2 - Background: Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. Objective: This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children?s gadget addiction. Methods: A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups? interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. Results: In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. Conclusions: This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children?s gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population?s psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. International Registered Report Identifier (IRRID): PRR1-10.2196/51833 UR - https://www.researchprotocols.org/2024/1/e51833 UR - http://dx.doi.org/10.2196/51833 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51833 ER - TY - JOUR AU - Bowen-Forbes, Camille AU - Khondaker, Tilovatul AU - Stafinski, Tania AU - Hadizadeh, Maliheh AU - Menon, Devidas PY - 2024/11/5 TI - Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review JO - JMIR Mhealth Uhealth SP - e58127 VL - 12 KW - children KW - youth KW - personal safety apps KW - smartphones KW - mobile apps KW - violence KW - bullying KW - suicide prevention KW - youth support KW - homeless support KW - mobile phone N2 - Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be ?at risk.? Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users? experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44% of apps), bullying and school violence prevention (n=2, 22% of apps), self-harm and suicide prevention (n=2, 22% of apps), and homeless youth support (n=1, 11% of apps). Of the 41 articles, 25 (61%) provided data solely on app descriptions and features, while the remaining 16 (39%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users? experiences, and effectiveness. Four articles reported on app use, 3 (75%) of which reported relatively high app use. Data on users? experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40% dating and sexual violence prevention; n=2, 40% self-harm and suicide prevention; and n=1, 20% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. UR - https://mhealth.jmir.org/2024/1/e58127 UR - http://dx.doi.org/10.2196/58127 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58127 ER - TY - JOUR AU - Pravosud, Vira AU - Ling, M. Pamela AU - Halpern-Felsher, Bonnie AU - Gribben, Valerie PY - 2024/10/21 TI - Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e49779 VL - 7 KW - adolescents KW - social media use KW - e-cigarette use KW - mental health KW - COVID-19 shelter-in-place orders KW - remote schooling KW - smoking KW - vape KW - e-cigarette implications KW - COVID-19 KW - anxiety KW - depression N2 - Background: Little is known about the role of exposure to e-cigarette?related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling. Objective: The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette?related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants? e-cigarette use. Methods: A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother?s education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration. Results: Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71?8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27?9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39?13.41), or had ?2 family members aware of participants? e-cigarette use (AOR 6.42, 95% CI 1.29?39.49) were more likely to report increased e-cigarette use. Conclusions: Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic. UR - https://pediatrics.jmir.org/2024/1/e49779 UR - http://dx.doi.org/10.2196/49779 ID - info:doi/10.2196/49779 ER - TY - JOUR AU - White, M. Brianna AU - Prasad, Rameshwari AU - Ammar, Nariman AU - Yaun, A. Jason AU - Shaban-Nejad, Arash PY - 2024/10/16 TI - Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review JO - JMIR Pediatr Parent SP - e58403 VL - 7 KW - digital health KW - digital technology KW - digital intervention KW - digital health technology KW - artificial intelligence KW - machine learning KW - adverse childhood experience KW - ACE KW - positive childhood experiences KW - children?s mental health KW - mental health KW - mental illness KW - mental disorder KW - pediatric mental health KW - disease surveillance N2 - Background: Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual?s life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood. Objective: This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth. Methods: Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability. Results: Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder. Conclusions: The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need. UR - https://pediatrics.jmir.org/2024/1/e58403 UR - http://dx.doi.org/10.2196/58403 ID - info:doi/10.2196/58403 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 - 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 - 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 - 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-ętre 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 - Campos, Susana AU - Nuńez, 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 - Grahlher, Kristin AU - Morgenstern, Matthis AU - Pietsch, Benjamin AU - Gomes de Matos, Elena AU - Rossa, Monika AU - Lochbühler, Kirsten AU - Daubmann, Anne AU - Thomasius, Rainer AU - Arnaud, Nicolas PY - 2024/7/23 TI - Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e51307 VL - 12 KW - prevention KW - vocational students KW - adolescents KW - mobile intervention KW - voluntary commitment KW - substance use KW - internet-related problems KW - mobile phone KW - adolescent KW - youths KW - student KW - students KW - use N2 - Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (?Meine Zeit ohne?) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants? characteristics, and (3) to study how variations in app use were related to participants? baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (?congruent use?: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users? characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x UR - https://mhealth.jmir.org/2024/1/e51307 UR - http://dx.doi.org/10.2196/51307 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51307 ER - TY - JOUR AU - Drazdowski, K. Tess AU - Castedo de Martell, Sierra AU - Sheidow, J. Ashli AU - Chapman, E. Jason AU - McCart, R. Michael PY - 2024/7/22 TI - Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch JO - JMIR Res Protoc SP - e60671 VL - 13 KW - peer recovery support services KW - contingency management KW - emerging adults KW - rural N2 - Background: Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. Objective: This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. Methods: Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. Results: Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. Conclusions: While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study?s strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. Trial Registration: ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993 International Registered Report Identifier (IRRID): PRR1-10.2196/60671 UR - https://www.researchprotocols.org/2024/1/e60671 UR - http://dx.doi.org/10.2196/60671 UR - http://www.ncbi.nlm.nih.gov/pubmed/39037768 ID - info:doi/10.2196/60671 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 - Kunchay, Sahiti AU - Linden-Carmichael, N. Ashley AU - Abdullah, Saeed PY - 2024/6/20 TI - Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study JO - JMIR Hum Factors SP - e50795 VL - 11 KW - smartwatches KW - substance use KW - ecological momentary assessment KW - mobile health KW - mHealth KW - human-centered design KW - feasibility studies KW - mobile phone N2 - Background: Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused. Objective: This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life. Methods: This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period. Results: Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users? experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts. Conclusions: This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden. UR - https://humanfactors.jmir.org/2024/1/e50795 UR - http://dx.doi.org/10.2196/50795 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50795 ER - TY - JOUR AU - Baillie Abidi, Catherine AU - Patten, San AU - Houle, A. Stephanie AU - Hoffer, Ken AU - Reeves, Kathryn AU - Bélanger, Stéphanie AU - Nazarov, Anthony AU - Wells, Samantha PY - 2024/6/14 TI - Canadian Armed Forces Veterans? Perspectives on the Effects of Exposure to Children in Armed Conflict During Military Service: Protocol for a Qualitative Study JO - JMIR Res Protoc SP - e57146 VL - 13 KW - moral injury KW - mental health KW - Canadian Armed Forces Veterans KW - children KW - deployments KW - conflicts KW - military culture KW - trauma-informed research KW - people-centered research KW - participatory action research N2 - Background: The mental health of military personnel has garnered increased attention over the last few decades; however, the impacts of perpetuating, observing, or failing to prevent acts that transgress deeply held moral standards, referred to as moral injuries, are less understood, particularly in relation to encounters with children during deployment. This paper describes a multiphased research protocol that centers around the lived experiences of Canadian Armed Forces (CAF) Veterans to understand how encounters with children during military deployments impact the well-being and mental health of military personnel. Objective: This study has four objectives: (1) highlight the lived experiences of CAF Veterans who encountered children during military deployments; (2) improve understanding of the nature of experiences that military personnel faced that related to observing or engaging with children during military service; (3) improve understanding of the mental health impacts of encountering children during military service; and (4) use participatory action research (PAR) to develop recommendations for improving preparation, training, and support for military personnel deployed to contexts where encounters with children are likely. Methods: The research project has 2 main phases where phase 1 includes qualitative interviews with CAF Veterans who encountered children during military deployments and phase 2 uses PAR to actively engage Canadian Veterans with lived experiences of encountering children during military deployments, as well as health professionals and researchers to identify recommendations to better address the mental health effects of these encounters. Results: As of January 26, 2024, a total of 55 participants and research partners have participated in the 2 phases of the research project. A total of 16 CAF Veterans participated in phase 1 (qualitative interviews), and 39 CAF Veterans, health professionals, and researchers participated in phase 2 (PAR). The results for phase 1 have been finalized and are accepted for publication. Data collection and analysis are ongoing for phase 2. Conclusions: Prioritizing and valuing the experiences of CAF Veterans has deepened our understanding of the intricate nature and impacts of potentially morally injurious events involving children during military deployments. Together with health professionals and researchers, the PAR approach empowers CAF Veterans to articulate important recommendations for developing and improving training and mental health support. This support is crucial not only during the deployment cycle but also throughout the military career, helping lessen the effects of moral injury among military personnel. International Registered Report Identifier (IRRID): DERR1-10.2196/57146 UR - https://www.researchprotocols.org/2024/1/e57146 UR - http://dx.doi.org/10.2196/57146 UR - http://www.ncbi.nlm.nih.gov/pubmed/38874998 ID - info:doi/10.2196/57146 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 - 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 - Côté, José AU - Chicoine, Gabrielle AU - Vinette, Billy AU - Auger, Patricia AU - Rouleau, Genevičve AU - Fontaine, Guillaume AU - Jutras-Aswad, Didier PY - 2024/4/17 TI - Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies JO - J Med Internet Res SP - e55031 VL - 26 KW - cannabis KW - young adults KW - digital intervention KW - systematic review KW - meta-analysis KW - behavior change technique analysis KW - mobile phone N2 - Background: The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. Objective: We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. Methods: We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Results: Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by ?6.79 days of use in the previous month (95% CI ?9.59 to ?4.00; P<.001). Conclusions: Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. Trial Registration: PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959 UR - https://www.jmir.org/2024/1/e55031 UR - http://dx.doi.org/10.2196/55031 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630515 ID - info:doi/10.2196/55031 ER - TY - JOUR AU - Birrell, Louise AU - Debenham, Jennifer AU - Furneaux-Bate, Ainsley AU - Prior, Katrina AU - Spallek, Sophia AU - Thornton, Louise AU - Chapman, Catherine AU - Newton, Nicola PY - 2023/9/27 TI - Evaluating a Peer-Support Mobile App for Mental Health and Substance Use Among Adolescents Over 12 Months During the COVID-19 Pandemic: Randomized Controlled Trial JO - J Med Internet Res SP - e45216 VL - 25 KW - mental health KW - substance use KW - prevention KW - school-based KW - peer support KW - anxiety KW - social support KW - psychosocial support systems KW - depression KW - adolescent KW - mobile apps KW - eHealth KW - mHealth KW - mobile phone KW - COVID-19 N2 - Background: Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. Objective: The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. Methods: A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Results: Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=?1.86, 95% CI ?3.73 to 0.02; Cohen d=?0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Conclusions: Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954 International Registered Report Identifier (IRRID): RR2-10.2196/26796 UR - https://www.jmir.org/2023/1/e45216 UR - http://dx.doi.org/10.2196/45216 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756116 ID - info:doi/10.2196/45216 ER - TY - JOUR AU - Beaman, Walter Jason AU - Miner, Josephine Cherie AU - Bolinger, Cadence PY - 2023/8/22 TI - Quantifying Adverse Childhood Experiences in Oklahoma With the Oklahoma Adversity Surveillance Index System (OASIS): Development and Cross-Sectional Study JO - JMIR Public Health Surveill SP - e45891 VL - 9 KW - statewide intervention KW - adverse childhood experiences KW - public health KW - surveillance system KW - trauma KW - rural KW - mental illness KW - childhood trauma KW - surveillance KW - developmental trauma KW - adult N2 - Background: Developmental trauma depending on several factors may lead to later adult health risks and is an increasing public health concern, especially in states with predominantly rural populations. Oklahoma remains one of the states in America with the highest count of adverse childhood experiences (ACEs); therefore, more refined research methods for quantifying ACEs are vital for ensuring proper statewide interventions. Objective: While data sets already exist at the state level measuring specific ACEs like divorce or child abuse, the state currently lacks a single source for specific ACEs that can incorporate regions to allow for the identification of counties where ACEs are especially high. This county identification will allow for assessing trends in adversity prevalence over time to indicate where targeted interventions should be done and which counties experience amplified long-term consequences of high ACE rates. Thus, the model for the Oklahoma Adversity