Digital Mental Health Services Research Articles

Psychological distress and digital health service use during COVID-19: A national Australian cross-sectional survey.

Previous research suggests that the COVID-19 pandemic caused significant disruption to the lives and mental health of Australians. In response, health services adapted rapidly to digital modes of treatment, prevention and care. Although a large amount of research emerged in the first year of the pandemic, the longer-term mental health impacts, contributing factors, and population-level utilization of digital health services are unknown. A population-based online survey of 5,100 Australians adults was conducted in October 2021. Psychological distress was assessed with the Kessler 6-item Psychological Distress Scale. Additional survey questions included use and satisfaction with digital health services. Where available, data were compared with our previous survey conducted in 2018, permitting an examination of pre- and post-pandemic digital health service utilization. In 2021, almost a quarter (n = 1203, 23.6%) of respondents reported serious levels of psychological distress; participants with pre-existing health related conditions, of younger age, lower educational attainment, those who lost their job or were paid fewer hours, or living in states with lockdown policies in place were at highest risk of serious psychological distress. Almost half of all respondents (n = 2177, 42.7%) reported using digital health technologies in 2021, in contrast to just 10.0% in 2018. In 2021, respondents with serious psychological distress were significantly more likely to consult with a healthcare professional via telephone/videoconferencing (P < 0.001), access healthcare via a telephone advice line (P < 0.001), or via an email or webchat advice service (P < 0.001) than those with no serious psychological distress. Those with and without psychological distress were highly satisfied with the care they received via digital health technologies in 2021. Rates of serious psychological distress during the second year of the pandemic remained high, providing further evidence for the serious impact of COVID-19 on the mental health of the general population. Those with psychological distress accessed digital mental health services and were satisfied with the care they received. The results highlight the continued need for mental health support and digital health services, particularly for people living with chronic conditions, younger adults and people most impacted by the COVID-19 pandemic, both in the short term and beyond.

Metaverse as a possible tool for reshaping schema modes in treating personality disorders.

Personality disorders (PD) are usually treated with face-to-face sessions and/or digital mental health services. Among many schools of therapies, schema therapy stands out because rather than simply targeting the symptoms of PD, it cordially targets the cause of PD and heals the early maladaptive schema, thus is exceptionally good at soothing emotional disturbances before enacting cognitive restructuring, resulting in long-term efficacy. However, according to Piaget’s genetic epistemology, the unmet needs lie in the fact that the schemata that determine the adaptive behavior can only be formed in the interaction with the real world that the patient is living in and reconsolidated by the feedback from the object world upon the patient’s newly-formed behavior. Therefore, in order to reshape the patient’s schema modes to support adaptive behavior and regain emotional regulation capabilities of the healthy adult, one may have to reconstruct the object world surrounding the patient. Metaverse, the bestowed successor to the Internet with the cardinal feature of “the sense of full presence,” can become a powerful tool to reconstruct a new object world for the patient with the prescription of a psychotherapist, so as to transform the treatment techniques in schema therapy into the natural autobiographical experiences of patients in the new object world, thus gradually reshape the patient’s schema modes that can ultimately result in an adaptive, and more inclusive, interaction with the real world. This work describes the underlying theory, the mechanism, the process, and ethical considerations of such promising technology for the not-too-far future.

Digital mental health and employment - Lessons from the Australian experience

Background and objectivesThis paper reviews Australia's take-up of digital mental health interventions, including some specific reference to their application in relation to employment. Use of these interventions in Australia was already significant. Under COVID-19 they have exploded. The Australian experience offers useful lessons for European and other countries, and these are summarised. MethodsThis paper presents a narrative review of key texts, resources, policies and reports, from government and other sources. It also presents data reflecting the take-up of digital mental health services and the employment of people with a mental illness in Australia. ResultsWe present data showing the explosion in uptake of digital mental health services. There is very limited evidence about the impact of these services in improving employment outcomes for people with a mental illness in Australia. The Government has moved to make them a permanent feature of mental health care, in addition to traditional face-to-face care. ConclusionKey lessons emerge from the Australian experience, including the need for target clarity; the importance of blending digital services into broader frameworks of mental health care; the need for quality and safety standards to be developed and applied to digital services; and the need for better evaluation of the outcomes of digital interventions in the workplace.The digital mental health genie is out of the bottle. New capacity for evaluation of the outcomes of digital mental health services is vital to ensure value and quality of such investments.

