Formal Mental Health Research Articles

Help-Seeking Preferences and Factors Associated with Attitudes Toward Seeking Mental Health Services Among First-Year Undergraduates

Many first-year university students experience stressors that impact their adjustment and well-being. Their help-seeking attitudes and preferred sources of support may be associated with various factors. The purpose of the present study was to (1) examine help-seeking preferences amongst first-year university students, (2) explore factors associated with students’ attitudes toward seeking mental health services, and (3) identify perceived barriers associated with accessing formal sources of support. First-year students at a Canadian university (N = 167) completed a survey assessing help-seeking attitudes and preferences, as well as challenges associated with seeking support. Participants also provided information about their perceived levels of social support, personality characteristics, and their tendency to experience positive and negative affect. Findings suggest that social support and negative affect were significantly associated with positive attitudes toward seeking mental health services. However, students were more inclined to rely on informal sources of support, such as family members and friends, compared to formal sources of support available through on- or off-campus mental health services. For thosestudents who are inclined to access formal mental health support, barriers may impede access to care. Perceived barriers include cost and concerns about the availability of services and their overall effectiveness. These findings call for the creation of more opportunities for on-campus informal support in addition to better access to on-campus mental health services.

Psychological challenges and coping strategies of quarantined healthcare workers exposed to confirmed COVID-19 cases in a tertiary hospital in Edo state

Objectives: Healthcare workers (HCWs) face a significant risk of exposure to the new SARS-CoV-2 virus due to its high infectivity. This study aimed to determine the mental health consequences of quarantine and the coping strategies used by quarantined healthcare workers (HCW) at the University of Benin Teaching Hospital (UBTH). Materials and Methods: This was a cross-sectional survey of 32 HCWs quarantined due to exposure to confirmed case of COVID-19. The primary outcome variables were the frequency of depression, anxiety, and anxiety-depression. Data was collected with the use of a self-administered questionnaire adapted from the patient health questionnaire-9 and the general anxiety disorder-7 questionnaires respetively. Results: There were 32 quarantined health workers with a mean ± SD age of 32.4 ± 8.4 years, and 59.4% were female. Twenty-three (71.9%) had spent <5 years in service. Doctors and nurses made up an equal proportion of 46.9% of the respondents, respectively. The prevalence of anxiety, depression, and anxiety-depression was 9.4%, 12.5%, and 9.4%, respectively. Coping measures employed by the health workers centered on preventing boredom and improving communication. Conclusion: There was a low frequency of anxiety, depression, and anxiety-depression in HCWs who were quarantined as a result of exposure to COVID-19. Health-care managers need to support the establish formal workplace mental health programs to support the psychological well-being of all staff.

Trauma involving violation of trust and mental health help seeking among homeless adults

ABSTRACT Objective Lack of trust in others is a barrier to mental health help seeking and may be a consequence of trauma exposure, which is highly prevalent among people who experience homelessness. This study examined the association between trauma involving violation of trust and mental health help seeking. Method This study was a secondary analysis of data collected for a randomised controlled trial comparing a 3-year homelessness intervention with standard service provision. The sample included trauma-exposed adults with a history of chronic homelessness in Melbourne (N = 73). Participants identified their worst lifetime trauma and indicated whether someone they knew and trusted was responsible for that event. The primary outcome was 12-month formal mental health help seeking. Results Controlling for randomisation and baseline posttraumatic stress disorder symptom severity, participants whose worst trauma involved violation of trust reported, on average, 4.34 times as many visits to an outpatient service (e.g., hospital, mental health facility, alcohol and other drug service) as those whose worst trauma did not involve a violation of trust, p = .002. Conclusions Contrary to expectation, chronically homeless adults whose worst trauma involved violation of trust sought outpatient care more than those whose worst trauma did not involve violation of trust. Mental health professionals should adopt a trauma-informed approach and be aware that trauma exposure may influence help seeking among people who experience chronic homelessness. Key Points What is already known about this topic: Chronically homeless adults have high rates of trauma exposure, trauma-related mental health disorders, and unmet mental health care needs. People experiencing homelessness face multiple barriers to accessing mental health care, and qualitative studies have found feelings of mistrust may be one such barrier. In the general population, interpersonal trauma, particularly trauma involving betrayal, is associated with reduced trust in others, including physicians and health care systems. What this topic adds: Over 12 months, greater outpatient service use was reported by chronically homeless adults whose worst trauma involved violation of trust compared to those whose worst trauma did not involve violation of trust. The violation of trust group included a higher percentage of Aboriginal persons, and a higher percentage of participants whose worst trauma occurred in childhood compared to the no violation of trust group. Mental health professionals, such as psychologists, should apply trauma-informed care principles when providing mental health care for chronically homeless adults.

