E-mental Health Interventions Research Articles

Overcoming non-usage of e-mental health: A qualitative study in a Dutch general practice

Abstract Background Worldwide percentages of people with mental health problems are substantial and increased during the COVID pandemic (to about 25 % in the general population). E-mental health has potential to help with waiting lists, rising health care costs and work pressure. To reach the desired effects, participants need to use the technology as intended. Non-usage though is a common problem. Research question is: what elements obstruct the intention to use e-mental Health interventions, plus what are barriers to bridging the intention-behaviour gap? Methods In a qualitative study, semi-structured interviews were conducted (interview guide). We recruited patients who were invited for an e-mental health intervention in a Dutch general practice but did not start the intervention. Data saturation occurred with 11 patients. Open, axial and selective coding was done on the transcribed interviews using the software ATLAS.ti. Results Five main themes were associated with non-use: 1) ‘Expectations about the eHealth in general’ were neutral to positive. 2) ‘thresholds to start e-mental health’ were: negative expectations about the content, lacking mental capacity due to mental problems, missing personal contact, the therapy with the mental health professional in general did not fit their needs or aversion towards more screen time. 3) ‘lack of planning’. 4) lacking encouragement from mental health professional 5) ‘Expectations from therapy in general’. (a.o. face-to-face contact and tailoring) Conclusions Embedding the e-mental health more into regular therapy has potential to overcome non-usage. The mental health care professional has social influence to increase usage, by a clear and convincing introduction plus joint review of the exercises during consultations. This study needs to be repeated in other clinical settings. Future research should also include age (computer use) and disease prognosis to define when e-mental health is a suitable solution for patients. Key messages • E-mental health interventions have potential to help with waiting lists, rising health care costs and workload, but non usage is a problem. • Embedding the e-mental health more into regular therapy has potential to overcome non-usage.

Determining the acceptance of e-mental health interventions in elite athletes using the unified theory of acceptance and use of technology.

Elite athletes are exposed to many different sport-specific stressors that may put them at particular risk for mental health symptoms and disorders. E-mental health interventions could be a feasible option to support elite athletes in need. The aim of the present study was to assess the acceptance of e-mental health interventions among elite athletes and explore its underlying drivers and barriers. A cross-sectional study was conducted with N = 382 elite athletes. Of these, N = 275 (71.99%, 167 females) were included in the statistical analyses. The impact of various sociodemographic, sport-related and medical characteristics on acceptance was assessed. EHealth-related data and acceptance of e-mental health interventions were examined using a modified assessment based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Overall, the acceptance of e-mental health interventions in elite athletes can be classified as high (M = 3.69 SD = 0.97). In the UTAUT regression model sex, financial situation, depression symptoms, digital confidence, digital overload as well as the UTAUT predictors performance expectancy, effort expectancy, and social influence predicted acceptance significantly. The UTAUT model has proven to be a valuable instrument in predicting of acceptance of e-mental health interventions in elite athletes. Given the strong association between acceptance and future use, new interventions should focus on the explored factors to establish effective e-mental health interventions for elite athletes.

A systematic review and meta analysis on digital mental health interventions in inpatient settings

E-mental health (EMH) interventions gain increasing importance in the treatment of mental health disorders. Their outpatient efficacy is well-established. However, research on EMH in inpatient settings remains sparse and lacks a meta-analytic synthesis. This paper presents a meta-analysis on the efficacy of EMH in inpatient settings. Searching multiple databases (PubMed, ScienceGov, PsycInfo, CENTRAL, references), 26 randomized controlled trial (RCT) EMH inpatient studies (n = 6112) with low or medium assessed risk of bias were included. A small significant total effect of EMH treatment was found (g = 0.3). The effect was significant both for blended interventions (g = 0.42) and post-treatment EMH-based aftercare (g = 0.29). EMH treatment yielded significant effects across different patient groups and types of therapy, and the effects remained stable post-treatment. The results show the efficacy of EMH treatment in inpatient settings. The meta-analysis is limited by the small number of included studies.