The design and development of an experience measure for a peer community moderated forum in a digital mental health service.

Online digital mental health communities can contribute to users' mental health positively and negatively. Yet the measurement of experience, outcomes and impact mechanisms relating to digital mental health communities is difficult to capture. In this paper we demonstrate the development of an online experience measure for a specific children and young people's community forum inside a digital mental health service. The development of the Peer Online Community Experience Measure (POCEM) is informed by a multi-phased design: (i) item reduction through Estimate-Talk-Estimate modified Delphi methods, (ii) user testing with think-aloud protocols and (iii) a pilot study within the digital service community to explore observational data within the platform. Experts in the field were consulted to help reduce the items in the pool and to check their theoretical coherence. User testing workshops helped to inform the usability appearance, wording, and purpose of the measure. Finally, the pilot results highlight completion rates, differences in scores for age and roles and "relate to others", as the most frequent domain mechanism of support for this community. Outcomes frequently selected show the importance of certain aspects of the community, such as safety, connection, and non-judgment previously highlighted in the literature. Experience measures like this one could be used as indicators of active therapeutic engagement within the forum community and its content but further research is required to ascertain its acceptability and validity. Multi-phased approaches involving stakeholders and user-centred design activities enhances the development of digitally enabled measurement tools.

Foundations for fairness in digital health apps.

Digital mental health applications promise scalable and cost-effective solutions to mitigate the gap between the demand and supply of mental healthcare services. However, very little attention is paid on differential impact and potential discrimination in digital mental health services with respect to different sensitive user groups (e.g., race, age, gender, ethnicity, socio-economic status) as the extant literature as well as the market lack the corresponding evidence. In this paper, we outline a 7-step model to assess algorithmic discrimination in digital mental health services, focusing on algorithmic bias assessment and differential impact. We conduct a pilot analysis with 610 users of the model applied on a digital wellbeing service called Foundations that incorporates a rich set of 150 proposed activities designed to increase wellbeing and reduce stress. We further apply the 7-step model on the evaluation of two algorithms that could extend the current service: monitoring step-up model, and a popularity-based activities recommender system. This study applies an algorithmic fairness analysis framework for digital mental health and explores differences in the outcome metrics for the interventions, monitoring model, and recommender engine for the users of different age, gender, type of work, country of residence, employment status and monthly income.Systematic Review Registration: The study with main hypotheses is registered at: https://osf.io/hvtf8

Measuring Client Satisfaction With Digital Services: Validity and Reliability of a Short-Form Digital Tool

Background Because of the COVID-19 pandemic’s preventive measures, mental health care services were forced to reorganize and develop remote telehealth services. This led to newer modes of receiving treatment, both internet-based and video-based therapies, to meet patients’ need for help, while at the same time keeping the COVID-19 pandemic under control. This shift calls for an evaluation of the patient experience during times of increased use of novel approaches of receiving treatment. Brief evaluation forms are ideal for this purpose. Objective As there are no validated brief measurement tools to evaluate patient-reported experiences in Norwegian mental health settings, we aimed to explore the internal consistency and factor validity of the 4-item self-administrated Client Satisfaction Questionnaire (CSQ-4). Methods We examined the internal consistency and factor structure of a brief digitally administrated patient satisfaction measure in a sample of 145 outpatients in Norwegian mental health settings during the COVID-19 pandemic. Results The internal consistency of a digital Norwegian CSQ-4 was high, with a Cronbach α of .92. A clear unidimensional structure (eigenvalue=3.22), which explained 80.4% of the variance, emerged from our data. A Mann-Whitney U test found a nonsignificant difference in satisfaction between genders (U=2546.5; P=.17). A Spearman rank correlation between satisfaction and age in our data was not statistically significant (r144=.110, P=.19). Conclusions A measurement tool such as the CSQ-4 would be a valuable resource to improve the development and application of digital mental health services. Our results may support the use of the Norwegian CSQ-4 as a valid and reliable measure of satisfaction with mental health care services. In addition, as the CSQ-4 is a short-form and generic tool, it can be implemented in a wide range of routine evaluations of patient-reported satisfaction with telehealth services.

