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Baffsky R, Ivers R, Cullen P, Batterham PJ, Toumbourou J, Calear AL, Werner-Seidler A, McGillivray L, Torok M. A cluster randomised effectiveness-implementation trial of an intervention to increase the adoption of PAX Good Behaviour Game, a mental health prevention program, in Australian primary schools: Study protocol. Contemp Clin Trials Commun 2022; 28:100923. [PMID: 35669488 PMCID: PMC9163694 DOI: 10.1016/j.conctc.2022.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/08/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rachel Baffsky
- School of Population Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
- Corresponding author.
| | - Rebecca Ivers
- School of Population Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
| | - Patricia Cullen
- School of Population Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, The Australian National University, 62 Mills Road, Acton, ACT, Australia
| | - John Toumbourou
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Alison L. Calear
- Centre for Mental Health Research, The Australian National University, 62 Mills Road, Acton, ACT, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, Australia
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Beames JR, Lingam R, Boydell K, Calear AL, Torok M, Maston K, Zbukvic I, Huckvale K, Batterham PJ, Christensen H, Werner-Seidler A. Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study. BMJ Open 2021; 11:e042133. [PMID: 33436468 PMCID: PMC7805380 DOI: 10.1136/bmjopen-2020-042133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial. METHODS AND ANALYSIS Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools. TRIAL REGISTRATION NUMBER ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabel Zbukvic
- Orygen The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Kit Huckvale
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
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Lo B, Shi J, Hollenberg E, Abi-Jaoudé A, Johnson A, Wiljer D. Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review. JMIR Ment Health 2020; 7:e15942. [PMID: 32348261 PMCID: PMC7381002 DOI: 10.2196/15942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Education, Technology and Innovation, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Martínez-Miranda J, Martínez A, Ramos R, Aguilar H, Jiménez L, Arias H, Rosales G, Valencia E. Assessment of users' acceptability of a mobile-based embodied conversational agent for the prevention and detection of suicidal behaviour. J Med Syst 2019; 43:246. [PMID: 31240494 DOI: 10.1007/s10916-019-1387-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/14/2019] [Indexed: 12/01/2022]
Abstract
The use of embodied conversational agents in mental health has increased in the last years. Several studies exist describing the benefits and advantages of this technology as a complement to psychotherapeutic interventions for the prevention and treatment of depression, anxiety, or post-traumatic stress disorder, to name a few. A small number of these works implement capabilities in the virtual agent focused on the detection and prevention of suicidality risks. The work presented in this paper describes the development of an embodied conversational agent used as the main interface in HelPath, a mobile-based application addressed to individuals detected with any of the suicidal behaviours: ideation, planning or attempt. The main objective of HelPath is to continuously collect user's information that, complemented with data from the electronic health record, supports the identification of risks associated with suicidality. Through the virtual agent, the users also receive information and suggestions based on cognitive behaviour therapy that would help them to maintain a healthy condition. The paper also presents the execution of an exploratory pilot to assess the acceptability, perception and adherence of users towards the virtual agent. The obtained results are presented and discussed, and some actions for further improvement of the embodied conversational agent are also identified.
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Affiliation(s)
- Juan Martínez-Miranda
- CONACYT - Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico.
| | | | - Roberto Ramos
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico
| | | | | | | | - Giovanni Rosales
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico
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Perry Y, Werner-Seidler A, Calear A, Mackinnon A, King C, Scott J, Merry S, Fleming T, Stasiak K, Christensen H, Batterham PJ. Preventing Depression in Final Year Secondary Students: School-Based Randomized Controlled Trial. J Med Internet Res 2017; 19:e369. [PMID: 29097357 PMCID: PMC5691241 DOI: 10.2196/jmir.8241] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/08/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background Depression often emerges for the first time during adolescence. There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment. Objective This trial investigated the effectiveness of SPARX-R, a gamified online cognitive behavior therapy intervention for the prevention of depression relative to an attention-matched control intervention delivered to students prior to facing a significant stressor—final secondary school exams. It was hypothesized that delivering a prevention intervention in advance of a stressor would reduce depressive symptoms relative to the control group. Methods A cluster randomized controlled trial was conducted in 10 government schools in Sydney, Australia. Participants were 540 final year secondary students (mean 16.7 [SD 0.51] years), and clusters at the school level were randomly allocated to SPARX-R or the control intervention. Interventions were delivered weekly in 7 modules, each taking approximately 20 to 30 minutes to complete. The primary outcome was symptoms of depression as measured by the Major Depression Inventory. Intention-to-treat analyses were performed. Results Compared to controls, participants in the SPARX-R condition (n=242) showed significantly reduced depression symptoms relative to the control (n=298) at post-intervention (Cohen d=0.29) and 6 months post-baseline (d=0.21) but not at 18 months post-baseline (d=0.33). Conclusions This is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents. It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12614000316606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365986 (Archived by WebCite at http://www.webcitation.org/ 6u7ou1aI9)
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Affiliation(s)
- Yael Perry
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | | | - Alison Calear
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Catherine King
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Jan Scott
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Sally Merry
- Department of Psychological Medicine, University of Auckland, Grafton, New Zealand
| | - Theresa Fleming
- Department of Psychological Medicine, University of Auckland, Grafton, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, University of Auckland, Grafton, New Zealand
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Philip J Batterham
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia
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Witt K, Spittal MJ, Carter G, Pirkis J, Hetrick S, Currier D, Robinson J, Milner A. Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC Psychiatry 2017; 17:297. [PMID: 28810841 PMCID: PMC5558658 DOI: 10.1186/s12888-017-1458-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Online and mobile telephone applications ('apps') have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm. METHODS Seven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review. RESULTS Fourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide. CONCLUSIONS Most studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended.