From theory to practice in implementation science: qualitative insights from the implementation model developed by a commercial eMental Health provider

BackgroundAlthough eMental health interventions are a viable solution to address disparities in access to mental healthcare and increase its efficiency, they still face challenges of implementation. Literature highlights numerous barriers such as diffusion of responsibility and unclear expectations of what implementation entails might hinder this process. While research mostly focuses on analyzing these barriers, there is an urgent need to increase uptake in practice. In turn, commercial companies focus mostly on increasing uptake, while overlooking research outputs. To bridge the gap between research and practice, attention to how implementation occurs in practice is required. This study investigates “Make it Happen” (MiH), the implementation model developed by the eMental Health company Minddistrict, aiming to gain more insight into operationalizing implementation frameworks by 1) describing MiH and its conceptual underpinnings, and 2) gaining lessons learned from the development of MiH. Ultimately, this work aims at improving existing scientific frameworks by extending them with knowledge from practice.MethodsFirst, individual interviews and focus groups with Minddistrict implementation managers were performed. Second, individual interviews with project leads in mental healthcare organizations that were involved in the implementation of Minddistrict were conducted. Within Minddistrict, 7 implementation managers and account managers were involved, in addition to 11 project leads from mental healthcare organizations. Data were elaborated with thematic analysis.ResultsA comprehensive description of MiH and its 5 main phases was achieved. During the 1) Onboarding phase, implementing organizations are guided by Minddistrict to build a team responsible for implementation, which then 2) designs patient and client journeys, 3) builds, tailors and configures their offer, 4) trains key-users and, 5) evaluates the success of implementation. All participants had extensive and aligned definitions and articulated expectations on implementation. Points of improvement for the model such as role ambiguity and excessive workload were identified. As strengths, internal motivation and good relationships with the provider were valued.ConclusionThe present study highlights the importance of clear role division and stakeholder engagement in implementation processes, and suggest that a strong collaboration between companies and academia could optimize implementation efforts and ensure a better fit between humans, context, and technologies.

The effectiveness of e-mental health interventions on stress, anxiety, and depression among healthcare professionals: a systematic review and meta-analysis

BackgroundMany healthcare professionals are experiencing psychological distress. Electronic mental health (e-mental health) interventions are convenient and multifunctional. This review aimed to examine the effectiveness of e-mental health interventions in enhancing the well-being of healthcare professionals and to identify moderating factors.MethodsA comprehensive and systematic retrieval of randomized controlled trial (RCT) studies was conducted across eight databases. Population, intervention, comparison, and outcome (PICO) were used to define eligibility criteria. Stress, anxiety, and depression were included as the main outcomes. The overall effect was calculated based on the random effect model, and the effect size was presented using the standardized mean difference. The characteristics of the research design, intervention object, and intervention design were further selected as potential moderating factors for subgroup analysis. Meta-regression analyses were finally performed, incorporating intervention duration and sample size as independent variables.ResultsA total of 20 studies were included in the systematic review, and 17 were included in the meta-analysis. A large effect on relieving stress and anxiety and a small-to-medium effect on reducing depression were observed. Subgroup analyses showed that features including mindfulness approaches, online courses, computer use, group interventions, and professional guidance were more favorable in the design of services. Meta-regression revealed that intervention duration only affected anxiety symptoms. Caution should be exercised, as some subgroups had fewer studies and higher heterogeneity. For the secondary outcomes, a large effect on emotional exhaustion and a small-to-medium effect on well-being were observed.ConclusionIn general, e-mental health interventions significantly improve the psychological health of healthcare staff. Future high-quality, large-scale studies targeting healthcare professionals and specific intervention scenarios are warranted.