Real world effectiveness of digital mental health services during the COVID-19 pandemic.

BackgroundThe COVID-19 pandemic created an unprecedented need for mental health services that can be remotely delivered. Digital mental health services that offer personalized care recommendations hold promise to efficiently expand service, but evidence of the effectiveness of digitally delivered mental health care in real-world settings remains limited.MethodsA retrospective cohort of adults (N = 1,852) receiving care through a digital mental health platform with elevated depressive symptoms during the COVID-19 pandemic was analyzed to estimate changes in subjective well-being and clinical improvement in depressive symptoms (using the World Health Organization-Five [WHO-5] Well-Being Index), as well as compare the relative effectiveness and cost of different care utilization patterns.ResultsThe average improvement in WHO-5 score was 10.1 points (CI: 9.3–10.9, p<0.001) at follow-up, which constituted a medium effect size (d = 0.73). The odds of clinical improvement in depressive symptoms were significantly greater among those who utilized telecoaching (aOR = 2.45, 95%CI: 1.91–3.15, p < .001), teletherapy (aOR = 2.01, 95%CI: 1.57–2.57, p < .001), and both services (aOR = 2.28, 95%CI: 1.67–3.11, p < .001) compared to those who only utilized assessments, adjusting for baseline WHO-5 score, age, sex, and number of days between baseline and follow-up assessments. The average estimated cost of care for telecoaching was $124 per individual, which was significantly less than teletherapy ($413) or both services ($559).ConclusionDigitally delivered care with a therapist and/or coach was effective in improving subjective well-being and clinical improvement in depressive symptoms. Although clinical outcomes were similar across utilization patterns, the cost of care was lowest among those utilizing telecoaching.

Australian Psychologists Experiences with Digital Mental Health: a Qualitative Investigation

Digital mental health is changing the landscape of service delivery by addressing challenges associated with traditional therapy. However, practitioners’ use of these resources remains underexamined. This study explored psychologists’ attitudes and experiences with digital mental health intervention. Taking a qualitative exploratory approach via thematic analysis, the study sought to answer the following research questions: (i) How do psychologists perceive digital mental health? and (ii) What is their experience using digital mental health as part of routine practice? Ten practising psychologists participated in online semi-structured interviews (approximately 50 min), with interviews then transcribed verbatim. Interview data were analysed according to the six-phase approach to thematic analysis proposed by Braun and Clarke. Three themes were identified: (1) attitudes towards digital mental health; (2) use within routine practice; and (3) perspectives on an effective model for implementation. Practitioners play a major role in the design and delivery of digital mental health services. Barriers and facilitators at the practitioner-level (e.g. knowledge and competence with tools, perceptions on the utility of digital interventions) and the service-level (e.g. government support for digital health) should be considered in the future design of digital mental health resources and service delivery.

Developing the Workforce of the Digital Future: Leveraging Technology to Train Community-Based Mobile Mental Health Specialists

Challenges in training, dissemination, and implementation have impeded the ability of providers to integrate promising digital health tools in real-world services. There is a need for generalizable strategies to rapidly train real-world providers at scale to support the adoption of digital health. This study describes the development of principles guiding rapid training of community-based clinicians in the support of digital health. This training approach was developed in the context of an ongoing trial examining implementation strategies for FOCUS, a mobile mental health intervention designed for people with serious mental illness. The SAIL (Simple, Accessible, Inverted, Live) model introduces how digital tools can be leveraged to facilitate rapid training of community agency-based personnel to serve as digital mental health champions, promoters, and providers. This model emphasizes simple and flexible principles of intervention delivery, accessible materials in a virtual learning environment, inverted or “flipped” live training structure, and live consultation calls for ongoing support. These initial insights lay the groundwork for future work to test and replicate generalizable training strategies focused on real-world delivery of digital mental health services. These strategies have the potential to remove key obstacles to the implementation and dissemination of digital health interventions for mental health.

