E-Mental Health for People with Personality Disorders: A Systematic Review

Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study

BACKGROUND

Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR).

OBJECTIVE

This study aimed to evaluate the patients' and midwives' levels of satisfaction with the connected mobile app.

METHODS

We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users' opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives.

RESULTS

Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app's ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors.

CONCLUSIONS

The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team's workload, the time savings provided by the app constitute a nonnegligible advantage.

Health Programmes for Older Adults Who Are the Primary Family Caregivers for Their Partners: A Scoping Review

Aim: To examine and map health programmes that have been implemented and evaluated to improve health outcomes amongst older adults who are the primary family caregivers for their partners. Methods: A scoping review was carried out, following the methodology of the Joanna Briggs Institute (JBI) and PRISMA-ScR reporting guidelines. The search was conducted in six databases (PubMed/Medline, Cochrane, CINAHL, Web of Science, Scopus, and EMBASE) between December 2023 and March 2024. Results: Eleven studies were included, covering different health programmes implemented and evaluated with the aim of improving health outcomes in older adults who assume the role of primary family caregiver for their partner. The programmes were carried out by multidisciplinary teams and psychologists. The programmes varied in content, frequency, and duration. Discrepancies were found in the effects of the interventions on stress, depression, quality of life, and caregiver burden. Conclusions: This scoping review shows that programmes aimed at improving health outcomes in older adults who are the primary family caregiver for their partner vary widely in both content and effectiveness. While some interventions reduced the burden and psychological distress, others did not show clear improvements in quality of life. It can be concluded that there is a need for randomised controlled trials that rigorously evaluate the outcomes of long-term, personalised interventions.

Sexual Interventions in the Metaverse: Attitudes Towards Novel Therapeutic Approaches, a Qualitative Study

BACKGROUND AND OBJECTIVE

Mental health treatment for psychosexual problems is effective, but treatment rates are low. Metaverse-based therapy offers one solution to increase overall treatment rates. Understanding attitudes towards this novel approach could lead to wider adoption of metaverse-based therapy, resulting in higher treatment rates for psychosexual problems.

METHODS

Twenty-one participants across three focus groups of different ages shared their perceptions and attitudes about metaverse-based therapy broadly and for treating sexual disorders. A content analysis of the transcribed text from the focus groups using qualitative data analysis software was conducted.

RESULTS

Participants identified several perceived benefits of metaverse-based intervention, including avoiding the perceived embarrassment of going to a clinic and accessing patients (a) with diverse physical or mental functionality, (b) living in remote areas and/or (c) balancing different family/work obligations or duties. The two main concerns with metaverse-based therapy were the fear of online therapy being less personal than traditional therapy and the technological fluency needed. Clarifying their acceptance of the therapy, participants reported that they would be more likely to engage in metaverse-based therapy if they trusted their therapist. Also, although it might be effective for mild and moderate disorders, participants were more reluctant about its use for severe mental illness.

CONCLUSIONS

Results suggest that attitudes towards metaverse-based intervention are mainly positive, since it removes some barriers that hinder access to psychological treatment in general and, specifically, for problems of a sexual nature.

PATIENT AND PUBLIC CONTRIBUTION

During the design stage, a person with sexual difficulties was consulted to understand the patient's perspective. Members of the public advised the implementation of the focus groups. Three potential service users were involved in the coding of the text during the content analysis.

The effectiveness of e-mental health interventions on stress, anxiety, and depression among healthcare professionals: a systematic review and meta-analysis

BACKGROUND

Many healthcare professionals are experiencing psychological distress. Electronic mental health (e-mental health) interventions are convenient and multifunctional. This review aimed to examine the effectiveness of e-mental health interventions in enhancing the well-being of healthcare professionals and to identify moderating factors.

METHODS

A comprehensive and systematic retrieval of randomized controlled trial (RCT) studies was conducted across eight databases. Population, intervention, comparison, and outcome (PICO) were used to define eligibility criteria. Stress, anxiety, and depression were included as the main outcomes. The overall effect was calculated based on the random effect model, and the effect size was presented using the standardized mean difference. The characteristics of the research design, intervention object, and intervention design were further selected as potential moderating factors for subgroup analysis. Meta-regression analyses were finally performed, incorporating intervention duration and sample size as independent variables.

RESULTS

A total of 20 studies were included in the systematic review, and 17 were included in the meta-analysis. A large effect on relieving stress and anxiety and a small-to-medium effect on reducing depression were observed. Subgroup analyses showed that features including mindfulness approaches, online courses, computer use, group interventions, and professional guidance were more favorable in the design of services. Meta-regression revealed that intervention duration only affected anxiety symptoms. Caution should be exercised, as some subgroups had fewer studies and higher heterogeneity. For the secondary outcomes, a large effect on emotional exhaustion and a small-to-medium effect on well-being were observed.

CONCLUSION

In general, e-mental health interventions significantly improve the psychological health of healthcare staff. Future high-quality, large-scale studies targeting healthcare professionals and specific intervention scenarios are warranted.

Web-Based Initiatives to Prevent Sexual Offense Perpetration: A Systematic Review

PURPOSE OF REVIEW

Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives.

RECENT FINDINGS

We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.

