Evaluation of the Use of Digital Mental Health Platforms and Interventions: Scoping Review

Users' positive attitudes, perceived usefulness, and intentions to use digital mental health interventions: A systematic literature review and meta-analysis

BACKGROUND

Digital Mental Health Interventions (DMHIs) hold significant potential in addressing gaps in mental health treatment, enhancing mental health literacy, and mitigating associated stigma. However, DMHIs have not been systematically evaluated in terms of potential users' attitudes, perceived usefulness, and intentions to use. Thus, this study aims to consolidate evidence to ascertain users' attitudes, perceived usefulness, and intentions to utilize DMHIs.

METHODS

The meta-analysis reports adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search of databases: Medline, CINHAL, PsycINFO, SCOPUS, and Web of Science, was conducted. As part of the screening process, Covidence database management software was used. Metaprop command was used to calculate the outcome using a random-effects model. Heterogeneity was assessed using Cochrane chi-square (χ2) and the index of heterogeneity (I2 statistics) test. Sensitivity test and subgroup analysis were performed. Publication bias was examined by funnel plots and Egger's test.

RESULTS

In total, 26 studies were analyzed, including data from 13,923 participants. The overall percentage of users' positive attitudes, perceived usefulness, and intentions to use DHMIs was 0.66 (95 % CI; 0.52, 0.79), 0.73 (95 % CI; 0.64, 0.81), and 0.67 (95 % CI; 0.6, 0.74), respectively. Significant heterogeneity was observed; nonetheless, sensitivity analyses indicated that none of the included individual studies exerted undue influence on the overall pooled prevalence. Assessment of funnel plots and Egger's test (p ≤ 0.895) showed no evidence of publication bias.

CONCLUSION

The results of this meta-analysis indicate that, overall, two-thirds of participants have a positive attitude toward DMHIs, around three-quarters find DMHIs useful, and around two-thirds intend to use them. The findings suggest the need to target users' positive attitudes, perceived utility, and willingness for the improved adoption and sustained use of DMHIs.

Facilitators and Barriers to Digital Mental Health Interventions for Depression, Anxiety, and Stress in Adolescents and Young Adults: Scoping Review

BACKGROUND

Digital mental health interventions (DMHIs) offer unique strengths as emerging services with practical applications for adolescents and young adults (AYAs) experiencing depression, anxiety, and stress. Although promising, acceptance and participation in DMHIs vary across interventions, participants, and contexts. It is essential to delineate and synthesize the factors that promote or hinder DMHI use.

OBJECTIVE

This review aims to assess and synthesize the facilitators and barriers to accessing DMHIs for depression, anxiety, and stress in AYAs through a scoping review.

METHODS

A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, PsycINFO, CNKI, OpenGrey, and APA PsycExtra, up to October 31, 2023. Articles examining facilitators and barriers to DMHIs among AYAs with disorders or symptoms of depression, anxiety, and stress were included. Data synthesis and analysis involved quality assessment, thematic analysis, and relative frequency meta-analysis.

RESULTS

A total of 27 records met the eligibility criteria, and 14 facilitators and 13 barriers were identified across the external, intervention, and individual levels. The relative frequency meta-analysis indicated that factors influencing AYAs' use of DMHIs varied based on delivery modes. Among these factors, "quality and effect" emerged as the predominant theme-high quality and effect served as the primary facilitator, while low quality and effect acted as a barrier across both portable and nonportable devices, as well as single and multiple platforms.

CONCLUSIONS

The uptake of DMHIs among AYAs is influenced by a complex interplay of facilitators and barriers, particularly those related to quality and effect. Our syntheses provide crucial guidance for intervention designers, emphasizing the importance of user-centered approaches that balance scientific rigor with engaging and adaptive features. Enhancing the alignment of DMHIs with adolescent needs can improve both adoption and real-world mental health impact.

TRIAL REGISTRATION

PROSPERO CRD42023479880; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023479880.

