Enhancing Self-Efficacy for Help-Seeking Among Transition-Aged Youth in Postsecondary Settings With Mental Health and/or Substance Use Concerns, Using Crowd-Sourced Online and Mobile Technologies: The Thought Spot Protocol

Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes

Background

Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited.

Objective

This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes.

Methods

A qualitative study was conducted with 40 adolescents aged 13-19 years (mean age 15.8, SD 1.9 years; 18/40, 45% male; 22/40, 55% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50%), depression (15/40, 38%), and both (5/40, 13%). Of these, 10 (25%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests.

Results

The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16-19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13-15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95% CI 1.6-5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95% CI 1.7-5.6; P=.001). Usability challenges included complex navigation (20/40, 50%), interface design issues (12/40, 30%), and content overload (8/40, 20%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50%) and gamification features (10/40, 25%), while lack of personalization (14/40, 35%) and external distractions (18/40, 45%) were significant barriers. Mood improvement (15/40, 38%) and learning new coping skills (12/40, 30%) were the most reported outcomes.

Conclusions

The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement.

Protocol for a qualitative study exploring the pharmacist's role in supporting postsecondary students with psychotropic medication management

INTRODUCTION

Findings from the National College Health Assessment (2019) stated that anxiety and depression are the most prevalent diagnosed mental illnesses among Canadian postsecondary students with one-fifth of students self-reporting a lifetime diagnosis. Psychotropic medications can be an important component of a multifaceted approach to the management and treatment of mental illness and are the most commonly dispensed via community pharmacies. Community pharmacies provide an opportunity for pharmacists to have a prominent role in supporting patients' psychotropic medication management. However, there has been limited exploration of how pharmacists can address patients' psychotropic medication management needs, experiences and opportunities for improvements especially for emerging adults.

METHODS AND ANALYSIS

This qualitative study will incorporate Thorne's approach to interpretative description. Purposeful snowball sampling will be used to identify students (18-25 years) taking psychotropic medication(s) to manage their mental health. Participants will be interviewed one on one using a semistructured interview guide virtually. Inductive thematic analysis is underway with data analysis being iterative and reflexive using NVivo. Information provided from the interviews will be reviewed and summarised into key themes.

ETHICS AND DISSEMINATION

This study was approved by the University of Toronto Health Sciences Research Ethics Board (REB #43185). It is expected that there will be a very low risk for mild psychological and social harm for participants as they will have the ability to stop the interview at any time and will be aware of confidentiality. The results from this study will be used to create or adapt healthcare team services including the role of pharmacists within the healthcare ecosystem at the university and contribute to developing the next stage of research to evaluate feasibility and effectiveness of programmes at the university that help postsecondary students to manage psychotropic medication.

Substance Use Among Young Adult Survivors of Childhood Cancer With Cognitive Impairment: An Analysis of the Project Forward Cohort

PURPOSE

Young adult childhood cancer survivors (YACCSs) are often impacted by cancer-related cognitive impairment (CRCI) and psychological distress. Using the Project Forward Cohort, we evaluated the relationship between CRCI and substance use behaviors.

METHODS

YACCSs were surveyed between 2015 and 2018 (N = 1,106, female = 50.8%, Hispanic = 51.5%, median age = 25.5 years). Associations between CRCI and substance use (tobacco, binge drinking, marijuana, prescription drug misuse, and e-cigarette/vaporizer) were examined in multivariate logistic or log-binomial regressions, adjusting for child at diagnosis (0-14 years), years since diagnosis, sex, race/ethnicity, cancer type, and treatment intensity. Mediation analysis was performed to determine opportunities for interventions.

RESULTS

CRCI was reported by 144 (13.0%) survivors. The highest prevalence was observed in CNS cancers (25.4%) and leukemia (13.3%) survivors. After covariate adjustment, CRCI was associated with 2.26 times the odds of prior 30-day vaping (95% CI, 1.24 to 4.11; P = .007). Mediators with significant indirect effects in the CRCI-vaping relationship include depressive symptoms (Center for Epidemiological Studies Depression Scale) and having two or more cancer-related late effects (P < .05).

CONCLUSION

CRCI among YACCSs was associated with reports of vaping. Oncologists should screen for vaping behavior if CRCI is apparent. Increasing access to long-term follow-up clinics, addressing physical and mental health issues, and monitoring and educating on vaping and other substance use behaviors is recommended to improve the long-term health of YACCSs.

Predictors of Mental Health Literacy and Information Seeking Behavior Toward Mental Health Among University Students in Resource-Limited Settings

BACKGROUND

This paper investigated mental health literacy level and information seeking behavior, and mental health-related information sources in limited-resource settings, in the case of Ethiopian university students.

METHODS

A cross-sectional, self-administered web-based survey was conducted among Dilla University students, from 1 January to 29 February 2022, with a total of 780 respondents. We presented descriptive statistics using mean, standard deviations, and proportions. Bivariate and multivariate logistic regression were employed to identify factors associated with mental health literacy and information seeking behavior of students. Further, path analysis was also employed.