Stage and symptoms of bipolar disorders

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. During mood swings, there may be features of psychosis (delusions and hallucinations) that are mood-congruent. Although psychotic symptoms are seen only in a minority of patients, they explain the early terminology of manic–depressive psychosis. Stage 1a is defined as mild or non-specific symptoms of mood disorder and intervened as formal mental health literacy; family psychoeducation; substance abuse reduction; cognitive behavioral therapy. Euphoric means the experience of pleasure or excitement and intense feelings of well-being and happiness. Certain natural rewards and social activities, such as aerobic exercise, laughter, listening to or making music, and dancing, can induce a state of euphoria. Racing thoughts are consistent, persistent, often intrusive thoughts that come in rapid succession. There is a direct link between depression and anxiety and racing thoughts. Whereas jumping from topic to topic as in the flight of ideas can be observed by others, ascertainment of racing thoughts requires asking the child whether his or her thoughts seem to be going too fast.

Barriers and facilitators of help seeking among morally injured Canadian Armed Forces Veterans and service members: A qualitative analysis

LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of extremely challenging events that threaten one’s moral beliefs and core values. MI is characterized by intense shame, guilt, anger, loss of trust in oneself and others, and social withdrawal — factors that may impede a person’s willingness to seek help for mental health problems. The authors analyzed interviews with 13 Canadian Armed Forces service members and Veterans struggling with MI. They identified themes representing four main barriers to help seeking (stigma, denial, no knowledge of problem or MI, negative perceptions of the military health system) and five main facilitators of help seeking (a sense of shared experience, screening, encouragement from others to seek help, purpose as motivation, alternatives to formal mental health care). The themes identified largely overlap with factors shown in previous research to be barriers to help seeking among military samples. The results of this study suggest that additional education on the mental health consequences associated with MI, and enhanced screening for this type of distress, may lead to increased support seeking among service members and Veterans struggling with MI.

“One cannot make it alone”: experiences of a community faith-based initiative to support latino mental health

ABSTRACT Latinos encounter structural and cultural barriers that hinder their ability to access mental health services, often turning to faith-based organizations for support. This grounded theory study aimed to analyze the impact of a faith-based mental health literacy program on Latino mental health. Qualitative interviews were used to generate data and results were evaluated through social constructivism and intersectionality lenses. Findings demonstrated that the impact of the program extended past the individual level to the family and community level, ultimately enhancing mental health literacy, improving parenting practices, breaking intergenerational stigma, and promoting engagement with formal mental health services.

Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic.

Purpose of reviewIn the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae.Recent findingsEvidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD.SummaryA disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources.