Leveraging Digital Technology to Enhance Mind-Body Approaches in Cancer Treatment

PURPOSE

Cancer treatment involves significant psychological and emotional challenges. Conventional therapies often diminish quality of life, exacerbating stress, anxiety, and depression. Mind-body practices, such as sophrology, offer complementary solutions to improve well-being. Digital technology has expanded access to these practices, providing personalized tools to manage stress and emotional health remotely.

MATERIALS AND METHODS

This review examines digital applications in cancer care, focusing on sophrology and other mind-body techniques. Studies evaluating the efficacy of digital platforms and artificial intelligence-driven interventions for stress management, fatigue reduction, and psychological support are analyzed, highlighting their impact on patient outcomes.

RESULTS

Digital platforms integrating sophrology significantly alleviate cancer-related side effects. The ePAL app reduced pain scores by 30% over 8 weeks, and StressProffen improved fatigue scores by 20% and adherence to stress management (75% v 50% in controls). The PINK! app increased physical activity by 35% and reduced psychological distress by 30% over 12 weeks. During the COVID-19 pandemic, internet-based mindfulness programs reduced anxiety by 18% and depression by 22%. These tools enhance autonomy and promote community support through virtual sessions, reducing isolation.

CONCLUSION

Digital technology complements traditional cancer treatments, improving patient access, personalization, and adherence. Challenges such as digital literacy, data privacy, and regulatory oversight must be addressed. These tools provide holistic support and foster resilience, enhancing the cancer care continuum.

Predicting clinical improvement in youth using a national-scale multicomponent digital mental health intervention

INTRODUCTION

Youth mental health services are characterised by high demand and modest clinical outcomes. While digital mental health interventions (DMHIs) have been shown to be clinically effective, the relationship between DMHI use and outcome is unclear. The current study sought to identify the factors affecting the relationship between DMHI use and depression and anxiety symptom improvement in sub-groups of young people.

METHOD

An observational cohort design included young people aged 12-25 years engaging with a DMHI (MOST) from October 2020 to October 2023. The primary outcome was improvement at 12 weeks on the Patient Health Questionnaire-4 (PHQ4). DMHIs were combinations of self-paced digital cognitive-behavioural therapy content, social network interactions, and professional support. A machine learning clustering algorithm was used to identify distinct user clusters based on baseline characteristics and multiple logistic regression models examined the relationship between DMHI usage and improvement.

RESULTS

Two distinct user clusters emerged, differing by symptom severity, age, service setting, and concurrent external treatment. 46.7% of "Severe" users and 39.8% of "Mild-Moderate" users significantly improved. Greater use of therapy content and professional support interactions were associated with improvement for the Mild-Moderate group only (OR = 1.16, 95% CI: 1.04-1.30, p = 0.008).

CONCLUSION

While a greater proportion of users in the Severe group significantly improved, increased MOST use was associated with symptom improvement only for the Mild-Moderate group. These findings highlight the complexity of the relationship between DMHI use and outcome. Other unmeasured mediating or moderating factors such concurrent 'offline' treatment may help explain the results. Further research is required to better understand the relationship between DMHI use and clinical outcomes.

A national evaluation of a multi-modal, blended, digital intervention integrated within Australian youth mental health services

BACKGROUND

Youth mental health (YMH) services have been established internationally to provide timely, age-appropriate, mental health treatment and improve long-term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time-bound support. To bridge this gap, MOST was developed as a scalable, blended, multi-modal digital platform integrating real-time and asynchronous clinician-delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth-focused online community. The implementation of MOST within Australian YMH services has been publicly funded.

OBJECTIVE

The primary aim of this study was to evaluate the real-world engagement, outcomes, and experience of MOST during the first 32 months of implementation.

METHOD

Young people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing.

RESULTS

Five thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35-0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement.

CONCLUSIONS

MOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.

