Jmir Mental Health最新文献

Background: The COVID-19 pandemic has accelerated the adoption of video consultations in mental health care, highlighting the importance of therapeutic alliances for successful treatment outcomes in both face-to-face and web-based settings. Telepresence, the sense of being present with the mental health specialist (MHS) rather than feeling remote, is a critical component of building a strong therapeutic alliance in video consultations. While patients often report high telepresence levels, MHSs express concerns about whether video consultations can replicate the quality of face-to-face interactions. Despite its importance, research on telepresence development in MHSs over time and the dyadic interplay between patients and MHSs remains limited.

Objective: This study aimed to evaluate the mutual influence within patient-MHS dyads on telepresence development during video consultations, using data from a randomized controlled trial assessing the feasibility of video consultations for depression and anxiety disorders in primary care.

Methods: The study included 22 patient-MHS dyads (22 patients, 4 MHSs). Telepresence was measured using the Telepresence in Videoconference Scale. Dyadic data were analyzed using the actor-partner interdependence model with a distinguishable dyad structural equation model. Actor effects refer to the impact of an individual's telepresence at time point 1 (T1) on their telepresence at time point 2 (T2), while partner effects represent the influence of one party's telepresence at T1 on the other's telepresence at T2. Sensitivity analyses excluded data from individual MHSs to account for their unique effects.

Results: A significant actor effect for MHSs (P<.001) indicated a high temporal stability of telepresence between T1 and T2. In contrast, the actor effect for patients was not statistically significant, suggesting a greater variability between T1 and T2. No significant partner effects for both patients and MHSs were observed, suggesting no mutual influence between dyad members. Age was a significant covariate for telepresence in both groups.

Conclusions: Consistent with prior findings, MHSs experienced increased telepresence over time, whereas patients reported high telepresence levels from the start of therapy. The lack of dyadic influence highlights the need for further exploration into factors affecting telepresence development, such as age, technical proficiency, and prior treatment experience. Future studies with larger samples and more sessions are necessary to enhance the generalizability of these findings and to optimize the use of video consultations in mental health care.

Background: Third-wave psychological treatments such as acceptance and commitment therapy can be effective for improving depression and anxiety in youth. However, third-wave therapeutic techniques such as cognitive defusion can be abstract, challenging to learn, and difficult to apply in real-world settings. Translating these techniques into virtual reality (VR) may provide interactive, enjoyable, and concrete learning opportunities, potentially enhancing engagement and effectiveness. This study evaluated a novel VR application that translates the technique of cognitive defusion into a brief, gamified VR experience.

Objective: The objectives of this study were to evaluate the feasibility, acceptability, usability, and safety of the VR cognitive defusion application; examine whether it could improve negative thinking and mood states; and understand how it compared to a non-VR cognitive defusion exercise.

Methods: In a mixed methods experimental study, 20 young people completed both a VR and audio cognitive defusion exercise in a randomized order within a single session. Quantitative state-based measures were taken before and after each exercise, and a qualitative interview at the end focused on how the two experiences compared.

Results: It was feasible to recruit participants, and all participants completed both exercises and assessments. Both the VR and audio exercises were acceptable to participants, with qualitative themes highlighting a preference for VR due to the novel and engaging format; however, there was a need for better guidance and more personalized environments. No severe adverse events were reported, although one participant experienced distress during the VR exercise. Pretest-posttest effects showed improvements in thought discomfort, cognitive defusion, and state anger for both the VR and audio conditions (P<.05), with the latter showing broader improvements, including thought negativity, rumination, tension, depression, distress, and confusion (P<.05).

Conclusions: The VR cognitive defusion application was feasible, safe, and acceptable for young people, with potential to enhance mental health treatment through an engaging and enjoyable approach to learning third-wave cognitive behavioral therapy techniques. While VR was preferred by participants, further refinements could improve effectiveness. Future research should focus on enhancing the VR application design based on user feedback, incorporating audio guidance, and conducting a larger trial in real-world settings to thoroughly evaluate the effectiveness and implementation of the VR application.

