Mental Health Tools Research Articles

How do clinicians use, experience, and value applications of outcome information in daily care? A mixed-methods study.

To support data-driven healthcare, digital applications of patient and outcome information bundled in dashboards can be used in daily care. This study investigated the usage, user-friendliness, and added value of patient and outcome information applications from a clinician's perspective. We used a mixed-methods design, including surveys (n = 56 clinicians), interviews (n = 16 clinicians), and eye-tracking experiments (n = 8 clinicians) across 3 different settings: a specialized clinic, a rehabilitation centre, and a general hospital. The applications, bundled in dashboards, include visual representations of patient information, individual treatment goals, screening tools for mental health, pain, and physical function, individual predictions of recovery and treatment effect, visuals of treatment outcome information, and identification of extreme values that fall outside the expected values. Applications were used for managing patient expectations, treatment selection, goal setting, and treatment evaluation. While usage frequency varied between applications and clinicians generally reported positive experiences with outcome information, a complex interaction of factors influenced use in clinical practice. The value of each application depends on its clinical actionability and clinicians' confidence. From clinicians' perspectives, the applications provide meaningful conversation starters, can lead to a more targeted conversation, and allow for better patient-clinician connection.

From Innovation to Implementation: A Qualitative Study of New Zealand Mental Health Clinicians’ Views on Digital Tools

Abstract The objective was to explore New Zealand mental health clinicians’ and trainees’ knowledge, utilization, and attitudes towards digital mental health tools through semi-structured interviews. Participants were recruited from an online survey about digital mental health tools. At the survey’s conclusion, participants could express interest and provide contact details via a link. One-on-one in-depth Zoom interviews were conducted, lasting an average of 45 min each. Data collection occurred between August 2021 and February 2022. Anonymized transcripts were analyzed using reflexive thematic analysis. Seventeen clinicians took part, and four primary themes emerged: (1) receptiveness to digital innovation, most had used digital mental health tools with clients, observing beneficial outcomes and positive responses; (2) digital technology remains a double-edged sword, offering significant supportive opportunities while also highlighting the digital divide; (3) impediments to clinical implementation, stemming from concerns about maintaining clinical safety and the need to adapt beyond established comfort zones; (4) aspirations for digital technology in clinical practice, encompassing innovative ideas, desire for tools responsive to New Zealand’s diverse communities, and ideas to maximize their potential. This qualitative study gives voice to New Zealand mental health practitioners and their interest in digital innovations to improve client care. However, integrating digital mental health tools into clinical practice effectively depends on overcoming challenges like the digital divide, data privacy, safety concerns, and the lack of tools that reflect New Zealand culture or offer personalization to meet individual needs. It highlights the need for collaboration in developing and deploying digital interventions that are both aligned with clinician requirements and adapted to the specific contexts of their client communities. This research provides a historical (albeit 3-year-old) account of clinician attitudes and knowledge. Given the rapid pace of technological innovation—particularly the rise of generative AI since late 2023—taking snapshots of changing attitudes becomes ever more important as the technological landscape continues to evolve.

Leveraging social circles and algorithmic processes in digital mental health tools for college students' stress management

Introduction. College students frequently face stress from academic pressures, social demands, and the challenges of daily life. Digital mental health (DMH) interventions have shown promise in helping manage these stressors. However, many students quickly abandon DMH tools, which limits their effectiveness. Previous research has identified social interaction as a key factor in improving user engagement with DMH tools. Still, most existing DMH tools have not been designed with these sharing practices in mind. Moreover, research on recommender systems (RSs) has mainly focused on single-user interactions, leaving a gap in the development of RSs for group settings, particularly in the health domain. Method. To address this gap, we developed a technological probe that integrates social features with algorithmic processes to provide recommendations for both individuals and groups, aimed at supporting students' stress management efforts. We conducted a user study with 15 college students and their social circles, who interacted with the probe over the course of a day. Results. Our findings revealed that students appreciated the opportunity to share daily activities with friends and felt motivated to engage in well-being-enhancing behaviours. Participants also gave valuable feedback on the stress management recommendations. We discuss and provide recommendations for future research.

