A Study on College Students' Digital Attachment Behavior and Its Influencing Factors in the Context of Digital Government Mental Health Services

BackgroundSexual minority youth, particularly sexual minority youth of color, report elevated mental health challenges and persistent barriers to care. The COVID-19 pandemic exacerbated these disparities and catalyzed a shift toward digital health and digital mental health services. This rapid transition has made it challenging to understand digital exclusion and the digital divide.ObjectiveThis cross-sectional study identified the prevalence of digital health and digital mental health service use among US adolescents during the COVID-19 pandemic and examined heterogeneity by sexual orientation, race and ethnicity, and their intersection.MethodsNationally representative data were obtained from the 2021 Adolescent Behaviors and Experiences Survey (N=7705). Weighted distributions of digital health and digital mental health use were calculated, and modified Poisson regression models estimated adjusted prevalence ratios (aPRs) by sexual orientation, race and ethnicity, and their intersection.ResultsAcross the sample, digital health and digital mental health use were 25.8% and 8.5%, respectively. (All percentages reported are weighted estimates.) Digital mental health use was 5.6% among heterosexual participants and 18.1% among all sexual minority youth. In adjusted models, sexual minority subgroups had higher prevalence of digital mental health use than heterosexual peers (lesbian, gay, and bisexual [LGB]: aPR 2.60; sexually diverse: aPR 2.41; all P≤.05). This pattern held among White, Black or African American, and multiracial LGB participants. Digital mental health use was 10.2% among White participants and ranged from 4.8% to 15% among racially or ethnically minoritized participants. Black or African American, Hispanic or Latino, and Asian or Pacific Islander participants had lower prevalence of digital mental health use than White peers overall (Black or African American: aPR 0.70; Hispanic or Latino: aPR 0.55; Asian or Pacific Islander: aPR 0.48; all P≤.05) and among sexual minority youth (Black or African American: aPR 0.60; Hispanic or Latino: aPR 0.35; Asian or Pacific Islander: aPR 0.23; all P≤.05). Racial and ethnic disparities in digital mental health use were pronounced among LGB (Hispanic or Latino: aPR 0.52; P≤.05) and sexually diverse participants (Black or African American: aPR 0.36; Hispanic or Latino: aPR 0.17; Asian or Pacific Islander: aPR 0.10; all P≤.05), but not heterosexual participants. Digital health use did not differ by sexual orientation. However, Black or African American and Hispanic or Latino participants had lower prevalence of digital health use than White peers (28.8%) overall (Black or African American: aPR 0.76; Hispanic or Latino: aPR 0.78; all P≤.05) and among heterosexual (Black or African American: aPR 0.73; Hispanic or Latino: aPR 0.80; all P≤.05) and sexual minority youth participants (Hispanic or Latino: aPR 0.75).ConclusionsDigital platforms offer promise for expanding access to mental health care among sexual minority youth, but persistent inequities must be addressed. Cocreation with lived-experience experts may be critical to ensure digital services are trusted, inclusive, and accessible for all youth.

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The widespread popularity of digital technology has brought about significant changes in the treatment of mental health problems. Traditional mental health services can no longer meet the needs of society for mental health, and digital mental health services are developing vigorously. Digital mental health services have shown significant advantages in rapid diagnosis, improving mental health, and improving mental service efficiency. This article outlines the development and application of mental health services so far. On the basis of describing the various uses of digital psychological intervention measures, it focuses on the ethical issues faced by the current application of digital mental health services, such as privacy and data security caused by Big data, potential ethical risks caused by digital technology, insufficient clinical verification, imperfect market regulations and professional threats to psychological workers. To ensure the rational and compliant use of digital technology in the field of mental health, this article discusses the ethical problem- solving directions of current digital mental health services from three levels: technical policies, ethical norms and systems, and social individuals, in order to promote the integration of digital technology and mental health services and improve the quality and efficiency of digital mental health services.