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Affiliation(s)
- Katrina Witt
- Population Health, Turning Point, Eastern Health Clinical School, Monash University, 54-62 Gertrude Street, Fitzroy, Victoria, 3065, Australia.
| | - Matthew J. Spittal
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Gregory Carter
- 0000 0000 8831 109Xgrid.266842.cCentre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales Australia
| | - Jane Pirkis
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Sarah Hetrick
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria Australia
| | - Dianne Currier
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Jo Robinson
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria Australia
| | - Allison Milner
- 0000 0001 2179 088Xgrid.1008.9Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
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Wozney L, Huguet A, Bennett K, Radomski AD, Hartling L, Dyson M, McGrath PJ, Newton AS. How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies. J Med Internet Res 2017; 19:e266. [PMID: 28793983 PMCID: PMC5569246 DOI: 10.2196/jmir.7573] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/05/2017] [Accepted: 06/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) have been delivered face-to-face. However, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based CBT and IPT involve therapeutic content, interaction between the user and the system, and different technological features embedded into the online program (eg, multimedia). Studies of Internet-based CBT and IPT for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the treatment conditions that influence therapy outcomes is important to designing and evaluating these novel therapies. Objective Our aim was to examine the technological and program delivery features of Internet-based CBT and IPT for adolescent depression and to document their potential relation to treatment outcomes and program use. Methods We performed a realist synthesis. We started with an extensive search of published and gray literature. We included intervention studies that evaluated Internet-based CBT or IPT for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the Mixed-Methods Appraisal Tool to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how Internet-based CBT and IPT, as technology-based systems, influence the attitudes and behaviors of system users. PSD components described for the therapies were linked to reported outcomes using a cross-case comparison method and thematic synthesis. Results We identified 19 Internet-based CBT programs in 59 documents. Of those, 71% (42/59) were of moderate to high quality. The PSD features surface credibility (competent “look and feel”), dialogue support (online program + in-person support), liking and similarity (esthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction, and adherence, as well as symptom and functional impairments. Conclusions When incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction, and depression-related outcomes. Testing of these features using hypothesis-driven dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness.
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Affiliation(s)
- Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Anna Huguet
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Kathryn Bennett
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ashley D Radomski
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Martínez-Miranda J. Embodied Conversational Agents for the Detection and Prevention of Suicidal Behaviour: Current Applications and Open Challenges. J Med Syst 2017; 41:135. [PMID: 28755270 DOI: 10.1007/s10916-017-0784-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
Embodied conversational agents (ECAs) are advanced computational interactive interfaces designed with the aim to engage users in the continuous and long-term use of a background application. The advantages and benefits of these agents have been exploited in several e-health systems. One of the medical domains where ECAs are recently applied is to support the detection of symptoms, prevention and treatment of mental health disorders. As ECAs based applications are increasingly used in clinical psychology, and due that one fatal consequence of mental health problems is the commitment of suicide, it is necessary to analyse how current ECAs in this clinical domain support the early detection and prevention of risk situations associated with suicidality. The present work provides and overview of the main features implemented in the ECAs to detect and prevent suicidal behaviours through two scenarios: ECAs acting as virtual counsellors to offer immediate help to individuals in risk; and ECAs acting as virtual patients for learning/training in the identification of suicide behaviours. A literature review was performed to identify relevant studies in this domain during the last decade, describing the main characteristics of the implemented ECAs and how they have been evaluated. A total of six studies were included in the review fulfilling the defined search criteria. Most of the experimental studies indicate promising results, though these types of ECAs are not yet commonly used in routine practice. The identification of some open challenges for the further development of ECAs within this domain is also discussed.
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Affiliation(s)
- Juan Martínez-Miranda
- CONACYT - Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico.
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9
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Ebert DD, Cuijpers P, Muñoz RF, Baumeister H. Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research. Front Psychiatry 2017; 8:116. [PMID: 28848454 PMCID: PMC5554359 DOI: 10.3389/fpsyt.2017.00116] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/15/2017] [Indexed: 01/08/2023] Open
Abstract
Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs). This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs), effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include substance use disorders, bipolar disorders, stress-related disorders, phobic disorders and panic disorder, obsessive-compulsive disorder, impulse-control disorders, somatic symptom disorder, and insomnia. In summary, there is a need for more rigorously conducted large scale randomized controlled trials using standard clinical diagnostic instruments for the selection of participants without MHD at baseline and the assessment of MHD onset. Subsequently, we discuss future directions for the field in order to fully exploit the potential of IMI for the prevention of MHD.
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Affiliation(s)
- David Daniel Ebert
- Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ricardo F Muñoz
- Palo Alto University, Palo Alto, CA, United States.,University of California, San Francisco, San Francisco, CA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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