Digital Mental Health Services Research Articles

Digital futures in mind: Why lived experience collaboration must guide digital mental health technologies

AbstractDigital mental health technologies and services are here. More are coming. Such technologies and services present both risks and opportunities. At their best, they may enhance the most humane, communal and caring parts of our social systems and communities. At their worst, they may reinforce reductionist approaches to distress and crisis, increase surveillance and control, as well as extracting data and wealth from people seeking care. In this paper, we argue that lived experience‐led governance and collaborative development of these technologies and services will enhance the best opportunities and mitigate against the biggest risks. This paper provides a commentary emerging from work by authors with lived experience, and those without, that explored accountability in digital mental health technologies and services. The commentary offers guidance to anyone interested in supporting lived experience‐led, and collaborative governance of, digital mental health technologies. This guidance, drawing on interdisciplinary and lived experience‐led research and grey literature, assists readers in understanding why collaboration should take place, when, where and with whom, on what issues this could start, and how collaborators should approach this.

Therapeutic Communication in Mental Health Telemedicine Services Through the Halodoc Application

This qualitative study explores the communication dynamics between psychologists and clients within the framework of utilising mental health services provided by Halodoc. Telemedicine has emerged as a popular alternative for individuals seeking mental health support in the digital age. Using a case study methodology, in-depth interviews were conducted with psychologists and clients who availed themselves of Halodoc’s mental health features. The findings reveal both advantages and challenges associated with communication via Halodoc. Advantages include enhanced accessibility, convenience, and privacy for clients, while challenges encompass the absence of non-verbal cues, difficulties in building rapport, and occasional technical constraints affecting session quality. This research offers valuable insights into the communication dynamics of digital mental health services, laying the groundwork for enhancing service efficacy and user experience. In conclusion, the study emphasises the need to address challenges within telemedicine platforms and continuously improve them to optimise mental health service delivery in the digital realm. Ultimately, the study contributes to advancing our understanding of communication in digital mental health services and underscores the importance of ongoing refinement in telemedicine platforms to meet the evolving needs of clients and psychologists alike.

Improvement and Maintenance of Clinical Outcomes in a Digital Mental Health Platform: Findings From a Longitudinal Observational Real-World Study.

Digital mental health services are increasingly being provided by employers as health benefit programs that can improve access to and remove barriers to mental health care. Stratified care models, in particular, offer personalized care recommendations that can offer clinically effective interventions while conserving resources. Nonetheless, clinical evaluation is needed to understand their benefits for mental health and their use in a real-world setting. This study aimed to examine the changes in clinical outcomes (ie, depressive and anxiety symptoms and well-being) and to evaluate the use of stratified blended care among members of an employer-sponsored digital mental health benefit. In a large prospective observational study, we examined the changes in depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item Generalized Anxiety Disorder scale), and well-being (5-item World Health Organization Well-Being Index) for 3 months in 509 participants (mean age 33.9, SD 8.7 years; women: n=312, 61.3%; men: n=175, 34.4%; nonbinary: n=22, 4.3%) who were newly enrolled and engaged in care with an employer-sponsored digital mental health platform (Modern Health Inc). We also investigated the extent to which participants followed the recommendations provided to them through a stratified blended care model. Participants with elevated baseline symptoms of depression and anxiety exhibited significant symptom improvements, with a 37% score improvement in depression and a 29% score improvement in anxiety (P values <.001). Participants with baseline scores indicative of poorer well-being also improved over the study period (90% score improvement; P=.002). Furthermore, over half exhibited clinical improvement or recovery for depressive symptoms (n=122, 65.2%), anxiety symptoms (n=127, 59.1%), and low well-being (n=82, 64.6%). Among participants with mild or no baseline symptoms, we found high rates of maintenance for low depressive (n=297, 92.2%) and anxiety (n=255, 86.7%) symptoms and high well-being (n=344, 90.1%). In total, two-thirds of the participants (n=343, 67.4%) used their recommended care, 16.9% (n=86) intensified their care beyond their initial recommendation, and 15.7% (n=80) of participants underused care by not engaging with the highest level of care recommended to them. Participants with elevated baseline depressive or anxiety symptoms improved their mental health significantly from baseline to follow-up, and most participants without symptoms or with mild symptoms at baseline maintained their mental health over time. In addition, engagement patterns indicate that the stratified blended care model was efficient in matching individuals with the most effective and least costly care while also allowing them to self-determine their care and use combinations of services that best fit their needs. Overall, the results of this study support the clinical effectiveness of the platform for improving and preserving mental health and support the utility and effectiveness of stratified blended care models to improve access to and use of digitally delivered mental health services.

Efficacy of Internet-based Cognitive Behavioral Therapy for Hong Kong University Students: A Randomized Controlled Trial

Purpose: This study examined the efficacy of a 10-week internet-based cognitive behavioral therapy (iCBT) program “REST Online” for Hong Kong university students with mild to moderate levels of psychological distress. Method: A total of 206 Hong Kong university students were randomized into: (1) web-based and (2) app-based iCBT, and (3) waitlist control (WLC) groups. Results: Compared with the WLC group, the participants in the two iCBT groups showed a significant reduction in psychological distress, depression and anxiety symptoms, and negative thoughts and emotions, and significant increase in positive thoughts and emotions, with medium to large effect sizes. The positive effects were sustained at the 3-month follow-up test. No significant intervention effects were found between the two iCBT groups except for anxiety symptoms. Discussion: The findings were discussed in terms of program design and service delivery, and suggestions for delivering digital mental health service in Hong Kong universities were proposed.

The Effectiveness of EduMind for Mental Health Promotion Among Youths.

Introduction The global surge in mental health issues, particularly among the youth, is evident. Despite the proliferation of digital mental health services, their adoption remains limited, hindered by various barriers. To address this issue, an evidence-based, validated digital mental health intervention is necessary. Although much research has explored the effectiveness of such interventions, there was limited evidence supporting those within the youth population. The objective of this research is to assess the effects of aninterventional module on depression, anxiety, and stress symptoms among youths. Methods The EduMind online mental health intervention contents were developed from a needs assessment and a scoping review of effective psychotherapies, achieving a high content validation index (CVI) of 0.96. The contents were integrated into a web application to assess its effectiveness among the target population which consisted of university students of a local institution. A quasi-experimental study compared the intervention group (n=264) to a waitlist-control group (n=200), evaluating changes in mental health status with the Depression, Anxiety and Stress Scale 21 (DASS-21) questionnaire using analysis of covariance (ANCOVA) to analyse mean differences. Results Participants in the intervention group indicated a significant decrease (p< 0.001) in depression, anxiety, and stress. The pre-test and post-test mean scores in the intervention group were 15.81 and 8.97 for depression, 11.46 and 7.02 for anxiety and 14.64 and 6.33 for stress, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for depression. However, there was a slight significant reduction for anxiety with pre- and post-test scores of13.31 and 12.95. Stress mean scores exhibited a slight increase, rising from 13.55 to 14.24. The final phase revealed significant improvements in mental health status between groups, with significant effect sizes for stress (ƞp2= 0.57, p < 0.001), depression (ƞp2= 0.71, p < 0.001), and anxiety (ƞp2= 0.27, p < 0.001). Conclusion The findings contribute to the advancement of technology-assisted health services, facilitating greater uptake among the population.This study utilized a comprehensive module development framework and demonstrated the effectiveness of the expert-guided mental health intervention module.Furthermore, the study suggests potential integration with the National Strategic Plan for Mental Health 2020-2025 and the National Mental Health Policy, proposing the web application as a potential compulsory student screening tool administered by universities. The information gathered by this application could inform future research directions, propelling technological-assisted mental health services to new heights.

Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis.

In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes-inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients' requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people's fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements.