Digital mental health interventions are effective and can greatly enhance access to mental health care. They can reach people in remote and low-income areas and reduce the stigma of seeking mental health help by offering anonymity. Despite these benefits, they have not been fully integrated into mental health service delivery. The aim of this study was to understand consumers’ experiences and perceptions of accessing care through digital mental health services. Consumers of three key Australian Digital Mental Health Services completed an online survey about their experience receiving mental health care through digital mental health services. Some consumers were also invited to elaborate on their responses by taking part in a phone interview. A total of 351 participants completed an online survey (overall response rate of 11% of all those invited to take part), and 23 participants of whom also completed a phone interview. Most consumers were female and under the age of 50 years. Overall, consumers were very positive about their experience of using digital mental health services. They appreciated the accessibility, convenience, self-paced nature, therapeutic support, and guidance. Most found the services user-friendly, easy to use and navigate and were satisfied with their experience. A small number of consumers experienced difficulties with technology and internet connections. Most consumers would recommend services to their peers and recommend that digital mental health services be better promoted to improve awareness. Digital mental health services have a vital role in mental health care provision. Further research is needed to examine how digital mental health services can cater to the specific needs of disadvantaged sub-populations and diverse cultural populations and be seamlessly implemented in mental health care systems.

First Nations people in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve the mental health outcomes of First Nations Australians. However, evidence on the effectiveness of DMH services for First Nations people in Australia is yet to be synthesized. This systematic scoping review aims to fill this gap and to identify the facilitators and barriers that influence the implementation of DMH services among First Nations people in Australia. A systematic search was conducted across 6 academic databases to search for studies related to DMH services for First Nations people in Australia. Search terms relating to First Nations people, geographic terminologies of Australia, mental health, and DMH services were used. Studies were included if they assessed the effectiveness of DMH services or the determinants of the facilitators and barriers of implementing DMH interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, and were then synthesized using a thematic analysis framework. In total, 22 studies met the inclusion criteria. DMH services were used to support and treat First Nations Australians and conduct psychological assessments in these individuals. Evidence of effectiveness was stronger for nonsevere mental health conditions. The determinants of the facilitators and barriers of the implementation of DMH services included the following: (1) organizational and administrative factors; (2) cultural appropriateness; (3) accessibility; (4) integration of DMH services in the existing health system; (5) engagement between clients and service providers; (6) coverage of different conditions and clients; (7) acceptability to DMH services; (8) digital literacy; and (9) efficiency. Evidence on the use of DMH services for First Nations Australians remains heterogeneous in terms of study design and outcome measurement. DMH services appear to be most effective for managing nonsevere mental health conditions. Successful implementation requires multilevel structural support, including policy and organizational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians.

Objectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions. Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively. Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility. Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.

Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care. To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research. Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes. Key policy, training and practice implications are discussed.

After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath. In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews. This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=-0.49; 95% CI -0.74 to -0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=-0.66; 95% CI -1.23 to -1.0; P=.02) significantly. The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post-COVID-19 era. PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym.

Given the diversity of human characteristics and experiences, personalization in nudges, messages, choice presentations, interventions, and overall product design has been increasingly adopted in digital health to promote engagement. Past studies on moderators and personalization in digital health and mental health services generally focused on demographic and symptom variables, with generally inconsistent findings or null findings. Cognitive, motivational, and decisional psychological attributes are largely overlooked. Psychology often uses long self-report scales to measure various psychological attributes. Although they are useful in tapping into individuals' psychological profiles, when applied in real-life, everyday settings to assess individual differences, people are most likely unwilling to complete them. With the pressing need to personalize digital health platforms to enhance uptake, retention, and engagement, ultrashort versions of these psychological scales may be considered to allow assessment of multiple attributes at the same time. Scale shortening can be achieved through regression analyses of each item, factor analyses, item response theory, ant colony optimization, and machine learning methods, with each method having advantages, disadvantages, and conditions required to make it suitable. To illustrate, we provided examples of regression analyses of each item and factor analyses, with potential implications for personalizing narrative versus research-based messages in digital mental health contexts. We present a 3-tiered decision framework for scale shortening method selection depending on goals and possible constraints, with guidelines on validation methods for ultrashort scales. Moving forward, more validation studies and field studies in digital health platforms are needed to evaluate the ecological validity, reliability, and generalizability of these methods, bearing in mind the limitations and conditions where such shortening methods may not work well. Researchers may compare the effectiveness and limitations of personalization using ultrashort scales with other commonly adopted personalization methods (eg, based on longer scales, behavioral data, and large language models). Ethical concerns need to be considered and mitigated carefully, respecting diverse preferences, informed choices, and the privacy of service users. Our viewpoint piece is primarily intended for digital mental health researchers and practitioners, but may also be informative for the fields of digital health and medicine as well as personalization (eg, personalized health care, personalized nudging, and message matching) more broadly, given the common goal of boosting uptake and engagement as well as improving service users' experiences.