Mental Health in the Middle East: Historical Perspectives, Current Challenges, and Future Implications

Mental health practices and services in the Middle East have been profoundly shaped by the region's rich historical and cultural context, intertwined with the traditions of major monotheistic religions. This analytical literature review synthesizes existing scholarly research to examine the historical development of mental health approaches, current challenges and barriers, and potential future implications. Tracing the evolution from ancient practices to the establishment of psychiatric institutions and the integration of Western medicine, the review uncovers the impact of the Middle East's unique heritage on its mental health landscape. Current challenges include pervasive stigma, inadequate training for healthcare professionals, limited access to evidence-based interventions, and cultural barriers hindering open communication. The review explores recommendations such as implementing e-mental health interventions, developing national mental health strategies, collaborating with traditional healers, promoting public education campaigns, providing culturally responsive services and training, and garnering robust government support. By bridging knowledge gaps, challenging systemic barriers, and fostering cross-cultural collaborations, the Middle East can pave the way towards destigmatizing mental health, increasing accessibility, and embracing comprehensive, culturally sensitive support for individuals and communities.

Effects of a Serious Game for Adolescent Mental Health on Cognitive Vulnerability: Pilot Usability Study.

Adolescent mental health is of utmost importance. E-mental health interventions, and serious games in particular, are appealing to adolescents and can have beneficial effects on their mental health. A serious game aimed at improving cognitive vulnerability (ie, beliefs or attitudes), which can predispose an individual to mental health problems, can contribute to the prevention of these problems in adolescents. This study aimed to assess the feasibility of the prototype of a serious game called "Silver." The prototype of the serious game was developed using a user-centered participatory design. The prototype of Silver focused on 1 aspect of a serious game for improving cognitive vulnerability in adolescents, that is, the recognition and identification of cognitive distortions. Through the game, players were required to identify and classify the character's thoughts as helpful or unhelpful. Upon successful advancement to the next level, the task becomes more challenging, as players must also identify specific types of cognitive distortions. A pre- and posttest uncontrolled design was used to evaluate the game, with a 1-week intervention phase in which participants were asked to play the game. Participants aged 12-16 years were recruited in schools. The outcomes of interest were the recognition of cognitive distortions and presence of participants' cognitive distortions. The game was also evaluated on its effects, content, and usefulness. A total of 630 adolescents played Silver and completed the assessments. Adolescents were significantly better at recognizing cognitive distortions at the pretest (mean 13.09, SD 4.08) compared to the posttest (mean 13.82, SD 5.09; t629=-4.00, P<.001). Furthermore, their cognitive distortions decreased significantly at the posttest (mean 38.73, SD 12.79) compared to the pretest (mean 41.43, SD 10.90; t629=7.98, P<.001). Participants also indicated that the game helped them recognize cognitive distortions. Many participants considered the game appealing (294/610, 48.2%) but boring (317/610, 52%) and preferred a more comprehensive game (299/610, 49%). Findings from this study suggest that a serious game may be an effective tool for improving cognitive vulnerability in adolescents. The development of such a serious game, based on the prototype, is recommended. It may be an important and innovative tool for the universal prevention of mental health problems in adolescents. Future research on the effects of the game is warranted.

Evaluation of the e-Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial.

Make It Training is an e-mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. e-Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support.

E-mental health interventions for men: an urgent call for cohesive Australian policy and investment

Abstract Few men who experience a common mental disorder access any mental healthcare from a health professional. E-mental health (eMH; online) interventions may facilitate men’s access to mental healthcare and reduce inequities in access via assistance in a format that aligns with their preferences and needs. Recent reviews show that men who have used these programmes generally find them useful and satisfactory; however, data on their effectiveness and factors impacting effectiveness in men’s use are limited. Few eMH interventions have been designed specifically to suit men’s preferences and circumstances, and little is known about the eMH-related experiences and needs of men from vulnerable and marginalized backgrounds. Despite their potential, Australian men’s health, digital mental health, preventive health, and Aboriginal and Torres Strait Islander mental health and social and emotional well-being policies—and men’s health policies from Malaysia, Ireland, and South Africa—make no specific mention to progressing the use or evaluation of eMH for men. We present a series of policy recommendations, aiming to improve men’s access to effective and acceptable mental health assistance via eMH and increase health professional confidence to recommend and support these programmes. These include (i) the need for specific, connected health policy actions and targeted funding; (ii) policy priorities for intervention development, dissemination and evaluation; and (iii) for the experiences of men, particularly those from marginalized and vulnerable backgrounds, to be centred in policy. eMH for men should be promoted alongside interventions to reduce systems and social-level determinants of men’s mental health inequities.