Background: Early assessment of mild cognitive impairment (MCI) in older adults is crucial, as it enables timely interventions and decision-making. In recent years, researchers have been exploring the potential of gamified interactive systems (GISs) to assess pathological cognitive decline. However, effective methods for integrating these systems and designing GISs that are both engaging and accurate in assessing cognitive decline are still under investigation.

Objective: We aimed to comprehensively investigate GISs used to assess MCI. Specifically, we reviewed the existing systems to understand the different game types (including genres and interaction paradigms) used for assessment. In addition, we examined the cognitive functions targeted. Finally, we investigated the evidence for the performance of assessing MCI through GISs by looking at the quality of validation for these systems in assessing MCI and the diagnostic performance reported.

Methods: We conducted a scoping search in IEEE Xplore, ACM Digital Library, and Scopus databases to identify interactive gamified systems developed for assessing MCI. Game types were categorized according to genres and interaction paradigms. The cognitive functions targeted by the systems were compared with those assessed in the Montreal Cognitive Assessment (MoCA). Finally, we examined the quality of validation against the reference standard (ground truth), relevance of controls, and sample size. Where provided, the diagnostic performance on sensitivity, specificity, and area under the curve was reported.

Results: A total of 81 articles covering 49 GISs were included in this review. The primary game types used for MCI assessment were classified as casual games (30/49, 61%), simulation games (17/49, 35%), full-body movement games (4/49, 8%), and dedicated interactive games (3/49, 6%). Of the 49 systems, 6 (12%) assessed cognitive functions comprehensively, compared to those functions assessed via the MoCA. Of the 49 systems, 14 (29%) had validation studies, with sensitivities ranging from 70.7% to 100% and specificities ranging from 56.5% to 100%. The reported diagnostic performances of GISs were comparable to those of common screening instruments, such as Mini-Mental State Examination and MoCA, with some systems reporting near-perfect performance (area under the curve>0.98). However, these findings often stemmed from small samples and retrospective designs. Moreover, some of these systems' model training and validation exhibited substantial deficiencies.

Conclusions: This review provides a comprehensive summary of GISs for assessing MCI, exploring the cognitive functions assessed by these systems and evaluating their diagnostic performance. The results indicate that current GISs hold promise for the assessment of MCI, with several systems demonstrating diagnostic performance comparable to establis

Background: The impact of smartphone use on mental health is being rigorously debated. Some questionnaire-based research suggests that smartphone use correlates with nonsuicidal self-injury (NSSI). Self-reported data seem unlikely to capture actual smartphone use precisely, requiring objective measures to advance this field.

Objective: The aim of the study is to examine whether objectively measured smartphone use was associated with NSSI among college students.

Methods: This multicenter cross-sectional study was conducted from 2022 to 2024, enrolling college students from 559 classes across 6 universities in China. NSSI was measured by the Ottawa Self-Injury Inventory including 10 items of NSSI without suicidal intent within the past month. Participants answering "ever" were classified as having NSSI. Objectively measured smartphone screen time and number of smartphone unlocks were obtained from screenshots of smartphone use records. The association between objectively measured smartphone use and NSSI was analyzed using binary logistic regression models and restricted cubic spline regression.

Results: Of 16,668 included participants, 627 (3.8%) reported NSSI. Mean (SD) smartphone screen time and number of smartphone unlocks were 48.8 (28.8) hours per week and 271.6 (291.0) times per week. The models adjusted for different factors showed a significant association between smartphone use and NSSI. Compared to participants with 0-21 hours per week of smartphone screen time, those with ≥63 hours per week of smartphone screen time had higher odds of NSSI (odds ratio [OR] 1.63, 95% CI 1.32-2.01). Likewise, compared to participants with 0-50 times per week of smartphone unlocks, those with ≥400 times per week of smartphone unlocks had higher odds of NSSI (OR 1.53, 95% CI 1.25-1.88). No significant NSSI risk increase was observed for participants with 21-42 and 42-63 hours per week of smartphone screen time nor for those with 50-150 and 150-400 times per week of smartphone unlocks. Moreover, restricted cubic spline analyses showed that the increasing risk of NSSI was associated with elevated smartphone screen time and number of smartphone unlocks.