Surveillance Index System (OASIS) was born?a public health tool to map ACEs at the county level and grade them by severity over time. Methods: County-level data for 6 ACEs (mental illness, divorce, neglect, child abuse, domestic violence, and substance use) were collected from the Oklahoma Department of Human Services, Oklahoma State Department of Health, and Oklahoma Community Mental Health Centers for the years 2010 to 2018. First, a potential ACEs score (PAS) was created by standardizing and summing county rates for each ACE. To examine the temporal change in the PAS, a bivariate regression analysis was conducted. Additionally, an ACEs severity index (ASI) was created as a standardized measure of ACE severity across time. This included scoring counties based on severity for each ACE individually and summing the scores to generate an overall ASI for each county, capturing the severity of all ACEs included in the analysis. Results: Mental illness and substance use showed the highest rates at the state level. Results from the regression were significant (F1,76=5.269; P=.02), showing that county PAS showed an increase over years. The ASI scores ranged from 0 to 6, and 4 Oklahoma counties (Adair, McCurtain, Muskogee, and Pittsburg) received a score of 6. Conclusions: OASIS involves the identification of counties where ACEs are most prevalent, allowing for the prioritization of interventions in these ?hot spot? counties. In addition, regression analysis showed that ACEs increased in Oklahoma from 2010 to 2018. Future efforts should center on adding additional ACEs to the ASI and correlating adverse outcome rates (such as violence and medical disorder prevalence) at the county level with high ASI scores. UR - https://publichealth.jmir.org/2023/1/e45891 UR - http://dx.doi.org/10.2196/45891 UR - http://www.ncbi.nlm.nih.gov/pubmed/37467063 ID - info:doi/10.2196/45891 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 - 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 - Helseth, A. Sarah AU - Guigayoma, John AU - Price, Dayna AU - Spirito, Anthony AU - Clark, A. Melissa AU - Barnett, P. Nancy AU - Becker, J. Sara PY - 2022/3/11 TI - Developing a Smartphone-Based Adjunct Intervention to Reduce Cannabis Use Among Juvenile Justice-Involved Adolescents: Protocol for a Multiphase Study JO - JMIR Res Protoc SP - e35402 VL - 11 IS - 3 KW - mobile intervention KW - juvenile justice KW - justice KW - court KW - adolescent KW - teenager KW - substance use KW - cannabis KW - youth KW - adolescence KW - protocol KW - mHealth KW - mobile health KW - user design KW - behavioral app KW - health app KW - development KW - pilot KW - prototype KW - feasibility KW - acceptability KW - smartphone app KW - marijuana KW - mobile phone N2 - Background: Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis. Objective: This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner. Methods: Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes. Results: Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively. Conclusions: This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth. International Registered Report Identifier (IRRID): DERR1-10.2196/35402 UR - https://www.researchprotocols.org/2022/3/e35402 UR - http://dx.doi.org/10.2196/35402 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275086 ID - info:doi/10.2196/35402 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 - 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 - 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 - Slovak, Petr AU - Ford, Q. Brett AU - Widen, Sherri AU - Daudén Roquet, Claudia AU - Theofanopoulou, Nikki AU - Gross, J. James AU - Hankin, Benjamin AU - Klasnja, Predrag PY - 2021/11/9 TI - An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e28914 VL - 10 IS - 11 KW - randomized controlled trial KW - children KW - emotion regulation KW - in situ intervention KW - intervention KW - emotion KW - protocol KW - exploratory KW - efficacy KW - model KW - prevention KW - treatment KW - risk factor N2 - Background: Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot?in the form of an interactive plush toy?that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children?s emotion regulation routines, there is no quantitative evidence of the intervention?s impact on child outcomes. Objective: The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation?Purrble?that can be deployed across prevention and treatment contexts. Methods: Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents? rating of child dysregulation will be ?10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child?s emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis. Results: The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022. Conclusions: This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization. Trial Registration: ClinicalTrials.gov NCT04810455; http://clinicaltrials.gov/ct2/show/NCT04810455 International Registered Report Identifier (IRRID): PRR1-10.2196/28914 UR - https://www.researchprotocols.org/2021/11/e28914 UR - http://dx.doi.org/10.2196/28914 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751666 ID - info:doi/10.2196/28914 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 - 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 - 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 - 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 - Ranney, L. Megan AU - Pittman, K. Sarah AU - Moseley, Isabelle AU - Morgan, E. Kristen AU - Riese, Alison AU - Ybarra, Michele AU - Cunningham, Rebecca AU - Rosen, Rochelle PY - 2021/8/27 TI - Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design JO - JMIR Form Res SP - e25900 VL - 5 IS - 8 KW - adolescent KW - mobile health KW - digital health KW - cyberbullying KW - user-centered design KW - qualitative KW - mobile phone N2 - Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. UR - https://formative.jmir.org/2021/8/e25900 UR - http://dx.doi.org/10.2196/25900 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448702 ID - info:doi/10.2196/25900 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 - 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 - Karim, Sana AU - Hsiung, Kimberly AU - Symonds, Maria AU - Radovic, Ana PY - 2021/7/22 TI - Experience of Peer Bloggers Using a Social Media Website for Adolescents With Depression or Anxiety: Proof-of-Concept Study JO - JMIR Form Res SP - e26183 VL - 5 IS - 7 KW - adolescent KW - social media KW - blogging KW - depression KW - anxiety N2 - Background: Supporting Our Valued Adolescents (SOVA) is a moderated and anonymous social media website intervention. SOVA ambassadors are adolescents and young adults (AYA) asked to write monthly blog posts and comments on others? posts on topics surrounding mental health. Objective: This study aims to understand the feasibility and acceptability of peer blogging for a moderated mental health intervention website and explore whether bloggers?AYA who self-report symptoms of depression and anxiety?experience potential benefits. Methods: AYA aged 14 to 26 years with a self-reported history of depression or anxiety were recruited to the SOVA Peer Ambassador Program. Participants were asked to write one blog post a month and comment at least four times a month on other blog posts, for which they were compensated for up to US $15 monthly. Outcome variables measured at baseline and 3 months after intervention included website usability and feasibility, depressive symptoms, anxiety symptoms, mental health treatment history, cybercoping, personal blogging style, self-esteem, loneliness, mental health stigma, social support, and positive youth development characteristics. Open-ended questions were asked about their blogging acceptability and usability. Results: Of 66 AYA showing interest and completing onboarding, 71% (47/66) wrote at least one blog post, with an average of 3 posts per person. A sample of 51% (34/66) of participants completed a 3-month survey for the full analysis. Almost all 34 participants were satisfied with the experience of blogging (32/34, 94%) and rated the website usability as good (80.1, SD 14.9). At 3 months, self-esteem scores increased by 2.1, with a small-medium effect size (P=.01; Cohen d=0.45), and youth competence and confidence increased by 0.7 (P=.002) and 1.3 (P=.002), with medium effect sizes (Cohen d=0.62 and 0.60), respectively. Conclusions: A blogging intervention for AYA with a history of depression or anxiety was feasible with regular and active engagement and shows evidence in a one-sample design for positive changes in strength-based assets?self-esteem, competence, and confidence?which map onto resilience. UR - https://formative.jmir.org/2021/7/e26183 UR - http://dx.doi.org/10.2196/26183 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292161 ID - info:doi/10.2196/26183 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 - 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 - 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 - 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-ŕ-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 - 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 - 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 - 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 - Maybery, Darryl AU - Reupert, Andrea AU - Bartholomew, Catherine AU - Cuff, Rose AU - Duncan, Zoe AU - Foster, Kim AU - Matar, Jodie AU - Pettenuzzo, Laura PY - 2020/6/18 TI - A Web-Based Intervention for Young Adults Whose Parents Have a Mental Illness or Substance Use Concern: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e15626 VL - 9 IS - 6 KW - young adult KW - mental health KW - substance use KW - internet-based intervention N2 - Background: One in 5 young people grow up in a family where one parent has experienced a mental health problem or substance use concern. Compared with their same-aged peers, these youth are at a higher risk of academic failure and acquiring a substance abuse and/or mental health issue. There is a paucity of accessible, age-appropriate interventions that address their needs. Objective: A 6-week, web-based intervention, ?mental illness: supported, preventative, online, targeted? (mi.spot), was developed based on previous research and the competence enhancement model. This paper describes the protocol for a randomized controlled trial and details how the usage, safety, acceptability, and feasibility of the intervention will be determined. Methods: Participants will be recruited through social media and clinician referral. A total of 70 Australians, aged 18 to 25 years, who grew up with parents