간호대학생의 e-헬스 리터러시(인터넷 건강정보이해능력)가 정신건강증진행위에 미치는 영향

This study is a descriptive study conducted to identify the influence of e-health literacy on mental health promotion behaviors among nursing students. Data were collected from April to June 2023 from 248 nursing students in the first to fourth grades at a university in S-si, Gyeonggi-do. The e-health literacy was measured with a modified tool for eHEALS (eHealth Literacy Scale), and mental health promotion behavior was measured by modifying the situation awareness of the mental health tool. The data were analyzed using the SPSS WIN 29.0 Program, independent t-test and One-way ANOVA, Scheffé's test, Pearson correlation coefficient, and multiple regression analysis. As a result of the study, there were significant differences in mental health promotion behavior according to grade, self-perceived physical health status, self-perceived mental health status, coping strategy for mental stress, and health concerns. e-health literacy and mental health promotion behavior have a positive correlation (r=.38, p<.001). In the regression analysis, e-health literacy (β=.36, p<.001), second grade (β=.24, p<.001), first grade (β=.23, p<.001), health concern (β=.19, p=.001), coping strategy for mental stress with professional counseling (β=.17, p=.002), and conversation with friends (β=.15, p=.018) were followed, and these factors explained 29% of the variance. Therefore, to strengthen the mental health promotion behavior of nursing students, it is proposed to develop an education program that can increase the level of e-health literacy considering school years.

Digital Mental Health Screening, Feedback, and Referral System for Teens With Socially Complex Needs: Protocol for a Randomized Controlled Trial Integrating the Teen Assess, Check, and Heal System into Pediatric Primary Care.

Teens with socially complex needs-those who face multiple and potentially overlapping adversities-are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929. DERR1-10.2196/65245.

The Development and Psychometric Validation of the Fainareti Screening Tool for Perinatal Mental Health in Greek Pregnant Women.

Background/Objectives: It would be helpful for primary healthcare professionals to have access to a brief, general screening tool allowing them to detect patients suffering from major mental illness. This also holds for organizations and institutions at which pregnant women ask for support during the perinatal period. An evaluation of the psychometric properties, validity, and reliability of the Fainareti mental health screening tool was carried out in Greek women in this study. Methods: The study participants consisted of 518 women retrospectively followed from pregnancy to their first year postpartum as part of a health intervention at the Day Center for Women's Mental Health Care (Perinatal Mental Health Disorders), operated by the non-profit organization Fainareti. Alongside the newly developed screening tool, this study utilized the Perinatal Anxiety Screening Scale (PASS), the Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Results: The assessment of the tool's internal reliability included computing two separate internal consistency indices, with both indicating its significant level of reliability. The correlation analysis between the tool and the scales included in this study demonstrated the tool's strong convergent validity, while factor analyses confirmed its satisfactory construct validity. Conclusions: Overall, these findings suggest that the one-factor Fainareti mental health screening tool is suitable for initial assessments of the mental health of Greek women.

Shame, Guilt and Psychedelic Experience: Results from a Prospective, Longitudinal Survey of Real-World Psilocybin Use

ABSTRACT The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. Despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of shame-related processes with psychedelic use. This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health. Acute feelings of shame or guilt during psilocybin experiences were commonly reported (68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2–4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2–3 months after use (Cohen’s dz = 0.37). Trait shame increased in a notable minority of participants (29.8%). The activation of self-conscious emotions with psychedelics deserves further attention as a challenging experience subcategory that may be relevant to psychological outcomes. Such experiences could pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shame-related memory reconsolidation.