Differential attrition in randomized controlled trials of digital mental health interventions in the workplace: A systematic review and meta-analysis (EMPOWER H2020 project)

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

The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study.

Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.

Exploring subgroups of acceptance prediction for e-mental health among psychotherapists-in-training: a latent class analysis.

Research of E-Mental Health (EMH) interventions remains a much-studied topic, as does its acceptance in different professional groups as psychotherapists-in-training (PiT). Acceptance among clinicians may vary and depend on several factors, including the characteristics of different EMH services and applications. Therefore, the aims of this study were to investigate the factors that predict acceptance of EMH among a sample of PiT using a latent class analysis. The study will 1) determine how many acceptance prediction classes can be distinguished and 2) describe classes and differences between classes based on their characteristics. A secondary analysis of a cross-sectional online survey was conducted. N = 216 PiT (88.4% female) participated. In the study, participants were asked to rate their acceptance of EMH, as operationalized by the Unified Theory of Acceptance and Use of Technology (UTAUT) model, along with its predictors, perceived barriers, perceived advantages and additional facilitators. Indicator variables for the LCA were eight items measuring the UTAUT-predictors. Best model fit emerged for a two-class solution; the first class showed high levels on all UTAUT-predictors, the second class revealed moderate levels on the UTAUT-predictors. This study was able to show that two classes of individuals can be identified based on the UTAUT-predictors. Differences between the classes regarding Performance Expectancy and Effort Expectancy were found. Interestingly, the two classes differed in theoretical orientation but not in age or gender. Latent class analysis could help to identify subgroups and possible starting points to foster acceptance of EMH.

An e-mental health intervention to reduce depression symptoms in individuals with obesity: study protocol for the randomized, controlled, two-armed, confirmatory LightMood trial

BackgroundPatients with obesity often experience psychological distress, specifically depression symptoms. Due to various barriers, such as limitations of healthcare offers, digital interventions, for example medical apps, can provide a suitable approach to support affected people. In the envisaged prospective randomized controlled trial, we aim to examine the efficacy of the LightMood intervention. The LightMood intervention is a manualized and user-centered, digital intervention for patients with obesity, with a duration of 4 months, which contains elements of cognitive behavioral therapy and mindfulness-based and skills-based exercises. We expect the LightMood intervention to be superior to treatment as usual (TAU) in terms of reducing depression symptoms.MethodsThe trial incorporates four distinct measurement time points: the baseline assessment, the post-treatment assessment, and 1- and 3-month follow-up assessments. Furthermore, we implemented in-treatment assessments for both groups. Participants will be randomized into two groups (LightMood intervention vs TAU). The aim is to include 128 participants (64 per group) in the study. Inclusion criteria are patients who are obese, at least 18 years old, with a private Internet access, and with adequate digital literacy and show depression symptoms (PHQ ≥ 10). Exclusion criteria are weekly outpatient individual psychotherapy, obesity surgery within the last year or planned within the next 7 months, no private Internet access, and the prescription of a new psychotropic drug within the last 2 weeks. The primary outcome is the post-assessment reduction in depression symptoms. Secondary outcomes will include the improvement in self-efficacy, quality of life, mindfulness, reduction in eating disorder symptoms, and body mass index (BMI). Furthermore, we expect a positive development of depression symptoms throughout the different time points (T1, T2, and T3) in patients with obesity.DiscussionLightMood is an evidence-based, efficient, low-threshold online intervention that aims to reduce depression symptoms in people with obesity. Online interventions could offer a promising alternative to conventional face-to-face therapy. The primary objective of the current study is to add essential insight into the feasibility, efficacy, effectiveness, and acceptance of e-mental health interventions for people with obesity and depression symptoms.Trial registrationGerman Clinical Trial Register (DRKS), DRKS00029219. Registered on May 19, 2023

Attitudes of patients and mental health professionals towards hypothetical use of serious games in psychotherapy.

