Health Treatment Research Articles

Debate: How much should nonspecialists be involved in mental health care when resources are limited? A perspective from low- and middle-income countries.

Millions of children and young people (CYP) in low- and middle-income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task-sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task-sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task-shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task-shared programmes need to be embedded in a balanced system-wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task-sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task-sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability.

We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party?

Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public's assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness.

Clinicians’ perspectives of immersive tools in clinical mental health settings: a systematic scoping review

BackgroundVirtual Reality in mental health treatment has potential to address a wide spectrum of psychological and neurocognitive disorders. Despite the proven benefits, integration into clinical practice faces significant challenges. There is a critical need for research into clinicians’ perceptions of virtual reality due to the gap between rapid technological advancements and their adoption in mental health services.MethodA scoping review was conducted to comprehensively understand clinicians’ perspectives on the application of immersive virtual reality technologies within mental health settings. 4 data bases were searched, from inception, with the search areas of clinicians’, technology, perspectives and mental health. The scoping review followed the PRISMA-ScR checklist. All results were thematically analysed to identify and categorise themes with a focus on qualitative analyses of clinicians’ experiences and perceptions of VR applications in therapeutic contexts.Results17 articles were selected, encompassing a range of mental health settings. The findings indicate that the integration of VR in clinical environments is heavily influenced by clinicians’ knowledge and experience, with unfamiliarity often leading to scepticism. Positive attitudes towards VR, bolstered by direct experience and training, were found to drive acceptance, as clinicians’ acknowledged its potential to complement traditional therapies. However, there are still gaps in understanding VR’s therapeutic applications, particularly concerning its impact on human interaction and its suitability for specific patient groups. Balancing VR’s clinical benefits with ethical and safety concerns is crucial, especially when working with vulnerable populations. Furthermore, structural and administrative support is essential to overcoming the financial and logistical challenges of VR implementation, ensuring its safe and effective integration into mental health care.ConclusionWhile VR holds significant potential for enhancing mental health care, its successful integration into clinical practice necessitates addressing existing gaps in knowledge, training, and structural support. By carefully balancing its clinical benefits with ethical, practical, and safety considerations, VR can be effectively utilised as a valuable tool in mental health treatment, providing innovative solutions while ensuring that patient care remains paramount.

Household job insecurity, food insufficiency, and children’s mental health needs: Household Pulse Survey in June 2023

BackgroundEconomic hardships have far-reaching implications for families with children, impacting their well-being and development during the COVID-19 pandemic. The pandemic has led to household financial problems following job loss and reduced income. As parents or caregivers face financial difficulties, children may experience emotional distress through heightened anxiety and a sense of helplessness. This study examined the effects of household job insecurity and food insufficiency due to the pandemic's aftermath on the mental well-being of children in the United States.MethodThis study utilized data from the Household Pulse Survey (HPS) during June 7–19, 2023 (Phase 3.9). The prevalence and effect of job insecurity, delineated by recent household job loss and employment status, and food insufficiency, measured through levels of food insufficiency, were analyzed across households with different age groups of children: under 5 years, 5–11 years, and 12–17 years, with an overall perspective on children under 18. We calculated unweighted observations, survey-weighted proportions, and survey-weighted 95% confidence intervals to analyze the impact of job insecurity and food insufficiency on children’s mental health treatment needs.ResultsThis study highlighted differences in economic hardships due to household job insecurity and food insufficiency across households with children in multiple age groups. There were almost twice as many respondents with no work in the last 7 days (33.68%) compared to those who experienced job loss within the last 4 weeks (14.82%). Additionally, 51.68% of respondents reported food insufficiency over the last 7 days, with more than half of the households experiencing food insufficiency due to the inability to afford more food. Mental health treatment needs among children were significantly higher in households experiencing job loss and food insufficiency. The need for mental health support for children increased with age in households facing job loss or no employment.ConclusionsThis study enhances our understanding of post-pandemic economic hardships and their influence on children’s mental health needs across different age groups. By identifying disparities and patterns, policymakers and practitioners can design targeted interventions to address employment opportunities and food access in the aftermath of the COVID-19 pandemic. Providing mental health treatments is crucial, especially for children aged 5–11 and 12–17, who are at higher risk of experiencing emotional distress due to household economic hardships.