Family-focused intervention programme to foster adolescent mental health and well-being: protocol for a multicountry cluster randomised factorial trial (FLOURISH Phase 2)

IntroductionAdolescent mental health problems represent a significant global health issue, particularly in low- and middle-income countries, such as the Republic of North Macedonia and the Republic of Moldova. Effective and...

Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study.

Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy-based digital intervention for common mental health difficulties developed for the South African context. This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as "unemployed but seeking employment" (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa.

A mixed-methods investigation of a digital mental health tool to manage posttrauma anger.

Problematic anger affects up to 30% of individuals who have experienced trauma. Digital mental health approaches, such as ecological momentary assessment (EMA) delivered via smartphone and wearabledevices (i.e., wearables), hold significant potential for the development of novel digital technology treatments. The objective of this cohort study was to examine the acceptability, feasibility, and outcomes from 10 days of usage of a digital mental health tool combining EMA and wearable use among trauma-exposed adults with problematic anger. We used mixed methods to examine feasibility and acceptability and explored quantitative changes in mental health symptoms among participants over the study period (N = 98, 80.4% women, Mage = 38 years). Quantitative and qualitative data revealed that regular EMA combined with a wearable was feasible and acceptable in the sample. We observed reductions in problem anger, p <.001, repeated-measures d (dRM) = -0.81, 95% CI [-1.04, -0.59]; and posttraumatic stress disorder symptoms, p =.025, dRM = -0.26, 95% CI [-0.55, -0.03], over the 10 days of monitoring. Qualitative findings suggest that by regularly "checking in" on anger symptoms, participants improved their self-awareness and ability to self-manage their mood. These findings provide valuable learnings for building future personalized digital mental health tools.

"I think we're on a cusp of some change:" coping and support for mental wellness among Black American women.

Public discussions in the media (e.g., social media and reality shows) about Black women's mental health have become more common. Notably, celebrities have become more vocal about their own mental health challenges and sought to normalize seeking care. This study aimed to gain a better understanding of Black women's: (1) past and current causes of stress, anxiety, and depression, and coping skills used; (2) their attitudes and perceptions toward mental health and receiving mental health treatment; and (3) times in their life they felt anxious or depressed, and what type of support or resources would have been helpful to have access to. Focus groups were conducted with 20 women (mean age 36.6 years, SD 17.8 years), with 5 participants per group. Descriptive qualitative content analysis of the focus group transcripts was conducted. Results consistently showed that intersectional identities of being both Black and a woman resulted in feelings of both hypervisibility and invisibility, representation matters when it comes to mental health providers, an increased openness to therapy across age groups, and a willingness to try digital health tools (e.g., smartphone app) for mental health needs. There is still work to be done to normalize mental health treatment among Black women. Subgroups within the community (e.g., young adults) have less stigma around mental health and are acting as catalysts for change. Intentional inclusion of Black women in mental health research and evolving treatment paradigms is important to eliminate inequities in access to culturally relevant mental health care.

Thought Field Therapy intervention to improve mental health during the COVID-19 pandemic: A randomized controlled trial.

Thought Field Therapy intervention to improve mental health during the COVID-19 pandemic: A randomized controlled trial.

Mental Health and Well-Being in the Modern Era: A Comprehensive Review of Challenges and Interventions.

A critical global concern in the modern era is mental health and well-being, where rapid socioeconomic change, technological advancements, and lifestyle shifts have significantly impacted individuals' psychological health. Primary stressors today include urbanization, digital dependency, social isolation, and economic pressures, alongside the escalating prevalence of mental health disorders such as depression, anxiety, and burnout.The COVID-19 pandemic has further exacerbated global mental health crises, increasing the vulnerability of populations during times of uncertainty and instability. This paper critically examines emerging connections between mental health and lifestyle factors such as sleep, diet, and exercise. Interventions are discussed from a multidimensional perspective, encompassing pharmacological treatments, psychotherapy, digital mental health tools, and community-based programs. Special attention is given to the rise of telemedicine and mobile mental health apps, offering innovative solutions to bridge gaps in mental healthcare accessibility. Furthermore, the review underscores the importance of preventive approaches, promoting mental health literacy, reducing stigma, and fostering resilience through mindfulness, cognitive behavioral techniques, and social support systems.