Presentations to the emergency department with self-harm or suicidal behaviours: A role for digital mental health services?

Emergency Department (ED) is an important site for assessing people presenting with self-harm or suicidal behaviors. Digital mental health services (DMHS) offer evidence-based interventions for mental health issues, but are often under-utilised, and information about them is rarely provided in ED. This feasibility study explored whether offering information about a DMHS to individuals presenting to ED with self-harm/suicidal behaviors resulted in self-enrolment in DMHS interventions for anxiety, depression and/or chronic pain. Methods: all individuals aged 18+ presenting with self-harm/suicidal behaviors to a metropolitan ED were screened for symptoms of anxiety, depression and/or chronic pain. Those with these symptoms were invited to participate in a study investigating enrolment with a DMHS. Study participants were provided with information about DMHS and followed up at one month. Results: 260 individuals presented with self-harm/suicidal behaviors over the 6-month study period. Many reported low mood (73.5%, n = 191) anxiety (67.2%, n = 174) and/or chronic pain (18.5%, n = 48). Half of those eligible for DMHS agreed at point of ED discharge to be contacted about participation in the DMHS study (51.4%, n = 108). One-third of these participated in the study (35.2%, n = 38). Rates of past-month high-risk SB (65.8%, n = 25), depression (92.1%, n = 35), anxiety (78.9%, n = 30) and chronic pain (57.9%, n = 22) were very high. Of these, 39.5% (n = 15) self-enrolled with the DMHS; almost all (80.0%, n = 13) engaged with an online intervention. Conclusions: A subset of people presenting to emergency department with suicidal behaviors will engage with DMHS. Better understanding is needed of factors contributing to uptake of DMHS in this group.

Understanding Components of Therapeutic Alliance and Well-Being from Use of a Global Digital Mental Health Benefit During the COVID-19 Pandemic: Longitudinal Observational Study

Digital mental health services leverage technology to increase access to care, yet less is known about the quality of therapeutic relationships in a virtual setting. This study examined components of therapeutic alliance (a mechanism underlying successful treatment) and its association with beneficial treatment outcomes in a real-world, virtual setting. The objective is to examine (1) participant ratings of components of therapeutic alliance with providers in a virtual setting, (2) changes in subjective well-being and depressive symptoms among participants who began care with elevated depressive symptoms, and (3) the association between components of alliance and changes in participants’ well-being. Adults (N = 3,087, M age = 36 ± 9 years, 54% female) across the world with access to digital mental health benefits who engaged in videoconference sessions with a licensed therapist (18%, 555/3,087), certified coach (65%, 2,003/3,087), or both (17%, 529/3,087) between Sept. 29, 2020 and Oct. 12, 21. Participants completed 2 adapted items from the Working Alliance Inventory (goals and bonds subscales) after each session, and ratings were averaged across visits (Cronbach’s ɑ = .72). Participants’ World Health Organization-Five (WHO-5) Well-Being Index scores at the start and end of the study period were used to measure changes in subjective well-being. Descriptive and inferential statistics were conducted to examine average alliance ratings across demographics and utilization types and the association between alliance and well-being. The median adapted therapeutic alliance score was 4.8 (range: 1–5) and did not differ by age, country, or baseline well-being (Ps > .07). Females reported higher components of alliance than males (4.88 vs. 4.67, P = .01). Participants utilizing telecoaching reported higher components of alliance than those utilizing teletherapy or both telecoaching and teletherapy (4.83 v. 4.75, P = .004), though effect sizes were negligible. Among those with elevated baseline depressive symptoms (n = 835), participants reported an average WHO-5 increase of 15.42 points (95% CI 14.19–16.65, P < .001, Cohen d = 1.06) with 58% (485/835) reporting clinical recovery and 57% (481/835) reporting clinical improvement in depressive symptoms. Higher components of therapeutic alliance scores predicted greater well-being at follow-up (b = 2.04, 95% CI 0.09–3.99, P = .04) after controlling for age, sex, baseline WHO-5, and number of days in care (R2 = .06, P < .001). Exploratory analyses indicated this association did not differ by utilization type, baseline well-being, or session utilization (Ps > .34). People with access to one-on-one videoconferencing care via a digital mental health benefit formed a strong bond and sense of alignment on goals with both coaches and therapists. Higher components of alliance scores were associated with improvements in subjective well-being among participants who began care with elevated depressive symptoms, providing evidence that a positive bond and goal alignment with a provider are two of many factors influencing virtual care outcomes. Continued focus on the quality of therapeutic relationships will ensure digital mental health services are patient-tailored as these platforms expand equitable access to evidence-based care.