The impact of maternal obesity on newborn and maternal health status

BACKGROUND: Obesity and overweight are more common, especially among women of reproductive age. Therefore, the approach to maternal obesity requires a multidisciplinary approach, especially health professionals working in primary care preventive health services.AIM: The aim of the study is to determine the effect of maternal obesity on maternal and newborn health in Al Khansaa Teaching Hospial, City of Mosul, Iraq.MATERIALS AND METHODS: The study, which was planned as à case-control study, was conducted in the Al Khansa Teaching Hospital City of Mosul, Iraq.The inclusion criteria included women in postnatal period in the same Hospital, speaking and understanding Arabic, knowing her pre-pregnancy weight, not having any chronic disease (diabetes, hypertension, trioid diseases, etc.) before pregnancy, pre-pregnancy body mass index (BMI) 18.5–25, those with a BMI >29.9, and those with primary school or higher education were included. The exclusion criteria included multiple pregnancies, without any formal education, physical disability (that prevented the completion of the data collection forms), and mental health problems. Data were collected with the data collection form and Edinburgh Postpartum Depression Scale.RESULTS. The study was completed with 286 women, 142 cases and 144 control groups. There was no statistical difference between the case and control groups in terms of family type and employment status (p>0.050). While the mean age, pregnancy and number of living children of the women in the case group were statistically higher, their educational status was found to be lower (p<0.050). It was found that women with obesity experienced health problems such as urinary tract infection, anemia, gestational diabetes, psychological problems, and preeclampsia/gestational hypertension at a higher rate than women in the control group (p<0.010), and women in the control group gained 13.94±5.29 kg (p=0.001).CONCLUSION In conclusion, it was found that women in the case group experienced pregnancy, early and late postpartum complications at a higher rate than the control group, while there was no difference between the groups in terms of depression at the end of the sixth week postpartum.

Legal, mental health and psychosocial outcomes of the RePresent Games: a quasi-experimental study

This study evaluated a pair of video games called the RePresent games that taught users how to represent themselves in civil court. A quasi-experimental study was conducted that compared 69 RePresent game users and 78 non-game users with civil legal issues across four U.S. states on legal, mental health and psychosocial outcomes over 3 months. The results revealed that RePresent game users reported greater legal knowledge, better mental health and higher quality of life than non-game users across time, and a greater rate of improvement in legal knowledge than non-game users over time. These findings suggest that gamifying education about legal procedures for the general public holds great potential in helping individuals obtain self-help legal assistance although some formal mental health treatment may be needed for many seeking legal aid.

Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care.

Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments. Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, n=212) or a primary care clinic (IC model, n=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression. WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=0.016). WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.

Service Utilization, Self-Efficacy, Positive Attitude and Well-Being Among Asian American Family Caregivers of Persons with Serious Mental Illnesses.

The well-being of the family caregivers of people with serious mental illnesses (SMIs) is a crucial success factor in the recovery of the afflicted family member. This cross-sectional quantitative study examined the associations between the use of formal mental health services, self-efficacy, and positive attitudes and their effects on the well-being of Asian American family caregivers of people with SMIs. Using convenience and snowball sampling, 116 Asian American family caregivers of people with SMIs in Northern California were recruited for this study. We found that formal mental health service utilization predicted an enhanced sense of self-efficacy. Higher levels of self-efficacy were related to attitudes being more positive, and these positive attitudes contributed to enhanced overall well-being. These findings suggest that mental health professionals should develop culturally competent and tailored services for Asian American family caregivers to support self-efficacy, which is fundamental to maintaining positive attitudes and promoting wellness.

EACVI survey on burnout amongst cardiac imaging specialists during the 2019 coronavirus disease pandemic.

AimsThe European Association of Cardiovascular Imaging Scientific Initiatives Committee conducted a global survey to evaluate the impact of the 2019 coronavirus disease (COVID-19) pandemic on the mental well-being of cardiac imaging specialists.Methods and resultsIn a prospective international survey performed between 23 July 2021 and 31 August 2021, we assessed the mental well-being of cardiac imaging specialists ∼18 months into the COVID-19 pandemic. One-hundred-and-twenty-five cardiac imaging specialists from 34 countries responded to the survey. More than half described feeling anxious during the pandemic, 34% felt melancholic, 27% felt fearful, and 23% respondents felt lonely. A quarter of respondents had increased their alcohol intake and more than half reported difficulties in sleeping. Two-thirds of respondents described worsening features of burnout during the past 18 months, 44% considered quitting their job. One in twenty respondents had experienced suicidal ideation during the pandemic. Despite these important issues, the majority of participants (57%) reported having no access to any formal mental health support at work.ConclusionThe survey has highlighted important issues regarding the mental well-being of cardiac imaging specialists during the COVID-19 pandemic. This is a major issue in our sub-specialty, which requires urgent action and prioritization so that we can improve the mental health of cardiovascular imaging specialists.