Conclusions: These findings emphasize that ≥63 hours per week of smartphone screen time and ≥400 times per week of smartphone unlocks are risk factors for NSSI among college students, and interventions targeting NSSI should consider the apparent association with smartphone use.

Background: Internet-based interventions for depression are increasingly integrated into health care due to their effectiveness, availability, and cost-effectiveness. However, negative effects have largely been ignored.

Objective: This study aimed to evaluate both positive and negative effects of an unguided intervention.

Methods: In total, 303 participants were analyzed using mixed models for repeated measures to assess changes in depressive symptoms via Beck Depression Inventory-II (primary outcome) after 12 weeks compared to waitlist controls with care as usual. Secondary endpoints included depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), self-esteem, and quality of life. Negative effects were evaluated using the positive and negative effects of psychotherapy scale for internet-based interventions (PANEPS-I). Moderation analyses were conducted to explore influential effects on treatment outcomes.

Results: The intervention group showed greater reduction in depressive symptoms compared to controls, with small to medium effect sizes (g=0.30-0.42) with averaged 14 logins. Although improvements in self-esteem and quality of life were not observed in intention-to-treat analyses, the completer sample indicated higher self-esteem in the intervention group. Negative effects were reported by 22% (22/100) to 68% (66/97), with the highest rates for program-related effects (eg, not addressing personal problems). No moderation effects were identified.

Conclusions: The intervention effectively reduces depressive symptoms. Although negative effects were present, they did not impact treatment outcome, tentatively suggesting that overall benefits may outweigh the negative effects for users.

Background: Digital addiction, affecting a significant portion of the population, particularly young people, is linked to psychological issues and social problems, making its prevention and management a crucial public health issue.

Objective: This umbrella review aimed to comprehensively analyze the factors influencing digital addiction by re-evaluating the methodologies and evidence quality of existing meta-analyses.

Methods: Databases including PubMed, Web of Science, the Cochrane Library, and Embase were systematically searched for reviews and meta-analyses related to factors associated with digital addiction up to September 24, 2024. The methodological quality of the identified studies was assessed using the modified "A Measurement Tool to Assess Systematic Reviews 2" (AMSTAR 2) tool, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the quality of the evidence presented in the literature.

Results: A total of 18 articles were included in the review, with AMSTAR 2 assessments revealing 6 moderate-quality, 4 low-quality, and 8 very low-quality studies. In total, 29 significant factors associated with digital addiction were identified. Notably, 4 studies achieved both moderate AMSTAR 2 and GRADE ratings, indicating that positive parent-child relationship (r=-0.15, 95% CI-0.18 to -0.11; P<.05) effectively mitigate the risks of digital addiction. Conversely, urban residence (odds ratio [OR] 2.32, 95% CI 1.19-4.53; P<.001), adverse childhood experiences (r=0.21, 95% CI 0.18-0.24; P<.001), and social anxiety (r=0.34, 95% CI 0.19-0.48; P<.001) were identified as factors that may increase the risk of developing digital addiction.

Conclusions: This study found that social factors such as urban residence were associated with an increased risk of digital addiction, whereas social support served as a protective factor against this risk. Nonetheless, the methodologies used in analyzing the factors related to digital addiction require further refinement.

Unlabelled: Despite the growing enthusiasm for and a proliferation of digital mental health innovations, their integration into routine clinical care remains limited-often stalled at the pilot, research, or demonstration stage. This editorial argues that the successful adoption, scale-up, and sustainability of digital mental health innovations require intentional infrastructure, not just technology. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) implementation science framework, we examine how challenges across the seven framework domains (condition, technology, value proposition, adopters, organization, wider context, and their interactions over time) continue to hinder meaningful progress. We describe a focused digital mental health innovation infrastructure as a model for overcoming these barriers. Drawing on experiences from the Digital Innovation Hub at Canada's largest mental health and addictions teaching hospital, we illustrate how investing in the right infrastructure may move digital mental health innovations from "promising" to "impactful." We call for global collaboration to share knowledge and accelerate the real-world integration of digital innovations in routine mental health clinical care.