RESULTS

The result showed 71 (9.1%) respondents had a diagnosed history of mental illness. Overall, 397 (50.9%) respondents were identified as having adequate mental health literacy and 420 (53.8%) sought mental health information. In multivariate analysis, mental health literacy was significantly associated with: being female (AOR = 2.8; 95% CI (1.5-5.4)), higher digital health literacy (AOR=2.8; 95% CI (1.5-5.4), seeking mental health-related information (AOR=1.6; 95% CI: (1.1-2.5)), having family with mental illness, and students in health-related programs (AOR = 2.1; 95% CI (1.0-4.2)). Furthermore, health-related programs, level of mental health literacy, exposure to mental health problems in the family, and were associated with information seeking behavior regarding mental health. Further, path analysis revealed significant positive associations of information seeking behavior and digital health literacy with mental health literacy.

CONCLUSION

The result indicated the status of university students' mental health literacy level and information seeking behavior were low and inadequate. This study suggests the need to improve students' digital health competencies by designing mental health literacy programs by collaboration of different stakeholders, and mental health literacy programs need to optimize access to internet and online resources in the university settings.

Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study

BACKGROUND

The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually.

OBJECTIVE

Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology.

METHODS

Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19-related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses.

RESULTS

In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend.

CONCLUSIONS

This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support.

Online mental health interventions designed for students in higher education: A user-centered perspective

BACKGROUND

Digital mental health interventions have been posited as a way of reducing the burden on mental health services in higher education institutions. However, low adherence and high attrition rates present a challenge that limits the effectiveness of these interventions. User-centered design has been proposed as a suitable approach in improving the adherence of users to these interventions.

OBJECTIVE

The objective of this scoping review was to examine digital mental health interventions that have been designed specifically for students in higher education. It aimed to summarize the published literature on digital mental health interventions which take a user-centered approach in developing interventions for students in higher education.

METHODS

A scoping review of peer-reviewed research papers from the following electronic databases was conducted: Embase, ACM digital library, Web of Science, IEEE Explore, SCOPUS, EBSCO Host (including APA PyscInfo, CINAHL PLUS, APA PsycArticles, Medline), PubMed and Google Scholar. Databases were searched from inception until 13 Jan and 14 Jan 2021. Of the 755 articles that were identified, 57 articles were selected for full review. 34 articles were excluded for not matching the inclusion criteria.

RESULTS

23 studies were included in this review. The included interventions targeted various areas of mental health including depression, anxiety, overall wellbeing, and mental health awareness. The interventions were commonly delivered through mobile apps, web-based apps, and desktop apps. In addition, we explore design methodologies applied in the development of the interventions: we note significant stakeholder engagement in the studies, the inclusion of multiple stakeholder types (students, health care professionals, university staff, and young people in the general population), and limited use of design frameworks. Finally, in exploring user engagement, attrition rates and user acceptance, we find that most of the studies have not progressed enough (i.e., at pilot/prototype stages of development) to determine the impact of design methodologies on the success of these interventions.

CONCLUSION

Our review revealed a need for further research on the impact of user-centered design practices on the success of digital mental health interventions in this population. Further, we provide recommendations that researchers/designers in this field of research should take into consideration when designing online mental health interventions for students in higher education. Some of the recommendations include: add personalization; improve user interfaces; take adequate steps to ensure anonymity/privacy/security; include peer engagement; and include access to mental health professionals.

Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience

BACKGROUND

There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students.

OBJECTIVE

This study focuses on understanding postsecondary students' attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience.

METHODS

Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants' overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts.

RESULTS

User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time.

CONCLUSIONS

Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/resprot.6446.

Assessing the usability and user engagement of Thought Spot - A digital mental health help-seeking solution for transition-aged youth

OBJECTIVE

To evaluate the perceived usability of and user engagement with a digital platform (Thought Spot) designed to enhance mental health and wellness help-seeking among transition-aged youth (TAY; 17-29-years old).

MATERIALS AND METHODS

Survey responses and usage patterns were collected as part of a randomized controlled trial evaluating the efficacy of Thought Spot. Participants given Thought Spot completed an adapted Usefulness, Satisfaction, and Ease of Use (USE) Questionnaire to measure perceived usability of the platform. User engagement patterns on Thought Spot were examined using analytics data collected throughout the study (March 2018-June 2019).

RESULTS

A total of 131 transition-aged participants completed the USE questionnaire and logged on to Thought Spot at least once. Ease of learning scored higher than ease of use, usefulness and satisfaction. Participants identified numerous strengths and challenges related to usability, visual appeal, functionality and usefulness of the content. In terms of user engagement, most participants stopped using the platform after 3 weeks. Participants searched and were interested in a variety of resources, including mental health, counselling and social services.

DISCUSSION

Participants reported mixed experiences while using Thought Spot and exhibited low levels of long-term user engagement. User satisfaction, the willingness to recommend Thought Spot to others, and the willingness for future use appeared to be influenced by content relevance, ease of learning, available features, and other contextual factors. Analysis of the types of resources viewed and searches conducted by TAY end-users provided insight into their behaviour and needs.

