TY - JOUR AU - Steadman, Jack AU - Saunders, Rob AU - Freestone, Mark AU - Stewart, Robert PY - 2025/4/15 TI - Subtyping Service Receipt in Personality Disorder Services in South London: Observational Validation Study Using Latent Profile Analysis JO - Interact J Med Res SP - e55348 VL - 14 KW - latent profile analysis KW - latent variable mixture modeling KW - service use KW - personality disorder KW - applied health research KW - electronic health records N2 - Background: Personality disorders (PDs) are typically associated with higher mental health service use; however, individual patterns of engagement among patients with complex needs are poorly understood. Objective: The study aimed to identify subgroups of individuals based on patterns of service receipt in secondary mental health services and examine how routinely collected information is associated with these subgroups. Methods: A sample of 3941 patients diagnosed with a personality disorder and receiving care from secondary services in South London was identified using health care records covering an 11-year period from 2007 to 2018. Basic demographic information, service use, and treatment data were included in the analysis. Service use measures included the number of contacts with clinical teams and instances of did-not-attend. Results: Using a large sample of 3941 patients with a diagnosis of PD, latent profile analysis identified 2 subgroups characterized by low and high service receipt, denoted as profile 1 (n=2879, 73.05%) and profile 2 (n=1062, 26.95%), respectively. A 2-profile solution (P<.01) was preferred over a 3-profile solution, which was nonsignificant. In unconditional (t3941,3939=19.53; P<.001; B=7.27; 95% CI 6.54-8) and conditional (t3941,3937=?3.31; P<.001; B=?74.94; 95% CI ?119.34 to ?30.56) models, cluster membership was significantly related to receipt of nursing contacts, over and above other team contacts. Conclusions: These results suggest that routinely collected data may be used to classify likely engagement subtypes among patients with complex needs. The algorithm identified factors associated with service use and has the potential to inform clinical decision-making to improve treatment for individuals with complex needs. UR - https://www.i-jmr.org/2025/1/e55348 UR - http://dx.doi.org/10.2196/55348 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55348 ER - TY - JOUR AU - Reisner, Sari AU - Liu, Yuxin AU - Tham, Regina AU - Kane, Kaiden AU - Cole, Wilson S. AU - Boskey, R. Elizabeth AU - Katz-Wise, L. Sabra AU - Keuroghlian, S. Alex AU - Xu, Rena PY - 2025/3/24 TI - Prevalence and Correlates of Clinically Elevated Depressive Symptoms in a Nationwide Sample of Transgender, Nonbinary, and Gender Diverse Young Adults in the United States: Cross-Sectional Survey Study JO - Interact J Med Res SP - e66630 VL - 14 KW - transgender KW - depression KW - preventive screening KW - young adult KW - LGBTQ+ KW - nonbinary KW - gender minority KW - gender diverse KW - mental health KW - prevalence KW - cross-sectional KW - survey KW - questionnaire KW - nationwide KW - USA KW - United States KW - North America N2 - Background: In the United States, transgender, nonbinary, and gender diverse (TGD) young adults experience a higher risk of depression compared to their cisgender peers. Understanding factors associated with increased risk of depression within the TGD young adult population is important to guide clinical care as well as inform the development of interventions to reduce mental health disparities. Objective: This exploratory study investigated the prevalence and correlates of positive screening for depressive symptoms among TGD young adults to inform the design, development, and implementation of national interventions aimed at improving mental health in this at-risk population. Methods: In August 2022, a cross-sectional, nationwide online survey was conducted among TGD young adults aged 18?25 (N=104) in the United States. Measures included sociodemographic variables, family characteristics, mental health care utilization, and the two-item Patient Health Questionnaire-2 (PHQ-2) screener for depression. Poisson regression models with robust variance estimation were fitted to estimate adjusted prevalence ratios (aPR) and 95% CI for correlates of PHQ-2 depression (score ?3). Results: The study sample had a mean age of 22 (SD 2) years; 48/104 (46%) individuals identified as Black, Indigenous, or other People of Color, and 69/104 (66%) were nonbinary. Overall, 44 (42%) individuals screened positive for depression using PHQ-2. In a multivariable model adjusted for age, race and ethnicity, US census region, and health insurance status, factors associated with increased depression prevalence using PHQ-2 included low versus high family support (aPR 1.54, 95% CI 1.05?2.27) and identifying with a nonChristian religion versus being unaffiliated (aPR 1.66, 95% CI 1.04?2.63). Factors associated with reduced depression prevalence included living in a rural versus suburban area (aPR 0.48, 95% CI 0.26?0.92) and receiving mental health therapy versus not (aPR 0.71, 95% CI 0.53?0.97). Conclusions: The high prevalence of depressive symptoms among TGD young adults in this study sample highlights the need for comprehensive mental health evaluation and support in this population. Depression risk is increased among certain subgroups, such as those with low family support. These findings are valuable in informing the development of interventions that aim to improve mental health outcomes among TGD young people. UR - https://www.i-jmr.org/2025/1/e66630 UR - http://dx.doi.org/10.2196/66630 ID - info:doi/10.2196/66630 ER - TY - JOUR AU - Schwarz, Julian AU - Meier-Diedrich, Eva AU - Scholten, Matthé AU - Stephenson, Lucy AU - Torous, John AU - Wurster, Florian AU - Blease, Charlotte PY - 2025/3/18 TI - Integration of Psychiatric Advance Directives Into the Patient-Accessible Electronic Health Record: Exploring the Promise and Limitations JO - J Med Internet Res SP - e68549 VL - 27 KW - advance statements KW - advance choice documents KW - advance care planning KW - mental health KW - online record access KW - patient accessible electronic health records KW - interoperability KW - fast healthcare interoperability eesources KW - FHIR KW - self-binding directives KW - mobile phone UR - https://www.jmir.org/2025/1/e68549 UR - http://dx.doi.org/10.2196/68549 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68549 ER - TY - JOUR AU - Nesbitt, Brittany AU - Virgadamo, Danielle AU - Aguirre, Carlos AU - DeCamp, Matthew AU - Dredze, Mark AU - Harrigian, Keith AU - Lhaksampa, Tenzin AU - Meuchel, M. Jennifer AU - Meyer, M. Aja AU - Walker, Alex AU - Zirikly, Ayah AU - Chisolm, S. Margaret AU - Zandi, P. Peter AU - Miller, Leslie PY - 2025/3/5 TI - Testing a Dashboard Intervention for Tracking Digital Social Media Activity in Clinical Care of Individuals With Mood and Anxiety Disorders: Protocol and Design Considerations for a Pragmatic Randomized Trial JO - JMIR Res Protoc SP - e63279 VL - 14 KW - digital mental health KW - mental health KW - dashboards KW - psychiatry KW - measurement-based care KW - electronic communication KW - social media KW - depression KW - anxiety KW - personal health information N2 - Background: Mood and anxiety disorders are prevalent mental health diagnoses. Numerous studies have shown that measurement-based care, which is used to monitor patient symptoms, functioning, and treatment progress and help guide clinical decisions and collaboration on treatment goals, can improve outcomes in patients with these disorders. Including digital information regarding patients? electronic communications and social media activity is an innovative approach to augmenting measurement-based care. Recent data indicate interest and willingness from both mental health clinicians and patients to share this type of digital information in treatment sessions. However, the clinical benefit of systematically doing this has been minimally evaluated. Objective: This study aims to develop an electronic dashboard for tracking patients? digital social activity and a protocol for a pragmatic randomized trial to test the feasibility and efficacy of using the dashboard in real-world clinical care of patients with depression or anxiety disorders. Methods: We developed a personalized electronic dashboard that tracks patients? electronic communications and social media activity, visualizes data on these interactions through key graphics and figures, and provides a tool that can be readily integrated into routine clinical care for use by clinicians and patients during treatment sessions. We then designed a randomized trial to evaluate the feasibility and effectiveness of using the electronic dashboard in real-world care compared to treatment as usual. The trial included patients aged ?12 years with a mood or anxiety disorder who were receiving treatment in outpatient psychiatry clinics in the Johns Hopkins Health System and the Kennedy Krieger Institute. The primary outcome includes changes in patient-rated depression symptoms. Secondary outcomes include changes in patient-rated anxiety symptoms and overall functioning. Exploratory analyses examine the impact of the intervention on measures of therapeutic alliance and the detection of clinically actionable targets. Results: We successfully developed an electronic dashboard for tracking patients? electronic communications and social media activity, and we implemented a protocol for evaluating the feasibility and efficacy of using the dashboard in routine care for mood or anxiety disorders. The protocol was approved by the Johns Hopkins University School of Medicine Institutional Review Board. In this study, we report the technological, ethical, and pragmatic considerations in developing the dashboard and testing it in a real-world setting. Conclusions: The integration of an electronic dashboard to monitor digital social activity in mental health care treatment is novel. This study examines the feasibility and effectiveness of the dashboard and the challenges in implementing this protocol. The lessons learned from developing and implementing the study will inform ongoing discussions about the value of gathering collateral information on patients? digital social activity and how to do so in a way that is acceptable and clinically effective. Trial Registration: ClinicalTrials.gov NCT03925038; https://clinicaltrials.gov/study/NCT03925038 International Registered Report Identifier (IRRID): DERR1-10.2196/63279 UR - https://www.researchprotocols.org/2025/1/e63279 UR - http://dx.doi.org/10.2196/63279 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053788 ID - info:doi/10.2196/63279 ER - TY - JOUR AU - Schenzel, A. Holly AU - Palmer, K. Allyson AU - Shah, B. Neel AU - Lawson, K. Donna AU - Fischer, M. Karen AU - Lapid, I. Maria AU - DeFoster, E. Ruth PY - 2025/2/26 TI - Weighted Blankets for Agitation in Hospitalized Patients with Dementia: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e57264 VL - 14 KW - dementia KW - hospitalized dementia patients KW - agitation KW - aggression KW - behaviors KW - sleep KW - weighted blankets KW - nonpharmacologic strategy KW - pilot study KW - inpatients KW - occupational therapy N2 - Background: There are limited therapies approved for the treatment of aggression and agitation in patients with dementia. While antipsychotics and benzodiazepines are commonly used, these medications have been associated with significant side effects and US Food and Drug Administration (FDA) boxed warnings. Weighted blankets have been associated with decreased anxiety and improved sleep. Weighted blankets are potentially a nonpharmacologic option to reduce agitation in hospitalized patients with dementia. Objective: The aim of this study is to investigate the effect of weighted blankets on aggression and agitation in hospitalized patients with dementia. Methods: A pilot study will be conducted on a total of 30 hospitalized patients with a documented clinical diagnosis of dementia and ongoing agitated behaviors admitted to a medicine or psychiatry service. Patients will be randomly allocated to receive either a weighted blanket for 3 nights or continued usual care. The primary outcome is the change in the observational version of the Cohen-Mansfield Agitation Inventory (CMAI-O) over the course of the 3-night study period. The secondary outcomes are changes in Edmonton Symptom Assessment System Revised (ESAS-r) and Clinical Global Impression (CGI) scores, hours of sleep, use of antipsychotics and benzodiazepines, and incidence of delirium. Identical study assessments will be completed for both the usual care and the weighted blanket study groups. At 5 study time points (baseline, postnight 1, postnight 2, postnight 3, and a final assessment 48-72 h after the last use of the weighted blanket), patients will be assessed with the CMAI-O, ESAS-r, and CGI tools. All assessments will be completed by the bedside nurse or patient care assistant caring for the patient each day. Within 2 to 4 weeks post discharge from the hospital, study coordinators will contact the patient?s legally authorized representative (LAR) to assess for continued use of the weighted blanket. Results: Enrollment of participants began on April 23, 2023. As of November 2024, a total of 24 participants have been enrolled in the study. Baseline characteristics of enrolled participants will be analyzed and reported upon completion of enrollment. We anticipate completing data collection by March 2026. Conclusions: The study will determine the effect of weighted blankets on agitation in hospitalized patients with dementia. Insights into the effect of weighted blankets on sleep will also be gained. The results of this study will be relevant in the setting of increasing numbers of older adults with dementia exhibiting agitation, leading to increased hospitalizations, caregiver burden, and health care costs. Trial Registration: ClinicalTrials.gov NCT03643991; http://clinicaltrials.gov/ct2/show/NCT03643991 International Registered Report Identifier (IRRID): DERR1-10.2196/57264 UR - https://www.researchprotocols.org/2025/1/e57264 UR - http://dx.doi.org/10.2196/57264 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57264 ER - TY - JOUR AU - El Boudi, Islam AU - Riant, Mathilde AU - Bellier, Alexandre AU - Vuillerme, Nicolas PY - 2025/2/26 TI - French Versions of 4 English Questionnaires on Problematic Smartphone Use: Cross-Cultural Linguistic Translation and Adaptation Study JO - Interact J Med Res SP - e53958 VL - 14 KW - problematic use KW - smartphone KW - French questionnaire KW - linguistic translation KW - forward/backward process KW - mobile phone N2 - Background: Excessive use of smartphones is recognized as a major problem in our modern society and can have dramatic consequences on the health of adolescents and young adults. Measuring problematic smartphone use in research and clinical practice is generally operationalized with self-reported questionnaires. In order to comprehensively assess the issue of problematic smartphone usage within the French population, it is imperative to employ validated French-language questionnaires. However, at this point, existing questionnaires are primarily available in English. Furthermore, to the best of our knowledge, these English questionnaires have yet to undergo validation processes for French-speaking cohorts. Objective: The aim of this study was to perform a cross-cultural translation of the Smartphone Addiction Scale, Nomophobia Questionnaire, Problematic Use of Mobile Phones scale, and Smartphone Addiction Proneness Scale to French. Methods: The translation process was performed using the forward/backward method. The first translation phase involved asking 4 independent French translators to translate the original English version of the questionnaires into French. In the second phase, the French version was backtranslated to English by a native English speaker. In the third phase, 2 concept experts were asked to comment and suggest modifications to the statements if necessary. Finally, the last version of the translated questionnaires was presented to 18 participants to assess the clarity, intelligibility, and acceptability of the translations. Results: During the forward translation step, the translation differences were minor. During the backward translation, the English native speaker correctly backtranslated 18 of the 33 items of the Smartphone Addiction Scale, 17 of the 20 items of the Problematic Use of Mobile Phones scale, and 13 of the 15 items of the Smartphone Addiction Proneness Scale. Backtranslation for the Nomophobia Questionnaire was less satisfactory, with only 10 out of 20 items that were correctly backtranslated. The linguistic verification step revealed a minimal modification for the 4 questionnaires. The participants also suggested few improvements that we have considered for the final version. We produced the final version directly after this step. Conclusions: We successfully adapted and effectively translated 4 questionnaires that assess problematic smartphone use to French. This step is a prerequisite for the validation of the French questionnaires. These adapted measures can serve as valuable research instruments for investigating and addressing issues related to problematic smartphone use in French-speaking countries and for making international comparisons. UR - https://www.i-jmr.org/2025/1/e53958 UR - http://dx.doi.org/10.2196/53958 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53958 ER - TY - JOUR AU - Erasmus, Pieter AU - Borrmann, Moritz AU - Becker, Jule AU - Kuchinke, Lars AU - Meinlschmidt, Gunther PY - 2025/2/24 TI - Comparing Digital Versus Face-to-Face Delivery of Systemic Psychotherapy Interventions: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - Interact J Med Res SP - e46441 VL - 14 KW - systemic psychotherapy KW - family therapy KW - adolescent KW - systematic review KW - meta-analysis KW - face to face KW - digital KW - remote KW - distance KW - telehealth KW - delivery modality N2 - Background: As digital mental health delivery becomes increasingly prominent, a solid evidence base regarding its efficacy is needed. Objective: This study aims to synthesize evidence on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities. Methods: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for searching PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and PSYNDEX and conducting a systematic review and meta-analysis. We included randomized controlled trials comparing mental, behavioral, and somatic outcomes of systemic psychotherapy interventions using self- and therapist-guided digital versus face-to-face delivery modalities. The risk of bias was assessed with the revised Cochrane Risk of Bias tool for randomized trials. Where appropriate, we calculated standardized mean differences and risk