Exploring the psychological effects of war on indirectly affected groups: a cross-sectional study on residents of Jordan

The Gaza War has significantly escalated conflict and humanitarian crises in the Gaza Strip, causing profound human suffering and psychological impact. This study investigates the mental health of residents of Jordan, examining anxiety and depression levels, sociodemographic factors, and resilience mechanisms to understand the psychological resilience of communities facing conflict-related stressors. This cross-sectional study used a convenience sampling method to collect data from Jordanian residents over 18 years of age. An online questionnaire shared on social media platforms was used, the Patient Health Questionnaire-4 (PHQ-4) was used to measure anxiety and depression, the Perceived Stress Scale (PSS) 4-item questionnaire was used to measure perceived stress, and the Brief Resilience Scale was used to measure population resilience. A total of 1,664 participants were included in the study. The mean stress score was reported as 8.72 (SD +/-2.342). Stress, anxiety, and depression were significantly associated with age and sex, with younger populations and female participants reporting higher stress scores. Among the sample, 65.0% of individuals displayed both anxiety and depression indicators, with 25.9% exhibiting severe, 66.4% exhibiting moderate and 33.6% exhibiting mild level. A comprehensive, multi-institutional approach is needed to increase awareness and screening of mental health conditions.

A mobile intervention to reduce anxiety among university students, faculty, and staff: Mixed methods study on users' experiences

Anxiety is highly prevalent among college communities, with significant numbers of students, faculty, and staff experiencing severe anxiety symptoms. Digital mental health interventions (DMHIs), including Cognitive Bias Modification for Interpretation (CBM-I), offer promising solutions to enhance access to mental health care, yet there is a critical need to evaluate user experience and acceptability of DMHIs. CBM-I training targets cognitive biases in threat perception, aiming to increase cognitive flexibility by reducing rigid negative thought patterns and encouraging more benign interpretations of ambiguous situations. This study used questionnaire and interview data to gather feedback from users of a mobile application called "Hoos Think Calmly" (HTC), which offers brief CBM-I training doses in response to stressors commonly experienced by students, faculty, and staff at a large public university. Mixed methods were used for triangulation to enhance the validity of the findings. Qualitative data was collected through semi-structured interviews from a subset of participants (n = 22) and analyzed thematically using an inductive framework, revealing five main themes: Effectiveness of the Training Program; Feedback on Training Sessions; Barriers to Using the App; Use Patterns; and Suggestions for Improvement. Additionally, biweekly user experience questionnaires sent to all participants in the active treatment condition (n = 134) during the parent trial showed the most commonly endorsed response (by 43.30% of participants) was that the program was somewhat helpful in reducing or managing their anxiety or stress. There was overall agreement between the quantitative and qualitative findings, indicating that graduate students found it the most effective and relatable, with results being moderately positive but somewhat more mixed for undergraduate students and staff, and least positive for faculty. Findings point to clear avenues to enhance the relatability and acceptability of DMHIs across diverse demographics through increased customization and personalization, which may help guide development of future DMHIs.

Getting help early: An online mental health self-assessment tool for young people

BACKGROUND

Online self-assessments are becoming more popular. They can serve as a screening tool for specific conditions or assess mental health more broadly but often lack in depth evaluation.

METHODS

This study presents preliminary data from an online self-assessment tool for young people within the age range of 12-30 years (Link: redcap.hmri.org.au/surveys/?s = MK7RCELJ79). It covers key symptoms of mood and psychotic disorders and risk factors, such as eating issues, substance use, suicidality, and deliberate self-harming behaviours. Participants self-assessed their level of functioning, access to ongoing interventions, and satisfaction with the help received. Based on the severity of mental health problems and the level of risk, different recommendations of how to seek help were provided.

RESULTS

Out of 303, 114 participants gave permission to analyse their data. A high-risk profile was defined by anxiety symptoms, panic attacks, suicidal ideation, and urges to self-harm. These individuals were more likely to report psychotic or depression symptoms, recreational substance use and low day-to-day functioning. Ongoing treatment and the satisfaction with it were not determined by the severity of symptoms.

CONCLUSIONS

These preliminary results suggest that the online self-assessment tool reaches the intended young audience, particularly those with some degree of mental health problems.