with a mental illness or substance use concern will participate in a 2-arm parallel randomized controlled trial. The assessment will consist of a baseline measurement and 2 follow-up periods, posttest and 6-week follow-up, using the Mental Health Continuum short form; the Depression, Anxiety, and Stress Scale; the Coping Orientation to Problems Experienced inventory; the General Help Seeking Questionnaire; the Social Connectedness Scale; the Mental Health Literacy Scale; the General Self-Efficacy Scale; and the Attribution of Responsibility for Parental Mental Illness Measure. Impact will be examined at pre, post, and follow-up time periods using analyses of variance that will include a within-subjects factor (time) and a between-subjects factor (intervention/control). Facilitator interviews will ascertain intervention feasibility. Participant interviews will ascertain intervention acceptability. Interview data will be analyzed within a qualitative framework. Usage (data analytics) across site features and several indicators of clinical safety will also be reported. Results: The impact of mi.spot will be examined at pre, post, and follow-up time periods using analyses of variance on each of the measures outlined above. There will be a within-subjects factor (time) and a between-subjects factor (intervention/control). Data analysis will employ the intention-to-treat principle by including all participants in the analyses. Qualitative interview data will be analyzed using interpretative phenomenological analysis along with respondent validation. The Monash University Human Research Ethics Committee (reference number: 2019-18660-30434) approved the trial on April 17, 2019. As of October 2, 2019, 30 participants were enrolled in the control group and 34 participants were enrolled in the intervention group. Result are expected to be submitted for publication in December 2020. Conclusions: Study results will provide reliable evidence on a web-based intervention that has the potential to make a difference to the lives of many vulnerable young adults. Implementation guidelines are needed to embed the intervention in different service sectors. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000335190; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000335190 International Registered Report Identifier (IRRID): DERR1-10.2196/15626 UR - http://www.researchprotocols.org/2020/6/e15626/ UR - http://dx.doi.org/10.2196/15626 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554368 ID - info:doi/10.2196/15626 ER - TY - JOUR AU - Oram, Daniel AU - Tzilos Wernette, Golfo AU - Nichols, P. Lauren AU - Vydiswaran, Vinod V. G. AU - Zhao, Xinyan AU - Chang, Tammy PY - 2018/12/04 TI - Substance Use Among Young Mothers: An Analysis of Facebook Posts JO - JMIR Pediatr Parent SP - e10261 VL - 1 IS - 2 KW - adolescents KW - Facebook KW - mobile phone KW - pregnant KW - substance use KW - social media N2 - Background: Substance use among young pregnant women is a common and significant public health concern associated with a number of adverse outcomes for both mothers and infants. Social media posts by young women can provide valuable, real-world insight into their perceptions of substance use immediately before and during pregnancy. Objective: The aim of this study was to characterize the frequency and content of posts regarding substance use in the year before pregnancy and during pregnancy among young mothers. Methods: Facebook posts were mined from young pregnant women (age, 16-24 years) who consented from 2 Midwest primary care clinics that serve a predominantly low-income community. Natural language processing was used to identify posts related to substance use by keyword searching (eg, drunk, drugs, pot, and meth). Using mixed-methods techniques, 2 investigators iteratively coded and identified major themes around substance use from these mined Facebook posts. Outcome measures include the frequency of posts and major themes expressed regarding substance use before and during pregnancy. Results: Women in our sample (N=43) had a mean age of 21 (SD 2.3) years, and the largest subgroup (21/43, 49%) identified as non-Hispanic black; 26% (11/43) identified as non-Hispanic white; 16% (7/43) as Hispanic; and 9% (4/43) as non-Hispanic mixed race, Native American, or other. The largest subgroup (20/43, 47%) graduated high school without further education, while 30% (13/43) completed only some high school and 23% (10/43) completed at least some postsecondary education. Young women discussed substance use on social media before and during pregnancy, although compared with the year before pregnancy, the average frequency of substance-related posts during pregnancy decreased. Themes identified included craving alcohol or marijuana, social use of alcohol or marijuana, reasons for abstaining from substance use, and intoxication. Conclusions: Facebook posts reveal that young pregnant women discuss the use of substances, predominantly alcohol and marijuana. Future work can explore clinical opportunities to prevent and treat substance use before and during pregnancy among young, at-risk mothers. UR - http://pediatrics.jmir.org/2018/2/e10261/ UR - http://dx.doi.org/10.2196/10261 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518312 ID - info:doi/10.2196/10261 ER -