Effectiveness of the mobile application Holidaily in reducing work-related rumination when returning to work after vacation: a randomized controlled trial.

BackgroundStress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one’s mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce.ObjectiveThis study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes.MethodsA randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale–21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics.ResultsSignificant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males.ConclusionsThis study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation.Trial RegistrationClinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277

BackgroundThere is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible.ObjectiveThis review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs.MethodsA literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts “child and adolescent mental health,” “digital intervention,” and “engagement.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively.ResultsThis study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs.ConclusionsThe development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs.

BackgroundWhile work-related rumination increases the risk of acute stressors developing into chronic load reactions and adverse health, mental detachment has been suggested as a way to interrupt this chain. Despite the importance of mentally detaching from work during leisure time, workers seem to struggle to disengage and, instead, experience the constant mental representation of work-related stressors, regardless of their absence. Those who struggle with work-related rumination could benefit from an easy-access intervention that fosters mental detachment by promoting recreational activities. Especially during vacations, workers appear to naturally engage in sufficient recovery activities; however, this beneficial behaviour is not sustained. The smartphone app-based intervention “Holidaily” promotes recovery behaviour and, thus, mental detachment from work with the intension of extending the beneficial effects of workers’ vacations into their daily working life.MethodsThis randomised-controlled trial (RCT) evaluates the efficacy of “Holidaily”. The Holidaily app is a German stand-alone program for mobile devices with either Android/iOS operating systems. The sample includes workers, who are awaiting to go on vacation and are randomly assigned to either the intervention (IG) or a waitlist-control group (CG). The IG receives two weeks pre-vacation access to Holidaily, while the CG receives access two weeks post-vacation. On a daily basis participants in the IG are provided with three options promoting recreational activities and beneficial recovery experiences. Online questionnaires are distributed to all participants at several timepoints. The primary outcome measure assesses participants’ work-related rumination (Irritation Scale). A significant difference two weeks post-vacation is expected, favouring the IG. Secondary outcomes include symptoms of depression, insomnia severity, emotional exhaustion, thinking about work, recovery experiences, vacation specifics, work and personal characteristics. To help explain the intervention’s effect, explorative analyses will investigate the mediation properties of the frequency of engaging in recreational activities and the moderation properties of Holidaily users’ experiences.DiscussionIf successful, workers will maintain their recovery behaviour beyond their vacation into daily working life. Findings could, therefore, provide evidence for low-intensity interventions that could be very valuable from a public-health perspective. App-based interventions have greater reach; hence, more workers might access preventative tools to protect themselves from developing adverse health effects linked to work-related rumination. Further studies will still be needed to investigate whether the vacation phenomenon of “lots of fun quickly gone” can be defied and long-term benefits attained.Trial registrationGerman Clinical Trials Registration DRKS00013650. Registered retrospectively 15.01.2018.

Early identification and intervention for mental health (MH) problems in childhood offers lifelong benefits. Many children with MH problems do not receive appropriate help. To address this need, an online universal MH screening tool, the Growing Minds Check-In for parents/caregivers (GMCI-P), was developed to provide feedback to parents on their children's MH, identify children at risk of MH problems, and link parents to evidence-based online programs/information, with the goal of facilitating parent help-seeking, and ultimately reducing the prevalence of child MH problems. A randomised controlled trial (RCT) with 440 parents/caregivers will be conducted to 1) examine the efficacy of GMCI-P for increasing parent help-seeking; 2) explore acceptability; and 3) cost-effectiveness. Participants will be Australian parents/caregivers with a child aged from birth to 17years, 6months, who will be randomly allocated to GMCI-P (intervention) or waitlist control (WLC) group, and complete baseline measures. The intervention group will complete the GMCI-P immediately, the post-GMCI-P intervention questions, a three-month and six-month follow-up. The WLC group will receive access to GMCI-P after their three-month follow-up but will not be followed up further. The primary outcome is parent help-seeking behaviour for child MH, and secondary outcomes include child MH, parenting, parent wellbeing, acceptability, cost-effectiveness, and unintended negative effects. The results from this study will provide efficacy, acceptability and cost-effectiveness data on a universal online, parent-report child MH Check-In. These results can be used to inform public policy on universal screening for child MH. ACTRN12624000098538.