Econometric analysis of consumers' preference heterogeneity for yoghurt and ice cream products in Tanzania: A latent class model and mixed logit model

In Tanzania, a growing upper and middle classes, particularly among urbanites, exhibit distinct preferences for higher-quality processed foods, including dairy products. This study examines variations in consumer preferences and their willingness to pay for yogurt and ice cream, which serve as stand-ins for processed milk products. The analysis is based on a discrete choice experiment involving 400 participants in Dar es Salaam. A random parameter logit model was utilized to account for preference heterogeneity, while latent class models (LCMs) were applied to uncover the underlying factors driving these differences in preferences. Our findings reveal three distinct consumer classes: processed milk sceptics (who prefer unprocessed dairy products), processed milk advocates (who prefer processed products), and neutral consumers (indifferent between processed and unprocessed milk). Preferences are influenced by product attributes, socioeconomic characteristics, and attitudes towards processed foods. The results indicate that Tanzanian consumers place the greatest value on sensory attributes, packaging, and the product's origin (local versus imported). This research offers fresh perspectives on the intricate preferences of dairy consumers in Tanzania, a topic that has been relatively underexplored. The findings suggest that producers and marketers must adapt to the dynamic market by balancing intrinsic and extrinsic factors against price. Understanding consumers' socioeconomic and product attributes is essential for increasing market share and effectively segmenting markets. These findings would be useful incorporated into strategic planning to enhance the competitiveness and sustainability of Tanzania's dairy industry.

Predictors of adherence to a publicly available self-guided digital mental health intervention

Low adherence to self-guided digital mental health interventions (DMHIs) have raised concerns about their real-world effectiveness. Naturalistic data from self-guided DMHIs are often not available, hindering our ability to assess adherence among real-world users. This study aimed to analyze 3 years of user data from the public launch of an empirically supported 12-session self-guided DMHI, to assess overall program adherence rates and explore predictors of adherence. Data from 984 registered users were analyzed. Results showed that only 14.8% of users completed all 12 modules and 68.6% completed less than half of the modules. Users who were younger, had milder depression, had never seen a mental health provider, and who rejected signing-up for weekly program emails completed significantly more modules. Results add to concerns about the generalizability of controlled research on DMHIs due to lower adherence outside of research trials. This study highlights the potential of user data in identifying key factors that may be related to adherence. By examining adherence patterns among different sub-sets of users, we can pinpoint and focus on individuals who may adhere and benefit more from self-guided programs. Findings could also have implications for guiding intervention personalization for individuals who struggle to complete DMHIs.

Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review

BACKGROUND

Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems.

OBJECTIVE

This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths.

METHODS

The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted.

RESULTS

The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education.

CONCLUSIONS

The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents' resilience skills.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58681.

A Scoping Review of Digital-Based Intervention for Reducing Risk of Suicide Among Adults

Suicide is a serious public health problem, especially among adults. Risk factors for suicide include the presence of mental health disorders, history of previous suicide attempts; substance or alcohol use and lack of social support. The impact of suicide risk includes psychological loss, as well as the trauma and emotional stress that can be felt by the families and communities left behind. Digital interventions have emerged as a promising alternative for suicide risk prevention. Previous research has focused on the findings of various designs, which did not provide clear intervention information to inform the implementation of the intervention. This study aims to describe a digital intervention to reduce the risk of suicidal behavior in adults. The design used in this study was a scoping review. The authors conducted a literature search from the Scopus, PubMed, and CINAHL databases. Inclusion criteria in this study were articles discussing digital interventions aimed at preventing suicide risk in adult populations, English language, full-text, RCT or quasi-experiment design, and publication period of the last 10 years (2014-2024). The major keywords used in the article search were suicide prevention, digital intervention, and adults. Data extraction used manual table and data analysis used descriptive qualitative with a content approach. The results showed that there were 9 articles that discussed digital-based interventions to reduce suicide risk in adults. The various types of digital interventions used were smartphone apps, online learning modules, and game-based interventions. These interventions offer significant potential in reducing the risk of suicidal behavior in adults. Digital interventions have an important role in reducing the risk of suicidal behavior in adults by considering aspects of suitability to individual needs and understanding digital literacy. Then, the development of mental health services and public health policies presented needs to be done with collaboration between stakeholders in suicide prevention efforts.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes

Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25 years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12-25 years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia's leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided. Five relevant online databases were searched for articles published from 2018 to 2023, yielding 22,482 articles for screening and 22 studies were included in the present analysis. User experience outcomes relating to satisfaction and engagement were assessed for each included intervention, with experience indicators relating to usefulness, usability, value, credibility, and desirability being examined. Elements associated with positive/negative outcomes were extracted. Elements shown to positively influence user experience included peer engagement, modern app-based delivery, asynchronous support, and personalized content. In contrast, users disliked static content, homework/log-keeping, the requirement for multiple devices, and social media integration. Asynchronous interventions showed high satisfaction but faced engagement issues, with combined asynchronous/synchronous interventions reporting better completion rates. DMHIs offer a promising platform for youth mental health support and has the potential to dramatically increase the reach of interventions through the adoption of technological and user experience best practices. While young people respond positively to many aspects of intervention modernization, such as interactive, app-based design, other concepts, such as social media integration, they need to be adopted by the field more cautiously to ensure trust and engagement.Trial Registration CRD42023405812.

What are practitioners' views of how digital health interventions may play a role in online child sexual abuse service delivery?

Introduction

Online child sexual abuse (OCSA) affects considerable numbers of children globally and is associated with a variety of mental health problems. Existing practitioner studies suggest that young people are infrequently asked about online abuse and practitioners have a fragmented understanding of the problems experienced or how they might approach them. There are very few evidence-based interventions that guide clinical assessment or practice. Digital Health Interventions (DHIs) have the potential to be an effective option where children and young people's services are challenged, including accessibility and anonymity. The aim of this study was to explore mental health practitioners' views of how DHIs may play a role in supporting young people who have experienced OCSA, and the role they can play in healthcare delivery.

Method

In-depth qualitative interviews and one focus group were conducted with 25 child mental health professionals across two sites (Manchester and Edinburgh). Data was analyzed using reflexive thematic analysis.

Results

Three overarching themes and 9 sub-themes were identified: (1) feeling a little bit lost; (2) seeing potential problems; and (3) knowing what works. Practitioners expressed interest in a DHI to support this client group and saw it as a way of managing waiting lists and complementing existing therapies. They felt that many young people would see this as a preferred medium to in-person therapy, would be empowering, and offers new ways of learning how to stay safe online. However, there were concerns about how much time would be needed by staff to deliver a DHI, anxieties about safety issues in relation to content and data protection, some of which may be unique to this population of young people, and concerns about the absence of a therapeutic relationship with vulnerable children.

Discussion

Our findings indicated that practitioners were uncertain about working with children subjected to OCSA but were receptive to the possibility of using a DHI to support their practice and to reduce waiting lists. Concerns were expressed about the time needed for staff training and support as well as concerns over patient safety and the lack of evidence about the effectiveness of an unsupported DHI.

[Digital technologies to improve mental health]

The burden of mental diseases is enormous and constantly growing worldwide. The resulting increase in demand for psychosocial help is also having a negative impact on waiting times for psychotherapy in Germany. Digital interventions for mental health, such as interventions delivered through or with the help of a website (e.g. "telehealth"), smartphone, or tablet app-based interventions and interventions that use text messages or virtual reality, can help. This article begins with an overview of the functions and range of applications of digital technologies for mental health. The evidence for individual digital forms of interventions is addressed. Overall, it is shown that digital interventions for mental health are likely to be cost-effective compared to no therapy or a non-therapeutic control group. Newer approaches such as "digital phenotyping" are explained in the article. Finally, individual papers from the "Leibniz ScienceCampus Digital Public Health" are presented, and limitations and challenges of technologies for mental health are discussed.