“My problems aren't severe enough to seek help”: Stress levels and use of mental health supports by Canadian hospital employees during the COVID-19 pandemic

Due to the unique set of stressors associated with the COVID-19 pandemic, healthcare workers in acute care settings may be facing elevated rates of mental health symptomatology. The purpose of this study was to assess levels of depression, anxiety, and stress in a sample of healthcare employees working in hospitals and their use of formal and informal mental health supports. Data was gathered over a three-week period in December 2020 as COVID cases began to rise sharply in Ontario, Canada. Results from an online survey of 650 healthcare employees suggested that overall levels of depression, anxiety, and stress were mild. However, a significant minority of participants reported severe or extremely severe levels of depression (14.4%), anxiety (21.8%), and stress (13.5%). Levels of distress were higher among women, younger participants, those who did not work directly with COVID+ patients, and those who were redeployed. Use of formal mental health supports (e.g., Employee Assistance Plans, teletherapy) was very low (<10%), with the most frequently-reported reason for not using supports being “problems not severe enough to require this service”. Implications are considered for healthcare policy decisions as hospital systems attempt to address the mental health needs of their employees.

The influence of caregiver attitudes and socioeconomic group on formal and informal mental health service use among youth.

Young people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those related to the caregiver's profile. We interviewed 1,400 Brazilian primary caregivers of young people (aged 10-19), participants of a high-risk cohort. Caregivers reported on young people's formal/informal mental health care utilization, and associated barriers and facilitators to care. Data were also collected on youth mental health and its impact on everyday life; and caregiver characteristics-education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization. Persistence and greater impact of youth mental health conditions were associated with a higher likelihood of care, more clearly for formal care. Caregiver characteristics, however, also played a key role in whether young people received any care: lower parental stigma was associated with greater formal service use, and lower socioeconomic class showed higher odds of informal care (mainly from religious leaders). This study highlights the key role of the caregivers as gatekeepers to child treatment access, particularly parental stigma influencing whether young people received any mental health care, even in a low resource setting. These results help to map barriers for treatment access and delivery for young people, aiming to improve intervention efforts and mental health support.

Perspectives on Mental Health Evaluation in Pediatric Pulmonary Hypertension: A Call to Action

Background The already high rates of anxiety and depression among healthy children have increased further since the COVID-19 pandemic began in early 2020. Prepandemic data suggest children with chronic disease were already experiencing increased rates of anxiety and depression as compared to their healthy peers. There is currently a paucity of literature on the prevalence of anxiety and depression in patients with pediatric pulmonary hypertension. In addition, there are no practice recommendations regarding mental health screening in this population. Implications for Providers We evaluated provider perception of mental health screening at 14 pediatric pulmonary hypertension care centers across the United States and Canada using a cross-sectional survey. Thirty-seven providers from 14 pediatric pulmonary hypertension centers in North America completed the survey. Conclusion Health care providers caring for pediatric pulmonary hypertension patients perceive their patient cohort to frequently experience anxiety and depression. In addition, these providers believe that their patients would benefit from formalized, and routine, assessment of anxiety and depression with referral to mental health services as appropriate. This highlights the need to better understand the prevalence of anxiety and depression in pediatric pulmonary hypertension patients and to establish formal mental health screening practices within pediatric pulmonary hypertension care centers.

Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach.

BackgroundThe prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts.ObjectiveWe present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD).MethodsWe highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research.ResultsIn this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process.ConclusionsUCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions.