Effectiveness of mental-health interventions for children and adolescents placed in residential care by the welfare services: A systematic review

BackgroundChildren and adolescents in residential youth care are a vulnerable population with great needs of mental health. PurposeThe present study undertook a systematic review to seek available mental health interventions and investigate its effectiveness. MethodsFollowing PRISMA guidelines, a systematic search was performed for publications between 1992 and July 2023 in seven databases and relevant journals for residential care. Methodological quality was assessed using the Mixed Methods Appraisal Tool. After multi-stage screening, 14 eligible articles were retrieved for analysis and a narrative synthesis performed. ResultsThirteen interventions were identified, predominantly focusing on internalising difficulties, showing congruently positive results mostly on internalised-related outcomes. Most interventions were based on cognitive-behaviour therapy and outdoor-based therapies (surf-, animal assisted, and forest-therapy). Short-term interventions, delivered on a weekly basis in group format, were the most frequent delivery mode. Most studies managed to recruit a comparison group but follow-ups were generally absent. Poor reporting and lack of methodological rigor were common features of the reviewed studies. ConclusionsThis systematic review extends the state of the art regarding psychological interventions in residential youth care. Evidence-based interventions are still needed, and future research should focus on developing and rigorously testing more interventions within this care system.

Travel as a Tool for Trauma Recovery: A Mixed-Methods Analysis Integrating Quantitative and Qualitative Approaches

This study aims to explore how travel serves as a tool for trauma recovery, aiding individuals in coping with psychological trauma and promoting mental health. We adopted a pragmatic mixed-methods approach, conducting two complementary studies: qualitative interviews with individuals who have experienced trauma and a quantitative survey. The qualitative interviews reveal the mechanisms and key factors of travel in the trauma recovery process. Based on the interview data, we constructed a conceptual model that includes latent variables such as travel experience, emotional regulation, self-reflection, social support, and trauma recovery. This model was subsequently validated through a quantitative survey study using Partial Least Squares Structural Equation Modeling. The results indicate that travel significantly promotes trauma recovery by providing a restorative environment, facilitating emotional regulation, and enhancing social interaction. This study provides new insights into the role of travel in trauma recovery and offers practical guidance for mental health interventions.

Prevalence and determinants of occupational depression, anxiety, and stress among Ethiopian healthcare workers

Studies on the prevalence and factors of depression, and anxiety symptoms from a work-ascribed or causal perspective are not available and studies on the prevalence of occupational stress in Ethiopia are limited. Therefore, this study aimed to determine the prevalence of occupational depression, job anxiety, and occupational stress, and to identify their determinants in healthcare workers. We conducted a multicenter cross-sectional study in selected public hospitals in the Central and Southern Ethiopia from 16th January to 28th February 2023. We used stratified random sampling to select 9 public hospitals from three strata: primary, general and tertiary hospitals. We collected data using scales of perceived occupational stress, occupational depression inventory, and job anxiety. We performed a confirmatory factor analysis followed by determining the prevalence of those mental symptoms and identifying independent factors using multiple ordinal logistic regression. Among 1426 healthcare workers, the overall prevalence of occupational depressive, job anxiety, and occupational stress symptoms were 39.0%, 57.6%, and 68.0%, respectively. Females, medical specialists, participants with a history of disease or injury, those with low job dissatisfaction, higher sleeping disorder scores, higher life-threatening events (LTEs) scores, and longer working hours were more likely to report occupational depressive symptoms. Participants with poor perceived health significantly increased the odds of reporting job anxiety symptoms. Participants with low job satisfaction, a history of workplace verbal violence, higher scores for sleep disorders, and higher LTEs score had significantly greater odds of reporting both job anxiety and occupational stress symptoms. Younger participants were also more likely to report occupational stress symptoms. Our study highlights the need to prioritize workplace mental health interventions for healthcare workers. The study also suggested the need to address gender, educational level, job satisfaction, and sleep hygiene, develop coping mechanisms for LTEs, prevent workplace violence, and manage of working hours per week to enhance the mental well-being of healthcare workers in Ethiopia.

A community-based treatment and rehabilitation pathway for people with mental disorders recently convicted of an offence.

People with mental disorders can receive treatment in the community. Some, however, fall out of services and into the criminal justice system, running the risk of imprisonment and a deteriorating mental health cycle. This editorial describes Mental Health Treatment Requirements (MHTRs), that is court-imposed sentences that enable people in the UK to access treatment in the community and divert them from short custodial sentences. MHTRs have proven successful for people with primary care mental health needs. It remains difficult to secure these sentences for people with secondary care mental health needs. Three new 'proof of concept' sites for secondary care MHTRs may help understand barriers and find solutions.

Core Mental Health Clinician Capacity and Use Rates in the US Military

Active duty service members have higher mental health stress and cannot choose where to live. It is imperative to understand how geographic access may be associated with their ability to obtain mental health treatment and how the COVID-19 pandemic was associated with these patterns. To identify changes in the prevalence and intensity of mental health care use when service members experienced changes in core mental health clinician (defined to include psychiatrists, psychiatric nurse practitioners, clinical psychologists and social workers, and marriage and family therapists) capacity in their communities and whether patterns changed from before to after the onset of the COVID-19 pandemic. This retrospective cohort study of the active duty population between January 1, 2016, and December 31, 2022, was conducted using individual fixed-effects models to estimate changes in the probability of mental health care visits and visit volume when a person moved across communities with adequate core mental health clinician capacity (≥1 clinician/6000 beneficiaries), shortage areas (<1 clinician/6000 beneficiaries), and areas with 0 clinicians within a 30-minute drive time. All US active duty service members stationed in the continental US, Hawaii, and Alaska were included. Data were analyzed from January through July 2024. The first set of outcomes captured the probability of making at least 1 mental health care visit in a given quarter; the second set of outcomes captured the intensity of visits (ie, the number of visits log transformed). This study included 33 039 840 quarterly observations representing 2 461 911 unique active duty service members from the Army, Navy, Marines, and Air Force (1 959 110 observations among Asian or Pacific Islander [5.9%], 5 309 276 observations among Black [16.1%], 5 287 168 observations among Hispanic [16.0%], and 18 739 827 observations among White [56.7%] individuals; 27 473 563 observations among males [83.2%]; mean [SD] age, 28.20 [7.78] years). When an active duty service member moved from a community with adequate capacity at military treatment facilities to one with 0 clinicians within a 30-minute drive, the probability of a mental health visit to any clinician decreased by 1.13 percentage points (95% CI, -1.21 to -1.05 percentage points; equivalent to a 11.6% relative decrease) and the intensity of total visits was reduced by 7.7% (95% CI, -9.0% to -6.5%). The gap increased from before to after the onset of the COVID-19 pandemic, from 8.5% (equivalent to -0.82 percentage points [95% CI, -0.92 to -0.73 percentage points]) to 16.2% (equivalent to -1.58 percentage points [95% CI, -1.70 to -1.46 percentage points]) in the probability of visiting any clinician type for mental health. In this study, active duty personnel assigned to locations without core military mental health clinicians within a 30-minute drive time were less likely to obtain mental health care and had fewer mental health care visits than those in communities with adequate military mental health capacity even if there was adequate coverage from the civilian sector. The care disparity increased after the onset of the COVID-19 pandemic.

Evaluation of the impact of a digital care navigator on increasing patient registration with digital mental health interventions in routine care

BackgroundLess than half of adults with mental health disorders in the United States receive appropriate or timely care. Digital Mental Health Interventions (DMHIs) have the potential to bridge this gap. However, real-world adoption of DMHIs is impeded by patient and provider-level technological barriers. Care navigators have the potential to address these challenges by providing technical support and enhancing patients' experience with DMHIs. ObjectiveThis study explores the effect of a digital care navigator (DCN) on patient registration latency and rates of DMHIs implemented as part of a digital-first behavioral health care model integrated within routine care at a large multispecialty group medical practice. MethodsData were collected from electronic medical records and DMHI registration data were obtained from the DMHI vendors. Descriptive statistics were used to describe the DCN's efforts to help patients register with their DMHIs. Moods median tests evaluated differences in registration latency and weekly registration rate pre- and post- DCN implementation. Change in registration likelihood as a function of DCN outreach latency was investigated using a Kaplan-Meier plot. ResultsDuring the first eight months, the DCN made 1306 phone calls to 680 unique patients, successfully connecting with 66 %. DCN implementation also increased the median registration rate from 61.9 % to 76.9 %. Results showed that the expediency by which the DCN outreached patients directly impacted registration rate such that of those who were outreached by the DCN on the day of their referral to a DMHI, 96.86 % registered. This number was reduced to 76.15 % if the DCN reached them 1-day following referral, and 41.39 % 5-days after their referral. ConclusionsUse of a DCN shows promise for enhancing patient registration rates with DMHIs in routine healthcare settings.

Implementing a mental health app intervention in a university setting: multi-methods evaluation study

Purpose The number of university students seeking mental health support is rapidly increasing. To provide additional psychological support to students accessing well-being services, this study aimed to pilot a mental health Web application (app) called Orpheus®. Design/methodology/approach Guided by student consultations, a multi-methods approach was adopted, including an examination of in-app data, chart reviews of routinely collected student information and interviews with mental health practitioners. Usage data were analysed descriptively. Changes in mental health outcomes were examined using means, standard deviations and reliable change indices for anxiety and depression scores. Inductive and deductive thematic analysis was conducted on qualitative data from staff interviews and student feedback. Findings A total of 26 students registered an account with 39 completed app visits. On 37 of the 39 (94.9%) occasions, students reported reductions in the intensity of unwanted negative emotions. Statistically significant reductions in the average pooled anxiety and depression scores were observed. Of the 15 students who completed pre- and post-routine outcome measures, between 20% and 60% showed reliable and meaningful symptom improvements. Students reported that the app was helpful and easy to set up and use, with no adverse events. Practitioners highlighted barriers and facilitators related to the technology features, situational contexts and individual differences. Originality/value Integrating Orpheus in real-world settings resulted in promising implementation processes, potential for future uptake and positive outcomes. However, ongoing research, staff training and app testing are needed to further improve the implementation processes for digital mental health interventions.

A Reinforcement Learning-Based Approach for Promoting Mental Health Using Multimodal Emotion Recognition

This research aims to enhance mental well-being by addressing symptoms of anxiety and depression through a personalized, culturally specific multimodal emotion prediction system. It employs an emotionally aware Reinforcement Learning (RL) agent to suggest tailored Cognitive Behavioral Therapy (CBT) activities. The study focuses on developing precise, individualized emotion prediction models using facial expressions, vocal tones, and text, and integrates these models with the RL agent for emotionally aware CBT recommendations. The mHealth approach combines deep learning models with RL, achieving accuracies of 72% for facial expressions, 73% for vocal tones, and 86% for text, all fine-tuned for the Sri Lankan context. Validation through real-world use and user feedback consistently demonstrated that each model exceeds 70% accuracy, fulfilling the objective of precise emotion prediction. A weighted algorithm was introduced to refine the emotion prediction experience and personalize forecasts across the three modalities to enhance mental well-being. The RL-enabled agent suggests CBT activities approved by mental health professionals, tailored based on predicted emotions, and delivered through the same mHealth application. The effectiveness of these interventions was assessed using the DASS-21 questionnaire, revealing significant reductions in depression scores (from 21.08 to 13.54) and anxiety scores (from 19.85 to 10.46) in the study group compared to the control group. The study concludes that integrating multimodal emotion prediction models with RL-based CBT suggestions positively impacts mental well-being and contributes to personalized mental health interventions.