Telepsychiatry and Digital Mental Health Interventions: The Future of Psychiatric Nursing

The rapid advancement of digital health technologies is transforming psychiatric nursing, with telepsychiatry and digital mental health interventions emerging as essential tools for improving mental healthcare accessibility, efficiency, and patient outcomes. Telepsychiatry, a subset of telemedicine, enables remote psychiatric consultations via video conferencing, while digital interventions such as artificial intelligence (AI)-powered chatbots, mobile mental health apps, and wearable monitoring devices provide real-time support and symptom tracking. These innovations allow psychiatric nurses to deliver high-quality care to underserved populations, reduce wait times, and enhance continuous patient engagement through digital platforms. One of the most significant benefits of telepsychiatry is its ability to bridge the mental health gap, particularly in rural and low-resource settings where psychiatric services are scarce. Additionally, digital mental health tools facilitate early intervention, allowing nurses to monitor patients remotely and intervene before crises escalate. The integration of AI and machine learning in mental health diagnostics further enhances personalized care by predicting symptom progression and recommending targeted therapeutic strategies. However, despite these advancements, challenges such as data security, ethical concerns, and the digital divide remain critical barriers to widespread adoption. Ensuring compliance with privacy regulations and addressing disparities in technology access are essential for the equitable implementation of digital psychiatric nursing. Looking ahead, emerging innovations such as virtual reality (VR)-assisted therapy, augmented reality (AR)-based nursing education, and AI-driven predictive analytics will further revolutionize psychiatric care. As telepsychiatry and digital interventions become integral to mental health services, psychiatric nurses must adapt by acquiring new competencies in digital healthcare technologies. Strengthening policies, funding research, and enhancing digital literacy among psychiatric nurses will be crucial for ensuring the effectiveness and sustainability of telepsychiatry in the future of mental health care.

Organizational factors impacting the implementation of a digital mental health tool in Alberta's mental health care of youth and young adults.

With mental health concerns on the rise among youth and young adults (age 12-24), increased mental health options include virtual care, apps and online tools, self-management and tracking tools, and digitally-enabled coordination of care. These tools may function as alternatives or adjuncts to face-to-face models of care. Innovative solutions in the form of digital mental health (dMH) services not only provide support, resources and care, but also decrease wait times and waitlists, increase access, and empower youth. However, organizational factors may impact the extent of dMH interventions are that accepted, used, and sustained in clinical settings. This qualitative study explores organizational barriers and facilitators surrounding the implementation of a digital platform (Innowell), which uses measurement-based care (MBC) to track youth progress and outcomes. Data was collected from 154 mental health care providers participating in 23 focus groups across Alberta, drawing on school and community settings, specialized mental health services, and primary care networks. A thematic analysis revealed the following: barriers included incompatibility with current systems and workflows, lack of inter-organizational collaboration, time commitment, perceived sustainability and lack of digital literacy. Facilitators included positive attitudes towards using dMH to optimize clinical practices by empowering youth and improving continuity of care, transitions in care, and quality of care, as well as workplace culture and leadership. The study highlights a critical need for decision makers and clinical leaders to address organizational factors by integrating training and support, establishing interoperability between digitized and in-person healthcare systems, and leveraging support for MBC and youth-centred care.

Evaluation of a culturally safe social and emotional well-being programme: a protocol

Transgenerational trauma continues to have detrimental impacts on Indigenous Australians. However, Indigenous Australians have always recognised that the healing from colonisation’s traumatic policies lies within culture. As such, there is an urgent need for community-driven culturally safe, well-being support, particularly for Indigenous young people. The development of an adventure-based Indigenous therapy programme aims to support and improve emotional and social well-being for Indigenous young people in North Queensland. We aim to evaluate this novel programme using validated and modified mental health tools and yarning. Analysis of the data will measure the direct impact of the programme; how past traumas influence the healing process and assess the use of modified culturally appropriate mental health tools. An evaluation with culturally appropriate recommendations will be produced from the analysis. Importantly, a strengths-based approach will be followed to identify levels of resilience and positive cultural experiences existent in communities.

Exploring digital therapeutics for mental health: AI-driven innovations in personalized treatment approaches

Digital therapeutics have emerged as a transformative approach in addressing mental health challenges, offering evidence-based, technology-driven interventions. As mental health disorders become increasingly prevalent globally, traditional methods of treatment often fail to meet the growing demand due to limited accessibility, stigmatization, and resource constraints. Digital therapeutics leverage advanced technologies, including artificial intelligence (AI), to bridge these gaps, providing scalable and personalized mental health solutions. AI has revolutionized this domain by enabling adaptive, data-driven interventions that cater to individual needs, ranging from mood disorders to complex conditions like post-traumatic stress disorder (PTSD) and depression. At a broader level, digital therapeutics represent a paradigm shift in healthcare, transitioning from generalized care models to highly personalized and proactive frameworks. AI-driven innovations, such as natural language processing (NLP), predictive analytics, and machine learning algorithms, have enhanced the efficacy of digital mental health tools by facilitating real-time monitoring, symptom analysis, and tailored therapeutic recommendations. These innovations integrate seamlessly with wearables, mobile applications, and virtual reality, providing patients with accessible and engaging platforms for mental health management. However, while AI-based digital therapeutics show immense promise, challenges remain. Ethical concerns about data privacy, bias in AI algorithms, and equitable access need to be addressed to maximize their potential. Additionally, integrating these tools into existing healthcare systems requires alignment with regulatory frameworks and clinician support. By narrowing the focus to personalized treatment approaches, this paper explores how AI-driven digital therapeutics can advance mental health care, providing actionable insights into creating more inclusive, effective, and accessible interventions.

Digital Platform for Pediatric Mental Health Support During Armed Conflicts: Development and Usability Study

Abstract Background The prevalence of mental health disorders among children and adolescents presents a significant public health challenge. Children exposed to armed conflicts are at a particularly high risk of developing mental health problems, necessitating prompt and robust intervention. The acute need for early intervention in these situations is well recognized, as timely support can mitigate long-term negative outcomes. Pediatricians are particularly suited to deliver such interventions due to their role as primary health care providers and their frequent contact with children and families. However, barriers such as limited training and resources often hinder their ability to effectively address these issues. Objectives This study aimed to describe the rapid development of a digital mental health tool for community pediatricians, created in response to the urgent need for accessible resources following the October 7th terror attack in Israel. The goal was to create a comprehensive resource that addresses a wide range of emotional and behavioral challenges in children and adolescents, with a particular focus on those affected by armed conflict and significant trauma exposure. In addition, the study aimed to evaluate the platform’s usability and relevance through feedback from primary users, thereby assessing its potential for implementation in pediatric practice. Methods A digital platform was developed using a collaborative approach that involved pediatricians and mental health professionals from various hospital clinics. The initial framework for the modules was drafted based on key emotional and behavioral issues identified through prior research. Following this, the detailed content of each module was cocreated with input from specialized mental health clinics within the hospital, ensuring comprehensive and practical guidance for community pediatricians. A focus group of 7 primary users, selected for their relevant hospital and community roles, provided feedback on the platform’s user experience, content relevance, and layout. The evaluation was conducted using a structured questionnaire complemented by qualitative comments. Results Fifteen detailed modules were created, each providing information, including anamnesis, initial intervention strategies, parental guidance, and referral options. The focus group feedback demonstrated high satisfaction, indicating a very good user experience (mean 4.57, SD 0.53), content relevance (mean 4.71, SD 0.48), and layout suitability (mean 4.66, SD 0.52). Specific feedback highlighted the value of concise, actionable content and the inclusion of medication information. Participants expressed a strong willingness to regularly use the platform in their practice (mean 4.40, SD 0.53), suggesting its potential for broad application. Conclusions This study demonstrates the effectiveness of a collaborative development process in creating a digital tool that addresses the mental health needs of children in crisis situations. The positive feedback from pediatricians indicated that the platform has the potential to become a valuable resource for early recognition, crisis intervention, and parental support in community pediatric settings. Future research will focus on broader implementation and assessing the platform’s impact on clinical outcomes.

Cadê o Kauê? Co-design and acceptability testing of a chat-story aimed at enhancing youth participation in the promotion of mental health in Brazil.

Adolescent mental health is vital for public health, yet many interventions fail to recognise adolescents as proactive community contributors. This paper discusses the co-design and acceptability testing of a chat-story intervention to enhance Brazilian adolescents' participation in the promotion of mental health in their peer communities. We specifically highlight the iterative process of co-creating this intervention with community stakeholders. The co-design was led by researchers, a youth collaborative group, and health-tech experts. Part 1 included quantitative (n = 1,768) and qualitative (n = 46) studies with Brazilian adolescents aged 15-18 for priority-setting. Part 2 involved co-creation and technical production, with input from youth advisors (n = 24), school staff (n = 11), and policy experts (n = 3). In Part 3, the chat-story was user tested (n = 32). Parts 4 and 5 assessed acceptability through a qualitative study in schools (n = 138) and initial efficacy during an online campaign (n = 795). Participants aspired to support their peers' mental health in schools, both one-to-one and collectively, but felt unprepared. This informed the chat-story's goal of enhancing peer support and collective action skills. Themes identified during Part 1, such as prejudice and academic pressure, were woven into the narrative to raise awareness of the social determinants of mental health, drawing from real-life stories. In the final story, players search for their missing best friend at school, uncovering his anxiety struggles and practicing skills such as empathic listening and partnership building. A manual for teachers was collaboratively designed for use within school settings, supplementing direct-to-user online applications. Acceptability testing showed participants found the tool authentic and user-friendly. Online users perceived the tool as preparing and motivating them to offer peer support and engage in collective action. The immersive co-creation model, enriched by input from key stakeholders, yielded a relevant and well-received intervention for Brazilian adolescents. Co-designed creative tools like chat-stories hold promise as digital mental health tools, fostering awareness, critical reflection, and inspiring adolescents to drive positive social change.

Implementing a Quality Improvement Initiative to Screen for Dementia in a Down Syndrome Specialty Clinic.

Using quality improvement methods, we aimed to implement a protocol to assess for dementia among adults with Down syndrome (DS). To track implementation, interval retrospective chart review of patients with DS with visits to the Massachusetts General Hospital DS Program (MGH DSP) was conducted quarterly. The impact of a newly implemented protocol created and informed by clinical experts in the MGH DSP including laboratory tests, imaging, referrals, and screening tools for dementia and mental health concerns, was analyzed using statistical process control charts. From December 2021 to December 2022, the MGH DSP developed and implemented a new clinical protocol to screen for dementia in 44 adults with DS, ages 40 and above, at a total of 48 visits. We found high rates of completion of two screening surveys (85% and 81%, respectively) and an 84% adherence to our overall protocol elements by clinical staff. Among those with dementia-like symptoms, medical evaluation was collected and summarized. We show that it is possible to successfully implement a new protocol, including the use of a dementia screener, in line with published evidence-based care guidelines for adults with DS. We present our protocol as one successful approach focused on pre-visit screening for symptoms of dementia and mental health concerns and evaluating for co-occurring medical conditions in adults with DS.