Healthiness as a Virtue: The Healthism of mHealth and the Challenges to Public Health

Mobile health (mHealth) technologies for self-monitoring health-relevant parameters such as heart frequency, sleeping patterns or exercise regimes aim at fostering healthy behavior change and increasing the individual users to promote and maintain their health. We argue that this aspect of mHealth supports healthism, the increasing shift from institutional responsibility for public health toward individual engagement in maintaining health as well as mitigating health risks. Moreover, this healthist paradigm leads to a shift from understanding health as the absence of illness to regarding health as the performance of certain rituals in order to project healthiness. By drawing from the analogy between healthiness and traditional virtues, we evaluate the promises made by proponents of mHealth technologies for self-monitoring. We argue that the implementation and use of mHealth risk entrenching existing inequalities and, more particularly, tend to exclude populations situated at the losing end of those inequalities from participating in the quasi-virtue of healthiness. Consequently, the implementation and use of mHealth technologies not only present challenges for social justice but also undermine their primary societal goal-to promote public health. Finally, we offer several suggestions on how to realize the potential benefit of mHealth.

Attending to the Mental Health of People Who Are Homeless by Mobile Telephone Follow-Up: A Systematic Review

BACKGROUND

More than 20% of the world's population has no decent or suitable home. People who are homeless have more health problems than the rest of the population, especially mental health-type problems. The main objective of this study was to identify follow-up interventions by using mobile telephones to improve the mental health of people who are homeless and to analyze their efficiency.

METHODS

To do so, a systematic review was carried out in the Web of Science, PubMed, Scopus, Ebscohost, and PsyInfo databases.

RESULTS

Studies conclude that mobile phone use is a suitable means to improve adherence to medication and the mental health of the homeless. However, significant attempts to demonstrate health benefits by means of reliable and valid instruments that supplement qualitative satisfaction and feedback instruments appear to be lacking.

CONCLUSIONS

The literature about mental health benefits through technology for people who are homeless is scarce and shows methodological limitations that can lead to failure when setting up methodologies in clinical practice.

Situating Meditation Apps Within the Ecosystem of Meditation Practice: Population-Based Survey Study

BACKGROUND

Meditation apps have the potential to increase access to evidence-based strategies to promote mental health. However, it is currently unclear how meditation apps are situated within the broader landscape of meditation practice and what factors may influence engagement with them.

OBJECTIVE

This study aimed to clarify the prevalence and correlates of meditation app use in a population-based sample of individuals with lifetime exposure to meditation in the United States. In addition, we sought to identify the concerns and desired features of meditation apps among those with lifetime exposure to meditation.

METHODS

A total of 953 participants completed an initial screening survey. Of these 953 participants, 434 (45.5%) reported lifetime exposure to meditation and completed a follow-up survey (434/470, 92.3% response rate) assessing their meditation app use, anxiety, depression, loneliness, initial motivation for meditation, and concerns about and desired features of meditation apps.

RESULTS

Almost half (434/953, 45.5%) of the participants who completed the screening survey reported lifetime exposure to meditation. Among those with lifetime exposure to meditation (ie, meditators), more than half (255/434, 58.8%) had used meditation apps at least once in their lives, and 21.7% (94/434) used meditation apps weekly or daily (ie, active users). Younger age, higher anxiety, and a mental health motivation for practicing meditation were associated with lifetime exposure to meditation apps. Among meditators, those with lifetime exposure to meditation apps were more likely to report concerns about apps, including concerns regarding the cost and effectiveness of apps, time required for use, technical issues with apps, and app user-friendliness. Meditators who used meditation apps weekly or daily (ie, active users) were younger, less likely to be men and non-Latinx White individuals and have lower income, and more likely to have an initial spiritual motivation for meditation. Active users reported more concerns regarding usability and technical problems and were less likely to report disinterest in apps. Headspace and Calm were the most frequently used apps. Tips and reminders for practice, encouragement of "mini" practices, and mental health content were the most desired features. Participants were less interested in social features (eg, the ability to communicate with other users or teachers).

CONCLUSIONS

Meditation apps are commonly used by meditators in the United States, with a higher use among certain demographic groups. Future studies may increase user engagement in meditation apps by addressing concerns (eg, cost and effectiveness) and incorporating desired features (eg, tips and reminders for practice).

A systematic review and meta-analysis of digital interventions targeted at individuals with borderline personality disorder (BPD), emotionally unstable personality disorder (EUPD), and related symptoms

OBJECTIVES

The present review investigates the impact of digital interventions for individuals with features of borderline personality disorder (BPD)/emotional unstable personality disorder (EUPD) as digital interventions show promise as therapeutic tools in underserved groups. BPD/EUPD features are identified as clinically relevant, yet previous reviews on the use of digital interventions fail to include subthreshold symptomatology.

METHODS

Five online databases were searched for terminology in three categories: BPD/EUPD and related symptoms, mental-health interventions, and digital technology. Additionally, four relevant journals and two trial registers were searched for additional papers meeting the inclusion criteria.

RESULTS

Twelve articles met all inclusion criteria. Meta-analyses revealed statistically significant differences in symptom measures between intervention and control groups at postintervention and decreases in BPD/EUPD symptomatology and well-being from pre- to postintervention. Service users' engagement, satisfaction, and acceptability of interventions were high. Results support the previous literature on the value of using digital interventions in populations with BPD/EUPD.

CONCLUSION

Overall, it was identified that digital interventions show promise for successful implementation with this population.