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition with profound public health, personal, and family consequences. ADHD requires comprehensive treatment; however, lack of communication and integration across multiple points of care is a substantial barrier to progress. Given the chronic and pervasive challenges associated with ADHD, innovative approaches are crucial. We developed the digital health intervention (DHI)—CoolTaCo [Cool Technology Assisting Co-regulation] to address these critical barriers. CoolTaCo uses Patient-Centered Digital Healthcare Technologies (PC-DHT) to promote co-regulation (child/parent), capture patient data, support efficient healthcare delivery, enhance patient engagement, and facilitate shared decision-making, thereby improving access to timely and targeted mental health intervention for children at significant risk for poor outcomes. The present paper will describe our planned protocol to evaluate the efficacy of CoolTaCo via randomized control trial (RCT).Methods/designWe will recruit 60 children (ages 8–12) with ADHD who will be randomized to either immediate (n = 30) or delayed (n = 30) treatment (i.e., a waitlist control group). Among those randomized to immediate treatment, half will be assigned to DHI (delivered via a smartwatch and smartphone application), the other half to an active control treatment as usual (TAU). Unlike the DHI group, the TAU group will receive the smartwatch with no assigned activities, applications, or interventions on the devices. The intervention period will last 16 weeks; after a participant has been in the delayed treatment group for 16 weeks and has completed the post-waiting period assessment, they will be randomly assigned to either the intervention or active control group. Thus, 30 participants will complete the intervention, and 30 will complete the active control, with half of the total sample completing a waitlist period.DiscussionIndividuals with ADHD have complex needs. Despite improvement in outcomes following cognitive behavioral therapies (CBT) and pharmaceutical treatment, long-term maintenance is a challenge often not addressed by traditional medical approaches, and, as we described, ineffective approaches to information sharing across points of care create further barriers to progress. Our research will fill a significant gap in translating early treatment investments and gains into long-term, sustainable outcomes.This study was registered as a clinic trial at ClinicalTrials.gov (Digital Health Intervention for Children With ADHD, ID# NCT06456372) on 06/13/2024.

BackgroundDepression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment.ObjectiveThis review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders.MethodsA systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation).ResultsA total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality.ConclusionsDigital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias.Trial RegistrationOpen Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M

BackgroundA growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences.ObjectiveThis study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants’ engagement and satisfaction with the program.MethodsA randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters.ResultsUsing an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes.ConclusionsThe Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program.Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk

BackgroundIn South Korea, access to mental health services remains limited due to stigma, cost, and self-reliance. While digital interventions can help reduce these barriers, few are designed to address the underlying cognitive-emotional patterns that perpetuate psychological distress.ObjectiveThis study evaluated the effectiveness of a schema-informed digital intervention (Mindling) aimed at reducing distress and enhancing coping in adults experiencing schema-linked difficulties such as perfectionism (unrelenting standards schema), low self-worth (self-sacrifice schema), social withdrawal (social isolation and alienation schema), and anxiety (negativity and dependence schemas).MethodsA total of 300 adults (aged 18-60 years) with elevated perceived stress and one dominant distress pattern were recruited on the web and randomized to an intervention group (n=201) or waitlist control (n=99). Participants were assigned to one of four 10-week web-based program modules tailored to their dominant distress pattern: perfectionism (Riggy), low self-worth and fear of rejection (Pleaser), social withdrawal (Shelly), or chronic anxiety (Jumpy). Each module included psychoeducation, guided reflection, and behavioral tasks. Outcomes, including perceived stress, perfectionism, self-esteem, loneliness, and anxiety, were measured at baseline, midintervention (week 5), and postintervention (week 10). Analyses were conducted on 218 participants who completed all 3 assessments (n=138 intervention; n=80 waitlist), using repeated-measures ANOVA or analysis of covariance, as appropriate. In addition, a 1-month follow-up assessment was conducted for the intervention group only to examine maintenance of effects.ResultsCompared with the waitlist group, the intervention group showed significantly greater improvement in perceived stress (F2,432=27.52; P<.001; partial η2=0.11) and improvements in pattern-linked outcomes: perfectionism (F2,102=6.24; P=.003; partial η2=0.10); self-esteem (F2,96=11.83; P<.001; partial η2=0.20); loneliness (F2,110=8.26; P<.001; partial η2=0.13); and anxiety (F2,110=10.75; P<.001; partial η2=0.16). Secondary outcomes (eg, depression, trait anxiety, and self-efficacy) also improved across most programs. These effects were maintained at a 1-month follow-up. As supplementary findings, adherence was high among those who accessed the platform, with 70.1% (131/187) completing all 10 sessions. The intervention group was also more likely than the waitlist to seek external mental health services (t216=2.59; P=.01; mean difference=0.45; 95% CI 0.12-0.80).ConclusionsThe schema-informed digital intervention led to significant (P<.05) short-term improvements in distress and associated psychological patterns, with high completion rates and increased help-seeking behavior among participants. These findings suggest the potential utility of structured, accessible digital interventions within stepped-care models for mental health support. However, limitations in study design, sample representativeness, and follow-up duration suggest that further research is needed to assess the long-term effectiveness and broader applicability of such digital programs.Trial RegistrationClinicalTrials.gov NCT06166693; https://clinicaltrials.gov/study/NCT06166693