ratios. We calculated separate mean differences for nonaggregated analysis. Results: We screened 3633 references and included 12 articles reporting on 4 trials (N=754). Participants were youths with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youths with anorexia nervosa. A total of 56 outcomes were identified. Two trials provided digital intervention delivery via videoconferencing: one via an interactive graphic interface and one via a web-based program. In total, 23% (14/60) of risk of bias judgments were high risk, 42% (25/60) were some concerns, and 35% (21/60) were low risk. Due to heterogeneity in the data, meta-analysis was deemed inappropriate for 96% (54/56) of outcomes, which were interpreted qualitatively instead. Nonaggregated analyses of mean differences and CIs between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 18% (10/56) of outcomes, superiority of the face-to-face delivery modality for 5% (3/56) of outcomes, equivalence between delivery modalities for 2% (1/56) of outcomes, and neither superiority of one modality nor equivalence between modalities for 75% (42/56) of outcomes. Consequently, for most outcome measures, no indication of superiority or equivalence regarding the relative efficacy of either delivery modality can be made at this stage. We further meta-analytically compared digital versus face-to-face delivery modalities for attrition (risk ratio 1.03, 95% CI 0.52-2.03; P=.93) and number of sessions attended (standardized mean difference ?0.11; 95% CI ?1.13 to ?0.91; P=.83), finding no significant differences between modalities, while CIs falling outside the range of the minimal important difference indicate that equivalence cannot be determined at this stage. Conclusions: Evidence on digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous, limiting conclusions regarding the differential efficacy of digital and face-to-face delivery. Nonaggregated and meta-analytic analyses did not indicate the superiority of either delivery condition. More research is needed to conclude if digital and face-to-face delivery modalities are generally equivalent or if?and in which contexts?one modality is superior to another. Trial Registration: PROSPERO CRD42022335013; https://tinyurl.com/nprder8h UR - https://www.i-jmr.org/2025/1/e46441 UR - http://dx.doi.org/10.2196/46441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46441 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 - Luk, F. Luke Y. AU - Ching, Y. Christie J. AU - Yip, Fung Tsz AU - Chan, L. Sunny C. AU - Lam, T. Catherine Y. AU - Lam, C. Elizabeth T. AU - Yue, B. Serena R. AU - Pang, Ching Hoi AU - Wong, H. Janet Y. AU - Wong, H. Carlos K. AU - Tong, Kwan Chak AU - Yamamoto, Tafu AU - Rainer, H. Timothy AU - Wai, C. Abraham K. AU - Ho, K. Joshua W. PY - 2025/2/10 TI - Incidence of Deliberate Self-Harm in Hong Kong Before and During the COVID-19 Pandemic: Population-Wide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e57500 VL - 11 KW - emergency department KW - COVID-19 KW - deliberate self-harm KW - mental health KW - self-harm KW - self-injury KW - self-violence KW - Hong Kong KW - SARS-Cov-2 N2 - Background: COVID-19 ended on May 5, 2023, and since then Hong Kong reported increased mental distress, which was speculated to be from the policies implemented during the pandemic. Despite this, longitudinal surveillance of deliberate self-harm (DSH) incidences throughout the pandemic in Hong Kong remained insufficient. Objective: The objective of this study was to outline the changes in DSH incidences before and during the COVID-19 pandemic in Hong Kong, with respect to sex, age, and co-occurring mental health issues. Methods: A quasi-experiment was conducted using an interrupted time series design to estimate the impact of the pandemic on DSH-related emergency department (ED) visits. This design enabled the estimation of DSH-related ED visits based on prepandemic data from 2016 to 2019, assuming the pandemic had not occurred, and allowed for a comparison with observed DSH-related ED visits during the pandemic. The descriptive results were reported as the observed monthly DSH-related ED visits and observed incidence ratios during the pandemic. Afterwards, a negative binomial model was fitted to the prepandemic data (2016?2019) and adjusted for temporal trends, seasonality, and population variation to estimate the expected monthly DSH-related ED visits and adjusted incidence ratios (aIRs). Results: Between January 2016 and December 2022, a total of 31,893 DSH episodes were identified. Initial descriptive analysis showed a significant difference in demographic characteristics (sex) and clinical characteristics (death within 28 d, diagnoses of co-occurring mental health issues, public assistance pay code, and triage level). Subsequent interrupted time-series analysis demonstrated significantly increasing trends in comparison with the prepandemic period. As reported in the aIRs among young adult males (aIR in 2020=1.34, P=.002; 2021: aIR=1.94, P<.001; and 2022: aIR=2.53, P<.001), adult males (aIR in 2020=1.58, P<.001; 2021: aIR=2.64, P<.001; and 2022: aIR=3.13, P<.001), adult females (aIR in 2020=1.13, P=.01; 2021: aIR=1.52, P<.001; and 2022: aIR=1.64, P<.001), and older male adults (aIR in 2020=1.53, P<.001; 2021: aIR=2.37, P<.001; and 2022: aIR=3.01, P<.001). Conclusions: The average annual DSH-related ED visits increased during the pandemic period. Therefore, there is a need to raise awareness for such vulnerable groups in Hong Kong to prepare for postpandemic spillover. UR - https://publichealth.jmir.org/2025/1/e57500 UR - http://dx.doi.org/10.2196/57500 ID - info:doi/10.2196/57500 ER - TY - JOUR AU - da Rosa, Teixeira André Luiz Schuh AU - da Costa, Barreto Marina Ribeiro AU - Sorato, Bezerra Gabriela AU - Manjabosco, Moura Felipe de AU - de Bem, Bonganhi Érica AU - Dellazari, Lucas AU - Falcăo, Bezerra Arthur AU - Cia, Oliveira Lucas de AU - Bezerra, Sorato Olivia AU - Borges, Boff Rogério AU - Rohde, Augusto Luis AU - Graeff-Martins, Soledade Ana PY - 2025/1/30 TI - Clozapine for Treatment-Resistant Disruptive Behaviors in Youths With Autism Spectrum Disorder Aged 10-17 Years: Protocol for an Open-Label Trial JO - JMIR Res Protoc SP - e58031 VL - 14 KW - neurodevelopmental disorders KW - clozapine KW - psychopharmacology KW - antipsychotic medication KW - autism spectrum disorder KW - youth N2 - Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition emerging in early childhood, characterized by core features such as sociocommunicative deficits and repetitive, rigid behaviors, interests, and activities. In addition to these, disruptive behaviors (DB), including aggression, self-injury, and severe tantrums, are frequently observed in pediatric patients with ASD. The atypical antipsychotics risperidone and aripiprazole, currently the only Food and Drug Administration?approved treatments for severe DB in patients with ASD, often encounter therapeutic failure or intolerance. Given this, exploring pharmacological alternatives for more effective management of DB associated with ASD is essential. Clozapine, noted for its unique antiaggressive effects in schizophrenia and in various treatment-resistant neuropsychiatric disorders, independent from its antipsychotic efficacy, remains underexplored in youths with ASD facing severe and persistent DB. Objective: This study aimed to evaluate the efficacy, tolerability, and safety of clozapine for treatment-resistant DB in youths with ASD. Methods: This is a prospective, single-center, noncontrolled, open-label trial. After a cross-titration phase, 31 patients with ASD aged 10-17 years and with treatment-resistant DB received a flexible dosage regimen of clozapine (up to 600 mg/day) for 12 weeks. Standardized instruments were applied before, during, and after the treatment, and rigorous clinical monitoring was performed weekly. The primary outcome was assessed using the Irritability Subscale of the Aberrant Behavior Checklist. Other efficacy measures include the Clinical Global Impression Severity and Improvement, the Swanson, Nolan, and Pelham questionnaire-IV, the Childhood Autism Rating Scale, and the Vineland Adaptive Behavior Scale. Safety and tolerability measures comprised adverse events, vital signs, electrocardiography, laboratory tests, physical measurements, and extrapyramidal symptoms with the Simpsons-Angus Scale. Statistical analysis will include chi-square tests with Monte Carlo simulation for categorical variables, paired t tests or Wilcoxon tests for continuous variables, and multivariate linear mixed models to evaluate the primary outcome, adjusting for confounders. Results: Recruitment commenced in February 2023. Data collection was concluded by April 2024, with analysis ongoing. This article presents the protocol of the initially planned study to provide a detailed methodological description. The results of this trial will be published in a future paper. Conclusions: The urgent need for effective pharmacological therapies in mitigating treatment-resistant DB in pediatric patients with ASD underscores the importance of this research. Our study represents the first open-label trial to explore the anti-aggressive effects of clozapine in this specific demographic, marking a pioneering step in clinical investigation. Adopting a pragmatic approach, this trial protocol aims to mirror real-world clinical settings, thereby enhancing the applicability and relevance of our findings. The preliminary nature of future results from this research has the potential to pave the way for more robust studies and emphasize the need for continued innovation in ASD treatment. Trial Registration: Brazilian Clinical Trials Registry RBR-54j3726; https://ensaiosclinicos.gov.br/rg/RBR-54j3726 International Registered Report Identifier (IRRID): DERR1-10.2196/58031 UR - https://www.researchprotocols.org/2025/1/e58031 UR - http://dx.doi.org/10.2196/58031 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58031 ER - TY - JOUR AU - Tanaka, Hiroki AU - Miyamoto, Kana AU - Hamet Bagnou, Jennifer AU - Prigent, Elise AU - Clavel, Céline AU - Martin, Jean-Claude AU - Nakamura, Satoshi PY - 2025/1/10 TI - Analysis of Social Performance and Action Units During Social Skills Training: Focus Group Study of Adults With Autism Spectrum Disorder and Schizophrenia JO - JMIR Form Res SP - e59261 VL - 9 KW - social performance rating scale KW - social skills training KW - autism spectrum disorder KW - schizophrenia KW - facial expressions KW - social KW - autism KW - training KW - communication KW - trainers KW - tool KW - neurological N2 - Background: Social communication is a crucial factor influencing human social life. Quantifying the degree of difficulty faced in social communication is necessary for understanding developmental and neurological disorders and for creating systems used in automatic symptom screening and assistive methods such as social skills training (SST). SST by a human trainer is a well-established method. Previous SST used a modified roleplay test to evaluate human social communication skills. However, there are no widely accepted evaluation criteria or social behavioral markers to quantify social performance during SST. Objective: This paper has 2 objectives. First, we propose applying the Social Performance Rating Scale (SPRS) to SST data to measure social communication skills. We constructed a Japanese version of the SPRS already developed in English and French. Second, we attempt to quantify action units during SST for people with autism spectrum disorder (ASD) or schizophrenia. Methods: We used videos of interactions between trainers, adults with ASD (n=16) or schizophrenia (n=15), and control participants (n=19) during SST sessions. Two raters applied the proposed scale to annotate the collected data. We investigated the differences between roleplay tasks and participant groups (ASD, schizophrenia, and control). Furthermore, the intensity of action units on the OpenFace toolkit was measured in terms of mean and SD during SST roleplaying. Results: We found significantly greater gaze scores in adults with ASD than in adults with schizophrenia. Differences were also found between the ratings of different tasks in the adults with schizophrenia and the control participants. Action units numbered AU06 and AU12 were significantly deactivated in people with schizophrenia compared with the control group. Moreover, AU02 was significantly activated in people with ASD compared with the other groups. Conclusions: The results suggest that the SPRS can be a useful tool for assessing social communication skills in different cultures and different pathologies when used with the modified roleplay test. Furthermore, facial expressions could provide effective social and behavioral markers to characterize psychometric properties. Possible future directions include using the SPRS for assessing social behavior during interaction with a digital agent. UR - https://formative.jmir.org/2025/1/e59261 UR - http://dx.doi.org/10.2196/59261 ID - info:doi/10.2196/59261 ER - TY - JOUR AU - Kraege, Vanessa AU - Dumans-Louis, Céline AU - Maglieri, Céline AU - Bochatay, Séverine AU - Durand, Marie-Anne AU - Garnier, Antoine AU - Selby, Kevin AU - von Plessen, Christian PY - 2025/1/7 TI - Citizen Worry and Adherence in Response to Government Restrictions in Switzerland During the COVID-19 Pandemic: Repeated Cross-Sectional Online Surveys JO - Interact J Med Res SP - e55636 VL - 14 KW - COVID-19 pandemic KW - citizens KW - worry KW - anxiety KW - communication KW - prevention KW - adherence KW - restrictions KW - Switzerland KW - cross sectional KW - online survey KW - survey KW - Swiss KW - adults KW - questionnaire KW - social media KW - linear regression KW - age KW - gender KW - health literacy KW - education KW - women KW - young people N2 - Background: Good communication between health authorities and citizens is crucial for adherence to preventive measures during a pandemic. Crisis communication often appeals to worries about negative consequences for oneself or others. While worry can motivate protective behavior, it can also be overwhelming and lead to irrational choices or become a mental health problem. Also, the levels and consequences of worry can differ between different groups of citizens. Little is known about the evolution of worries during the pandemic and adherence to measures in distinct groups. Objective: This study aimed to evaluate worries in the Swiss population as well as associations between worry levels and citizens? adherence to government restrictions during different phases of the COVID-19 pandemic. Methods: We carried out an observational study with 4 cross-sectional online surveys of adults in the Canton of Vaud, Switzerland. Questionnaires were distributed through social media and websites during 4 periods: survey 1: April 17 to May 14, 2020; survey 2: May 15 to June 22, 2020; survey 3: October 30 to December 12, 2020; and survey 4: June 18 to December 30, 2021. On visual analog scales from 0 to 100, participants reported worry, self-adherence to pandemic restrictions, and their perceived adherence to others. We used multivariable linear regression, adjusting for age, gender, health literacy, and education to assess associations between self-reported worry, adherence, and study periods. Results: We collected 7106 responses. After excluding 2377 questionnaires (incomplete, age <18 years, residence outside Vaud), 4729 (66.55%) were analyzed (mean age 47, SD 15.6 years, 63.96% women). Mean worry across the 4 periods was 42/100, significantly higher in women (44.25/100, vs 37.98/100; P<.001) and young people (43.77/100 in those aged 18-39 years, vs 41.69/100; P=.005; in those aged 40-64 years and 39.16/100; P=.002; in those aged >64 years). Worries were higher during survey 1 and survey 3 (52.41/100 and 56.32/100 vs 38.93/100, P<.001; and 35.71/100, P<.001) than during survey 2 and survey 4, respectively. This corresponds to pandemic peaks during which federal restrictions were better followed with self-reported adherence of 84.80/100 and 89.59/100 in survey 1 and survey 3 versus 78.69/100 (P<.001) and 78.64/100 (P<.001) in survey 2 and survey 4. A 2.9-point increase in worry score, adjusted for the pandemic period, gender, age, education, and health literacy, was associated with a 10-point increase in personal adherence score (95% CI 2.5-3.2; P<.001). Conclusions: Worries were higher in women, young people, and during the peak of the COVID-19 pandemic. Higher worry levels were associated with increased self-reported adherence to federal restrictions. Authorities should consider population worry levels and population subgroups in the planning and design of pandemic communication. UR - https://www.i-jmr.org/2025/1/e55636 UR - http://dx.doi.org/10.2196/55636 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55636 ER - TY - JOUR AU - Cheung, Gar-Mun Lauryn AU - Thomas, Carien Pamela AU - Brvar, Eva AU - Rowe, Sarah PY - 2025/1/3 TI - User Experiences of and Preferences for Self-Guided Digital Interventions for the Treatment of Mild to Moderate Eating Disorders: Systematic Review and Metasynthesis JO - JMIR Ment Health SP - e57795 VL - 12 KW - eating disorders KW - anorexia KW - bulimia KW - binge eating KW - other specified feeding or eating disorder KW - OSFED KW - intervention KW - digital intervention KW - self-help KW - systematic review N2 - Background: Digital interventions typically involve using smartphones or PCs to access online or downloadable self-help and may offer a more accessible and convenient option than face-to-face interventions for some people with mild to moderate eating disorders. They have been shown to substantially reduce eating disorder symptoms, but treatment dropout rates are higher than for face-to-face interventions. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centered digital interventions that are engaging and meet users? needs. Objective: This study aims to understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a metasynthesis of qualitative studies. We searched 6 databases for published and unpublished literature from 2013 to 2024. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: A total of 8 studies were included after screening 3695 search results. Overall, 7 metathemes were identified. The identified metathemes included the appeal of digital interventions, role of digital interventions in treatment, value of support in treatment, communication at the right level, importance of engagement, shaping knowledge to improve eating disorder behaviors, and design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible and that they fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviors. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalized content and functions. Conclusions: Users found digital interventions for eating disorders practical and effective but stressed the need for interventions to address the full range of symptoms, severity, and individual needs. Future digital interventions should be cocreated with users and offer more personalization. Further research is needed to determine the appropriate balance of professional and peer support and whether these interventions should serve as the first step in the stepped care model. Trial Registration: PROSPERO CRD42023426932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426932 UR - https://mental.jmir.org/2025/1/e57795 UR - http://dx.doi.org/10.2196/57795 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752210 ID - info:doi/10.2196/57795 ER - TY - JOUR AU - Larsson, Anna AU - Weineland, Sandra AU - Nissling, Linnea AU - Lilja, L. Josefine PY - 2025/1/3 TI - The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study JO - JMIR Pediatr Parent SP - e59489 VL - 8 KW - adolescents KW - parental support KW - anxiety KW - depression KW - primary care KW - mental health KW - ACT KW - acceptance and commitment therapy KW - iACT KW - internet-delivered acceptance and commitment therapy N2 - Background: Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support. Objective: This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning. Methods: Adolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children?s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children?s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution. Results: The iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children?s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: ?2.94; P=.003; r=?0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: ?2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children?s Global Assessment Scale were found. Conclusions: The results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study. UR - https://pediatrics.jmir.org/2025/1/e59489 UR - http://dx.doi.org/10.2196/59489 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752209 ID - info:doi/10.2196/59489 ER - TY - JOUR AU - Bur, Thomas Oliver AU - Berger, Thomas PY - 2024/12/16 TI - Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study JO - JMIR Form Res SP - e46860 VL - 8 KW - internet intervention KW - depression KW - guidance KW - contact behavior KW - messages KW - adherence KW - online KW - intervention KW - digital health KW - therapy KW - participant N2 - Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes. Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome. Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively. Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants? messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=?2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=?2.62, P=.004) and group 2 (Z=?2.47, P=.007). All other group comparisons did not yield significant differences. Conclusion: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies. Trial Registration: ClinicalTrials.gov NCT04318236; https://www.clinicaltrials.gov/study/NCT04318236 UR - https://formative.jmir.org/2024/1/e46860 UR - http://dx.doi.org/10.2196/46860 ID - info:doi/10.2196/46860 ER - TY - JOUR AU - Bernanke, Alyssa AU - Hasley, Rebecca AU - Sabetfakhri, Niki AU - de Wit, Harriet AU - Smith, M. Bridget AU - Wang, Lei AU - Brenner, A. Lisa AU - Hanlon, Colleen AU - Philip, S. Noah AU - Ajilore, Olusola AU - Herrold, Amy AU - Aaronson, Alexandra PY - 2024/12/13 TI - Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e58206 VL - 13 KW - mild traumatic brain injury KW - transcranial magnetic stimulation KW - intermittent theta burst stimulation KW - suicidality KW - suicidal ideation KW - impulsivity KW - neuromodulation KW - social and occupational functioning N2 - Background: Suicide remains a leading cause of death among veterans in the United States, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation (SI) and suicide attempts (SAs). mTBI worsens impulsivity and contributes to poor social and occupational functioning, which further increases the risk of SI and SAs. Repetitive transcranial magnetic stimulation is a neuromodulatory treatment approach that induces neuroplasticity, potentially repairing neurodamage. Intermittent theta burst stimulation (iTBS) is a second-generation form of transcranial magnetic stimulation that is safe, shorter in duration, displays a minimal side effect profile and is a promising treatment approach for impulsivity in mTBI. Our novel proposed treatment protocol uses frontal pole iTBS to target the ventromedial prefrontal cortex, which may reduce impulsivity by strengthening functional connectivity between the limbic system and frontal cortex, allowing for improved top-down control of impulsive reactions, including SI and SAs. Objective: The objectives of this study are to (1) develop an iTBS intervention for veterans with mTBI, impulsivity, and SI; (2) assess the feasibility and tolerability of the intervention; and (3) gather preliminary clinical outcome data on SI, impulsivity, and functions that will guide future studies. Methods: This is a pilot, double-blinded, randomized controlled trial. In developing this protocol, we referenced the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. We will enroll 56 participants (28 active iTBS and 28 sham iTBS). The iTBS intervention will be performed daily, 5 days a week, for 2 weeks. We will collect 10 validated, psychometric, quantitative outcome measures before, during, and after the intervention. Measures included will assess functioning, impulsivity, suicidality, posttraumatic stress disorder, and depressive symptoms. We will collect qualitative data through semistructured interviews to elicit feedback on the participants? experiences and symptoms. We will perform quantitative and qualitative analyses to (1) assess the feasibility, tolerability, and acceptability of the treatment; (2) gather advanced neuroimaging data to assess neural changes elicited by treatment; and (3) assess improvements in outcome measures of impulsivity and suicidality in veterans with mTBI. Results: This study protocol was approved by the Edward Hines, Jr. VA Hospital Institutional Review Board (Hines IRB number 14-003). This novel treatment is a 5-year research project (April 1, 2023, to March 31, 2028) funded by the Veterans Administration Rehabilitation Research and Development service (CDA2 award IK2 RX002938). Study results will be disseminated at or before the project?s end date in March 2028. Conclusions: We will provide preliminary evidence of the safety, feasibility, and acceptability of a novel frontal pole iTBS treatment for mTBI, impulsivity, SI and SAs, and functional deficits. Trial Registration: ClinicalTrials.gov NCT05647044; https://clinicaltrials.gov/study/NCT05647044 International Registered Report Identifier (IRRID): PRR1-10.2196/58206 UR - https://www.researchprotocols.org/2024/1/e58206 UR - http://dx.doi.org/10.2196/58206 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58206 ER - TY - JOUR AU - Edler, Johanna-Sophie AU - Winter, Michael AU - Steinmetz, Holger AU - Cohrdes, Caroline AU - Baumeister, Harald AU - Pryss, Rüdiger PY - 2024/12/3 TI - Predicting Depressive Symptoms Using GPS-Based Regional Data in Germany With the CORONA HEALTH App During the COVID-19 Pandemic: Cross-Sectional Study JO - Interact J Med Res SP - e53248 VL - 13 KW - depression KW - COVID-19 KW - mobile phone KW - geographic information systems KW - GPS-based data KW - mobile applications KW - mental health N2 - Background: Numerous studies have been conducted to predict depressive symptoms using passive smartphone data, mostly integrating the GPS signal as a measure of mobility. Environmental factors have been identified as correlated with depressive symptoms in specialized studies both before and during the pandemic. Objective: This study combined a data-based approach using passive smartphone data to predict self-reported depressive symptoms with a wide range of GPS-based environmental factors as predictors. Methods: The CORONA HEALTH app was developed for the purpose of data collection, and this app enabled the collection of both survey and passive data via smartphone. After obtaining informed consent, we gathered GPS signals at the time of study participation and evaluated depressive symptoms in 249 Android users with the Patient Health Questionnaire-9. The only GPS-based data collected were the participants? location at the time of the questionnaire, which was used to assign participants to the nearest district for linking regional sociodemographic data. Data collection took place from July 2020 to February 2021, coinciding with the COVID-19 pandemic. Using GPS data, each dataset was linked to a wide variety of data on regional sociodemographic, geographic, and economic characteristics describing the respondent?s environment, which were derived from a publicly accessible database from official German statistical offices. Moreover, pandemic-specific predictors such as the current pandemic phase or the number of new regional infections were matched via GPS. For the prediction of individual depressive symptoms, we compared 3 models (ie, ridge, lasso, and elastic net regression) and evaluated the models using 10-fold cross-validation. Results: The final elastic net regression model showed the highest explained variance (R2=0.06) and reduced the dataset from 121 to 9 variables, the 3 main predictors being current COVID-19 infections in the respective district, the number of places in nursing homes, and the proportion of fathers receiving parental benefits. The number of places in nursing homes refers to the availability of care facilities for the elderly, which may indicate regional population characteristics that influence mental health. The proportion of fathers receiving parental benefits reflects family structure and work-life balance, which could impact stress and mental well-being during the pandemic. Conclusions: Passive data describing the environment contributed to the prediction of individual depressive symptoms and revealed regional risk and protective factors that may be of interest without their inclusion in routine assessments being costly. UR - https://www.i-jmr.org/2024/1/e53248 UR - http://dx.doi.org/10.2196/53248 UR - http://www.ncbi.nlm.nih.gov/pubmed/39625745 ID - info:doi/10.2196/53248 ER - TY - JOUR AU - Oudshoorn, Cathelijn AU - Frielink, Noud AU - Riper, Heleen AU - Embregts, Petri PY - 2024/11/12 TI - Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals JO - JMIR Form Res SP - e52788 VL - 8 KW - acceptance KW - health care professionals KW - intellectual disabilities KW - eHealth KW - disability KW - psychological therapy KW - support KW - cross-sectional survey N2 - Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals? acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants? characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach ?=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. UR - https://formative.jmir.org/2024/1/e52788 UR - http://dx.doi.org/10.2196/52788 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52788 ER - TY - JOUR AU - Brooks Carthon, Margo J. AU - Brom, Heather AU - Amenyedor, Eyram Kelvin AU - Harhay, O. Michael AU - Grantham-Murillo, Marsha AU - Nikpour, Jacqueline AU - Lasater, B. Karen AU - Golinelli, Daniela AU - Cacchione, Z. Pamela AU - Bettencourt, P. Amanda PY - 2024/11/12 TI - Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e64575 VL - 13 KW - serious mental illness KW - health care disparities KW - Medicaid KW - evidence-based practice KW - implementation science KW - socioeconomic disparities in health N2 - Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective: This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods: This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ?18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results: This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions: We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration: ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID): DERR1-10.2196/64575 UR - https://www.researchprotocols.org/2024/1/e64575 UR - http://dx.doi.org/10.2196/64575 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64575 ER - TY - JOUR AU - Teferra, Gashaw Bazen AU - Rueda, Alice AU - Pang, Hilary AU - Valenzano, Richard AU - Samavi, Reza AU - Krishnan, Sridhar AU - Bhat, Venkat PY - 2024/11/4 TI - Screening for Depression Using Natural Language Processing: Literature Review JO - Interact J Med Res SP - e55067 VL - 13 KW - depression KW - natural language processing KW - NLP KW - sentiment analysis KW - machine learning KW - deep learning KW - transformer-based models KW - large language models KW - cross-cultural KW - research domain criteria KW - RDoC N2 - Background: Depression is a prevalent global mental health disorder with substantial individual and societal impact. Natural language processing (NLP), a branch of artificial intelligence, offers the potential for improving depression screening by extracting meaningful information from textual data, but there are challenges and ethical considerations. Objective: This literature review aims to explore existing NLP methods for detecting depression, discuss successes and limitations, address ethical concerns, and highlight potential biases. Methods: A literature search was conducted using Semantic Scholar, PubMed, and Google Scholar to identify studies on depression screening using NLP. Keywords included ?depression screening,? ?depression detection,? and ?natural language processing.? Studies were included if they discussed the application of NLP techniques for depression screening or detection. Studies were screened and selected for relevance, with data extracted and synthesized to identify common themes and gaps in the literature. Results: NLP techniques, including sentiment analysis, linguistic markers, and deep learning models, offer practical tools for depression screening. Supervised and unsupervised machine learning models and large language models like transformers have demonstrated high accuracy in a variety of application domains. However, ethical concerns related to privacy, bias, interpretability, and lack of regulations to protect individuals arise. Furthermore, cultural and multilingual perspectives highlight the need for culturally sensitive models. Conclusions: NLP presents opportunities to enhance depression detection, but considerable challenges persist. Ethical concerns must be addressed, governance guidance is needed to mitigate risks, and cross-cultural perspectives must be integrated. Future directions include improving interpretability, personalization, and increased collaboration with domain experts, such as data scientists and machine learning engineers. NLP?s potential to enhance mental health care remains promising, depending on overcoming obstacles and continuing innovation. UR - https://www.i-jmr.org/2024/1/e55067 UR - http://dx.doi.org/10.2196/55067 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55067 ER - TY - JOUR AU - Coppersmith, DL Daniel AU - Bentley, H. Kate AU - Kleiman, M. Evan AU - Jaroszewski, C. Adam AU - Daniel, Merryn AU - Nock, K. Matthew PY - 2024/10/31 TI - Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study JO - JMIR Ment Health SP - e58409 VL - 11 KW - suicidal thoughts KW - suicidal behaviors KW - ecological momentary assessment KW - crisis resources KW - real-time tool KW - self-report KW - psychoeducation KW - app N2 - Background: Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. Objective: The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. Methods: ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. Results: ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one?s own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). Conclusions: This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work. UR - https://mental.jmir.org/2024/1/e58409 UR - http://dx.doi.org/10.2196/58409 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58409 ER - TY - JOUR AU - Yu, Yue AU - Dykxhoorn, Jennifer AU - Plackett, Ruth PY - 2024/10/30 TI - The Impact of Different Types of Social Media Use on the Mental Health of UK Adults: Longitudinal Observational Study JO - J Med Internet Res SP - e56950 VL - 26 KW - social media KW - mental health KW - depression KW - anxiety KW - mental disorders KW - cohort studies KW - United Kingdom KW - longitudinal observational study N2 - Background: Previous studies have explored the association between social media use and mental health among adolescents. However, few studies using nationally representative longitudinal data have explored this relationship for adults and how the effect might change depending on how people use social media. Objective: This study investigated the longitudinal relationship between the frequency of viewing and posting on social media and mental health problems among UK adults. Methods: This study included 15,836 adults (aged 16 years and older) who participated in Understanding Society, a UK longitudinal survey. Social media use was measured with questions about the frequency of viewing social media and posting on social media in Understanding Society Wave 11 (2019-2021). We explored viewing and posting separately, as well as a combined exposure: (1) high viewing, high posting; (2) high viewing, low posting; (3) low viewing, high posting; and (4) low viewing, low posting. Mental health problems were measured in Wave 12 (2020-2022) using the General Health Questionnaire (GHQ-12), a validated scale for identifying symptoms of common mental health problems, where higher scores indicated more mental health problems (0 to 36). Unadjusted and adjusted linear regression models were estimated for viewing social media and posting on social media, adjusting for the baseline GHQ score, gender, age, ethnicity, employment, and education. We found no evidence for effect modification by gender and age so overall associations were reported. Results: In our adjusted models, we found no evidence of an association between the frequency of viewing social media and mental health problems in the following year. We found that adults who posted daily on social media had more mental health problems than those who never posted on social media, corresponding to a 0.35-point increase in GHQ score (?=0.35, 95% CI 0.01-0.68; P=.04). When we considered both social media behaviors, we found that those who frequently viewed and posted on social media scored 0.31 points higher on the GHQ score (?=0.31, 95% CI 0.04-0.58; P=.03) in the following year compared to those who rarely viewed or posted on social media. Conclusions: We found that a high frequency of posting on social media was associated with increased mental health problems a year later. However, we did not find evidence of a similar association based on the frequency of viewing social media content. This provides evidence that some types of active social media use (ie, posting) have a stronger link to mental health outcomes than some types of passive social media use (viewing). These results highlighted that the relationship between social media use and mental health is complex, and more research is needed to understand the mechanisms underlying these patterns to inform targeted interventions and policies. UR - https://www.jmir.org/2024/1/e56950 UR - http://dx.doi.org/10.2196/56950 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56950 ER - TY - JOUR AU - Park, Jin-Hyuck PY - 2024/10/30 TI - Discriminant Power of Smartphone-Derived Keystroke Dynamics for Mild Cognitive Impairment Compared to a Neuropsychological Screening Test: Cross-Sectional Study JO - J Med Internet Res SP - e59247 VL - 26 KW - digital biomarker KW - motor function KW - digital device KW - neuropsychological screening KW - screening tools KW - cognitive assessment KW - mild cognitive impairment KW - keystroke dynamics N2 - Background: Conventional neuropsychological screening tools for mild cognitive impairment (MCI) face challenges in terms of accuracy and practicality. Digital health solutions, such as unobtrusively capturing smartphone interaction data, offer a promising alternative. However, the potential of digital biomarkers as a surrogate for MCI screening remains unclear, with few comparisons between smartphone interactions and existing screening tools. Objective: This study aimed to investigate the effectiveness of smartphone-derived keystroke dynamics, captured via the Neurokeys keyboard app, in distinguishing patients with MCI from healthy controls (HCs). This study also compared the discriminant performance of these digital biomarkers against the Korean version of the Montreal Cognitive Assessment (MoCA-K), which is widely used for MCI detection in clinical settings. Methods: A total of 64 HCs and 47 patients with MCI were recruited. Over a 1-month period, participants generated 3530 typing sessions, with 2740 (77.6%) analyzed for this study. Keystroke metrics, including hold time and flight time, were extracted. Receiver operating characteristics analysis was used to assess the sensitivity and specificity of keystroke dynamics in discriminating between HCs and patients with MCI. This study also explored the correlation between keystroke dynamics and MoCA-K scores. Results: Patients with MCI had significantly higher keystroke latency than HCs (P<.001). In particular, latency between key presses resulted in the highest sensitivity (97.9%) and specificity (96.9%). In addition, keystroke dynamics were significantly correlated with the MoCA-K (hold time: r=?.468; P<.001; flight time: r=?.497; P<.001), further supporting the validity of these digital biomarkers. Conclusions: These findings highlight the potential of smartphone-derived keystroke dynamics as an effective and ecologically valid tool for screening MCI. With higher sensitivity and specificity than the MoCA-K, particularly in measuring flight time, keystroke dynamics can serve as a noninvasive, scalable, and continuous method for early cognitive impairment detection. This novel approach could revolutionize MCI screening, offering a practical alternative to traditional tools in everyday settings. Trial Registration: Thai Clinical Trials Registry TCTR20220415002; https://www.thaiclinicaltrials.org/show/TCTR20220415002 UR - https://www.jmir.org/2024/1/e59247 UR - http://dx.doi.org/10.2196/59247 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59247 ER - TY - JOUR AU - Ferrao Nunes-Zlotkowski, Kelly AU - Shepherd, L. Heather AU - Beatty, Lisa AU - Butow, Phyllis AU - Shaw, Margaret Joanne PY - 2024/10/29 TI - Blended Psychological Therapy for the Treatment of Psychological Disorders in Adult Patients: Systematic Review and Meta-Analysis JO - Interact J Med Res SP - e49660 VL - 13 KW - systematic review KW - blended psychological therapy KW - blended care KW - face-to-face KW - online KW - psychological intervention KW - intervention design KW - digital care KW - digital mental health KW - psychological disorder N2 - Background: Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models. Objective: We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure. Methods: PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=?1.1, 95% CI ?0.6 to ?1.6, P<.001, and z score=?4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=?0.1, 95% CI ?0.3 to 0.05, P=.17, and z score=?1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=?0.75, 95% CI ?0.56 to ?0.95; anxiety: n=8, Cohen d=?0.9, 95% CI ?0.6 to ?1.2); fewer (?6) face-to-face sessions (depression: n=9, Cohen d=?0.7, 95% CI ?0.5 to ?0.9; anxiety: n=7, Cohen d=?0.8, 95% CI ?0.3 to ?1.3); and a lower ratio (?50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=?0.8, 95% CI ?0.6 to ?1.1; anxiety: n=4, Cohen d=?0.8, 95% CI 0.006 to ?1.6). Conclusions: This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required. Trial Registration: PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258977 UR - https://www.i-jmr.org/2024/1/e49660 UR - http://dx.doi.org/10.2196/49660 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470720 ID - info:doi/10.2196/49660 ER - TY - JOUR AU - Elyoseph, Zohar AU - Gur, Tamar AU - Haber, Yuval AU - Simon, Tomer AU - Angert, Tal AU - Navon, Yuval AU - Tal, Amir AU - Asman, Oren PY - 2024/10/17 TI - An Ethical Perspective on the Democratization of Mental Health With Generative AI JO - JMIR Ment Health SP - e58011 VL - 11 KW - ethics KW - generative artificial intelligence KW - generative AI KW - mental health KW - ChatGPT KW - large language model KW - LLM KW - digital mental health KW - machine learning KW - AI KW - technology KW - accessibility KW - knowledge KW - GenAI UR - https://mental.jmir.org/2024/1/e58011 UR - http://dx.doi.org/10.2196/58011 ID - info:doi/10.2196/58011 ER - TY - JOUR AU - Pagnini, Francesco PY - 2024/10/9 TI - Supporting the Mind in Space: Psychological Tools for Long-Duration Missions JO - Interact J Med Res SP - e66626 VL - 13 KW - space psychology KW - astronauts KW - psychotherapy KW - isolated and confined environment KW - mindfulness KW - relaxation KW - mind-body UR - https://www.i-jmr.org/2024/1/e66626 UR - http://dx.doi.org/10.2196/66626 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382951 ID - info:doi/10.2196/66626 ER - TY - JOUR AU - Smith, Logan PY - 2024/10/9 TI - Automated Psychotherapy in a Spaceflight Environment: Advantages, Drawbacks, and Unknowns JO - Interact J Med Res SP - e58803 VL - 13 KW - mental health KW - deep space KW - astronauts KW - aerospace medicine KW - spaceflight KW - flight KW - psychotherapy KW - privacy KW - communication UR - https://www.i-jmr.org/2024/1/e58803 UR - http://dx.doi.org/10.2196/58803 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382952 ID - info:doi/10.2196/58803 ER - TY - JOUR AU - Adjei-Banuah, Yaw Nhyira AU - Ayiku, Barkey Roberta Naa AU - Reichenberger, Veronika AU - Sasu, David AU - Mirzoev, Tolib AU - Murphy, Adrianna AU - Ohene, Sammy AU - Antwi, Edward AU - Agyepong, Akua Irene PY - 2024/10/2 TI - Factors Influencing Primary Care Access for Common Mental Health Conditions Among Adults in West Africa: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e58890 VL - 13 KW - scoping review KW - mental health KW - noncommunicable disease KW - primary care KW - access KW - barriers KW - enablers N2 - Background: Mental health conditions are expressed in various ways in different people, and access to health care for these conditions is affected by individual factors, health care provider factors, and contextual factors. These factors may be enablers or barriers to accessing primary care for mental health conditions. Studies have reported a gap in treatment for mental health conditions in many countries in West Africa due to barriers along the access pathway. However, to the best of our knowledge, there is yet to be a review of the factors influencing access to primary care for common mental health conditions among adults in West Africa. Objective: Our scoping review will explore the factors influencing access to primary care for common mental health conditions among adults aged 18 years and older in West Africa from 2002 to 2024. Methods: Our review will follow the approach to scoping reviews developed by Arksey and O?Malley in 2005. This approach has five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. We will search electronic databases (PubMed, Embase, PsycINFO, Cairn.info, and Google Scholar), source gray literature from relevant websites (the World Health Organization and country-specific websites), and manually explore reference lists of relevant studies to identify eligible records. Pairs of independent authors (NYA-B, RNBA, VR, or DS) will screen the titles, abstracts, and full texts of studies based on predefined eligibility criteria. We will use a data extraction tool adopted from the JBI Manual for Evidence Synthesis to chart the data. Deductive, thematic analysis will be used to categorize factors influencing access to mental health care under predetermined themes. New themes derived from the literature will also be charted. Results: Database searches were conducted between February 1, 2024, and February 12, 2024. As of July 2024, the review report is being drafted, and it will be disseminated through publication in a peer-reviewed journal. Conclusions: The results of the review will inform decision-making on policies, programs, and their implementation in West Africa to improve primary care access for mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/58890 UR - https://www.researchprotocols.org/2024/1/e58890 UR - http://dx.doi.org/10.2196/58890 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58890 ER - TY - JOUR AU - Yun, Byungyoon AU - Park, Heejoo AU - Choi, Jaesung AU - Oh, Juyeon AU - Sim, Juho AU - Kim, Yangwook AU - Lee, Jongmin AU - Yoon, Jin-Ha PY - 2024/9/20 TI - Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e48047 VL - 10 KW - self-employed KW - employee KW - all-cause mortality KW - cardiovascular disease KW - mental illness KW - socioeconomic status KW - nationwide study KW - inequality KW - effect modification KW - health checkups N2 - Background: Self-employment is a significant component of South Korea?s labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. Objective: This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. Methods: This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20?59 y) who maintained the same insurance type (self-employed or employee insurance) for ?3 years (at least 2008?2010) were recruited for this study and monitored until death or December 2021?whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. Results: A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44%); all-cause mortality occurred in 1.27% (99,542/7,851,282) of employees and 3.29% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1% for employees and 2.8% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95% CI 1.42?1.45; female: adjusted HR 1.89, 95% CI 1.84?1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95% CI 0.74?0.79; female: RERI 1.13, 95% CI 1.05?1.21). Conclusions: This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association. UR - https://publichealth.jmir.org/2024/1/e48047 UR - http://dx.doi.org/10.2196/48047 ID - info:doi/10.2196/48047 ER - TY - JOUR AU - Moyce, Sally AU - Crawford, Cassidy PY - 2024/9/12 TI - Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study JO - JMIR Res Protoc SP - e57343 VL - 13 KW - behavioral activation KW - community health workers KW - implementation science KW - Latino KW - mental health provider shortage area KW - pilot study KW - evidence-based treatments N2 - Background: Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. Objective: The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. Methods: We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. Results: Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. Conclusions: Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. International Registered Report Identifier (IRRID): DERR1-10.2196/57343 UR - https://www.researchprotocols.org/2024/1/e57343 UR - http://dx.doi.org/10.2196/57343 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57343 ER - TY - JOUR AU - Xian, Xuechang AU - Chang, Angela AU - Xiang, Yu-Tao AU - Liu, Tingchi Matthew PY - 2024/8/12 TI - Debate and Dilemmas Regarding Generative AI in Mental Health Care: Scoping Review JO - Interact J Med Res SP - e53672 VL - 13 KW - generative artificial intelligence KW - GAI KW - ChatGPT KW - mental health KW - scoping review KW - artificial intelligence KW - depression KW - anxiety KW - generative adversarial network KW - GAN KW - variational autoencoder KW - VAE N2 - Background: Mental disorders have ranked among the top 10 prevalent causes of burden on a global scale. Generative artificial intelligence (GAI) has emerged as a promising and innovative technological advancement that has significant potential in the field of mental health care. Nevertheless, there is a scarcity of research dedicated to examining and understanding the application landscape of GAI within this domain. Objective: This review aims to inform the current state of GAI knowledge and identify its key uses in the mental health domain by consolidating relevant literature. Methods: Records were searched within 8 reputable sources including Web of Science, PubMed, IEEE Xplore, medRxiv, bioRxiv, Google Scholar, CNKI and Wanfang databases between 2013 and 2023. Our focus was on original, empirical research with either English or Chinese publications that use GAI technologies to benefit mental health. For an exhaustive search, we also checked the studies cited by relevant literature. Two reviewers were responsible for the data selection process, and all the extracted data were synthesized and summarized for brief and in-depth analyses depending on the GAI approaches used (traditional retrieval and rule-based techniques vs advanced GAI techniques). Results: In this review of 144 articles, 44 (30.6%) met the inclusion criteria for detailed analysis. Six key uses of advanced GAI emerged: mental disorder detection, counseling support, therapeutic application, clinical training, clinical decision-making support, and goal-driven optimization. Advanced GAI systems have been mainly focused on therapeutic applications (n=19, 43%) and counseling support (n=13, 30%), with clinical training being the least common. Most studies (n=28, 64%) focused broadly on mental health, while specific conditions such as anxiety (n=1, 2%), bipolar disorder (n=2, 5%), eating disorders (n=1, 2%), posttraumatic stress disorder (n=2, 5%), and schizophrenia (n=1, 2%) received limited attention. Despite prevalent use, the efficacy of ChatGPT in the detection of mental disorders remains insufficient. In addition, 100 articles on traditional GAI approaches were found, indicating diverse areas where advanced GAI could enhance mental health care. Conclusions: This study provides a comprehensive overview of the use of GAI in mental health care, which serves as a valuable guide for future research, practical applications, and policy development in this domain. While GAI demonstrates promise in augmenting mental health care services, its inherent limitations emphasize its role as a supplementary tool rather than a replacement for trained mental health providers. A conscientious and ethical integration of GAI techniques is necessary, ensuring a balanced approach that maximizes benefits while mitigating potential challenges in mental health care practices. UR - https://www.i-jmr.org/2024/1/e53672 UR - http://dx.doi.org/10.2196/53672 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53672 ER - TY - JOUR AU - Adhikary, Kumar Prottay AU - Srivastava, Aseem AU - Kumar, Shivani AU - Singh, Michael Salam AU - Manuja, Puneet AU - Gopinath, K. Jini AU - Krishnan, Vijay AU - Gupta, Kedia Swati AU - Deb, Sinha Koushik AU - Chakraborty, Tanmoy PY - 2024/7/23 TI - Exploring the Efficacy of Large Language Models in Summarizing Mental Health Counseling Sessions: Benchmark Study JO - JMIR Ment Health SP - e57306 VL - 11 KW - mental health KW - counseling summarization KW - large language models KW - digital health KW - artificial intelligence KW - AI N2 - Background: Comprehensive session summaries enable effective continuity in mental health counseling, facilitating informed therapy planning. However, manual summarization presents a significant challenge, diverting experts? attention from the core counseling process. Leveraging advances in automatic summarization to streamline the summarization process addresses this issue because this enables mental health professionals to access concise summaries of lengthy therapy sessions, thereby increasing their efficiency. However, existing approaches often overlook the nuanced intricacies inherent in counseling interactions. Objective: This study evaluates the effectiveness of state-of-the-art large language models (LLMs) in selectively summarizing various components of therapy sessions through aspect-based summarization, aiming to benchmark their performance. Methods: We first created Mental Health Counseling-Component?Guided Dialogue Summaries, a benchmarking data set that consists of 191 counseling sessions with summaries focused on 3 distinct counseling components (also known as counseling aspects). Next, we assessed the capabilities of 11 state-of-the-art LLMs in addressing the task of counseling-component?guided summarization. The generated summaries were evaluated quantitatively using standard summarization metrics and verified qualitatively by mental health professionals. Results: Our findings demonstrated the superior performance of task-specific LLMs such as MentalLlama, Mistral, and MentalBART evaluated using standard quantitative metrics such as Recall-Oriented Understudy for Gisting Evaluation (ROUGE)-1, ROUGE-2, ROUGE-L, and Bidirectional Encoder Representations from Transformers Score across all aspects of the counseling components. Furthermore, expert evaluation revealed that Mistral superseded both MentalLlama and MentalBART across 6 parameters: affective attitude, burden, ethicality, coherence, opportunity costs, and perceived effectiveness. However, these models exhibit a common weakness in terms of room for improvement in the opportunity costs and perceived effectiveness metrics. Conclusions: While LLMs fine-tuned specifically on mental health domain data display better performance based on automatic evaluation scores, expert assessments indicate that these models are not yet reliable for clinical application. Further refinement and validation are necessary before their implementation in practice. UR - https://mental.jmir.org/2024/1/e57306 UR - http://dx.doi.org/10.2196/57306 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57306 ER - TY - JOUR AU - Mendes, Guimarăes Camila AU - de Paula, Jardim Jonas AU - Miranda, Marques Débora PY - 2024/7/18 TI - Effects of Background Music on Attentional Networks of Children With and Without Attention Deficit/Hyperactivity Disorder: Case Control Experimental Study JO - Interact J Med Res SP - e53869 VL - 13 KW - attention KW - background music KW - ADHD KW - children KW - adolescents KW - music KW - attention network KW - effects KW - preliminary study KW - attention deficit/hyperactivity disorder N2 - Background: To sustain performance during a task that requires attention may be a challenge for children with attention deficit/hyperactivity disorder (ADHD), which strongly influences motivation for tasks and has been connected to the level of arousal. Objective: This study aimed to analyze the effect of musical stimulus on attentional performance in children with ADHD and typically developing children. Methods: A total of 76 boys (34 with ADHD and 42 typically developing) performed the Attention Network Test (ANT) for children under 2 experimental conditions (with and without music). Four attentional measures were extracted from the ANT. We tested the effect of the experimental condition and its interaction with the group using repeated measures ANOVA. Results: We found no significant main effects or interactions for the reaction times of the alerting, orienting, and conflict attentional networks of the ANT (all P>.05). Regarding ANT errors, we found a significant main effect for music, with a moderate effect size (F1,72=9.83; P=.03; ?p2=0.06) but the condition×group interaction was not significant (F1,72=1.79; P=.18). Participants made fewer errors when listening to music compared to the control condition. Conclusions: Music seems not to interfere in the attentional network in children and adolescents. Perhaps background music affects motivation. Future studies will be needed to validate this. Trial Registration: ReBEC.gov U1111-12589039; https://ensaiosclinicos.gov.br/rg/RBR-8s22sh8 UR - https://www.i-jmr.org/2024/1/e53869 UR - http://dx.doi.org/10.2196/53869 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53869 ER - TY - JOUR AU - Gallinat, Christina AU - Moessner, Markus AU - Wilhelm, Maximilian AU - Keuthen, Nancy AU - Bauer, Stephanie PY - 2024/7/18 TI - Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study JO - Interact J Med Res SP - e53831 VL - 13 KW - skin picking disorder KW - ecological momentary assessment KW - EMA KW - body-focused repetitive behavior KW - obsessive-compulsive spectrum KW - skin KW - dermatology KW - mental health KW - assessment KW - mobile phone N2 - Background: Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior?s variability. Objective: This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Methods: Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes? characteristics (eg, length, intensity, and consciousness) if applicable. Results: The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=?0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=?0.41). Conclusions: These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. Trial Registration: German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh UR - https://www.i-jmr.org/2024/1/e53831 UR - http://dx.doi.org/10.2196/53831 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53831 ER - TY - JOUR AU - Paquin, Vincent AU - Ackerman, A. Robert AU - Depp, A. Colin AU - Moore, C. Raeanne AU - Harvey, D. Philip AU - Pinkham, E. Amy PY - 2024/7/3 TI - Media Use and Its Associations With Paranoia in Schizophrenia and Bipolar Disorder: Ecological Momentary Assessment JO - JMIR Ment Health SP - e59198 VL - 11 KW - paranoia KW - social media KW - digital media KW - technology KW - psychosis KW - schizophrenia KW - schizoaffective KW - bipolar disorder KW - ecological momentary assessment KW - spectrum KW - sociodemographic KW - linear mixed model KW - media use KW - mental health KW - digital intervention KW - adult KW - adults KW - medical center KW - mental health clinic KW - psychiatry KW - psychiatrist N2 - Background: Paranoia is a spectrum of fear-related experiences that spans diagnostic categories and is influenced by social and cognitive factors. The extent to which social media and other types of media use are associated with paranoia remains unclear. Objective: We aimed to examine associations between media use and paranoia at the within- and between-person levels. Methods: Participants were 409 individuals diagnosed with schizophrenia spectrum or bipolar disorder. Measures included sociodemographic and clinical characteristics at baseline, followed by ecological momentary assessments (EMAs) collected 3 times daily over 30 days. EMA evaluated paranoia and 5 types of media use: social media, television, music, reading or writing, and other internet or computer use. Generalized linear mixed models were used to examine paranoia as a function of each type of media use and vice versa at the within- and between-person levels. Results: Of the 409 participants, the following subgroups reported at least 1 instance of media use: 261 (63.8%) for using social media, 385 (94.1%) for watching TV, 292 (71.4%) for listening to music, 191 (46.7%) for reading or writing, and 280 (68.5%) for other internet or computer use. Gender, ethnoracial groups, educational attainment, and diagnosis of schizophrenia versus bipolar disorder were differentially associated with the likelihood of media use. There was a within-person association between social media use and paranoia: using social media was associated with a subsequent decrease of 5.5% (fold-change 0.945, 95% CI 0.904-0.987) in paranoia. The reverse association, from paranoia to subsequent changes in social media use, was not statistically significant. Other types of media use were not significantly associated with paranoia. Conclusions: This study shows that social media use was associated with a modest decrease in paranoia, perhaps reflecting the clinical benefits of social connection. However, structural disadvantage and individual factors may hamper the accessibility of media activities, and the mental health correlates of media use may further vary as a function of contents and contexts of use. UR - https://mental.jmir.org/2024/1/e59198 UR - http://dx.doi.org/10.2196/59198 ID - info:doi/10.2196/59198 ER - TY - JOUR AU - Ong, Winslet AU - Omar, Arfa Noor AU - Zanudin, Asfarina AU - Alias, Faiz Muhamad AU - Hui Wen, Lim AU - Thang Xue Ee, Angel AU - Mohd Nordin, Azlin Nor AU - Manaf, Haidzir AU - Husin, Basri AU - Ahmad, Mahadir AU - Hisham, Hafifi PY - 2024/6/12 TI - The Relationship Between Physical Activity and Mental Health Among Individuals With Spinal Cord Injury: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e56081 VL - 13 KW - access barriers KW - depression KW - disability KW - exercise interventions KW - mental health KW - mobility limitations KW - physical activity KW - psychological outcomes KW - quality of life KW - spinal cord injury KW - SCI KW - mobility KW - scoping review KW - exercise KW - effectiveness KW - well-being KW - impairments KW - physical function KW - prevalence N2 - Background: Spinal cord injury (SCI) is a devastating condition that often leads to significant impairments in physical function, leading to disability and mental health disorders. Hence, understanding the prevalence of SCI and the relationship between physical activity and mental health in individuals with SCI is crucial for informing rehabilitation strategies and optimizing outcomes. Objective: This study aims to comprehensively analyze existing research on the link between physical activity and mental health and identify the level of physical activity and mental health status, the barriers to physical activity, and SCI?s impacts on psychological well-being in individuals with SCI. Methods: An electronic search strategy will be used to identify prevalence studies published since 1993 in health-related databases such as PubMed, MEDLINE, COCHRANE Library, and Wiley Library using the following query: ?Spinal Cord Injury? OR ?Paraplegia? OR ?Tetraplegia? AND ?Physical Activity? OR ?Exercise? AND ?Mental Health? OR ?Mental Illness? OR ?Mental Disorder.? Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies. The risk of bias in the included studies will be appraised using the Joanna Briggs Institute checklist for prevalence studies by 2 review authors. Any disagreement will be resolved by reaching a consensus. Results: Funding was received in October 2023, data collection will commence in July 2024, and the results are expected by 2025. We will summarize the selection of the eligible studies using a flowchart. The data from the studies will be extracted and tabulated. This scoping review will be published in a peer-reviewed journal in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Conclusions: This scoping review underscores the complex relationship between physical activity and mental health among individuals with SCI, highlighting the level of physical activity and mental health status, barriers to physical activity engagement, and psychological implications. Understanding these dynamics is crucial in devising tailored interventions aimed at enhancing mental well-being. This synthesis of evidence emphasizes the need for personalized strategies to promote physical activity, addressing unique challenges faced by this population to foster improved mental health outcomes and overall quality of life. Trial Registration: Open Science Framework osf.io/ugx7d; https://osf.io/ugx7d/ International Registered Report Identifier (IRRID): PRR1-10.2196/56081 UR - https://www.researchprotocols.org/2024/1/e56081 UR - http://dx.doi.org/10.2196/56081 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865699 ID - info:doi/10.2196/56081 ER - TY - JOUR AU - Pilunthanakul, Thanita AU - Tan, Yee Giles Ming PY - 2024/6/11 TI - Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period JO - Interact J Med Res SP - e49618 VL - 13 KW - dementia KW - COVID-19 KW - high dependency psychiatric unit KW - psychiatric intensive care unit KW - caregiver stress KW - SARS-CoV-2 KW - psychiatric KW - psychiatry KW - mental health KW - health care system KW - Alzheimer KW - ward KW - care facility UR - https://www.i-jmr.org/2024/1/e49618 UR - http://dx.doi.org/10.2196/49618 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861715 ID - info:doi/10.2196/49618 ER - TY - JOUR AU - Fernandes, Sofia AU - von Gunten, Armin AU - Verloo, Henk PY - 2024/5/28 TI - Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review JO - JMIR Nursing SP - e54496 VL - 7 KW - artificial intelligence KW - behavioral and psychological symptoms of dementia KW - neuropsychiatric symptoms KW - early detection KW - management KW - narrative literature review N2 - Background: The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence?based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. Objective: The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. Methods: A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. Results: A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. Conclusions: Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions. UR - https://nursing.jmir.org/2024/1/e54496 UR - http://dx.doi.org/10.2196/54496 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805252 ID - info:doi/10.2196/54496 ER - TY - JOUR AU - Batterham, J. Philip AU - Gulliver, Amelia AU - Heffernan, Cassandra AU - Calear, L. Alison AU - Werner-Seidler, Aliza AU - Turner, Alyna AU - Farrer, M. Louise AU - Chatterton, Lou Mary AU - Mihalopoulos, Cathrine AU - Berk, Michael PY - 2024/5/24 TI - A Brief Workplace Training Program to Support Help-Seeking for Mental Ill-Health: Protocol for the Helipad Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e55529 VL - 13 KW - help seeking KW - mental health KW - workplace KW - employee KW - implementation KW - internet KW - psychiatry KW - psychology KW - mobile phone N2 - Background: Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs. Objective: This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months. Methods: A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress. Results: Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024. Conclusions: If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376 International Registered Report Identifier (IRRID): PRR1-10.2196/55529 UR - https://www.researchprotocols.org/2024/1/e55529 UR - http://dx.doi.org/10.2196/55529 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787608 ID - info:doi/10.2196/55529 ER - TY - JOUR AU - Amiot, Odile AU - Sauvaget, Anne AU - Alamome, Isabelle AU - Bulteau, Samuel AU - Charpeaud, Thomas AU - Clair, Anne-Hélčne AU - Courtet, Philippe AU - Drapier, Dominique AU - Haffen, Emmanuel AU - Fakra, Eric AU - Gaudeau-Bosma, Christian AU - Gaillard, Adeline AU - Mouchabac, Stéphane AU - Pineau, Fanny AU - Narboni, Véronique AU - Duburcq, Anne AU - Lecardeur, Laurent PY - 2024/5/20 TI - Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study JO - JMIR Form Res SP - e53204 VL - 8 KW - prospective acceptability KW - digital health KW - depression KW - e-mental health KW - deprexis KW - psychotherapy N2 - Background: Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. Objective: This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. Methods: Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. Results: A total of 245 patients were eligible (n=159, 64.9% were women and n=138, 56.3% were single). The mean age was 40.7 (SD 14.1) years. A total of 78% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. Conclusions: DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression. UR - https://formative.jmir.org/2024/1/e53204 UR - http://dx.doi.org/10.2196/53204 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568139 ID - info:doi/10.2196/53204 ER - TY - JOUR AU - Fernandes, Sara AU - Brousse, Yann AU - Zendjidjian, Xavier AU - Cano, Delphine AU - Riedberger, Jérémie AU - Llorca, Pierre-Michel AU - Samalin, Ludovic AU - Dassa, Daniel AU - Trichard, Christian AU - Laprevote, Vincent AU - Sauvaget, Anne AU - Abbar, Mocrane AU - Misdrahi, David AU - Berna, Fabrice AU - Lancon, Christophe AU - Coulon, Nathalie AU - El-Hage, Wissam AU - Rozier, Pierre-Emmanuel AU - Benoit, Michel AU - Giordana, Bruno AU - Caqueo-Urízar, Alejandra AU - Yon, Keon Dong AU - Tran, Bach AU - Auquier, Pascal AU - Fond, Guillaume AU - Boyer, Laurent PY - 2024/5/16 TI - Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study JO - JMIR Ment Health SP - e49916 VL - 11 KW - psychiatry KW - public mental health KW - schizophrenia KW - major depressive disorders KW - bipolar disorders KW - patient-reported experience measures KW - quality of care KW - health services research KW - computerized adaptive testing KW - real-world data N2 - Background: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. Objective: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. Methods: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. Results: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. Conclusions: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial Registration: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866 UR - https://mental.jmir.org/2024/1/e49916 UR - http://dx.doi.org/10.2196/49916 UR - http://www.ncbi.nlm.nih.gov/pubmed/38753416 ID - info:doi/10.2196/49916 ER - TY - JOUR AU - Eager, Sharon AU - Killaspy, Helen AU - C, Joanna AU - Mezey, Gillian AU - McPherson, Peter AU - Downey, Megan AU - Thompson, Georgina AU - Lloyd-Evans, Brynmor PY - 2024/3/13 TI - A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study JO - Interact J Med Res SP - e45987 VL - 13 KW - social inclusion KW - supported accommodation KW - mental health KW - digital health KW - care planning N2 - Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through ?think-aloud? testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals? priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users? inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. UR - https://www.i-jmr.org/2024/1/e45987 UR - http://dx.doi.org/10.2196/45987 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477978 ID - info:doi/10.2196/45987 ER - TY - JOUR AU - AbdulHussein, Ali AU - Butt, Ahmad Zahid AU - Dimitrov, Stanko AU - Cozzarin, Brian PY - 2024/2/15 TI - Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - Interact J Med Res SP - e50064 VL - 13 KW - health care workers KW - COVID-19 KW - mental health KW - demographic factors KW - occupational factors KW - access to PPE KW - pandemic KW - health care system KW - psychological trauma KW - psychological KW - trauma KW - respirators KW - eye protection KW - face shields KW - support N2 - Background: Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. Objective: In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. Methods: We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). Results: Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively. Conclusions: Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention. UR - https://www.i-jmr.org/2024/1/e50064 UR - http://dx.doi.org/10.2196/50064 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358785 ID - info:doi/10.2196/50064 ER - TY - JOUR AU - Dang, Kevin AU - Ritvo, Paul AU - Katz, Joel AU - Gratzer, David AU - Knyahnytska, Yuliya AU - Ortiz, Abigail AU - Walters, Clarice AU - Attia, Mohamed AU - Gonzalez-Torres, Christina AU - Lustig, Andrew AU - Daskalakis, Zafiris PY - 2023/12/8 TI - The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth JO - Interact J Med Res SP - e46419 VL - 12 KW - accelerometer KW - anxiety KW - CBT KW - chronic pain KW - cognitive behavioral therapy KW - controlled trials KW - depression KW - depressive symptoms KW - digital health KW - eHealth KW - exercise KW - fitbit KW - intervention study KW - longitudinal study KW - major depressive disorder KW - mHealth KW - mindfulness KW - mindfulness-based CBT KW - objectively measured activity KW - online health KW - online intervention KW - online therapy KW - pain KW - physical activity KW - prospective study KW - randomized controlled trial KW - RCT KW - step KW - steps N2 - Background: Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data. Objective: This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement. Methods: Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA?s relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations. Results: Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps?.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40). Conclusions: This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 International Registered Report Identifier (IRRID): RR2-10.2196/11591 UR - https://www.i-jmr.org/2023/1/e46419 UR - http://dx.doi.org/10.2196/46419 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064262 ID - info:doi/10.2196/46419 ER - TY - JOUR AU - Esumi, Ryo AU - Ito-Masui, Asami AU - Kawamoto, Eiji AU - Ito, Mami AU - Hayashi, Tomoyo AU - Shinkai, Toru AU - Hane, Atsuya AU - Okuno, Fumito AU - Park, Jeong Eun AU - Kaku, Ryuji AU - Shimaoka, Motomu PY - 2023/11/29 TI - Correlation Between the Social Network Structure and Well-Being of Health Care Workers in Intensive Care Units: Prospective Observational Study JO - Interact J Med Res SP - e50148 VL - 12 KW - social network analysis KW - Center for Epidemiological Studies?Depression KW - CES-D KW - distributed leadership KW - intensive care unit KW - wearable sensor KW - face-to-face interaction N2 - Background: Effective communication strategies are becoming increasingly important in intensive care units (ICUs) where patients at high risk are treated. Distributed leadership promotes effective communication among health care professionals (HCPs). Moreover, beyond facilitating patient care, it may improve well-being among HCPs by fostering teamwork. However, the impact of distributed leadership on the communication structure and well-being of HCPs remains unclear. Objective: We performed a social network analysis (SNA) to assess the characteristics of each HCP in the network, identify the number of HCP connections, analyze 4 centralities that can measure an HCP?s importance, and evaluate the impact of distributed leadership structure on the well-being and communication structure of the medical staff. Methods: Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at Mie University Hospital, Japan. Participants wore a badge on the front of their clothing during working hours to measure the total frequency of face-to-face interactions. We collected data about the well-being of medical staff using the Center for Epidemiological Studies?Depression (CES-D) questionnaire and measured 4 centralities using SNA analysis. A CES-D questionnaire was administered during the study to measure the well-being of the HCPs. Results: Overall, 247 ICU workers participated in this clinical study for 4 weeks yearly in February 2016, 2017, and 2018. The distributed leadership structure was established within the ICU in 2017 and 2018. We compared these results with those of the traditional leadership structure used in 2016. Most face-to-face interactions in the ICU were among nurses or between nurses and other professionals. In 2016, overall, 10 nurses could perform leadership tasks, which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, SNA in 2018 showed that the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared with those in 2016. However, the eigenvector centrality significantly decreased in 2018 compared with that in 2016 (P=.01). The CES-D scores in 2018 also significantly decreased compared with those in 2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively correlated in 2016, whereas the closeness centrality and CES-D scores were negatively correlated (r=?0.318; P=.01). In 2018, the degree (r=?0.280; P=.01) and eigenvector (r=?0.284; P=.01) centralities were negatively correlated with CES-D scores. Conclusions: Face-to-face interactions of HCPs in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the introduction of distributed leadership created collaboration and informal leadership in the organization, altering the social network structure of HCPs and increasing organizational well-being. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000037046; https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000042211 UR - https://www.i-jmr.org/2023/1/e50148 UR - http://dx.doi.org/10.2196/50148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37935050 ID - info:doi/10.2196/50148 ER - TY - JOUR AU - Kim, Hyeonseong AU - Jeong, Seohyun AU - Hwang, Inae AU - Sung, Kiyoung AU - Moon, Woori AU - Shin, Min-Sup PY - 2023/9/29 TI - Validation of a Brief Internet-Based Self-Report Measure of Maladaptive Personality and Interpersonal Schema: Confirmatory Factor Analysis JO - Interact J Med Res SP - e48425 VL - 12 KW - maladaptive schema KW - measure of schema KW - self-report measure KW - internet-based measure KW - digital mental health care KW - interpersonal schema N2 - Background: Existing digital mental health interventions mainly focus on the symptoms of specific mental disorders, but do not focus on Maladaptive Personalities and Interpersonal Schemas (MPISs). As an initial step toward considering personalities and schemas in intervention programs, there is a need for the development of tools for measuring core personality traits and interpersonal schemas known to cause psychological discomfort among potential users of digital mental health interventions. Thus, the MPIS was developed. Objective: The objectives of this study are to validate the MPIS by comparing 2 models of the MPIS factor structure and to understand the characteristics of the MPIS by assessing its correlations with other measures. Methods: Data were collected from 234 participants who were using web-based community sites in South Korea, including university students, graduate students, working professionals, and homemakers. All the data were gathered through web-based surveys. Confirmatory factor analysis was used to compare a single-factor model with a 5-factor model. Reliability and correlation analyses with other scales were performed. Results: The results of confirmatory factor analysis indicated that the 5-factor model (?2550=1278.1; Tucker-Lewis index=0.80; comparative fit index=0.81; and Root Mean Square Error of Approximation=0.07) was more suitable than the single-factor model (?2560=2341.5; Tucker-Lewis index=0.52; comparative fit index=0.54; and Root Mean Square Error of Approximation=0.11) for measuring maladaptive personality traits and interpersonal relationship patterns. The internal consistency of each factor of the MPIS was good (Cronbach ?=.71-.88), and the correlations with existing measures were statistically significant. The MPIS is a validated 35-item tool for measuring 5 essential personality traits and interpersonal schemas in adults aged 18-39 years. Conclusions: This study introduced the MPIS, a concise and effective questionnaire capable of measuring maladaptive personality traits and interpersonal relationship schemas. Through analysis, the MPIS was shown to reliably assess these psychological constructs and validate them. Its web-based accessibility and reduced item count make it a valuable tool for mental health assessment. Future applications include its integration into digital mental health care services, allowing easy web-based administration and aiding in the classification of psychological therapy programs based on the obtained results. Trial Registration: ClinicalTrials.gov NCT05952063; https://www.clinicaltrials.gov/study/NCT05952063 UR - https://www.i-jmr.org/2023/1/e48425 UR - http://dx.doi.org/10.2196/48425 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773606 ID - info:doi/10.2196/48425 ER - TY - JOUR AU - Wislocki, Katherine AU - Tran, Mai-Lan AU - Petti, Emily AU - Hernandez-Ramos, Rosa AU - Cenkner, David AU - Bridgwater, Miranda AU - Naderi, Ghazal AU - Walker, Leslie AU - Zalta, K. Alyson PY - 2023/6/30 TI - The Past, Present, and Future of Psychotherapy Manuals: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e47708 VL - 12 KW - psychotherapy KW - manual KW - protocol KW - primer KW - evidence-based treatment KW - scoping review KW - review methodology KW - mental health KW - scoping KW - guideline KW - guidelines KW - book based KW - manuals KW - knowledge translation N2 - Background: Psychotherapy manuals are critical to the dissemination of psychotherapy treatments. Psychotherapy manuals typically serve several purposes, including, but not limited to, establishing new psychotherapy treatments, training providers, disseminating treatments to those who deliver them, and providing guidelines to deliver treatments with fidelity. Yet, the proliferation of psychotherapy manuals has not been well-understood, and no work has aimed to assess or review the existing landscape of psychotherapy manuals. Little is known about the breadth, scope, and foci of extant psychotherapy manuals. Objective: This scoping review aims to identify and explore the landscape of existing book-based psychotherapy manuals. This review aims to specify the defining characteristics (ie, foci, clinical populations, clinical targets, treatment type, treatment modality, and adaptations) of existing book-based psychotherapy manuals. Further, this review will demonstrate how this information, and psychotherapy manuals more broadly, has changed over time. This project aims to make a novel contribution that will have critical implications for current methods of developing, aggregating, synthesizing, and translating knowledge about psychotherapeutic treatments. Methods: This scoping review will review book-based psychotherapy manuals published from 1950 to 2022.This scoping review will be informed by guidance from the Joanna Briggs Institute Scoping Review Methodology Group and prior scoping reviews. Traditional search and application programming interface?based search methods will be used with search terms defined a priori to identify relevant results using 3 large book databases: Google Books, WorldCat, and PsycINFO. This review will leverage machine learning methods to enhance and expedite the screening process. Primary screening of results will be conducted by at least 2 authors. Data will be extracted and double-coded by research assistants using an iteratively defined codebook. Results: The search process produced 78,600 results, which were then iteratively deduplicated. Following deduplication, 50,583 results remained. The scoping review is expected to identify common elements of psychotherapy manuals, establish how the foci and content of manuals have changed over time, and illustrate coverage and gaps in the landscape of psychotherapy manuals. Results from this scoping review will be critical for future work focused on developing, aggregating, synthesizing, and disseminating knowledge about psychotherapeutic treatments. Conclusions: This review will provide knowledge about the vast landscape of psychotherapy manuals that exist. Findings from this study will inform future efforts to develop, aggregate, synthesize, and translate knowledge about psychotherapeutic treatments. International Registered Report Identifier (IRRID): DERR1-10.2196/47708 UR - https://www.researchprotocols.org/2023/1/e47708 UR - http://dx.doi.org/10.2196/47708 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389903 ID - info:doi/10.2196/47708 ER - TY - JOUR AU - Sander, B. Lasse AU - Beisemann, Marie AU - Doebler, Philipp AU - Micklitz, Moon Hannah AU - Kerkhof, Ad AU - Cuijpers, Pim AU - Batterham, Philip AU - Calear, Alison AU - Christensen, Helen AU - De Jaegere, Eva AU - Domhardt, Matthias AU - Erlangsen, Annette AU - Eylem-van Bergeijk, Ozlem AU - Hill, Ryan AU - Mühlmann, Charlotte AU - Österle, Marie AU - Pettit, Jeremy AU - Portzky, Gwendolyn AU - Steubl, Lena AU - van Spijker, Bregje AU - Tighe, Joseph AU - Werner-Seidler, Aliza AU - Büscher, Rebekka PY - 2023/6/26 TI - The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation: Systematic Review and Meta-Analysis of Individual Participant Data JO - J Med Internet Res SP - e46771 VL - 25 KW - meta-analysis KW - internet-based cognitive behavioral therapy KW - suicidal ideation KW - anxiety KW - depression KW - hopelessness KW - depressive KW - mental health KW - systematic review KW - review method KW - suicide KW - suicidal KW - psychotherapy KW - CBT KW - cognitive behavioral therapy N2 - Background: Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear. Objective: We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness). Methods: We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness?analyzed as 2 indices: symptom severity and treatment response. Results: We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=?0.17; 95% CI ?0.25 to ?0.09; P<.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; P=.008) after treatment. We did not find significant effects on anxiety and hopelessness. Conclusions: iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms. UR - https://www.jmir.org/2023/1/e46771 UR - http://dx.doi.org/10.2196/46771 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358893 ID - info:doi/10.2196/46771 ER - TY - JOUR AU - Gerke, Leonie AU - Ladwig, Sönke AU - Pauls, Franz AU - Trachsel, Manuel AU - Härter, Martin AU - Nestoriuc, Yvonne PY - 2022/9/30 TI - Optimized Informed Consent for Psychotherapy: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e39843 VL - 11 IS - 9 KW - expectation management KW - psychiatry KW - risks and side effects of psychotherapy KW - risk KW - counseling KW - consent KW - shared decision-making KW - decision-making KW - ethics KW - nocebo effect KW - side effect KW - adverse effect KW - psychotherapy KW - mental health KW - nocebo N2 - Background: Informed consent is a legal and ethical prerequisite for psychotherapy. However, in clinical practice, consistent strategies to obtain informed consent are scarce. Inconsistencies exist regarding the overall validity of informed consent for psychotherapy as well as the disclosure of potential mechanisms and negative effects, the latter posing a moral dilemma between patient autonomy and nonmaleficence. Objective: This protocol describes a randomized controlled web-based trial aiming to investigate the efficacy of a one-session optimized informed consent consultation. Methods: The optimized informed consent consultation was developed to provide information on the setting, efficacy, mechanisms, and negative effects via expectation management and shared decision-making techniques. A total of 122 participants with an indication for psychotherapy will be recruited. Participants will take part in a baseline assessment, including a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) disorders. Eligible participants will be randomly assigned either to a control group receiving an information brochure about psychotherapy as treatment as usual (n=61) or to an intervention group receiving treatment as usual and the optimized informed consent consultation (n=61). Potential treatment effects will be measured after the treatment via interview and patient self-report and at 2 weeks and 3 months follow-up via web-based questionnaires. Treatment expectation is the primary outcome. Secondary outcomes include the capacity to consent, decisional conflict, autonomous treatment motivation, adherence intention, and side-effect expectations. Results: This trial received a positive ethics vote by the local ethics committee of the Center for Psychosocial Medicine, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany on April 1, 2021, and was prospectively registered on June 17, 2021. The first participant was enrolled in the study on August 5, 2021. We expect to complete data collection in December 2022. After data analysis within the first quarter of 2023, the results will be submitted for publication in peer-reviewed journals in summer 2023. Conclusions: If effective, the optimized informed consent consultation might not only constitute an innovative clinical tool to meet the ethical and legal obligations of informed consent but also strengthen the contributing factors of psychotherapy outcome, while minimizing nocebo effects and fostering shared decision-making. Trial Registration: PsychArchives; http://dx.doi.org/10.23668/psycharchives.4929 International Registered Report Identifier (IRRID): DERR1-10.2196/39843 UR - https://www.researchprotocols.org/2022/9/e39843 UR - http://dx.doi.org/10.2196/39843 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178713 ID - info:doi/10.2196/39843 ER - TY - JOUR AU - Tougas, Hailee AU - Chan, Steven AU - Shahrvini, Tara AU - Gonzalez, Alvaro AU - Chun Reyes, Ruth AU - Burke Parish, Michelle AU - Yellowlees, Peter PY - 2022/9/6 TI - The Use of Automated Machine Translation to Translate Figurative Language in a Clinical Setting: Analysis of a Convenience Sample of Patients Drawn From a Randomized Controlled Trial JO - JMIR Ment Health SP - e39556 VL - 9 IS - 9 KW - telepsychiatry KW - automated machine translation KW - language barriers KW - psychiatry KW - assessment KW - automated translation KW - automated KW - translation KW - artificial intelligence KW - AI KW - speech recognition KW - limited English proficiency KW - LEP KW - asynchronous telepsychiatry KW - ATP KW - automated speech recognition KW - ASR KW - AMT KW - figurative language device KW - FLD KW - language concordant KW - language discordant KW - AI interpretation N2 - Background: Patients with limited English proficiency frequently receive substandard health care. Asynchronous telepsychiatry (ATP) has been established as a clinically valid method for psychiatric assessments. The addition of automated speech recognition (ASR) and automated machine translation (AMT) technologies to asynchronous telepsychiatry may be a viable artificial intelligence (AI)?language interpretation option. Objective: This project measures the frequency and accuracy of the translation of figurative language devices (FLDs) and patient word count per minute, in a subset of psychiatric interviews from a larger trial, as an approximation to patient speech complexity and quantity in clinical encounters that require interpretation. Methods: A total of 6 patients were selected from the original trial, where they had undergone 2 assessments, once by an English-speaking psychiatrist through a Spanish-speaking human interpreter and once in Spanish by a trained mental health interviewer-researcher with AI interpretation. 3 (50%) of the 6 selected patients were interviewed via videoconferencing because of the COVID-19 pandemic. Interview transcripts were created by automated speech recognition with manual corrections for transcriptional accuracy and assessment for translational accuracy of FLDs. Results: AI-interpreted interviews were found to have a significant increase in the use of FLDs and patient word count per minute. Both human and AI-interpreted FLDs were frequently translated inaccurately, however FLD translation may be more accurate on videoconferencing. Conclusions: AI interpretation is currently not sufficiently accurate for use in clinical settings. However, this study suggests that alternatives to human interpretation are needed to circumvent modifications to patients? speech. While AI interpretation technologies are being further developed, using videoconferencing for human interpreting may be more accurate than in-person interpreting. Trial Registration: ClinicalTrials.gov NCT03538860; https://clinicaltrials.gov/ct2/show/NCT03538860 UR - https://mental.jmir.org/2022/9/e39556 UR - http://dx.doi.org/10.2196/39556 UR - http://www.ncbi.nlm.nih.gov/pubmed/36066959 ID - info:doi/10.2196/39556 ER - TY - JOUR AU - Paul, Margot AU - Bullock, Kim AU - Bailenson, Jeremy PY - 2022/5/6 TI - Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial JO - JMIR Ment Health SP - e35526 VL - 9 IS - 5 KW - virtual reality KW - major depressive disorder KW - behavioral activation KW - depression N2 - Background: Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD. Objective: We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD. Methods: A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire?9. Results: Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant?s clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire?9 score. Conclusions: The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs. Trial Registration: ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316 International Registered Report Identifier (IRRID): RR2-10.2196/24331 UR - https://mental.jmir.org/2022/5/e35526 UR - http://dx.doi.org/10.2196/35526 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404830 ID - info:doi/10.2196/35526 ER - TY - JOUR AU - Weir, Charlene PY - 2022/5/4 TI - Through the Narrative Looking Glass: Commentary on ?Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review? JO - J Med Internet Res SP - e38513 VL - 24 IS - 5 KW - electronic health records KW - psychiatry KW - mental health KW - electronic medical records KW - health informatics KW - mental illness KW - scoping review KW - clinical decision support UR - https://www.jmir.org/2022/5/e38513 UR - http://dx.doi.org/10.2196/38513 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507399 ID - info:doi/10.2196/38513 ER - TY - JOUR AU - Kariotis, Charles Timothy AU - Prictor, Megan AU - Chang, Shanton AU - Gray, Kathleen PY - 2022/5/4 TI - Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review JO - J Med Internet Res SP - e30405 VL - 24 IS - 5 KW - electronic health records KW - psychiatry KW - mental health KW - electronic medical records KW - health informatics KW - mental illness KW - scoping review KW - clinical decision support N2 - Background: The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. Objective: This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. Methods: We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies? results and address the research questions. Results: The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health?related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. Conclusions: We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context. UR - https://www.jmir.org/2022/5/e30405 UR - http://dx.doi.org/10.2196/30405 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507393 ID - info:doi/10.2196/30405 ER - TY - JOUR AU - Braund, A. Taylor AU - Zin, The May AU - Boonstra, W. Tjeerd AU - Wong, J. Quincy J. AU - Larsen, E. Mark AU - Christensen, Helen AU - Tillman, Gabriel AU - O?Dea, Bridianne PY - 2022/5/4 TI - Smartphone Sensor Data for Identifying and Monitoring Symptoms of Mood Disorders: A Longitudinal Observational Study JO - JMIR Ment Health SP - e35549 VL - 9 IS - 5 KW - depression KW - bipolar disorder KW - sensors KW - mobile app KW - circadian rhythm KW - mobile phone N2 - Background: Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode. Objective: Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder. Methods: A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline. Results: Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants? social support networks at baseline (r=0.22; P=.03; R2=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5. Conclusions: Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders. UR - https://mental.jmir.org/2022/5/e35549 UR - http://dx.doi.org/10.2196/35549 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507385 ID - info:doi/10.2196/35549 ER - TY - JOUR AU - Mercadal Rotger, Josep AU - Cabré, Victor PY - 2022/5/2 TI - Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study JO - JMIR Ment Health SP - e36775 VL - 9 IS - 5 KW - online psychological intervention KW - therapeutic alliance KW - digital health KW - mental health KW - mental health education KW - mental health treatment KW - health interventions KW - health professional KW - online health KW - web-based health KW - intervention modality N2 - Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances?observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=?42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. UR - https://mental.jmir.org/2022/5/e36775 UR - http://dx.doi.org/10.2196/36775 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499910 ID - info:doi/10.2196/36775 ER - TY - JOUR AU - Yeager, M. Carolyn AU - Benight, C. Charles PY - 2022/5/2 TI - Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study JO - JMIR Ment Health SP - e35048 VL - 9 IS - 5 KW - engagement KW - digital health KW - digital mental health intervention KW - social cognitive theory KW - SCT KW - self-efficacy KW - outcome expectations KW - trauma KW - posttraumatic stress disorder KW - PTSD N2 - Background: Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. Objective: The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. Methods: A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). Results: Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit (?22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90% CI 0.040-0.064), indicating that engagement self-efficacy (?=.35; P<.001) and outcome expectations (?=.37; P<.001) were significant predictors of engagement (R2=39%). The overall indirect effect between engagement and PTSD symptom reduction was significant (?=?.065; P<.001; 90% CI ?0.071 to ?0.058). This relationship was serially mediated by both skill activation self-efficacy (?=.80; P<.001) and trauma coping self-efficacy (?=.40; P<.001), which predicted a reduction in PTSD symptoms (?=?.20; P=.02). Conclusions: The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies?skill activation and trauma coping?proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs. UR - https://mental.jmir.org/2022/5/e35048 UR - http://dx.doi.org/10.2196/35048 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499857 ID - info:doi/10.2196/35048 ER - TY - JOUR AU - Guemghar, Imane AU - Pires de Oliveira Padilha, Paula AU - Abdel-Baki, Amal AU - Jutras-Aswad, Didier AU - Paquette, Jesseca AU - Pomey, Marie-Pascale PY - 2022/4/19 TI - Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review JO - JMIR Ment Health SP - e36094 VL - 9 IS - 4 KW - social robots KW - socially assistive robots KW - SARs KW - mental health KW - mental health services KW - dementia KW - autism spectrum disorder KW - schizophrenia KW - depression KW - scoping review N2 - Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O?Malley?s framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. UR - https://mental.jmir.org/2022/4/e36094 UR - http://dx.doi.org/10.2196/36094 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438639 ID - info:doi/10.2196/36094 ER - TY - JOUR AU - Silva, Wnurinham AU - Virtanen, Eeva AU - Kajantie, Eero AU - Sebert, Sylvain PY - 2022/4/14 TI - Cognitive Function, Mental Health, and Quality of Life in Siblings of Preterm Born Children: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e34987 VL - 11 IS - 4 KW - preterm birth KW - birth weight KW - siblings KW - cognitive KW - mental health KW - quality of life KW - family N2 - Background: Children and adults born preterm are at increased risk of cognitive impairments, mental health disorders, and poorer quality of life. Epidemiological studies have shown that the impact of preterm birth extends to the immediate family members; however, existing research have focused on parents, and little attention has been given to siblings. Objective: The aim of the systematic review described in this protocol is to synthesize currently available evidence on the impact of exposure to preterm birth (ie, having a sibling born preterm) on cognition, mental health, and quality of life of term born siblings (index child) of preterm born children, and to critically appraise the evidence. Methods: This protocol outlines a systematic review designed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist. We will include all studies that assess outcomes in siblings of children born preterm. Quantitative and qualitative studies will be eligible for the systematic review, and only studies in English will be included. Firstly, search will be conducted electronically on PubMed, Scopus, Embase, Mednar, and opengrey.eu databases and, secondly, manually in Google Scholar and reference lists. The search strategy will include keywords and synonyms, Boolean operators, and text words (ie, within title and abstract). The team of reviewers will screen the search results, extract data from eligible studies, and critically appraise the studies. Analysis will involve both descriptive and quantitative approaches. Meta-analysis will be conducted if appropriate. Results: This systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) on December 18, 2020, and it is currently in progress. The findings will be synthesized to determine the effect of preterm birth on full-term siblings and the quality of the available evidence. Conclusions: The evidence derived from this study will shed light on gaps and limitations in the field of preterm birth, more specifically, the effect of preterm birth on full-term siblings. In addition, we hope that understanding the impact of preterm birth on family members will inform targeted interventions and policies for those identified at high risk and how to mitigate health risks. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021222887; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222887 International Registered Report Identifier (IRRID): DERR1-10.2196/34987 UR - https://www.researchprotocols.org/2022/4/e34987 UR - http://dx.doi.org/10.2196/34987 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436229 ID - info:doi/10.2196/34987 ER - TY - JOUR AU - Martin-Key, A. Nayra AU - Spadaro, Benedetta AU - Funnell, Erin AU - Barker, Jane Eleanor AU - Schei, Sofie Thea AU - Tomasik, Jakub AU - Bahn, Sabine PY - 2022/3/30 TI - The Current State and Validity of Digital Assessment Tools for Psychiatry: Systematic Review JO - JMIR Ment Health SP - e32824 VL - 9 IS - 3 KW - diagnostic accuracy KW - digital mental health KW - digital questionnaire KW - psychiatry KW - systematic review N2 - Background: Given the role digital technologies are likely to play in the future of mental health care, there is a need for a comprehensive appraisal of the current state and validity (ie, screening or diagnostic accuracy) of digital mental health assessments. Objective: The aim of this review is to explore the current state and validity of question-and-answer?based digital tools for diagnosing and screening psychiatric conditions in adults. Methods: This systematic review was based on the Population, Intervention, Comparison, and Outcome framework and was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO were systematically searched for articles published between 2005 and 2021. A descriptive evaluation of the study characteristics and digital solutions and a quantitative appraisal of the screening or diagnostic accuracy of the included tools were conducted. Risk of bias and applicability were assessed using the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2. Results: A total of 28 studies met the inclusion criteria, with the most frequently evaluated conditions encompassing generalized anxiety disorder, major depressive disorder, and any depressive disorder. Most of the studies used digitized versions of existing pen-and-paper questionnaires, with findings revealing poor to excellent screening or diagnostic accuracy (sensitivity=0.32-1.00, specificity=0.37-1.00, area under the receiver operating characteristic curve=0.57-0.98) and a high risk of bias for most of the included studies. Conclusions: The field of digital mental health tools is in its early stages, and high-quality evidence is lacking. International Registered Report Identifier (IRRID): RR2-10.2196/25382 UR - https://mental.jmir.org/2022/3/e32824 UR - http://dx.doi.org/10.2196/32824 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353053 ID - info:doi/10.2196/32824 ER - TY - JOUR AU - Villarreal-Zegarra, David AU - Alarcon-Ruiz, A. Christoper AU - Melendez-Torres, GJ AU - Torres-Puente, Roberto AU - Navarro-Flores, Alba AU - Cavero, Victoria AU - Ambrosio-Melgarejo, Juan AU - Rojas-Vargas, Jefferson AU - Almeida, Guillermo AU - Albitres-Flores, Leonardo AU - Romero-Cabrera, B. Alejandra AU - Huarcaya-Victoria, Jeff PY - 2022/3/29 TI - Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews JO - JMIR Ment Health SP - e34760 VL - 9 IS - 3 KW - telemedicine KW - digital health KW - internet-based intervention KW - mental health KW - mental disorders KW - systematic reviews KW - qualitative research KW - realist review KW - mHealth KW - eHealth KW - telehealth N2 - Background: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. Objective: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. Methods: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. Results: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. Conclusions: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811 International Registered Report Identifier (IRRID): RR2-10.12688/f1000research.27150.2 UR - https://mental.jmir.org/2022/3/e34760 UR - http://dx.doi.org/10.2196/34760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348469 ID - info:doi/10.2196/34760 ER - TY - JOUR AU - Hallenbeck, Wu Haijing AU - Jaworski, K. Beth AU - Wielgosz, Joseph AU - Kuhn, Eric AU - Ramsey, M. Kelly AU - Taylor, Katherine AU - Juhasz, Katherine AU - McGee-Vincent, Pearl AU - Mackintosh, Margaret-Anne AU - Owen, E. Jason PY - 2022/3/29 TI - PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public JO - JMIR Ment Health SP - e34744 VL - 9 IS - 3 KW - posttraumatic stress disorder KW - trauma KW - mental health KW - mHealth KW - mobile app KW - public health KW - self-management KW - mobile phone N2 - Background: With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated. Objective: We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach. Methods: We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users. Results: During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean ?1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean ?4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements. Conclusions: PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement. UR - https://mental.jmir.org/2022/3/e34744 UR - http://dx.doi.org/10.2196/34744 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348458 ID - info:doi/10.2196/34744 ER - TY - JOUR AU - Ainslie, Marcy AU - Brunette, F. Mary AU - Capozzoli, Michelle PY - 2022/3/21 TI - Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis JO - JMIR Ment Health SP - e33092 VL - 9 IS - 3 KW - telemedicine KW - mental health KW - serious mental illness KW - retention KW - mental illness KW - telehealth N2 - Background: Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. Objective: We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. Methods: We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. Results: A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. Conclusions: The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness. UR - https://mental.jmir.org/2022/3/e33092 UR - http://dx.doi.org/10.2196/33092 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311673 ID - info:doi/10.2196/33092 ER - TY - JOUR AU - Zheng, Fuhao AU - Wang, Ling AU - Zeng, Zhaonan AU - Wu, Siying PY - 2022/2/22 TI - International Technologies on Prevention and Treatment of Neurological and Psychiatric Diseases: Bibliometric Analysis of Patents JO - JMIR Ment Health SP - e25238 VL - 9 IS - 2 KW - neurological diseases KW - psychiatric diseases KW - patent KW - bibliometric analysis KW - prevention KW - treatment N2 - Background: Neurological and psychiatric disorders are serious and expensive global public health problems. Therefore, exploring effective intervention technologies plays an important role in improving patients? clinical symptoms and social functions, as well as reducing medical burden. Objective: The aim of this study is to analyze and summarize the key new technologies and innovative development trends witnessed globally for neurological illness and psychiatric disorders by mining the relevant patent data. Methods: A bibliometric analysis was conducted on patent applications, priority countries, main patentees, hot technologies, and other patent information on neurological and psychiatric disorders, revealing the current situation along with the trend of technology development in this field. Results: In recent years, inventions and innovations related to neurological and psychiatric diseases have become very active, with China being the largest patent priority country. Of the top patent holders, Visicu (headquartered in the United States) is the leader. The distribution of patent holders in China remains relatively scattered, with no monopoly organization at present. Global technologies on neurological illness and psychiatric disorders are mainly concentrated around A61B (diagnosis, surgery, and identification). Conclusions: This paper analyzed and summarized the key new technologies and global innovative development trends of neurological and psychiatric diseases by mining the relevant patent data, and provides practical references and research perspectives for the prevention and treatment of the aforesaid diseases. UR - https://mental.jmir.org/2022/2/e25238 UR - http://dx.doi.org/10.2196/25238 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191849 ID - info:doi/10.2196/25238 ER - TY - JOUR AU - Lynham, Joanne Amy AU - Jones, R. Ian AU - Walters, R. James T. PY - 2022/2/10 TI - Web-Based Cognitive Testing in Psychiatric Research: Validation and Usability Study JO - J Med Internet Res SP - e28233 VL - 24 IS - 2 KW - cognition KW - mental health KW - online KW - digital KW - assessment KW - validation KW - memory KW - attention KW - mobile phone N2 - Background: Cognitive impairments are features of many psychiatric disorders and affect functioning. A barrier to cognitive research on psychiatric disorders is the lack of large cross-disorder data sets. However, the collection of cognitive data can be logistically challenging and expensive. Web-based collection may be an alternative; however, little is known about who does and does not complete web-based cognitive assessments for psychiatric research. Objective: The aims of this study are to develop a web-based cognitive battery for use in psychiatric research, validate the battery against the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, and compare the characteristics of the participants who chose to take part with those of the individuals who did not participate. Methods: Tasks were developed by The Many Brains Project and selected to measure the domains specified by the MATRICS initiative. We undertook a cross-validation study of 65 participants with schizophrenia, bipolar disorder, depression, or no history of psychiatric disorders to compare the web-based tasks with the MATRICS Consensus Cognitive Battery. Following validation, we invited participants from 2 large ongoing genetic studies, which recruited participants with psychiatric disorders to complete the battery and evaluated the demographic and clinical characteristics of those who took part. Results: Correlations between web-based and MATRICS tasks ranged between 0.26 and 0.73. Of the 961 participants, 887 (92.3%) completed at least one web-based task, and 644 (67%) completed all tasks, indicating adequate completion rates. Predictors of web-based participation included being female (odds ratio [OR] 1.3, 95% CI 1.07-1.58), ethnicity other than White European (OR 0.66, 95% CI 0.46-0.96), higher levels of education (OR 1.19, 95% CI 1.11-1.29), diagnosis of an eating disorder (OR 2.17, 95% CI 1.17-4) or depression and anxiety (OR 5.12, 95% CI 3.38-7.83), and absence of a diagnosis of schizophrenia (OR 0.59, 95% CI 0.35-0.94). Lower performance on the battery was associated with poorer functioning (B=?1.76, SE 0.26; P<.001). Conclusions: Our findings offer valuable insights into the advantages and disadvantages of testing cognitive function remotely for mental health research. UR - https://www.jmir.org/2022/2/e28233 UR - http://dx.doi.org/10.2196/28233 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142640 ID - info:doi/10.2196/28233 ER - TY - JOUR AU - Shen, X. Francis AU - Silverman, C. Benjamin AU - Monette, Patrick AU - Kimble, Sara AU - Rauch, L. Scott AU - Baker, T. Justin PY - 2022/2/9 TI - An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint JO - J Med Internet Res SP - e31146 VL - 24 IS - 2 KW - digital phenotyping KW - computataional psychiatry KW - ethics KW - law KW - privacy KW - informed consent N2 - Background: Psychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data?on location, movement, email and text communications, and social media?with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI). Objective: The goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols. Methods: We explored the ELSI of digital health research in psychiatry, with a particular focus on what we label ?deep phenotyping? psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue. Results: Consistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (?the Ethics Checklist?). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report. Conclusions: Deep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey. UR - https://www.jmir.org/2022/2/e31146 UR - http://dx.doi.org/10.2196/31146 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138261 ID - info:doi/10.2196/31146 ER - TY - JOUR AU - Birnbaum, L. Michael AU - Abrami, Avner AU - Heisig, Stephen AU - Ali, Asra AU - Arenare, Elizabeth AU - Agurto, Carla AU - Lu, Nathaniel AU - Kane, M. John AU - Cecchi, Guillermo PY - 2022/1/24 TI - Acoustic and Facial Features From Clinical Interviews for Machine Learning?Based Psychiatric Diagnosis: Algorithm Development JO - JMIR Ment Health SP - e24699 VL - 9 IS - 1 KW - audiovisual patterns KW - speech analysis KW - facial analysis KW - psychiatry KW - schizophrenia spectrum disorders KW - bipolar disorder KW - symptom prediction KW - diagnostic prediction KW - machine learning KW - audiovisual KW - speech KW - schizophrenia KW - spectrum disorders N2 - Background: In contrast to all other areas of medicine, psychiatry is still nearly entirely reliant on subjective assessments such as patient self-report and clinical observation. The lack of objective information on which to base clinical decisions can contribute to reduced quality of care. Behavioral health clinicians need objective and reliable patient data to support effective targeted interventions. Objective: We aimed to investigate whether reliable inferences?psychiatric signs, symptoms, and diagnoses?can be extracted from audiovisual patterns in recorded evaluation interviews of participants with schizophrenia spectrum disorders and bipolar disorder. Methods: We obtained audiovisual data from 89 participants (mean age 25.3 years; male: 48/89, 53.9%; female: 41/89, 46.1%): individuals with schizophrenia spectrum disorders (n=41), individuals with bipolar disorder (n=21), and healthy volunteers (n=27). We developed machine learning models based on acoustic and facial movement features extracted from participant interviews to predict diagnoses and detect clinician-coded neuropsychiatric symptoms, and we assessed model performance using area under the receiver operating characteristic curve (AUROC) in 5-fold cross-validation. Results: The model successfully differentiated between schizophrenia spectrum disorders and bipolar disorder (AUROC 0.73) when aggregating face and voice features. Facial action units including cheek-raising muscle (AUROC 0.64) and chin-raising muscle (AUROC 0.74) provided the strongest signal for men. Vocal features, such as energy in the frequency band 1 to 4 kHz (AUROC 0.80) and spectral harmonicity (AUROC 0.78), provided the strongest signal for women. Lip corner?pulling muscle signal discriminated between diagnoses for both men (AUROC 0.61) and women (AUROC 0.62). Several psychiatric signs and symptoms were successfully inferred: blunted affect (AUROC 0.81), avolition (AUROC 0.72), lack of vocal inflection (AUROC 0.71), asociality (AUROC 0.63), and worthlessness (AUROC 0.61). Conclusions: This study represents advancement in efforts to capitalize on digital data to improve diagnostic assessment and supports the development of a new generation of innovative clinical tools by employing acoustic and facial data analysis. UR - https://mental.jmir.org/2022/1/e24699 UR - http://dx.doi.org/10.2196/24699 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072648 ID - info:doi/10.2196/24699 ER - TY - JOUR AU - Chinna Meyyappan, Arthi AU - Forth, Evan AU - Milev, Roumen PY - 2022/1/21 TI - Microbial Ecosystem Therapeutic-2 Intervention in People With Major Depressive Disorder and Generalized Anxiety Disorder: Phase 1, Open-Label Study JO - Interact J Med Res SP - e32234 VL - 11 IS - 1 KW - gut-brain axis KW - microbiome KW - Microbial Ecosystem Therapeutic KW - depression KW - anxiety N2 - Background: Recent studies have investigated the potential of treatments that modify the gut microbiome, such as fecal microbiota transplantation and probiotics, in individuals with psychiatric illnesses. Objective: The aim of this study was to investigate the safety, tolerability, and efficacy of a novel gut microbiome therapeutic, Microbial Ecosystem Therapuetic-2 (MET-2), in people with depression and anxiety. Methods: In this phase 1, open-label trial, 12 adults diagnosed with major depressive disorder, generalized anxiety disorder, or both were recruited. Over 8 weeks, participants consumed three capsules per day, orally, of an encapsulated microbial therapeutic (MET-2), which contained 40 strains of bacteria that were purified and lab-grown from the stool of a single healthy donor. Participants were assessed biweekly using clinical scales and questionnaires in order to evaluate the safety, efficacy, and tolerability of the therapeutic. Results: The therapeutic was found to be generally safe and tolerable, with limited adverse events and side effects and no serious adverse events. Of the 12 individuals included in this study, 9 (75%) responded to treatment (50% improvement in Montgomery-Asberg Depression Rating Scale [MADRS] scores, 7-item Generalized Anxiety Disorder scale [GAD-7] scores, or both, from baseline to the week-8 visit). Over the course of 10 weeks, MET-2 significantly decreased mean MADRS and GAD-7 scores (MADRS: F2.731, 30.05=8.784, P<.001; GAD-7: F2.778, 30.55= 9.638, P<.001). Multiple comparisons with Bonferroni adjustments showed a significant reduction in MADRS scores from baseline (mean 19.00, SD 4.843) to week 6 (mean 11.25, SD 8.001; P=.009), week 8 (mean 8.667, SD 8.732; P=.002), and week 10 (mean 8.250, SD 9.304; P=.006). Multiple comparisons showed a significant reduction in GAD-7 scores from baseline (mean 13.58, SD 4.010) to week 4 (mean 9.167, SD 5.096; P=.03), week 6 (mean 7.667, SD 4.539; P=.004), week 8 (mean 7.333, SD 6.583; P=.03), and week 10 (mean 7.500, SD 6.448; P=.03). Conclusions: The findings from this study are the first to provide evidence for the role of microbial ecosystem therapy in treating depression and anxiety. However, a double-blind, randomized controlled trial with a larger sample size is needed for more conclusive results. Trial Registration: ClinicalTrials.gov NCT04052451; https://www.clinicaltrials.gov/ct2/show/NCT04052451 International Registered Report Identifier (IRRID): RR2-10.2196/17223 UR - https://www.i-jmr.org/2022/1/e32234 UR - http://dx.doi.org/10.2196/32234 UR - http://www.ncbi.nlm.nih.gov/pubmed/35060914 ID - info:doi/10.2196/32234 ER - TY - JOUR AU - Sado, Mitsuhiro AU - Ninomiya, Akira AU - Nagaoka, Maki AU - Koreki, Akihiro AU - Goto, Naho AU - Sasaki, Yohei AU - Takamori, Chie AU - Kosugi, Teppei AU - Yamada, Masashi AU - Park, Sunre AU - Sato, Yasunori AU - Fujisawa, Daisuke AU - Nakagawa, Atsuo AU - Mimura, Masaru PY - 2022/1/21 TI - Effectiveness of Mindfulness-Based Cognitive Therapy With Follow-Up Sessions for Pharmacotherapy-Refractory Anxiety Disorders: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e33776 VL - 11 IS - 1 KW - mindfulness-based cognitive therapy KW - anxiety disorders KW - long-term effects KW - randomized controlled trial KW - cost-effectiveness N2 - Background: Augmented mindfulness-based cognitive therapy (MBCT) with treatment as usual (mainly pharmacotherapy) is reported to be effective after treatment for anxiety disorders. However, whether its effectiveness persists in the long term is unclear. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a follow-up program by conducting a feasibility randomized controlled trial (RCT) that compares augmented MBCT with follow-up sessions and that without follow-up sessions in preparation for a definitive RCT. Methods: The study involves an 8-week MBCT with a 10-month follow-up. Patients aged 20 to 65 years who meet the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for panic disorder, agoraphobia, or social anxiety disorder, which is not remitted with usual treatment for at least 4 weeks, will be included in the study and randomly allocated to receive augmented MBCT with follow-up sessions or augmented MBCT without follow-up sessions. For this feasibility RCT, the primary outcomes are (1) study inclusion rate, (2) dropout rate, (3) attendance rate, and (4) mean and standard deviation of several clinical measures at 8 weeks and 5, 8, and 12 months. Results: We started recruiting participants in January 2020, and 43 participants have been enrolled up to January 2021. The study is ongoing, and data collection will be completed by May 2022. Conclusions: This study is novel in terms of its design, which compares augmented MBCT with and without follow-up sessions. The limitations of the trial are as follows: (1) mixed participants in terms of the delivery mode of the intervention, and (2) lack of a pharmacotherapy-alone arm. Owing to its novelty and significance, this study will provide fruitful knowledge for future definitive RCTs. Trial Registration: UMIN Clinical Trials Registry UMIN000038626; https://tinyurl.com/2p9dtxzh International Registered Report Identifier (IRRID): DERR1-10.2196/33776 UR - https://www.researchprotocols.org/2022/1/e33776 UR - http://dx.doi.org/10.2196/33776 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787573 ID - info:doi/10.2196/33776 ER - TY - JOUR AU - Pszczolkowski, Stefan AU - Cottam, J. William AU - Briley, M. Paul AU - Iwabuchi, J. Sarina AU - Kaylor-Hughes, Catherine AU - Shalabi, Abdulrhman AU - Babourina-Brooks, Ben AU - Berrington, Adam AU - Barber, Shaun AU - Suazo Di Paola, Ana AU - Blamire, Andrew AU - McAllister-Williams, Hamish R. AU - Parikh, Jehill AU - Abdelghani, Mohamed AU - Matthäus, Lars AU - Hauffe, Ralf AU - Liddle, Peter AU - Auer, P. Dorothee AU - Morriss, Richard PY - 2022/1/20 TI - Connectivity-Guided Theta Burst Transcranial Magnetic Stimulation Versus Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Moderate to Severe Depression: Magnetic Resonance Imaging Protocol and SARS-CoV-2?Induced Changes for a Randomized Double-blind Controlled Trial JO - JMIR Res Protoc SP - e31925 VL - 11 IS - 1 KW - depression KW - magnetic resonance imaging KW - image-guidance KW - personalized medicine KW - transcranial magnetic stimulation N2 - Background: Depression is a substantial health and economic burden. In approximately one-third of patients, depression is resistant to first-line treatment; therefore, it is essential to find alternative treatments. Transcranial magnetic stimulation (TMS) is a neuromodulatory treatment involving the application of magnetic pulses to the brain that is approved in the United Kingdom and the United States in treatment-resistant depression. This trial aims to compare the clinical effectiveness, cost-effectiveness, and mechanism of action of standard treatment repetitive TMS (rTMS) targeted at the F3 electroencephalogram site with a newer treatment?a type of TMS called theta burst stimulation (TBS) targeted based on measures of functional brain connectivity. This protocol outlines brain imaging acquisition and analysis for the Brain Imaging Guided Transcranial Magnetic Stimulation in Depression (BRIGhTMIND) study trial that is used to create personalized TMS targets and answer the proposed mechanistic hypotheses. Objective: The aims of the imaging arm of the BRIGhTMIND study are to identify functional and neurochemical brain signatures indexing the treatment mechanisms of rTMS and connectivity-guided intermittent theta burst TMS and to identify imaging-based markers predicting response to treatment. Methods: The study is a randomized double-blind controlled trial with 1:1 allocation to either 20 sessions of TBS or standard rTMS. Multimodal magnetic resonance imaging (MRI) is acquired for each participant at baseline (before TMS treatment) with T1-weighted and task-free functional MRI during rest used to estimate TMS targets. For participants enrolled in the mechanistic substudy, additional diffusion-weighted sequences are acquired at baseline and at posttreatment follow-up 16 weeks after treatment randomization. Core data sets of T1-weighted and task-free functional MRI during rest are acquired for all participants and are used to estimate TMS targets. Additional sequences of arterial spin labeling, magnetic resonance spectroscopy, and diffusion-weighted images are acquired depending on the recruitment site for mechanistic evaluation. Standard rTMS treatment is targeted at the F3 electrode site over the left dorsolateral prefrontal cortex, whereas TBS treatment is guided using the coordinate of peak effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. Both treatment targets benefit from the level of MRI guidance, but only TBS is provided with precision targeting based on functional brain connectivity. Results: Recruitment began in January 2019 and is ongoing. Data collection is expected to continue until January 2023. Conclusions: This trial will determine the impact of precision MRI guidance on rTMS treatment and assess the neural mechanisms underlying this treatment in treatment-resistant depressed patients. Trial Registration: ISRCTN Registry ISRCTN19674644; https://www.isrctn.com/ISRCTN19674644 International Registered Report Identifier (IRRID): DERR1-10.2196/31925 UR - https://www.researchprotocols.org/2022/1/e31925 UR - http://dx.doi.org/10.2196/31925 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049517 ID - info:doi/10.2196/31925 ER - TY - JOUR AU - Thorarinsdottir, Kristjana AU - Holmes, A. Emily AU - Hardarson, Johann AU - Hedinsdottir, Unnur AU - Kanstrup, Marie AU - Singh, Laura AU - Hauksdottir, Arna AU - Halldorsdottir, Thorhildur AU - Gudmundsdottir, Berglind AU - Valdimarsdottir, Unnur AU - Thordardottir, Bjork Edda AU - Gamble, Beau AU - Bjornsson, Andri PY - 2021/11/4 TI - Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland JO - JMIR Form Res SP - e29873 VL - 5 IS - 11 KW - psychological trauma KW - intrusive memories KW - case report KW - visuospatial interference task KW - Tetris gameplay KW - mental imagery KW - mobile phone N2 - Background: Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event. Objective: This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session. Methods: This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms. Results: The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing. Conclusions: This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention. UR - https://formative.jmir.org/2021/11/e29873 UR - http://dx.doi.org/10.2196/29873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734830 ID - info:doi/10.2196/29873 ER - TY - JOUR AU - Liu, W. Jenny J. AU - Nazarov, Anthony AU - Easterbrook, Bethany AU - Plouffe, A. Rachel AU - Le, Tri AU - Forchuk, Callista AU - Brandwood, Alec AU - St Cyr, Kate AU - Auger, Edouard AU - Balderson, Ken AU - Bilodeau, Mathieu AU - Burhan, M. Amer AU - Enns, W. Murray AU - Smith, Patrick AU - Hosseiny, Fardous AU - Dupuis, Gabrielle AU - Roth, Maya AU - Mota, Natalie AU - Lavoie, Vicky AU - Richardson, Don J. PY - 2021/10/25 TI - Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy JO - JMIR Res Protoc SP - e33151 VL - 10 IS - 10 KW - military personnel KW - psychotherapy KW - pharmacotherapy KW - stress disorders KW - posttraumatic KW - meta-analysis KW - systematic review KW - therapy KW - stress KW - disorder KW - posttraumatic stress disorder KW - review KW - treatment KW - efficacy KW - military KW - Canada KW - veteran N2 - Background: Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations. Objective: This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD. Methods: This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes. Results: The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021. Conclusions: This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations. Trial Registration: PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59 International Registered Report Identifier (IRRID): DERR1-10.2196/33151 UR - https://www.researchprotocols.org/2021/10/e33151 UR - http://dx.doi.org/10.2196/33151 UR - http://www.ncbi.nlm.nih.gov/pubmed/34694228 ID - info:doi/10.2196/33151 ER - TY - JOUR AU - Spadaro, Benedetta AU - Martin-Key, A. Nayra AU - Bahn, Sabine PY - 2021/10/13 TI - Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators JO - J Med Internet Res SP - e27507 VL - 23 IS - 10 KW - digital implementation KW - digital mental health KW - digital psychiatry KW - digital technology KW - viewpoint UR - https://www.jmir.org/2021/10/e27507 UR - http://dx.doi.org/10.2196/27507 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643537 ID - info:doi/10.2196/27507 ER -