Mood Lifters: A Peer-Led Mental Health Program for Older Adults via Video Conferencing

Effective and scalable mental health programs are greatly needed for older adults, given the vast majority in need do not receive formal mental health services. In this study, we adapted Mood Lifters—a peer-led, community-based program promoting mental well-being—to address the unique needs of older adults. The 14 weekly program sessions were delivered via Zoom. Twelve older adults (mean age = 69.7 years; 4 men, 8 women) enrolled; 9 completed the program (2 of 3 dropouts were due to health issues). A battery of validated measures administered within one week before and after the program assessed domains including depression and anxiety, stress management, and health behaviors. Compared to baseline, participants who completed the program showed significant improvements in perceived stress (p=0.03), sleep quality (p=0.02), and emotion regulation via cognitive reappraisal (p=0.06). Depression and anxiety symptoms (assessed by the Geriatric Depression and Anxiety Scales, respectively) were lower at program completion, although improvements were not statistically significant. No significant changes from pre- to post-test were reported in loneliness and health behaviors. Participant ratings of program satisfaction were very high (mean = 4.78/5, with 1=poor, 5=excellent). Results from this pilot test of Mood Lifters for Seniors suggest it is feasible and acceptable for outreach to older adults, with preliminary evidence of benefits in several domains related to mental health and wellness. Future randomized trials with larger, more diverse samples will be necessary to confirm program benefits.

Piloting an Augmented Reality Life Review Experience to Promote Mental Health Outcomes in Aging Asian American Women

Asian-American older women report the highest prevalence of suicidal ideations and rates of completed suicide compared to other racial groups. Ironically, Asian-American communities report disproportionately low rates of formal mental health utilization—this may be attributed to the lack of culturally-relevant services and negatively ingrained perceptions of mental health aid. One potential solution that has not been widely investigated is the use of technology to help older Asian-American women engage in mental health interventions. This study leverages innovations in augmented reality (AR) technology (i.e., overlaying of digital holograms onto the real world) to create a life review intervention aimed at promoting mental health well-being. The application, Tell-Being, is a personalized holographic life review experience that facilitates older adults to foster a sense of coherence and wholeness within their lives. Pilot data collection was amassed from four aging Asian-American female participants averaging 51.3 (SD=8.61) years of age. Initial pre/post analyses showcased mean differences that trend towards a higher presence of emotion regulation from pre-test (M=4.88, SD=1.08) to post-test (M=5.21, SD=1.17). Although data collection was prematurely halted due to COVID-19, results trended in promising directions. The technological innovations and findings from this study may lead to promising novel avenues to address barriers for older Asian-American women in seeking mental health assessment and treatment in a “new normal” world.

Men's Help-Seeking for Distress: Navigating Varied Pathways and Practices.

There is a widely accepted dominant narrative surrounding men’s mental health help-seeking, that men are less likely to pursue formal mental health support on account of hegemonic masculine ideals that limit emotional expression and vulnerability. Across the literature, little attention has been given to the varied ways in which men can and will seek out help when experiencing mental health troubles. This paper reports findings from a qualitative study of men’s experiences of distress, specifically focused on their help-seeking and everyday coping and management of distress. Between 2016 and 2017, 38 individual interviews were carried out in South Wales, United Kingdom, with men of a range of ages (21–74 years of age) and social backgrounds. Analysis identifies nuanced help-seeking practices and pathways, emphasizing ways in which men can and will engage with mental health support. Some men struggled with articulating personal issues in mental health terms, and some portrayed ambivalence to help-seeking, yet at the same time reconstructed help-seeking to positively align with masculine values. The paper further highlights the significant influence of familial and friendship networks in the help-seeking process as well as the value of therapy for men experiencing mental health difficulties, challenging the idea that masculinity inhibits the disclosure of emotional problems. Awareness of the diversity of ways in which men can actively engage with their mental health is needed so that mental health support interventions and practitioners can best reach out to men experiencing distress and provide gender-sensitive support suitable to a range of different men.

Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis.

BackgroundAmong the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being.ObjectiveWe aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness.MethodsA comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims.ResultsIn total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=–0.24, 95% CI –0.34 to –0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality.ConclusionsThe emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs.