Health Treatment Research Articles

Conceptualizing Community Engagement for Mental and Brain Health Research in Low- and Middle-Income Countries: A Case of Kilifi County, Kenya.

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya.

Assessment of Navy Provider Knowledge of Women's Mental Health Services, Treatment Practices, and Training.

As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.

The limits of community-driven mental health interventions: integrating professional care for earthquake survivors.

The limits of community-driven mental health interventions: integrating professional care for earthquake survivors.

Dreaming big with little therapy devices: automated therapy from India

This paper examines the aspirations, imaginaries and utopias of designers of an AI-based mental health app in India. By looking at automated therapy as both technological fix and sociotechnical object, I ask, What can we learn from engaging with psy technologists’ imaginaries and practices of health care futures? What are the assumptions they encode in the app? How does automated therapy reconfigure the geographies and temporalities of care? While automated therapy as instantiated by Wysa provides, I argue, a modest mental health intervention, the scalar aspirations of designers are anything but small. The paper proceeds in three steps. First, it turns to designers’ imaginaries of what it means to care for current mental health needs in digitally saturated lifeworlds and how they inscribe them into the app. It identifies nonjudgmental listening, anonymity, acceptance, reframing, and agency as key ideas encoded in Wysa’s sociotechnical algorithms, along with a congruence between entrepreneurial and encoded ethics of care. Second, it situates automated therapy within anthropological scholarship on ‘little’ technical devices in global health to argue that automated therapy devices such as Wysa articulate dreams for minimalist interventions with macro effects. Finally, it explores the new geographies and temporalities of care that automated therapy spurs, tracing the ways the app bridges various spatial and temporal gaps and obstacles of human therapy and upends common global health pathways. This paper contributes to recent scholarship on aspirations, dreams and utopias and on digitization and datafication in global health.

Fostering community discussions and building a toolkit for mental health and wellness in STEM.

Mental health interventions can help mitigate the unique challenges that individuals in Science, Technology, Engineering, and Mathematics (STEM) face as they navigate these disciplines. We developed the "Mental Health and Wellness: Our Community and our Identity in STEM" workshop, which emphasizes leveraging our STEM community and promoting self-compassion, to foster a conversation among members of the STEM community on how to support mental health and wellness. This interactive workshop begins with a short lecture to define mental health and wellness and introduce evidence-based methods to increase self-compassion. Participants, who are often from diverse backgrounds and various career stages, then explore case studies that highlight experiences related to mental health across STEM career stages. Pre- and post-assessments of workshop participants suggest that participants had positive shifts in their ability to show compassion toward themselves as well as an increased comfort in discussing mental health within their STEM community. This workshop not only provided participants with practical tools and insights but also cultivated a supportive environment, underscoring the importance of mental health awareness and collective well-being within STEM fields. In this paper, we share tips on how this workshop was executed and lessons we have learned from our years of sharing similar workshops in the broader STEM community. We hope this paper serves as a valuable guide for potential facilitators to initiate conversations about mental health and wellness in their respective STEM spaces.

Interoceptive training with real-time haptic versus visual heartbeat feedback.

The perception of signals from within the body, known as interoception, is increasingly recognized as a prerequisite for physical and mental health. This study is dedicated to the development of effective technological approaches for enhancing interoceptive abilities. We provide evidence of the effectiveness and practical feasibility of a novel real-time haptic heartbeat supplementation technology combining principles of biofeedback and sensory augmentation. In a randomized controlled study, we applied the developed naturalistic haptic feedback on a group of 30 adults, while another group of 30 adults received more traditional real-time visual heartbeat feedback. A single session of haptic, but not visual heartbeat feedback resulted in increased interoceptive accuracy and confidence, as measured by the heart rate discrimination task, and in a shift of attention toward the body. Participants rated the developed technology as more helpful and pleasant than the visual feedback, thus indicating high user satisfaction. The study highlights the importance of matching sensory characteristics of the feedback provided to the natural bodily prototype. Our work suggests that real-time haptic feedback might be a superior approach for strengthening the mind-body connection in interventions for physical and mental health.

An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes.

This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health. Physical-Mental Multimorbidity in Ontario Youth.

Healthcare Barriers and Policy Implications for Non-Syrian Refugees Under International Protection in Türkiye

Türkiye hosts the largest number of refugees in the world, but research has mainly focused on Syrian refugees. This study fills this gap by exploring the experiences of non-Syrian refugees in accessing health services in Türkiye challenges they face. Using a qualitative methodology, 32 participants were selected, and data was collected through in-depth interviews. The analysis revealed three main themes: "health conditions of refugees," "difficulties in accessing health services" and "Professionals’ recommendations". The findings indicate that non-Syrian refugees face significant obstacles, including legal restrictions, financial constraints, language barriers, lack of knowledge of rights and discriminatory attitudes on the part of some health professionals. Access to mental health treatment was particularly difficult for non-Syrian refugees. This study has significant implications for policy makers and healthcare providers and identifies critical areas for intervention to improve access to essential healthcare services.

Bridging the gap: Can single session interventions help enhance mental health treatment delivery for young people in Australia?