An exploration in to how young-people from ethnic-minority backgrounds interact with online counselling

PurposeLiterature suggests young people (YP) from ethnic minority backgrounds face barriers in accessing mental health support due to discrimination and stigma and so this study aims to explore how YP from ethnic minority backgrounds interact with online counselling.Design/methodology/approachThe study used secondary data provided by Kooth, a digital mental health service for YP, for users who accessed the service from September 2020 to 2021 (N = 118,556). The users measure of need (YP-CORE) was assessed upon sign up to the service, and they also chose the ethnicity and background they felt best represented by. The study hypothesised the following: H1. There would be a significant difference between ethnic group of YP and source of referral; H2. There would be a significant difference in ethnic group of YP and YP-CORE score.FindingsThe one-way ANOVA and chi-squared analyses demonstrated a significant difference for both hypotheses indicating a significant association between source of referral and ethnicity, and a significant difference in measure of need when comparing YP who self-identified as White to those who self-identified as Asian.Originality/valueFindings reveal school-based services are the most popular source of referral for all YP; however, a higher number of YP from Asian and Black ethnicities reached out through informal sources such as Google as opposed to health professionals such as GPs. From the data, YP who identified as Indian, Chinese and African present to online counselling at a lower level of distress compared to their White British counterparts, contradictory to findings investigating measure of need in face-to-face settings.

Health-Related Quality of Life Among Members Using an On Demand Behavioral Health Platform: Pilot Observational Study.

BackgroundDespite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry, and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and thus, traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, this study used the health-related quality of life (HRQoL) tool from the Centers for Disease Control and Prevention “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical and subclinical individuals.ObjectiveThe purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL.MethodsA total of 288 members completed the 4-item HRQoL measure at baseline and at 1 month following use of the Ginger on demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively.ResultsMembers completed on average 1.92 (SD 2.16) coaching sessions and 0.91 (SD 1.37) clinical sessions during the assessment month. Paired samples t tests revealed significant reductions in the average number of unhealthy mental health days between baseline (mean 16, SD 8.77 days) and follow-up (mean 13.2, SD 9.02 days; t287=5.73; P<.001), and in the average number of days adversely impacted (meanbaseline 10.9, meanfollow-up 8.19; t287=6.26; P<.001). Both subclinical members (t103=3.04; P=.003) and clinical members (t183=5.5; P<.001) demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days (t183=5.82; P<.001). Finally, member engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days (B=–0.96; P=.04).ConclusionsTo our knowledge, this study is one of the first to use the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed.

How Psychological Wellbeing and Digital Mental Health Services Intervene the Role of Self-Efficacy and Affective Commitment of University Students in Their Performance?