What digital health technology types are used in mental health prevention and intervention? Review of systematic reviews for systematization of technologies

Digital health technology has been widely applied to mental health interventions worldwide. Using digital phenotyping to identify an individual's mental health status has become particularly important. However, many technologies other than digital phenotyping are expected to become more prevalent in the future. The systematization of these technologies is necessary to accurately identify trends in mental health interventions. However, no consensus on the technical classification of digital health technologies for mental health interventions has emerged. Thus, we conducted a review of systematic review articles on the application of digital health technologies in mental health while attempting to systematize the technology using the Delphi method. To identify technologies used in digital phenotyping and other digital technologies, we included 4 systematic review articles that met the inclusion criteria, and an additional 8 review articles, using a snowballing approach, were incorporated into the comprehensive review. Based on the review results, experts from various disciplines participated in the Delphi process and agreed on the following 11 technical categories for mental health interventions: heart rate estimation, exercise or physical activity, sleep estimation, contactless heart rate/pulse wave estimation, voice and emotion analysis, self-care/cognitive behavioral therapy/mindfulness, dietary management, psychological safety, communication robots, avatar/metaverse devices, and brain wave devices. The categories we defined intentionally included technologies that are expected to become widely used in the future. Therefore, we believe these 11 categories are socially implementable and useful for mental health interventions.

Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs

This review summarizes the effectiveness of scalable mind-body internet and mobile-based interventions (IMIs) on depression and anxiety symptoms in adults living with chronic physical conditions. Six databases (MEDLINE, PsycINFO, SCOPUS, EMBASE, CINAHL, and CENTRAL) were searched for randomized controlled trials published from database inception to March 2023. Mind-body IMIs included cognitive behavioral therapy, breathwork, meditation, mindfulness, yoga or Tai-chi. To focus on interventions with a greater potential for scale, the intervention delivery needed to be online with no or limited facilitation by study personnel. The primary outcome was mean change scores for anxiety and depression (Hedges' g). In subgroup analyses, random-effects models were used to calculate pooled effect size estimates based on personnel support level, intervention techniques, chronic physical condition, and survey type. Meta-regression was conducted on age and intervention length. Fifty-six studies met inclusion criteria (sample size 7691, mean age of participants 43 years, 58% female): 30% (n = 17) neurological conditions, 12% (n = 7) cardiovascular conditions, 11% cancer (n = 6), 43% other chronic physical conditions (n = 24), and 4% (n = 2) multiple chronic conditions. Mind-body IMIs demonstrated statistically significant pooled reductions in depression (SMD = -0.33 [-0.40, -0.26], p<0.001) and anxiety (SMD = -0.26 [-0.36, -0.17], p<0.001). Heterogeneity was moderate. Scalable mind-body IMIs hold promise as interventions for managing anxiety and depression symptoms in adults with chronic physical conditions without differences seen with age or intervention length. While modest, the effect sizes are comparable to those seen with pharmacological therapy. The field would benefit from detailed reporting of participant demographics including those related to technological proficiency, as well as further evaluation of non-CBT interventions. Registration: The study is registered with PROSPERO ID #CRD42022375606.

Critical design decisions and user demographics in enhancing real-time digital mental health interventions: A systematic review

Background

Real-time digital mental health interventions, primarily enabled by smartphone technology offer continuous, personalised support, that adapts in response to the changing needs of individuals. Despite being prominently explored in populations with psychiatric disorders, there remains a notable gap in the systematic analysis of demographic characteristics, as well as the foundational design decisions or rules that underpin the personalisation of these interventions.

Objectives

(a) Identifying the prevalent design decisions to enable personalisation within real-time digital mental health interventions, (b) the influence of these design decisions on the clinical outcomes of the interventions, and (c) the demographic characteristics of populations with psychiatric disorders targeted by real-time digital health interventions.

Methods

Following PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, a systematic literature review was conducted of peer-reviewed literature focusing on real-time digital interventions in populations with clinically diagnosed psychiatric disorders. We undertook a narrative synthesis to derive the demographics and personalisation design decisions of the interventions and conducted a pooled meta-analysis to evaluate clinical outcomes.