Since 2020, mental health concerns have become more severe worldwide, driven by the COVID-19 pandemic, economic instability, and social inequalities. During this period, digital and remote mental health services expanded, offering alternatives and complements to in-person care. This narrative review synthesizes global evidence on mental health trends from 2020 to 2025 and examines how Malaysia has responded, with a focus on digital and remote solutions. It brings together findings on mental disorders, vulnerable populations, suicide and self-harm, and the growing role of loneliness and social isolation, alongside Malaysian evidence on digital initiatives and implementation challenges. Overall, evidence indicates that depression and anxiety increased in the early stages of the pandemic, although patterns varied across regions and groups; healthcare workers, university students, children and adolescents. Children and adults experienced a disproportionate burden, while loneliness and social isolation emerged as important independent risk factors. Digital and remote interventions, including telepsychiatry, mobile applications, and web-based programs, generally produced small to moderate benefits and were well accepted, yet access remained uneven. Malaysian trials of smartphone- and text-based coaching tools, WhatsApp-delivered community support, and online suicide prevention initiatives demonstrated feasibility and promise but also highlighted barriers related to digital literacy, language, regulation, and infrastructure. Governmental and private-sector initiatives, such as telepsychiatry expansion, digital health platforms, and AI-enabled tools, signal a shift towards digital mental health. The review concludes that a coordinated national strategy that integrates community-based care, promotes digital equity, and is supported by robust governance is needed to realize the potential of digital and remote mental health services in Malaysia.

ObjectivesThe impact of the COVID-19 pandemic on population mental health has highlighted the potential for digital mental health to support the needs of those requiring care. This study sought to understand the digital mental health experiences and priorities of Canadians affected by mental health conditions (i.e. seekers, patients, and care partners).MethodsA national cross-sectional electronic survey of Canadians was administered through a market research firm's survey panel. Seekers, patients, and care partners were asked about their digital mental health experiences (e.g. uptake, barriers to access) and priorities. Survey responses were summarized using descriptive statistics.ResultsOverall, 1003 participants completed the survey. 70.2% of participants routinely use digital mental health supports to support themselves or those they care for; however, only 28.6% of participants are satisfied with the available digital mental health supports. Most participants (73.3%) have encountered some barriers when accessing digital mental health supports. Awareness of digital mental health supports was a top barrier identified by participants. The top digital mental health priorities consisted of digital mental health curation, navigation, and a digital mental health passport.ConclusionsMost participants use digital mental health supports for themselves or others, however, many are unaware of digital mental health supports available. Efforts to improve navigating access to digital and in-person mental health services are seen as a top priority, highlighting the need to enable seekers, patients, and care partners to find the appropriate support and make decisions on how to best improve their mental health.

Adolescence is a vulnerable developmental period, characterized by high rates of mental health concerns, yet few adolescents receive treatment. Public libraries support adolescents by providing them with access to teen programming, technological resources, and have recently been providing mental health services. Digital mental health (DMH) services may help libraries provide scalable mental health solutions for their adolescent patrons and could be well positioned to address the mental health needs of historically underrepresented racial and ethnic (HURE) adolescents; however, little research has been conducted on the compatibility of DMH services with adolescent patron mental health needs or resource needs of library workers supporting them. The research team formed a partnership with a public library, which serves a large HURE adolescent population. We conducted needs assessment and implementation readiness interviews with 17 library workers, including leadership, librarians, and workers with specialized areas of practice. Interview questions focused on library infrastructure, as well as library needs and preferences around the design and implementation of DMH services for adolescents. We used the Consolidated Framework for Implementation Research as guiding implementation determinant framework to code and analyze the interview transcripts. Our findings revealed library workers play an important role in guiding patrons to desired resources and share a goal of implementing adolescent DMH resources into the library and elevating marginalized adolescents' voices. Existing library resources, such as the library's role as a safe space for adolescents in the community, close relationships with external and community organizations, and availability of no-cost technological resources, could help facilitate the implementation of DMH services. Barriers related to community buy-in, mental health stigma, and library worker confidence in supporting adolescent mental health could affect service implementation. Our findings suggest public libraries are highly promising settings to deploy DMH services for adolescents. We identified important determinants that may impact the implementation of DMH services in public library settings. Special considerations are needed to design services to meet the mental health needs of HURE adolescent populations and those adolescents' most experiencing health inequities.

Despite the high prevalence of mental disorders in China, most patients do not utilize mental health services. Digital mental health services offer a potential solution, but their full potential remains untapped. Understanding consumer preferences is key to tailoring these services and boosting acceptance and adoption. This study aims to elicit preferences for digital mental health services in urban China. A discrete choice experiment was conducted with 867 participants, including both current and potential consumers of mental health services, recruited from urban areas in China. Under the guidance of the Theory of Planned Behavior, attributes relevant to digital mental health services were identified through a multi-stage process including a literature review and in-depth semi-structured interviews with 30 consumers and potential consumers of mental health services, and five professionals from Internet-based healthcare and online psychological counseling fields. Six attributes were identified: (1) professional engagement; (2) intervention type; (3) endorser/recommender; (4) mode of content delivery; (5) monthly costs; and (6) privacy policy. Recruited via a market research company, participants completed a discrete choice experiment survey with 11 option sets online. Participants' choices were analyzed with a mixed logit model and further stratified by experience with mental health services, sex, education, income, age, and risk for mental health conditions. The relative importance score was calculated to interpret the results of the discrete choice experiment. Additionally, the willingness-to-pay approach was used to estimate the monetary value of each attribute level. The most important influence on the choice of digital mental health services was the level of professional engagement (β = 2.470, β = 1.011), followed by the customized and adaptive intervention (β = 0.508) and data usage solely used for iterative product upgrades (β = 0.492). The relative importance score also revealed the most important attributes for consumers were professional engagement, intervention type, and privacy policy. Considering the professional engagement attribute, consumers were willing to pay an additional ¥3916.5 per month for services provided by mental health professionals throughout. Preferences diverged based on participant characteristics including experience with mental health services, sex, and education. Our results indicated a consistent preference for services provided by mental health professionals across demographics and regardless of previous mental health service experience. We also found a preference for personalized services, highlighting a shift towards customization in healthcare and emphasizing the need to customize digital mental health services.

BackgroundYoung people experience a disproportionate burden associated with mental illness that Australia’s mental health care system is ill-equipped to handle. Despite improvements in the provision of mental health services, the rates of service utilization among young people remain suboptimal, and there are still considerable barriers to seeking help. Digital mental health services can overcome a number of barriers and connect young people requiring support; however, the evidence base of digital interventions is limited.ObjectiveThe aim of this study is to examine the effectiveness of a brief, self-directed, unstructured digital intervention, ReachOut.com (hereafter ReachOut), in reducing depression, anxiety, stress, and risk of suicide.MethodsA cohort of 1982 ReachOut users participated in a 12-week longitudinal study, with a retention rate of 81.18% (1609/1982) across the duration of the study. Participants completed web-based surveys, with outcome measures of mental health status and suicide risk assessed at 3 time points across the study period.ResultsThe results demonstrated that over the 12-week study period, young people using ReachOut experienced modest yet significant reductions in symptoms of depression, anxiety, and stress. Significant, albeit modest, reductions in the proportion of participants at high risk of suicide were also observed.ConclusionsThe findings of this research provide preliminary evidence of the promise of an unstructured digital mental health intervention, ReachOut, in alleviating symptoms of mental ill-health and promoting well-being in young people. These findings are particularly important given that digital services are not only acceptable and accessible but also have the potential to cater to the diverse mental health needs of young people at scale, in a way that other services cannot.

Digital mental health services in Australia have grown rapidly since the COVID‐19 pandemic and continue to attract public and private investment. Yet, ambiguity remains about which regulatory bodies are responsible for addressing the ‘significant risks’ noted in Australia's National Safety and Quality Digital Mental Health Standards. These risks include threats to privacy, safety, and data security. This Practice and Policy note makes recommendations based on a mapping of Australian regulators potentially involved when a digital mental health service is found to pose such a risk. In practice, an average of three regulators may be relevant for each area of risk, and more than double in some instances. Such complexity can confound clarity about where to lodge complaints or concerns, and how any identified ‘significant risk’ is to be managed. This paper proposes ways to clarify referrals between the Australian Commission on Safety and Quality in Health Care, accrediting agencies, and other key regulators and recommends (1) further regulatory mapping and planning, (2) clearer complaints and feedback pathways, and (3) an evaluation of current regulatory infrastructure to ensure fitness for purpose.Points for practitioners Uncertainty currently exists about which bodies oversee different aspects of digital mental health service regulation in Australia. The National Safety and Quality Digital Mental Health Standards are world‐leading, but there is a need to confirm referral pathways for risks that arise during service accreditation. Clearer public complaint and feedback procedures would benefit service users, care providers, and regulators alike. Robust oversight and accessible complaints channels will help Australia maximise the benefits of digital innovations in mental health care while minimising harm.