Bridging the gap: Can single session interventions help enhance mental health treatment delivery for young people in Australia?

Chemodenervation is Associated With Reduced Mental Health Disorders in Patients With Synkinesis.

To compare the prevalence of mental health disorders in individuals with facial synkinesis, facial paralysis alone, and the general population. Retrospective cohort. Eighty-two health care organizations across the United States. The TriNetX Research Network was queried from 2011 to 2021 for patients with facial paralysis without synkinesis, facial paralysis and documented synkinesis, and controls, matched for age, sex, race, and ethnicity. Cases included infectious, iatrogenic, or idiopathic facial paralysis. Patients with pre-existing depression or anxiety were excluded. Two-year rates of newly diagnosed depression, anxiety, and mental health prescriptions were compared. Among 127,573 patients with facial paralysis, 92.5% (n = 117,976) had facial paralysis alone, and 7.5% (n = 9597) also had documented synkinesis. Compared to controls, patients with facial paralysis alone had increased risks of new depression (8.9% vs 7.3%, P < .001) and anxiety (10.1% vs 9.6%, P < .001), with higher mental health medication rates (16.6% vs 13.1%, P < .001). Patients with documented synkinesis, in comparison to controls, had the highest risks of depression (19.8% vs 8.6%, P < .001), anxiety (20.5% vs 10.5%, P < .001), and prescriptions (28.1% vs 15.8%, P < .001). The 27.8% (n = 2669) of synkinetic patients treated with chemodenervation had lower rates of depression (8.5% vs 23.5%, P < .001), anxiety (9.0% vs 23.8%, P < .001), and prescriptions (21.6% vs 30.0%, P < .001) compared to synkinetic patients who were not. Facial paralysis, particularly synkinesis, is linked to increased mental health disorders. Integrating mental health screening and treatment into a comprehensive approach is crucial. Chemodenervation is associated with decreased mental health disorders in synkinesis, highlighting its therapeutic potential.

Major depressive disorder: point prevalence, suicidal ideation, and risk factors among Sudanese children and adolescents during Sudan army conflict: a cross-sectional study

BackgroundTiredness, poor concentration, disturbed sleep and poor appetite can all be caused by depression, which is a common mental disorder and a leading cause of disability worldwide. This study aimed to assess the prevalence of major depressive disorder, suicidal ideation, and risk factors in Sudanese children and adolescents during the Sudanese army conflict.MethodsA descriptive cross-sectional community-based study was carried out among Sudanese children between 11 and 17 years old who living in Sudan at the start of the conflict by using a self-administered questionnaire under the guidance of parents, if necessary. The questionnaire was adapted from the Patients Health Questionnaire-9 (PHQ-9) checklist for the assessment of major depression disorder symptoms according to the Diagnostic and Statistical Manual Edition 5th Edition (DSM-5). The questionnaire was translated into Arabic by two expert translators, and its validity and reliability were confirmed. Data analysis was performed using Statistical Package for the Social Sciences version 25 software, and descriptive analysis and any appropriate statistical tests were performed.ResultsAmong the 963 participants, the mean age was 15.18 ± 2.1 years, 65.5% were female, and 67.7% had major depressive disorder. There was a significant relationship between MDD score, age, sex, current residency status, and traumatic event exposure, with P values less than 0.001 for all variables.ConclusionMajor depressive disorder was highly prevalent among Sudanese children and adolescents included in the present study. Additionally, suicidal ideation, which requires immediate intervention, was reported to be very high. The findings will help the government to provide proper mental health interventions for affected people.

What does it take to offer high-quality, community-based, accessible mental health care in Lebanon?

Background: Armed conflict, economic collapse, the 2020 explosion, the COVID-19 pandemic, and persistent political and social instability have had severe impact on mental health in Lebanon. Aim: To highlight the critical elements for setting up a free community-based mental health care centre in Lebanon. Methods: Following the Beirut blast in 2020, a non-government organization started providing free, essential, personcentred, and holistic mental health care to residents in Lebanon through a multidisciplinary team of psychiatrists, psychologists, social workers, and mental health nurses. Results: During its first year of operation, the health centre provided 5392 free mental health consultations to 590 beneficiaries. Majority (67%) of the beneficiaries were female, and nearly half (45%) were aged 18–24 years. The most prevalent mental health disorders were major depressive disorder, generalized anxiety disorder and post-traumatic stress disorder. Beneficiaries self-reported a 70% improvement in depression and a 76% improvement in anxiety after 3 months of treatment. Conclusion: Based on our experience, we advocate the community-based model as an effective approach to delivering mental health interventions and recommend a continuous evaluation of its impact in community settings.

Development of Mental Health and Social Rehabilitation Service Models for Psychosocial Disabilities

This study aims to determine the extent to which policies related to persons with disabilities and mental health can accommodate the rights of people with psychosocial disabilities, then the extent to which the model of mental health services and social rehabilitation for psychosocial disabilities contributes to mental health treatment in DIY. YAKKUM Rehabilitation Center through capital development of mental health services and post-recovery social rehabilitation that is accessible and community-resourced. This model is oriented towards improving the quality of life of people with psychosocial disabilities and the existence of communities that contribute proactively to community-based mental health efforts in DIY. The data mining method in this study uses a mixed method, namely discriptive studies, descriptive qualitative, participant as observer and participant non observer. Subjects in this study included people with psychosocial disabilities, caregivers, mental health cadres, village governments, puskesmas and related local organizations. The results of this study show that the service model developed by the YAKKUM rehabilitation center is able to encourage social recovery in people with psychosocial disabilities, strengthen their role in the community in community-based mental health, local mental health policies that accommodate the rights of people with psychosocial disabilities, the existence of a mental health service system that focuses on fulfilling the rights of psychosocial disabilities and social rehabilitation.

Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review.

Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.

Group dialectical behaviour therapy for adolescents with emotional dysregulation and maladaptive coping: pilot implementation in Qatar

This paper presents a pioneering pilot implementation of group dialectical behaviour therapy (DBT) for adolescents with maladaptive coping in Qatar's child and adolescent mental health services. The project highlights the positive effect on patient satisfaction and the potential for early intervention with adolescents displaying emotional dysregulation. This pioneering initiative was consistent with local cultural values, stressing the importance of interconnectedness in mental health interventions. The impact of the initiative stresses its significance in diverse cultural contexts, urging further adoption regionally for improved mental health outcomes, particularly among adolescents displaying features of an emerging emotionally unstable personality disorder.

Impact of an Online Discussion Forum on Self-Guided Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Randomized Trial.

Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT. We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants' feedback to inform future research and implementation efforts. In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis. Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time. Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions. ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582.

The need for affiliation and depression amidst the post-acute pandemic: The mediation of self-esteem and moderation of insecure attachment among university students

The study investigated the connection between the need for affiliation and depression in Chinese university students, considering the mediating role of self-esteem and the moderating effect of insecure attachment (both anxious and avoidant). Involving 804 students from two Chinese universities, participants provided self-reports on affiliation desire, self-esteem, depressive symptoms, and assessments of insecure attachment. The findings revealed that self-esteem partially mediated the relationship between the need for affiliation and depression. Both anxious and avoidant attachment styles moderated the connection between self-esteem and depression. A simple slopes analysis showed that high anxious attachment intensified the link between low self-esteem and high depression. Similarly, high avoidant attachment exacerbated the association between low self-esteem and higher levels of depression. The implications of these findings were discussed, emphasizing their significance for mental health support and interventions targeting university students.

Mental Health Care Support in Rural India

More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas. To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health-related stigma among adults residing in rural India. This parallel, cluster randomized, usual care-controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire-9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder-7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023. The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization. The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non-high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale. Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, -1.71; 95% CI, -2.53 to -0.89; P < .001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P = .001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, -0.35; 95% CI, -1.11 to 0.41; P = .36). A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness. Clinical Trial Registry India: CTRI/2018/08/015355.

Slipping Through the Cracks: Clinicians' Perspectives on the Gaps in New York City's Public Mental Health System.

Most people who seek mental health treatment cannot access it. Certain groups (e.g., Medicaid enrollees and the uninsured) face particularly severe treatment access barriers along the care continuum. We interviewed 31 clinicians across two studies about their perspectives working in New York City's public mental health system. Because every clinician across both studies reported gaps in the system, we deployed an emergent, "serendipitous finding" approach and qualitatively analyzed the interviews together. Clinicians described three public mental health system gaps. First, many treatment-seekers must wait long periods of time to receive care and some never receive it at all. Second, patients with more serious challenges cannot access longer-term, higher-intensity, or specialized treatment. Third, some patients receiving high-intensity services may benefit from lower-intensity mental health support that is better integrated with medical and social service support. Coordinated and sustained financial investments at every step of the mental healthcare continuum are needed.

Enrollment and completion rates of a nationwide guided digital parenting program for children with disruptive behavior before and during COVID-19.

Our aim was to study enrollment and completion levels for the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention, for parents of young children with disruptive behavior before and after the COVID-19 lockdown period. Population-based screening was carried out on 39,251 children during routine check- ups at 4years of age. The parents of children scoring at least 5 on the Strengths and Difficulties Questionnaire were assessed against inclusion and exclusion criteria. Associations with enrollment or completion were analyzed using logistic regression models. The effects of COVID-19 restrictions on these were estimated using interrupted timeseries analysis. Of 39,251 families, 4894 screened positive and met the eligibility criteria. Of those, 3068 (62.6%) decided to enroll in the SFSW program and 2672 (87.1%) of those families completed it. The highest level of disruptive behavior (OR 1.33, 95% CI 1.12-1.57, p < 0.001) and overall severity of difficulties (OR 2.22, 95% CI 1.91-2.57, p < 0.001) were independently associated with enrollment. Higher parental education was associated with enrollment and completion. Higher paternal age was associated with enrollment, and parent depressive symptoms with non-completion. The SFSW enrollment did not significantly change following the COVID-19 restrictions, while the completion rate increased (COVID-19 completion OR 1.75, 95% CI 1.22-2.50, p = 0.002). Guided digital parenting interventions increase the sustainability of services, by addressing the child mental health treatment gap and ensuring service consistency during crisis situations.