Enhancing the well-being of mentally healthy workers (i.e., those with lower psychological distress) is important to prevent mental health conditions, aligning with the trend of occupational positive psychology. No intervention study has investigated the effect of digital health intervention on well-being among workers with low levels of psychological distress in micro- and small-sized enterprises (MSEs). This secondary analysis examined the effectiveness of a fully automated text-based stress management program, “WellBe-LINE,” using the LINE app to improve the well-being of employees with low levels of psychological distress in MSEs. It used data from a previous randomized controlled trial (RCT) study. The previous RCT recruited adult Japanese full-time employees at an enterprise with fewer than 50 employees from registered members of a web survey company. From the RCT, only participants with low psychological distress (Kessler 6 score under 4) were employed for the present analyses. Participants in an intervention group received text messages once per week for 8 weeks. Well-being was assessed by the Mental Health Continuum-Short Form (MHC-SF) at baseline, post (2-month), and follow-up (6-month) surveys. A mixed model for repeated measures conditional growth model analysis was conducted using a group*time interaction as an intervention effect. 638 (62.5%) participants with low psychological distress were included in this secondary analysis from the 1,021 total participants. The intervention group showed a significant intervention effect post survey on improving well-being (Cohen’s d = 0.19 [95%CI 0.03–0.35], p = 0.016) and social well-being at both the post and follow-up survey with a small effect size (Cohen’s d = 0.26 [95%CI: 0.10–0.42], d = 0.17 [0.002–0.34]; respectively). No effect was observed on emotional and psychological well-being. This study suggested that fully automated universal mental health interventions with low intensity may benefit the healthy population. Further research is needed, focusing on the development and evaluation of programs aimed at promoting well-being and positive mental health among mentally healthy workers as part of primary mental health prevention.Trial registration: The study protocol was registered in the UMIN clinical trial registration before starting recruitments: UMIN000050624 (registration date: March 18, 2023) https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000057552. Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-11206-4.

BackgroundAn estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues.ObjectiveThis review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries).MethodsWe searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews.ResultsIn this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings.ConclusionsAlthough digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

This year's article on health information technology (HIT) illustrates the use of digital technology to prevent and treat diabetes by enabling consumer engagement, behavior change, and impact analytics. It provides a snapshot of current thinking about digital technology's capabilities and capacity to deliver personalized interventions at scale. Early results are promising. A growing number of digital programs are clinically proven to improve health and lower the cost of care. And pioneering health-care organizations are offering these programs to members and patients as part of their new models for value-based care. Their success will drive other organizations—payers, providers, and employers—to make similar investments in health. In the modern health-care world, experts agree that “value” will be created by enabling health, not just delivering care. With today's epidemic of diabetes, patients who use digital health technologies can benefit greatly from both short-term health improvements and long-term health self-management. The foundations have been laid with evidence-based programs. Now, more health-care organizations must embrace this population management strategy for health. As adoption increases, the next technology challenge will arise: consumer engagement at scale. This engagement will be digital: content-rich programs filled with social support to activate, educate, and engage consumers. Most of the articles included in this and prior ATTD Yearbook articles address the specifics of digital interventions once the person enrolls. But before enrollment, consumers must engage. And to engage consumers, one must understand their reasons for engaging and their expectations for results. These insights fall into the realm of digital marketing, rather than the domain of clinical programs. Using a multidisciplinary approach, digital engagement will be the next variable to solve in the equation for scalable digital health. Not for a lack of trying, we have been unable to find noteworthy articles presenting best practices for consumer engagement from outreach to enrollment. But the future looks quite bright for the science of marketing digital health interventions. Increasingly, “big data” is providing scientists, innovators, entrepreneurs, educators, health-care providers, and administrators with the insights they need to predict consumer interests and personalize experiences throughout the entire behavior change process—from outreach to outcomes. Over the coming year, we will continue to search the health-care landscape to bring more innovations in digital health and diabetes prevention, from consumer engagement to population impact.