Implementation of the Australian National Safety and Quality Digital Mental Health Standards.

Following the release of the Australian National Safety and Quality Digital Mental Health (NSQDMH) Standards in November 2020, our objective was to ensure effective implementation of the Standards. This included the development of an accreditation scheme to allow digital mental health services to be formally assessed against the Standards and provide service users with an assurance of safe and high-quality services. The accreditation scheme was adapted from the one used for the National Safety and Quality Health Service (NSQHS) Standards. As the digital mental health sector was largely unfamiliar with standards and accreditation, the scheme was pilot-tested with a range of service providers and further consultation took place to refine it. The accreditation scheme was launched in November 2022 with support resources published to aid implementation. The NSQDMH Standards accreditation scheme provides an assurance of safety and quality for digital mental health service users.

The Application and Ethical Issues of Digital Mental Health Services

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.

The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth.

Abstract Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.

Nourishing the Mind: How Food Security Influences Mental Wellbeing.

Food insecurity is a significant public health problem worldwide and critical to mental health. There is a complex relationship between food security and mental health. We carried out a narrative review study aiming to address how food insecurity impacts mental wellbeing by focusing on the mental health repercussions of food insecurity, recognizing its pivotal role in attaining Sustainable Development Goals 2 (on hunger) and 3 (on enhancing global wellbeing). A comprehensive search was conducted on PubMed and Google Scholar, incorporating Google searches for pertinent reports and policy documents. To address these questions, we emphasized and elucidated the interconnectedness between food security and mental health. The review shows that food security and mental health share a profound relationship influenced by multifaceted factors like socioeconomic conditions, access to nutritious food, and societal inequalities. We then provide recommendations for integrating food security into mental health strategies based on the insights and conclusions drawn. Strategies ranging from sustainable farming practices to urban agriculture initiatives and digital mental health services demonstrate avenues for enhancing food safety and mental wellbeing. This highlights the need for collaborative interdisciplinary efforts and systemic reforms to address these interconnected challenges.

Decision-making about uptake and engagement with digital mental health services: a qualitative exploration of service user perspectives

ABSTRACT Objective Digital mental health services (DMHS) overcome many barriers to help-seeking. Yet, people’s use and uptake of treatment with DMHSs varies considerably. This study explored service user perspectives on deciding to take up online assessment and treatment for anxiety and/or depression within a large national DMHS. Method Participants were 20 adults who had self-referred or were referred by a GP to an Australia-wide DMHS for psychological assessment (group 1), plus follow-up discussion of treatment/other service options with a therapist (group 2), plus enrolment into internet-delivered treatment with optional therapist guidance (group 3). Participants took part in one-to-one semi-structured interviews, with parallel question guides tailored to their group status. Interviews were transcribed verbatim and analysed thematically using framework methods. Results Analyses yielded three interlinking themes. Theme 1 highlighted the “importance of the broader treatment context, and its interaction with DHMS”; Theme 2 drew attention to “how the internal service structure shapes decision-making”; Theme 3 focussed on “the scope and limitations of DMHS”. Conclusion Findings provide in-depth insights into service user decision-making around engagement with DMHS and can inform the development of interventions to support users to take up DMHS offerings that are best suited to their needs, preferences, and current circumstances.

Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study.

Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.

Digital health literacy and digital engagement for people with severe mental ill health across the course of the COVID-19 pandemic in England

BackgroundAn unprecedented acceleration in digital mental health services happened during the COVID-19 pandemic. However, people with severe mental ill health (SMI) might be at risk of digital exclusion, partly because of a lack of digital skills, such as digital health literacy. The study seeks to examine how the use of the Internet has changed during the pandemic for people with SMI, and explore digital exclusion, symptomatic/health related barriers to internet engagement, and digital health literacy.MethodsOver the period from July 2020 to February 2022, n = 177 people with an SMI diagnosis (psychosis-spectrum disorder or bipolar affective disorder) in England completed three surveys providing sociodemographic information and answering questions regarding their health, use of the Internet, and digital health literacy.Results42.5% of participants reported experiences of digital exclusion. Cochrane-Q analysis showed that there was significantly more use of the Internet at the last two assessments (80.8%, and 82.2%) compared to that at the beginning of the pandemic (65.8%; ps < 0.001). Although 34.2% of participants reported that their digital skills had improved during the pandemic, 54.4% still rated their Internet knowledge as being fair or worse than fair. Concentration difficulties (62.6%) and depression (56.1%) were among the most frequently reported symptomatic barriers to use the Internet. The sample was found to have generally moderate levels of digital health literacy (M = 26.0, SD = 9.6). Multiple regression analysis showed that higher literacy was associated with having outstanding/good self-reported knowledge of the Internet (ES = 6.00; 95% CI: 3.18–8.82; p < .001), a diagnosis of bipolar disorder (compared to psychosis spectrum disorder – ES = 5.14; 95% CI: 2.47–7.81; p < .001), and being female (ES = 3.18; 95% CI: 0.59–5.76; p = .016).ConclusionsThese findings underline the need for training and support among people with SMI to increase digital skills, facilitate digital engagement, and reduce digital engagement, as well as offering non-digital engagement options to service users with SMI.

Prevalence and Predictors of Long COVID in Patients Accessing a National Digital Mental Health Service.

MindSpot is a national mental health service that provides assessments and treatment to Australian adults online or via telephone. Since the start of 2020, questions related to the mental health impacts of COVID-19 have been routinely administered. The objective of the current study is to report the prevalence and predictors of self-reported "long COVID" in patients completing an assessment at the MindSpot Clinic between 5 September 2022 and 7 May 2023 (n = 17,909). Consistent with the World Health Organization definition, we defined long COVID as the occurrence of ongoing physical or mental health symptoms three months after a COVID-19 infection. We conducted a descriptive univariate analysis of patients who reported: no COVID-19 diagnosis (n = 6151); a current or recent (within 3 months) COVID-19 infection (n = 2417); no symptoms three months post-COVID-19 infection (n = 7468); or COVID-related symptoms at least three months post-infection (n = 1873). Multivariate logistic regression was then used to compare patients with and without symptoms three months post-COVID to identify potential predictors for long COVID. The prevalence of long COVID was 10% of the total sample (1873/17909). Patients reporting symptoms associated with long COVID were older, more likely to be female, and more likely to be depressed and report a reduced ability to perform their usual tasks. Sociodemographic factors, including cultural background, education, and employment, were examined. These results provide evidence of the significant prevalence of symptoms of long COVID in people using a national digital mental health service. Reporting outcomes in an Australian context and in specific sub-populations is important for public health planning and for supporting patients.

Moderating mental health: Addressing the human–machine alignment problem through an adaptive logic of care

Covid-19 deepened the need for digital-based support for people experiencing mental ill-health. Discussion platforms have long filled gaps in health service provision and access, offering peer-based support usually maintained by a mix of professional and volunteer peer moderators. Even on dedicated support platforms, however, mental health content poses difficulties for human and machine moderation. While automated systems are considered essential for maintaining safety, research is lagging in understanding how human and machine moderation interacts when addressing mental health content. Working with three digital mental health services, we examine the interaction between human and automated moderation of discussion platforms, contrasting ‘reactive’ and ‘adaptive’ moderation practices. Presenting ways forward for improving digital mental health services, we argue that an integrated ‘adaptive logic of care’ can help manage the interaction between human and machine moderators as they address a tacit ‘risk matrix’ when dealing with sensitive mental health content.

Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study.

Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. Evidence of clinical improvements (% improvement; Hedges g) were found for all outcomes, including pain interference (18.9%; 0.55), depression (26.1%; 0.50), anxiety (23.9%; 0.39), pain intensity (12.8%; 0.41), pain self-efficacy (-23.8%; -0.46) and pain-catastrophizing (26.3%; 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63%; majority of the treatment = 75%) and satisfaction (very satisfied = 45%; satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.

Mental Health Help-Seeking Behavior of Male Video Game Players: An Online Survey.

Video gaming is a popular pastime for young males, having been shown to have both positive and negative effects on players' mental health. The aim of the current study was to ascertain the rate that male video gamers may seek mental health support for mental ill-health generally. The secondary aims were to (a) identify the most prolific barriers to seeking help; (b) determine how confident this group is to seek help; and (c) whether the variance in help-seeking efficacy be explained, in part, by age, hours gamed, self-esteem, and social capital. The survey included sections on demographic information, standardized measures of self-esteem (The Rosenberg Self-Esteem Scale), social capital (The Social Capital in Gaming Scale), help-seeking efficacy (Self-Efficacy to Seek Mental Health Care Scale), and non-standardized measures of help-seeking behavior and help-seeking barriers. The survey of 2,515 participants had a mean age of 21.37 years. The analysis identified that most participants had not sought mental health support for themselves. The most prolific barriers for this cohort to seek help were cost, confidentiality, and trust. Confidence to seek help was rated the lowest for overcoming embarrassment, understanding information, and coping with others' reactions. Help-seeking efficacy was found to be significantly predicted by age, hours spent gaming, self-esteem, and social capital. Low rates of seeking help, coupled with identifying the significant barriers of this group to seek help, may inform researchers aiming to develop targeted interventions for male youth interested in gaming and who are exhibiting mental ill-health to gain initial access, or engage more often, with mental health services when needed. Further research is recommended for investigating male gamers' insights in determining how to overcome the identified barriers for this cohort to improve mental health seeking behavior rather than avoidant behavior. From this, stigma reduction and ease of access to digital mental health services could be improved.

Patterns of engagement in a digital mental health service during COVID-19: a cohort study for children and young people.

The COVID-19 pandemic increased public use of digital mental health technologies. However, little is known about changes in user engagement with these platforms during the pandemic. This study aims to assess engagement changes with a digital mental healthcare service during COVID-19. A cohort study based on routinely collected service usage data from a digital mental health support service in the United Kingdom. Returning users aged 14-25 years that interacted for a maximum of two months were included. The study population was divided into pre-COVID and COVID cohorts. Demographic and usage information between cohorts were compared and usage clusters were identified within each cohort. Differences were tested using Chi-squared, two-sample Kolmogorov-Smirnov tests and logit regressions. Of the 624,103 users who joined the service between May 1, 2019, and October 1, 2021, 18,889 (32.81%) met the inclusion criteria: 5,048 in the pre-COVID cohort and 13,841 in the COVID cohort. The COVID cohort wrote more journals; maintained the same focus on messaging practitioners, posting discussions, commenting on posts, and having booked chats; and engaged less in writing journals, setting personal goals, posting articles, and having ad-hoc chats. Four usage profiles were identified in both cohorts: one relatively disengaged, one focused on contacting practitioners through chats/messages, and two broadly interested in writing discussions and comments within the digital community. Despite their broad similarities, usage patterns also exhibited differences between cohorts. For example, all four clusters had over 70% of users attempting to have ad-hoc chats with practitioners in the pre-COVID cohort, compared to one out of four clusters in the COVID cohort. Overall, engagement change patterns during the COVID-19 pandemic were not equal across clusters. Sensitivity analysis revealed varying strength of these defined clusters. Our study identified changes in user activity and engagement behavior within a digital mental healthcare service during the COVID-19 pandemic. These findings suggest that usage patterns within digital mental health services may be susceptible to change in response to external events such as a pandemic. Continuous monitoring of engagement patterns is important for informed design and personalized interventions.

"The library is so much more than books": considerations for the design and implementation of teen digital mental health services in public libraries.

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.

The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study

BackgroundLoneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform.MethodsA purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care.ResultsAt baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04).ConclusionsThis study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.