Hybrid 1 randomized controlled trial of an integrated stepped-care mental health intervention for traumatic injury patients

BackgroundAnnually, nearly 3 million individuals in the US are hospitalized after experiencing a traumatic injury (e.g., serious automobile crash, gunshot wound, stab injury). Many traumatically injured patients experience a trajectory of resilience. However, 20–40 % develop mental health problems such as posttraumatic stress disorder and depression; population estimates exceed 600,000 patients annually. Most trauma centers do not provide direct services to address mental health recovery, but the 2022 American College of Surgeons guidelines have established this as a priority. Cost-effective interventions are needed that meet the needs of patients at each stage of the recovery process while achieving sustainability at the level of implementation. This protocol paper describes a study that rigorously tests the Trauma Resilience and Recovery Program (TRRP), a scalable, sustainable technology-enhanced intervention to support the mental health recovery of patients who have experienced a traumatic injury. MethodsWe describe a randomized controlled trial with 1-year follow up of TRRP vs. enhanced usual care with 350 traumatically injured patients, including recruitment and retention procedures, assessment, implementation and fidelity monitoring, and statistical plans. ConclusionNovel components of our design include integration of technology-based elements, use of a stepped-care model, and implementation in a trauma center that did not previously have a mental health program. Data collected address the impact of TRRP and inform improvements to the model and its implementation in preparation for large-scale testing and implementation initiatives. This body of work is critical to informing the field as it continues to move toward national standards and recommendations.Trial registration:NCT05497115Clinicaltrials.gov

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

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

Former teachers’ perceptions of psychosocial supports leading to attrition

PurposeThe purpose of this study is to examine how former K-12 teachers’ perceptions of psychosocial support led to their decision to leave the profession.Design/methodology/approachThe researcher conducted eight interviews with former teachers who had been in the profession for 1.5–26 years and asked them about their thoughts on mental health interventions, leadership and collegial support and the stressors of teaching. The data were analyzed by qualitative analysis.FindingsFormer teachers had varying responses, and some of the biggest takeaways were the importance of strong leadership support, the request for more time and overall changes to the system and how teachers are supported overall. Results indicate the ultimate impetus for exiting the profession was not directly the result of mental health support or the lack thereof, yet support for well-being did play a role in job dissatisfaction with the teaching role.Originality/valueTeacher attrition is a significant issue in many countries. This study focuses on teachers in South Carolina, USA, yet the literature indicates similar problems across the USA and globally. The focus on former teachers was compelling, as most studies focus on current teachers.

“It’s a Double-Edged Sword”: Proximal Affinity in Relationships Between Rural Parole Officers and Parolees

Rural parole officers and people under their parole supervision indisputably face major challenges as they jointly navigate reentry. Such challenges include obtaining employment, accessing substance use and mental health treatment services, and navigating felony-related stigma. Utilizing 120 interviews conducted with parole officers and people on parole in Wyoming, we argue that proximal affinity – the degree to which individuals relate to and empathize with others based on their perceptions of one another as potential or actual neighbors in community – directly impacts the parole supervision relationship and, when exercised positively, may even help to explain why, despite rural areas’ extremely limited or even nonexistent numbers of reentry services, rural people on parole recidivate less often their peers in more populous areas.

Insistence on sameness, repetitive negative thinking and mental health in autistic and non-autistic adults.

Autistic people are more likely to have mental health problems than non-autistic people. We know that having repetitive and negative thoughts can contribute to multiple mental health problems such as depression and obsessive-compulsive disorder. Autistic people often do the same behaviours repetitively, and they may also have more repetitive thinking styles. This could contribute to higher rates of mental health problems in autistic people. In this research, we wanted to find out if higher rates of repetitive behaviours contributed to depression and anxiety, and whether this relationship was because of repetitive negative thinking. We asked three groups of autistic adults to take part in the research. Sixty-seven autistic clinical participants were recruited from clinical settings and had moderate depression. Fifty-four autistic community participants and 66 non-autistic community participants were recruited from community settings. All participants completed measures of repetitive behaviours; a measure of anxiety and depression; and two measures of repetitive negative thinking (ruminating and obsessing). Autistic community participants had significantly higher repetitive behaviours, rumination and obsessing scores than non-autistic community participants. We found that higher rates of repetitive behaviours contributed to more repetitive thinking (obsessing and ruminating), which contributed to higher rates of depression and anxiety. The higher rates of repetitive negative thinking found in autistic individuals may contribute to higher rates of mental health problems in this group. Mental health assessments and interventions for autistic people should therefore consider the role of multiple forms of repetitive negative cognition and behaviour, which cut across diagnostic categories such as anxiety, depression and obsessive-compulsive disorder. These should be considered when aiming to understand why individuals develop mental health conditions and why these conditions persist.

Predicting Mental Health Care Enrollment and Treatment Uptake among Newly Arrived Refugees in U.S. Resettlement Programs.

This article examines variables that predict mental health care enrollment and engagement among refugees. The authors explore a mental health care model designed to identify mental health needs early among refugee arrivals that may interfere with adjustment and overall health outcomes using data from a Midwest refugee resettlement program. Using ecological models of mental distress and theories on help-seeking behaviors, the authors used logistic and count regressions to predict enrollment in mental health care services and utilization rates. Gender, nationality, and presenting problems were significant predictors of enrollment and length of engagement in services. The findings provide guidance to practitioners and resettlement agencies on refugee mental health and opportunities to increasing access and engagement in mental health care.

Mobile mental health application use, and app feature preferences among individuals with mental disorders in Ethiopia: A cross-sectional survey

BackgroundMobile health applications have been shown to assist in the treatment of mental illnesses, yet their potential remains underutilized. As supportive care, mental health applications use may be useful tools in improving mental health literacy and treatment outcomes, but patients’ use of and interest in using these apps have not been studied in low-income countries like Ethiopia. This study explores the determinants of patients’ mental health app use interests and app feature preferences. MethodsA cross-sectional study was conducted with 419 outpatient individuals with mental health disorders at Amanuel Mental Specialized Hospital, Ethiopia, between October and November 2023, using a convenience sampling method. Patients’ self-reported mental health app use, interests, attitudes, and app feature preferences were collected. A multivariate logistic regression model was used to identify the associated factors. ResultsOverall prevalence of not interested, somewhat interested, interested, and extremely interested in mental health app use was 5.3 %, 16.9 %, 27.7 %, and 50.1 % respectively. The proportion of current mental health apps use was low (21.2 %). Current mental health app use is associated with living in an urban area (AOR = 6.69, CI: 3.19–14) and having a higher education level (4.12 (2.02–8.04). Furthermore, app features such as psychoeducation, symptom tracking, and self-management techniques ranked as the most preferred app features. ConclusionsMost study participants were interested in using mental health apps, but only about one in four were using mental health apps. This suggests promise for their utility in the Ethiopian context. App developers and policymakers should consider rural residents’, lower educational levels, and patient app preferences when developing these applications.

What makes a successful whole-school mental health intervention? A comparison of stakeholders’ perspectives and implications for schools and the future of English education

ABSTRACT This small-scale study compares stakeholders’ perspectives regarding what makes a successful whole-school Mental Health Intervention. Four study groups were included from an all-ability coeducational secondary school in south-east England: Students (n = 8), Teachers (n = 5), School-Leaders (n = 3), and YMCA Youth Workers (n = 3). Students took part in a focus group whereas the adult groups participated in semi-structured interviews. Subsequently, all participants ranked potential aspects of what might make a successful whole school Mental Health Intervention. No theme was mentioned consistently across the four groups, suggesting a diversity of perspectives regarding the benefits of Mental Health Interventions. All participants, except teachers, valued student involvement, a feature confirmed by the literature. Teachers occasionally adopted misinformed perspectives – arguably a result of insufficient training. Generally, participants’ job roles informed their responses. However, a loose trend existed whereby School-Leaders’ results were more aligned to an external charity association – the Young Men’s Christian Association (YMCA) – than Teachers’ despite the fact that the Teachers and School Leaders worked in the same context. Although the single context and small sample sizes for this research compromise generalisability, there are clear recommendations to inform future studies and for those who are leading and providing whole-school Mental Health Interventions. This study is set within the political and policy contexts of a competitive, market drive English education system and can comment on the wider system within which this intervention nests.