Background: Cognitive remediation improves cognition and psychosocial functioning in individuals with psychotic disorders. The use of virtual reality (VR) to deliver cognitive remediation in immersive environments that mimic real cognitively challenging situations has the potential to increase engagement to treatment and further enhance its impact on functioning.

Objective: We aimed to codevelop a cognitive remediation program in VR with individuals with psychotic disorders and health care professionals to identify and address their needs.

Methods: Individuals with lived experience of a psychosis-spectrum condition (n=11) met 9 times and the health care professionals (n=7) met 3 times. Participants discussed personal and professional opinions on the challenges associated with cognitive difficulties in individuals with psychotic disorders. They also provided feedback on the program development.

Results: We discerned 4 themes from the content expert working groups: the need for a program to address cognitive impairments, the key program design elements to support cognitive rehabilitation, the importance of leveraging technology as an intervention tool, and the need to improve community functioning. In total, 3 themes were identified for the health care professionals: the need for a clinically relevant program that addresses the research-to-practice gap, the need to improve patient engagement in services, and the need for a program that addresses the limited resources in health care. The needs of our end-user experts were placed at the center of the program development process. When possible, we also integrated their suggestions, like the incorporation of a virtual coach within the immersive environment.

Conclusions: Individuals with lived experience and health care professionals have distinct needs, which have informed the co-design of a novel cognitive remediation program in VR, ThinkTactic VR. To our knowledge, ThinkTactic VR is one of the first co-designed and codeveloped cognitive remediation programs in VR using an iterative, user-centered approach involving both individuals with psychotic disorders and health care professionals.

Background: Mental health care providers have widely adopted telemedicine since the onset of the COVID-19 pandemic. Some providers have reported difficulties in implementing telemedicine and are still assessing its sustainability for their practices. Recommendations, best practices, and guidelines for telemedicine-based mental health care (ie, telemental health care [TMH]) have been published, but the nature and extent of this guidance have not been assessed.

Objective: We aimed to determine (1) the form of TMH guidelines and recommendations presented to providers, (2) the most commonly presented recommendations and guidelines, and (3) the perceived benefits and challenges of these TMH guidelines and recommendations.

Methods: Through our scoping review of practice guidelines, we aimed to identify themes in TMH guidelines and clinical recommendations published between 2020 and 2024 in peer-reviewed journals. This review focused on the first 2 years of the COVID-19 pandemic to identify and characterize the available TMH guidance. We searched PubMed/MEDLINE and ScienceDirect for articles in peer-reviewed journals published between January 1, 2020, and July 16, 2024. We included articles that were available in English and presented recommendations, best practices, or guidelines for TMH. We excluded duplicates, articles unrelated to telehealth, brief editorial introductions, and those not publicly available. We applied the Healthcare Provider Taxonomy of the National Uniform Claim Committee to article titles and abstracts to identify records relevant to mental health. We used content and thematic analyses to identify key themes.

Results: Of the 1348 articles retrieved, we identified 76 that matched our criteria. Through content and thematic analyses, we identified 3 main themes-along with subthemes and topics-related to Facilitators, Concerns, and Changes Advised. The majority of articles called for further research (59/76) and for telemental health education and innovation in some form (43/76) regarding advised changes. Twenty-four articles included specific guidelines, recommendations, or checklists for providers.

Conclusions: The results highlight the need for further large-scale research to support the development of effective guidelines and protocols for therapy plans. Although TMH care is widespread, scholarly work emphasizes the need for a stronger evidence base that includes testing protocols in diverse settings and populations. The results also underscore the importance of increasing health professionals' knowledge of regulatory compliance and providing them with adequate TMH practice education.