The present study sought to identify the attitudes of psychotherapists and patients towards the hypothetical use of serious games in psychotherapy in the South African context. Online surveys assessed acceptance, experience, and requirements for the utilisation of serious games in therapeutic contexts. Clients utilising mental health services (n = 209) and psychotherapists delivering mental health services (n = 156) in South Africa completed the online survey. Knowledge about serious games is limited with only 15% of clients and 16% of therapists reporting knowledge of the existence and application of serious games. Use of serious games is even more infrequent with only 1% of therapists and 6% of clients currently using serious games as an intervention. Despite this, our findings highlight an apparent demand for their use, with 71% of therapists indicating that serious games would be a suitable adjunct treatment modality for their patients. Our results show a general openness toward the use of serious games in psychotherapy. The use of serious games as an e-mental health treatment modality is conceivable for both patients and therapists, particularly as a complementary strategy to traditional face-to-face psychotherapy.

Potential Implementers' Perspectives on the Development and Implementation of an e-Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study.

e-Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e-mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e-mental health intervention for caregivers of people living with CKD. Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e-mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e-mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development.

Evaluation of a digital intervention for depression among Lebanese&amp;Syrian refugees in Lebanon

Abstract Background Lebanon is a low-to-middle-income country, hosting more than 1.1 million Syrian refugees, with 90% mental health treatment gap. The National Mental Health Programme (NMHP) in Lebanon along with the World Health Organization (WHO) launched the Step-by-Step (SbS) e-mental health intervention for adults with depression. Step-by-Step is a 5-sessions, self-help, minimally guided digital program for adults with depression. Two Randomized Controlled Trials (RCTs) assessed its effectiveness and cost-effectiveness in the local setting. Methods Participants (n = 569 Syr, n = 680 Leb) were recruited online and randomly allocated to Step-by-Step (n = 283 Syr, n = 331), or Enhanced Care as Usual (n = 286 Syr, n = 349). The ECAU group received one-page psychoeducation and a referral list to services. Online assessments were administered at baseline, post-assessments at eight weeks after enrolment, and follow-up assessments at 20 weeks after enrolment. Primary outcomes were the Patient Health Questionnaire-9 and World Health Organization Disability Assessment Scale 2.0 scores at all post-assessments. Results Intention-to-treat analyses showed significant effects on depression scores (standardized mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97 for Lebanese, and SMD: 0.48; 95% CI: 0.26; 0.70 for Syrians). Significant results were maintained on all secondary outcomes and at follow-up assessments. Conclusions SbS proved effective for depressive and functionality symptoms. Subsequently, it was adopted by MoPH as an official, free-of-charge, and first-line service for depression. A global version of SbS is currently being developed by WHO to be replicated and used in several settings worldwide. Key messages • This landmark study provided unique evidence on the effectiveness of guided-e-mental health interventions for the Lebanese and Syrian refugees affected by adversity in Lebanon. • This study guided the scaled-up of SbS into a widely accessible service among the general population.

Evaluating the Effectiveness of a Codeveloped e-Mental Health Intervention for University Students: Protocol for a Randomized Controlled Trial.

University 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. This 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. This 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. Trial 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. The 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. ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601. DERR1-10.2196/49364.

Investigating perspectives on e-health interventions to enhance maternal mental well-being: Results of a stakeholder interview.

Peripartum mental disorders are highly prevalent conditions and associated with adverse outcomes for the mother, the infant and the whole family. Despite the high burden, help-seeking is low. E-mental health interventions could overcome help-seeking barriers and thus improve perinatal mental health. However, usage and adherence are rather low. This study aims to assess attitudes and needs of different stakeholder groups and to identify relevant topics to develop an intervention meeting the needs of pregnant and postpartum women and thus, increasing utilization and adherence. Therefore, semi-structured interviews and focus groups with pregnant women (n = 3), mothers (n = 4), women who have suffered from a postpartum mood disorder in the past (n = 5), gynaecologists (n = 5), and midwives (n = 5) were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Almost half of the stakeholders reported previous experiences with e-mental health services. Anonymity, flexibility, promoting help-seeking, or bridging waiting-time for treatment as usual were regarded as the main benefits. Concerns regarding the usefulness of e-mental health interventions, absence of face-to-face contact or lack of integration into routine care were considered as barriers. With regard to the desired program content, six main topics were identified: pregnancy and puerperium, peripartum mood swings and disorders, support options, self-care, partnership, and fatherhood. Regarding preferred characteristics of e-mental health programs, stakeholders mentioned customizability, individual guidance, evaluation of user-feedback and continuous adoption, as well as a responsive and user-friendly design. Overall, online interventions for perinatal mental health were mainly considered as beneficial. Stakeholders underlined the high need for education regarding the use and effectiveness of e-mental health, to overcome concerns and obstacles and improve acceptability. Furthermore, developing customizable and individually-guided interventions were considered as promising to increase utilization of and adherence to e-mental health interventions.