CONCLUSION

Users had mixed perceptions about the usability of Thought Spot, which may have contributed to the high attrition rate. User satisfaction and engagement appears to be influenced by content relevance, ease of learning, and the types of features available. Further investigation to understand the contextual factors that affect TAYs' adoption and engagement with digital mental health tools is required.

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial

Background

Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.

Objective

The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.

Methods

A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.

Results

A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).

Conclusions

Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.

Trial Registration

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.6446

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial

Background

Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.

Objective

The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.

Methods

A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.

Results

A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F_2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F_2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).

Conclusions

Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.

Trial Registration

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.6446

Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study

Background

Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help.

Objective

The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada.

Methods

A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes.

Results

Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help.

Conclusions

Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth.

Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review

BACKGROUND

Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions.

OBJECTIVE

This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years).

METHODS

A scoping review was conducted using the Arksey and O'Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis.

RESULTS

Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected.

CONCLUSIONS

This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.

What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review

BACKGROUND

Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap.

METHODS

Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10-19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis.

RESULTS

Ninety studies meet the inclusion criteria for this review for barrier and facilitators (n = 54) and interventions (n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements.

CONCLUSION

Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.

Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial

BACKGROUND

Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report.

OBJECTIVE

The study aimed to investigate the effect of Link on young people's positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions.

METHODS

Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ).

RESULTS

In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention.

CONCLUSIONS

The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further.

CLINICAL TRIAL

Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731.

E-mental health: Promising advancements in policy, research, and practice

The increasing need for mental health services in the population is posing significant challenges for the health system. It is therefore important to identify new approaches to delivering care that are sustainable and scalable in terms of reach and impact. E-mental health is one approach that shows promise in addressing the treatment gap in mental healthcare. E-mental health involves leveraging the Internet and related technologies such as smartphone apps, web sites, and social media to deliver mental health services. Over the past decade, this field has made significant advancements in Canada and internationally. In this article, the author introduces the e-mental health field and provides an overview of promising Canadian developments in relation to policy, research, and practice. In addition, the article discusses some of the challenges facing the wide-scale implementation of e-mental health and identifies priority areas of focus for health leaders to advance the field.

A Web- and Mobile-Based Map of Mental Health Resources for Postsecondary Students (Thought Spot): Protocol for an Economic Evaluation

Background

Youth demonstrate a low propensity to seek help for mental health issues and exhibit low use of health services despite the high prevalence of mental health challenges in this population. Research has found that delivering interventions via the internet and mobile devices is an effective way to reach youth. Thought Spot, a Web- and mobile-based map, was developed to help transition-aged youth in postsecondary settings overcome barriers to help-seeking, thereby reducing the economic burden associated with untreated mental health issues.

Objective

This paper presents the protocol for an economic evaluation that will be conducted in conjunction with a randomized controlled trial (RCT) to evaluate the effectiveness and cost of Thought Spot compared with usual care in terms of self-efficacy for mental health help-seeking among postsecondary students.

Methods

A partially blinded RCT will be conducted to assess the impact of Thought Spot on the self-efficacy of students for mental health help-seeking. Students from 3 postsecondary institutions in Ontario, Canada will be randomly allocated to 1 of 2 intervention groups (resource pamphlet or Thought Spot) for 6 months. The economic evaluation will focus on the perspective of postsecondary institutions or other organizations interested in using Thought Spot. Costs and resources for operating and maintaining the platform will be reported and compared with the costs and resource needs associated with usual care. The primary outcome will be change in help-seeking intentions, measured using the General Help-Seeking Questionnaire. The cost-effectiveness of the intervention will be determined by calculating the incremental cost-effectiveness ratio, which will then be compared with willingness to pay.

Results

The RCT is scheduled to begin in February 2018 and will run for 6 months, after which the economic evaluation will be completed.

Conclusions

We expect to demonstrate that Thought Spot is a cost-effective way to improve help-seeking intentions and encourage help-seeking behavior among postsecondary students. The findings of this study will help inform postsecondary institutions when they are allocating resources for mental health initiatives.

Trial Registration

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 (Archived at WebCite at http://www.webcitation.org/6xy5lWpnZ)

The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research

BACKGROUND

Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings.

OBJECTIVE

The aim of this study was to describe the process of engaging with postsecondary students through the PDR approaches, with the ultimate goal of optimizing the Thought Spot platform.

METHODS

Consistent with the PDR approaches, five student-led workshops, attended by 41 individuals, were facilitated to obtain feedback regarding the platform's usability and functionality and its potential value in a postsecondary setting. Various creative engagement activities were delivered to gather experiences and opinions, including semistructured focus groups, questionnaires, personas, journey mapping, and a world café. Innovative technological features and refinements were also brainstormed during the workshops.

RESULTS

By using PDR methods of engagement, participants knew that their ideas and recommendations would be applied. There was also an overall sense of respect and care integrated into each group, which facilitated an exchange of ideas and suggestions.

CONCLUSIONS

The process of engaging with students to redesign the Thought Spot platform through PDR has been effective. Findings from these workshops will significantly inform new technological features within the app to enable positive help-seeking behaviors among students. These behaviors will be further explored in the second phase that involves a randomized controlled trial.