Student performance is a critical factor in academic achievement. Other factors like the students' self-efficacy, affective commitment, and psychological wellbeing play a significant role in shaping their performance. The present study aims to understand the role of self-efficacy, affective commitment, and psychological wellbeing in the students' performance. To carry out the study, the data were collected from the 308 students currently enrolled in the public sector universities of China. Smart-PLS is used to check the validation of the proposed hypotheses. Partial least square structural equation modeling is used for hypothesis testing. Results of the study show that self-efficacy does not play a role in the student performance in public sector universities; however, the affective commitment of the students plays a significant role in their performance. The psychological wellbeing of the students has a substantial influence on their performance. Furthermore, the results have also indicated that psychological wellbeing is an important indicator of student performance. It has also been revealed that psychological wellbeing significantly mediates the relationship between self-efficacy, affective commitment, and student performance. The students who availed of the digital mental health services were found to have a low relationship between their self-efficacy and performance.

National Mental Health Platform in Egypt, Revolution of Mental Health Services

IntroductionThe General Secretariat of Mental Health and Addiction Treatment is a governmental body dedicated to the provision of mental health services in Ministry of Health in Egypt. Moreover, in response to the COVID-19 outbreak in Egypt, on line, advice tips, and counseling through the hotline services have became available through social media sites the past few months. Such digital remote MH services were very much welcomed by social media users. In the same time, for mental health professionals, the opportunity to provide help in this time of crisis – without an in-person consultation – was very desirable. In addition to the prevailing stigma of MH condition in the Egyptian culture, which this remote approach overcome it. Effective innovations in the field of mental health have the potential to change the face of mental health care, not only during pandemics but also in routine daily life.Objectives1. Develop a National strategy for E-Mental Health in Egypt. 2. Develop the National mental health platform as a universal implementation tool.MethodsThis project conducted in collaboration with WHO in Egypt, It run in 3 phases: Strategy, planning and infrastructure: include needs assessment and software development. Finalizing infrastructure, adaptation of the content Deployment: include training of the service providers on the usage of the adapted M.H platform, launching and advocacy.ResultsDevelopment of E-Mental Health strategy, Development of National Mental Health Platform, Training of 50 therapists on digital mental health services.ConclusionsNational Mental Health Platform is the future road of mental health services in EgyptDisclosureNo significant relationships.

Implementing shared decision-making in Australia

Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.

Exploring the potential of delivering mental health care services using digital technologies in Bangladesh: A qualitative analysis

BackgroundBangladesh is a lower-middle-income country affected by a severe lack of mental health service availability due to a scarcity of mental health experts, limited mental health literacy, and community stigma. In other low and middle-income countries, the online provision of mental health care services has addressed issues affecting service availability, accessibility, mass awareness of services, and stigma. ObjectiveThe current study sought to understand stakeholders' perceptions of the potential of digital media-based mental health care delivery in strengthening Bangladesh's mental health system. MethodOnline in-depth interviews were conducted with seven psychiatrists and eleven people with lived experiences of mental health issues. In addition, two online focus groups were conducted with ten psychologists and nine mental health entrepreneurs. A thematic analysis of the audio transcriptions was used to identify themes. ResultStakeholders perceived that the benefits of digital media-based mental health services included the potential of increasing the awareness, availability, and accessibility of mental health services. Participants recommended: the rehabilitation of existing pathways; the use of social media to raise awareness; and the implementation of strategies that integrate different digital-based services to strengthen the mental health system and foster positive mental health-seeking behaviors. ConclusionGrowing mental health awareness, combined with the appropriate use of digital media as a platform for distributing information and offering mental services, can help to promote mental health care. To strengthen mental health services in Bangladesh, tailored services, increased network coverage, and training are required on digital mental health.

Evaluating the Implementation of a Mental Health App for Overseas Filipino Workers in Macao China: A Mixed-Methods Study of Stakeholders' Perspectives.

BackgroundOverseas Filipino workers (OFWs) is one of the largest communities of international migrant workers. They face systemic barriers to fulfilling their health needs. The COVID-19 pandemic worsened this condition and provided a context to evaluate the utility of a digital mental health intervention delivered within a stepped-care model to address OFW mental health. Using an implementation science framework, this study aimed to evaluate stakeholders’ perspectives on the implementation of Kumusta Kabayan, a mobile phone-based mental health app, for OFWs in Macao.MethodsA mixed-methods convergent design was used by conducting two parallel steps, including quantitative and qualitative measures. The quantitative data was collected from Filipino team members and local non-governmental organization (NGO) staff members (N = 12). The qualitative data were gathered from interviews with OFWs in Macao who used the app (N = 25; 80% females, 76% domestic workers).ResultsFrom the online survey, the staff members of the local partner NGO and the Filipino team members strongly perceived that their organization could adapt Kumusta Kabayan to their program and generally evaluated that Kumusta Kabayan achieved its goal and was received well by OFWs. In the interviews, the OFW app users shared their experiences in using Kumusta Kabayan, which was thematically organized into six aspects of the participants’ experience: (1) promotional channel and expectation; (2) when to use the app and in what language; (3) lessons learnt; (4) memorable aspects; (5) key facilitators and barriers; and (6) suggestions.ConclusionKumusta Kabayan was well accepted and shows potential to be integrated into the existing support services for OFWs in Macao. This app has the promise of being scaled-up for OFWs in other countries by collaborating with local and overseas stakeholders. Lessons learnt from this evaluation could also be implemented in wider digital mental health services in different settings.

Antidepressant medication use by patients accessing a national digital mental health service

BackgroundDigital mental health services (DMHSs) provide psychological treatments via the internet or phone and are increasingly being offered as part of routine care. This study describes antidepressant (AD) medication use and treatment outcomes in a large sample of routine care patients accessing a DMHS. MethodsPatients completing an assessment with an Australia-wide DMHS (MindSpot Clinic) from 1st January to 31st December 2020 (n = 17,409) were asked about psychotropic medication use. Demographic characteristics and treatment outcomes on the PHQ-9 (depression), GAD-7 (anxiety), and K-10+ (general distress) were compared for patients taking an AD versus no AD. Treatment outcomes were also analyzed for a subgroup of patients reporting recent commencement of AD medication. ResultsAlmost one quarter of patients (4141/17409; 23.8%) reported taking an AD, mainly selective serotonin reuptake inhibitors (SSRIs). Patients taking ADs had more severe symptoms however effect sizes were large (Cohen's d's > 1.0). Patients recently commencing ADs had the highest baseline symptoms but showed greater symptom improvement at post-treatment and 3-month follow-up. LimitationsTreatment trajectory was measured weekly using standardized scales that are sensitive to change, however they did not allow formal clinical diagnoses of depression and were subject to the effects of missing data. The observational design did not control for spontaneous recovery or for comorbid conditions that might influence recovery. ConclusionsDespite these limitations, online treatment provided by a DMHS as part of routine care is acceptable and effective for patients reporting concurrent AD medication use.

Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study.

The present study aims to examine whether users perceive a therapeutic alliance with an AI conversational agent (Wysa) and observe changes in the t‘herapeutic alliance over a brief time period. A sample of users who screened positively on the PHQ-4 for anxiety or depression symptoms (N = 1,205) of the digital mental health application (app) Wysa were administered the WAI-SR within 5 days of installing the app and gave a second assessment on the same measure after 3 days (N = 226). The anonymised transcripts of user's conversations with Wysa were also examined through content analysis for unprompted elements of bonding between the user and Wysa (N = 950). Within 5 days of initial app use, the mean WAI-SR score was 3.64 (SD 0.81) and the mean bond subscale score was 3.98 (SD 0.94). Three days later, the mean WAI-SR score increased to 3.75 (SD 0.80) and the mean bond subscale score increased to 4.05 (SD 0.91). There was no significant difference in the alliance scores between Assessment 1 and Assessment 2.These mean bond subscale scores were found to be comparable to the scores obtained in recent literature on traditional, outpatient-individual CBT, internet CBT and group CBT. Content analysis of the transcripts of user conversations with the CA (Wysa) also revealed elements of bonding such as gratitude, self-disclosed impact, and personification. The user's therapeutic alliance scores improved over time and were comparable to ratings from previous studies on alliance in human-delivered face-to-face psychotherapy with clinical populations. This study provides critical support for the utilization of digital mental health services, based on the evidence of the establishment of an alliance.