The Effects of Using Psychotherapeutic e-Mental Health Interventions on Men’s Depression and Anxiety: Systematic Review and Meta-Analysis

AbstractWhile psychotherapeutic e-mental health interventions may circumvent barriers that many men face in accessing mental health care, the effects of men using these interventions have not been evaluated. We aimed to synthesise the characteristics of psychotherapeutic e-mental health interventions for depression or anxiety that have been trialled and evaluated in men, and synthesise and meta-analyse the effects of these interventions on men’s depression and anxiety, including examining influences of participant, intervention, and study characteristics on outcomes. Seven papers (N = 552 participant men) identified from systematic literature searches met inclusion criteria. A total 177 studies were excluded because although they met all other inclusion criteria, they did not present analysable data on participant men. The seven included interventions varied in content, length, and format; only one intervention was gender sensitive, having been designed specifically for men. All three randomised controlled trials detected no post-trial difference in men’s depression symptoms between intervention and control participants. All four treatment studies presenting pre-post data reported post-intervention improvements in depression or social anxiety symptoms; this was supported by our meta-analysis of two studies, which found a medium-sized, positive effect of depression treatment interventions on depression symptoms in pre-post data (g = 0.64, p &lt; 0.005). Further meta-analyses could not be conducted due to data limitations. Psychotherapeutic e-mental health treatment interventions result in pre- to post-intervention improvements in men’s depression symptoms. There is urgent need for consideration of gender and sex in the development, evaluation, and dissemination of e-mental health interventions for men, and for further information on their effects.

E-mental health in Germany — what is the current use and what are experiences of different types of health care providers for patients with mental illnesses?

BackgroundAs a new and effective support option, e-mental health interventions can be useful in complementing treatment in mental health care. To date, little is known about how health care providers use these programs to treat patients with mental illnesses in Germany. The present study aims to examine the use of and experiences with e-mental health interventions from the point of view of different types of health care providers for patients with mental illnesses.MethodsData from a cross-sectional survey of routine care health care providers in Germany in 2021 were analysed. In this survey, data were collected from n = 107 general practitioners (GPs), n = 114 specialist doctors, n = 102 psychotherapists, and n = 102 inpatient clinicians. Assessments included professional use of digital media, as well as knowledge, use and experiences regarding e-mental health interventions in care of people with mental illness.ResultsIn the total sample of n = 425, 65.6% (n = 279) were female. The study participants had an average age of 47.7 years (SD = 11.0) and their average work experience was 20.0 years (SD = 11.1). Overall, the majority (83.8%, n = 353) had heard of e-mental health interventions, but few felt well informed. Only 28.5% (n = 121) had already used e-mental health interventions for treatment support. The most commonly recommended e-mental health interventions in the sample were deprexis (39.7%, n = 48), moodgym (24.8%, n = 30), and iFightDepression (22.3%, n = 27). The use was predominantly considered to be helpful and satisfactory. Insufficient knowledge about e-mental health interventions and lack of informational materials for patients were reported as relevant barriers to the use of e-mental health interventions.ConclusionsE-mental health interventions can be a useful support option, but they are rarely used in the treatment of patients with mental illnesses. There is a need to disseminate information specific to the various types of health care providers. Tailored implementation strategies need to be developed in order to capitalize on the potential of effective e-mental health interventions and to improve health care for patients with mental illnesses.