Pregnancy is a vulnerable period for women, with an increased risk of mental health issues such as depression and anxiety. The perinatal period is particularly important, as maternal mental health significantly impacts maternal physical health, pregnancy outcomes, postnatal outcomes, and fetal and infant development. Psychotherapeutic interventions for depression are essential, especially given the limitations of medication use during pregnancy. However, perinatal women experiencing depression often encounter barriers to accessing these interventions. Digital health interventions may offer a promising approach to overcome these barriers. This study aimed to (1) evaluate the effectiveness of Avecmom, a self-help, mindfulness-based mobile intervention, in reducing depression severity among pregnant women with mild to moderate depression; (2) examine its impact on emotional well-being and maternal-fetal attachment; and (3) explore whether the effect on mental well-being is mediated by increased mindfulness and reduced depression severity. Participants were recruited both online and offline. Of 158 screened individuals, 90 met the inclusion criteria and were randomly assigned to either the intervention or control group. The intervention group used both the Avecmom and Big 4+ apps, while the control group used only the Big 4+ app. Depressive symptoms, anxiety, and stress were assessed as primary outcomes at baseline and postintervention. Mindfulness, mental well-being, positive and negative emotions, and maternal-fetal attachment were assessed as secondary outcomes. Analysis of covariance (ANCOVA) was conducted with postintervention scores as the dependent variable, adjusting for baseline scores. To estimate the mechanism of change following Avecmom mobile app use, the bootstrapping technique with PROCESS Macro Model 6 was employed, applying the difference score from postintervention to baseline. A total of 86 pregnant women (intervention group: n=42; control group: n=42) completed the study and were included in the final analysis, reflecting an overall dropout rate of 4% (4/90). At postintervention, the intervention group demonstrated lower depression severity scores (F1,84=5.69; P=.02; partial ƞ2=0.06) and higher scores of mindfulness (F1,84=11.18; P=.001; partial ƞ2=0.12), maternal-fetal attachment (F1,84=5.54; P=.02; partial ƞ2=0.06), mental well-being (F1,84=8.79; P=.004; partial ƞ2=0.10), and positive affect (F1,84=7.21; P=.009; partial ƞ2=0.08) compared to the control group. Serial mediation analysis revealed that Avecmom app use influenced mental well-being through sequential improvements in mindfulness and decreases in depression severity (standardized β=.33; Boot SE=0.12, 95% CI 0.12-0.58). Mindfulness-based mobile app interventions tailored for pregnant women may be more effective than self-monitoring alone in improving perinatal depression. These findings suggest that mindfulness-based mobile app interventions may help improve mental well-being in pregnant women, potentially by enhancing mindfulness and reducing depression severity.

Background: Adolescents are at a critical developmental stage marked by rapid cognitive, emotional, and social changes, making them highly susceptible to mental health issues. Recently, digital health interventions (DHIs) have emerged as innovative and scalable tools for promoting mental well-being in this population. Methods: This integrative review was conducted based on comprehensive literature searches of major academic databases, including PubMed, Scopus, Web of Science, and PsycINFO. Studies published between January 2010 and December 2024 were identified using keywords such as “adolescent mental health,” “digital health intervention,” “behavior change model,” “e-health,” “mobile mental health,” and “digital therapeutics.” The inclusion criteria comprised peer-reviewed studies on digital mental health interventions for adolescents that applied, fully or partially, a behavior change approach. Studies targeting adults, interventions without digital technology, the gray literature, and duplicate publications were excluded. Results: We examined intervention strategies based on developmental stage prevention, early intervention, and recovery and highlighted key digital components such as accessibility, anonymity, personalization, and continuous monitoring. Furthermore, we analyzed case studies from various countries, including Korea, the United Kingdom, Australia, and Japan, to identify best practices and contextual challenges. Conclusions: DHIs rooted in sound psychological theory and ethical design can complement school- and community-based interventions by offering effective personalized support. The practical implications and future directions are discussed.

IntroductionDigital interventions have been found to be successful in preventing occupational mental health concerns, however, they seem to be affected by attrition bias through high attrition rates and differential attrition. Differential attrition arises when the rates of participant dropouts differ across different treatment conditions and is considered a significant challenge to internal validity.ObjectivesWe aimed at systematically review and meta-analyse differential attrition of digital mental health interventions in the workplace setting.MethodsOn January 2, 2022, we performed a search in the following electronic databases: PubMed, Scopus, and Web of Science Core. We utilized a combination of terms from five distinct areas, namely mental health, intervention, workplace, implementation, and study design. The study encompassed adult employees who took part in a randomized control trial aimed at preventing mental health issues in the workplace through an online intervention. A team of six reviewers collaborated on the study selection process, while two independent researchers conducted the data extraction for the selected studies. We performed a meta-analysis of the log-transformed relative attrition rates of the included studies using a random-effects model with limited maximum-likelihood (REML) estimation to account for the degree of heterogeneity.ResultsA total of 19 studies were included in the meta-analysis. For baseline to post-intervention, the average total attrition was 26.27% (SD = 21.16%, range = 0 – 66.3%) and the random effects model revealed a higher attrition rate in the intervention group compared to the control group, with a pooled risk ratio of 1.05 (95% CI: 1.01 - 1.10, p = .014). For baseline to follow-up measurement the average total attrition was 27.71% (SD = 20.80%, range = 0 – 67.78%), however, in this case the random effects model did not indicate a higher attrition in the intervention group when compared to the control group (pooled risk ratio = 1.05, 95% CI: 0.98 – 1.12, p = .183).ConclusionsThere is an indication of higher attrition in the intervention group as compared to the control group in occupational e-mental health interventions from baseline to post-intervention, however this does not seem to be the case for baseline to follow-up attrition. These results should be taken into account in the design process of studies and statistical analyses should be adapted to counteract the bias that could result from differential attrition.Disclosure of InterestNone Declared

BackgroundUniversity life typically occurs during a period of life transition, where the incidence of mental health and substance use problems and disorders peaks. However, relatively few students obtain effective treatment and support. e-Interventions have proven effective in improving the psychological outcomes of university students and have the potential to provide scalable services that can easily integrate into existing models of care. Minder is a mobile app codeveloped with university students that offers users a collection of evidence-based interventions tailored to help university students maintain their mental health and well-being and manage their substance use.ObjectiveThis paper describes the protocol for a randomized controlled trial (RCT) that aims to assess the effectiveness of the Minder app in improving the mental health and substance use outcomes of university students.MethodsThis study is a 2-arm, parallel assignment, single-blinded, 30-day RCT with 1 intervention group and 1 waitlist control group. Overall, 1496 (748 per trial arm) university students from the University of British Columbia Vancouver Campus (N=54,000) who are aged ≥17 years, have a smartphone with Wi-Fi or cellular data, and speak English will be recruited via a variety of web-based and offline strategies. Participants will be randomized into the intervention or control group after completing a baseline survey. Those randomized into the intervention group will gain immediate access to the Minder app and will be assessed at 2 weeks and 30 days. Those randomized into the control group will be given access to the app content after their follow-up assessment at 30 days. The primary outcomes are measured from baseline to follow-up at 30 days and include changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured by the General Anxiety Disorder 7-Item scale, Patient Health Questionnaire 9-Item scale, and US Alcohol Use Disorders Identification Test-Consumption Scale, respectively. Secondary outcomes include measures related to changes in the frequency of substance use, mental well-being, self-efficacy in managing mental health and substance use, readiness to change, and self-reported use of mental health services and supports (including referral) from baseline to follow-up at 30 days.ResultsTrial recruitment and data collection began in September 2022, and the completion of data collection for the trial is anticipated by June 2023. As of May 10, 2023, a total of 1425 participants have been enrolled.ConclusionsThe RCT described in this protocol paper will assess whether the Minder app is effective in improving the mental health and substance use outcomes of a general population of Canadian university students. Additional secondary outcome research aims to explore additional outcomes of interest for further research and better understand how to support students’ general mental well-being.Trial RegistrationClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601International Registered Report Identifier (IRRID)DERR1-10.2196/49364