Results

Interventions predominantly targeted female and Caucasian demographics, yielding modest clinical improvements. Our analysis identified nine critical personalisation design decisions concerning measurement, intervention, and interactions with health professional with varying influence on clinical outcomes.

Conclusion

Understanding the complex nuances of design decisions that shape real-time digital health interventions, as well as identifying which patient demographics benefit most, is fundamental for their effective clinical impact and safe use.

Prospero Registration

PROSPERO CRD42020161663.

The intersection of technology and mental health: enhancing access and care

In recent times, technology has increasingly become a central force in shaping the landscape of mental health care. The integration of various technological advancements, such as teletherapy, virtual care platforms, mental health apps, and wearable devices, holds great promise in improving access to mental health services and enhancing overall care. Technology's impact on mental health care is multi-faceted. Teletherapy and virtual care have brought about a revolution in service delivery, eliminating geographical barriers and offering individuals convenient and flexible access to therapy. Mobile mental health apps empower users to monitor their emotional well-being, practice mindfulness, and access self-help resources on the move. Furthermore, wearable devices equipped with biometric data can provide valuable insights into stress levels and sleep patterns, potentially serving as valuable indicators of mental health status. However, integrating technology into mental health care comes with several challenges and ethical considerations. Bridging the digital divide is a concern, as not everyone has equal access to technology or the necessary digital literacy. Ensuring privacy and data security is crucial to safeguard sensitive client information. The rapid proliferation of mental health apps calls for careful assessment and regulation to promote evidence-based practices and ensure the delivery of quality interventions. Looking ahead, it is vital to consider future implications and adopt relevant recommendations to fully harness technology's potential in mental health care. Continuous research is essential to evaluate the efficacy and safety of digital interventions, fostering collaboration between researchers, mental health professionals, and technology developers. Proper training on ethical technology utilization is necessary for mental health practitioners to maintain therapeutic boundaries while leveraging technological advancements responsibly.

Patterns of engagement in a digital mental health service during COVID-19: a cohort study for children and young people

Introduction

The COVID-19 pandemic increased public use of digital mental health technologies. However, little is known about changes in user engagement with these platforms during the pandemic. This study aims to assess engagement changes with a digital mental healthcare service during COVID-19.

Methods

A cohort study based on routinely collected service usage data from a digital mental health support service in the United Kingdom. Returning users aged 14-25 years that interacted for a maximum of two months were included. The study population was divided into pre-COVID and COVID cohorts. Demographic and usage information between cohorts were compared and usage clusters were identified within each cohort. Differences were tested using Chi-squared, two-sample Kolmogorov-Smirnov tests and logit regressions.

Results

Of the 624,103 users who joined the service between May 1, 2019, and October 1, 2021, 18,889 (32.81%) met the inclusion criteria: 5,048 in the pre-COVID cohort and 13,841 in the COVID cohort. The COVID cohort wrote more journals; maintained the same focus on messaging practitioners, posting discussions, commenting on posts, and having booked chats; and engaged less in writing journals, setting personal goals, posting articles, and having ad-hoc chats. Four usage profiles were identified in both cohorts: one relatively disengaged, one focused on contacting practitioners through chats/messages, and two broadly interested in writing discussions and comments within the digital community. Despite their broad similarities, usage patterns also exhibited differences between cohorts. For example, all four clusters had over 70% of users attempting to have ad-hoc chats with practitioners in the pre-COVID cohort, compared to one out of four clusters in the COVID cohort. Overall, engagement change patterns during the COVID-19 pandemic were not equal across clusters. Sensitivity analysis revealed varying strength of these defined clusters.

Discussion

Our study identified changes in user activity and engagement behavior within a digital mental healthcare service during the COVID-19 pandemic. These findings suggest that usage patterns within digital mental health services may be susceptible to change in response to external events such as a pandemic. Continuous monitoring of engagement patterns is important for informed design and personalized interventions.

Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses

BACKGROUND

Digital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts.

OBJECTIVE

This paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors.

METHODS

This study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework.

RESULTS

On the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate.

CONCLUSIONS

The successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor).